Psychiatry Flashcards
1
Q
What can guanfacine be used to treat in children?
A
ADHD and tics
2
Q
Clonidine Use in Withdrawal
A
Centrally acting alpha-2 receptor agonist and reduces circulating NE release; Treats autonomic sx of withdrawal but not cravings, insomnia, lethargy, pain; Not FDA approved
3
Q
Meige Syndrome
A
Forced blinking, tongue/jaw contractions; treated with Botox
4
Q
What is the average IQ?
A
90-109
5
Q
What is Kubler-Ross’s death and dying sequence?
A
Denial, Anger, Bargaining, Sadness, Acceptance
6
Q
What is Remeron’s mechanism?
A
Blocks 5HT2A, 2C and 3, directing serotonin to 5HT1A; NE receptor antagonist; blocks alpha-2 adrenergic presynaptic inhibitory autoreceptors and heteroreceptors; H1 antagonist
7
Q
What is prazosin’s mechanism?
A
Post-synaptic alpha-1 receptor antagonist
8
Q
What is guanfacine’s mechanism?
A
Post-synaptic alpha-2 receptor antagonist
9
Q
What is clonidine’s mechanism?
A
Nonselective alpha-2 receptor agonist and reduces NE release
10
Q
What is memantine’s mechanism?
A
Noncompetitive antagonists of NMDA receptor; Used to treat Alzheimer’s; blocks excessive stimulation of glutamate receptors which may cause cell toxicity
11
Q
What is galantamine’s mechanism?
A
Cholinesterase inhibitor
12
Q
What is rivastigmine’s mechanism?
A
Acetylcholinesterase inhibitor
13
Q
What is TCA’s mechanism?
A
Increase 5HT and NE
14
Q
What is trazodone’s mechanism?
A
SARI - Serotonin antagonist and reuptake inhibitor
15
Q
How does selegeline treat PD?
A
Increases dopamine
16
Q
What level must ANC be to start clozapine?
A
> 1,500 or >1,000 in those with BEN
17
Q
What conditions are beta-blockers contraindicated in?
A
COPD and asthma; beta-1 selective beta-blockers are better tolerated but still contraindicated (beta-2 receptors are on bronchial smooth muscle)
18
Q
Where do metastatic brain lesions most often come from?
A
Non-small cell lung cancer
19
Q
What are absence seizures treated with? What do they look like on EEG?
A
Ethosuximide; 3 Hx spike and wave complexes
20
Q
What is Buspar’s mechanism?
A
5HT1A partial agonist at postsynaptic receptors; 5HT1A full agonist at presynaptic receptors; presynaptic DA antagonist at D2, D3, D4; partial alpha-1 receptor agonist
21
Q
What is prochlorperazine?
A
An atypical antipsychotic used to treat nausea and vertigo
22
Q
What is the lateral geniculate nucleus?
A
An area in the thalamus responsible for visual processing
23
Q
What is the medical geniculate nucleus?
A
An area in the thalamus responsible for audio processing
24
Q
What medications are FDA-approved for tics?
A
Haldol, Abilify, pimozide
25
What is tramadol's mechanism?
Binds mu-opioid receptors, also inhibits reuptake of serotonin and norepinephrine
26
What is Kluvey-Blucy syndrome?
A lesion to the amygdala that causes hypersexuality, hyperorality, visual agnosia and docility; can occur in Pick's disease
27
What is Prader-Willi syndrome?
Absence of expression of paternal genes on chromosome 15; Clinical symptoms include insatiable appetite/obesity, hypogonadism and short stature
28
Topiramate Side Effects
Can cause metabolic acidosis via carbonic anhydrase and cause kidney stones, drowsiness
29
Carbamazepine Side Effects
Mechanism: Na+ channel blocker; Inducer/Substrate of 3A4; Can cause hyponatremia, leukopenia, TEN, SJS
30
How does Li affect the parathyroid?
Associated with hyperplasia and adenomas leading to hyperparathyroidism and hypercalcemia
31
What to do when administering both VPA and Lamictal?
Half the dose of Lamictal
32
What anatomical finding is seen in Huntington's?
Caudate atrophy
33
What theory did Adolf Meyer coin?
"Genetic Dynamic" approach; Blended the genetic model with the influence of the social environment
34
Lisdexamfetamine Structure
L-lysine with covalent bond to d-amphetamine; It is an amphetamine prodrug
35
What is kava-kava?
Kava is a sedative that acts on GABA receptors; When combined with alcohol or benzodiazepines it can cause dangerous CNS depression
36
St. John's Wort (Hypericum perforatum) Mechanism
Serotonin reuptake inhibitor; CYP inducer (decreases the level of warfarin, digoxin)
37
Epidemiology of BAD
BAD1 rates are similar for men and women (1%); BAD2 rates are higher for women
38
Sleep Architecture
Stage 1: 5% of sleep; Stage 2: 50% of sleep, sleep spindles and K-complexes; Stage 3: 10-20% of sleep, slow wave; REM: 20-25% of sleep
39
Which SGA is most weight-neutral?
Ziprasidone
40
What is the triad of NPH?
Urinary incontinence, gait disturbance, dementia
41
What is the rate of SCZ in the general population? In siblings? In twins?
1% in general population; 10% in siblings; 50% in identical twins
42
What is Gingko biloba?
Herbal supplement thought to enhance cognition and blood flow; Should be avoided in those on antiplatelets/anticoagulation
43
According to Piaget, at what stage are children able to understand conservation of mass?
Concrete Operational Stage (~7 years old)
44
What NTs do MAOis impact? What causes the side effects?
5HT, NE, DA; Tyramine is unable to be metabolized by monoamine oxidase.
45
What is Zyprexa's mechanism?
D2 and 5HT2 antagonism
46
What is adrenoleukodystrophy?
X-linked peroxisome disorder; peroxisomes cannot degrade saturated long chain fatty acids; progressive central demyelination and adrenal cortical insufficiency; vision/hearing impairment, intellectual disability, aphasia, paralysis, seizures, coma, seizures
47
What is Lesch Nyhan syndrome?
Excess of uric acid as a result of hypoxanthine-guanine phosphoribosyltransferase; Recessive disorder; ID, choreoathetosis, spasticity, self-mutilation
48
What would percentage of people would be include in 1 SD on a bell curve? 2? 3?
68%; 95%; 99.7%
49
What is Bowlby known for? What are Bowlby's stages of separation?
Attachment Theory; Protest, Despair, Detachment
50
Which gene is involved in the predisposition to psychosis with cannabis use?
AKT1
51
What is selegeline's mechanism?
Inhibits MAO-A and MAO-B in the CNS. Irreversible MAO-B inhibitor in the gut. At higher doses it loses it's specificity and also inhibits MAO-A
52
What is the prevalence of autism?
1%
53
What is Suboxone's mechanism?
Partial agonist at mu-opioid receptors
54
Which SNRI is not metabolized by the CYP system?
Desvenlafaxine
55
What is the mechanism of Donepezil? Side effects?
Reversible acetylcholintesterase inhibitor; Cholinergic - diarrhea, N/V
56
What action does phenytoin have on the CYP system?
It is an inducer of CYP 3A4
57
When should children begin to take puberty-suppressing hormones?
Tanner Stage 2; ~12 years old; the first stage when secondary sexual characteristics start to form
58
Criteria for Reactive Attachment Disorder
Age of diagnosis b/w 9mos and 5 yrs; history of neglect; emotionally withdrawn, unable to be comforted, lack of positive affect
59
Freud's Stages
1: Oral (birth-18mos); 2: Anal (1-3 yrs); 3: Phallic (3-6 yrs); 4: Latency (7-11); 5: Genital (12-on)
60
Which SSRIs tend to be more activating?
Sertraline and Fluoxetine
61
What medications are associated with eosinophilic colitis?
Clozapine and VPA
62
How long should patient's with eating disorders be observed after meals?
2 Hours
63
Criteria for Admission for Adults with Eating Disorders
Weight <85% estimate BW; BP <90/60; HR <40; T<97; K<3; Glucose <60
64
What is an "ultra-metabolizer"?
Someone with amplification of CYP2D6; Usually require higher doses of medications; Have higher level of metabolite in urine
65
Mahler's Theory
1. Autistic Phase - total detachment and self-absorption; first weeks of life
2. Symbiotic Phase - recognizes mother, but lacks individualism; until 5 months
3. Seperation-Individuation - a) hatching: increasing interest in outside wold b) practicing/physical ability to explore (9-16mos) c) rapprochement: infant explores, but still requires mother (15-24mos)
66
Symptoms of Neurosyphilis
Hyperreflexia, Personality Changes, Argy Robinson Pupils (accommodate but don't react to light), Delusions, Memory Loss
67
What is sensory gating?
The ability to filter out stimuli; May contribute to schizophrenia
68
Wernicke's Encephalopathy
Thiamine Deficiency; Nystagmus/Ophthalmoplegia, Ataxia, Confusion
69
Mullein Agenesis
XX; short vagina, no uterus/ovaries
70
Modafinil Mechanism
DA reuptake inhibitor (binds DAT); also histaminergic mechanism
71
Where is Melatonin synthesized?
Pineal Gland
72
What is the relationship between Loxapine and Amoxapine?
Loxapine is a typical antipsychotic with 5HT blockade that is metabolized to Amoxapine, which is a TCA with DA blocking effects
73
What is the Huntington's defect?
Chromosome 4 with trinucleotide repeats CAG in the HTT gene
74
Mechanism of Tramadol
Partial mu-agonist
75
Williams Syndrome
Microdeletion on chromosome 7q11.23; Elfin appearance (low nasal bridge), starburst irises, cheerful demeanor, developmental delay, good language skills, CV problems, hyperacusis, strabismus; caused by a deletion from chromosome 7
76
What is the gene associated with late AD?
Apolipoprotein E (epsilon 4 allele) on chromosome 19
77
What is the gene associated with early AD?
PSEN2/presenilin 2 on chromosome 1; PSEN1/presenilin 1 on chromosome 14; and APP/amyloid precursor protein on chromosome 21
78
Who coined the term "transitional object" and "good enough mother"?
Winnicot
79
Is VPA an inducer and inhibitor?
Inhibitor
80
Is fluoxetine an inducer and inhibitor?
Inhibitor
81
Is sertraline an inducer or inhibitor?
Inhibitor
82
Is fluvoxamine an inducer and inhibitor?
Inhibitor
83
Is phenytoin an inducer and inhibitor?
Inducer
84
Is phenobarbitol an inducer and inhibitor?
Inducer
85
Is Rifampin an inducer and inhibitor?
Inducer
86
What type of amnesia occurs in Kosakoff syndrome?
Both anterograde and retrograde
87
Vitamin B12 Deficiency
Dorsal column loss of vibratory and position sense, dementia, megaloblastic anemia
88
Environmental Risk Factors for Schizophrenia
Nutritional deficiencies, maternal rubella, late winter/early Spring brith, urban birth, irradiation in the first trimester, prolonged labor, perinatal complications, advanced paternal age
89
What is benztropine's mechanism?
Muscarinic acetylcholine receptor antagonist
90
What does the Telencephalon develop into?
Cerebral Hemispheres, limbic system, basal ganglia
91
What does the Diencephalon develop into?
Thalamus, hypothalamus
92
What does the Mesencephalon develop into?
Substantia Nigra, periaquaductal grey
93
What does the Metencephalon develop into?
Pons, Cerebellum
94
What does the Myelencephalon develop into?
Medulla
95
Lesions caused by CO occur where?
Globus Pallidus
96
What is attributable risk?
Risk of exposed group minus risk of unexposed group
97
What is relative risk?
Experimental event rate divided by control event rate
98
What is varencycline's mechanism?
Alpha-4-beta-2 nicotinic partial agonist
99
Which substances are considered hallucinogens? Dissociative agents?
Hallucinogens - LSD, PCP, MDMA; Dissociative - Ketamine
100
What is Tyramine broken down by?
Predominantly MAO-A
101
Which MAOis predominantly affects MAO-A, requiring dietary restrictions?
Phenelzine
102
Which MAOis predominantly affect MAO-B and do not require dietary restrictions at lower doses?
Selegeline, Rasaligine, Moclobemide
103
What are the hallmark neuropathological findings of AD?
Amyloid plaques (made of amyloid-beta which is derived from amyloid precursor protein) and neurofibrillary tangles (hyperphosphorylated tau)
104
What is Wilson's disease?
Autosomal Recessive disease with mutation in ATP7B in chromosome 13; deposits of Cu in the basal ganglia; cirrhosis, ataxia, psychosis, Kayser-Fleischer rings; decreased serum ceroloplasmin
105
Are barbiturates inducers or inhibitors?
Inducers
106
Where is Wernicke's area in the brain?
Temporoparietal junction on the L side of the brain; responsible for speech comprehension
107
Which TCA is contraindicated in breastfeeding?
Doxepin
108
Which TCA has an indication for childhood enuresis?
Imipramine
109
Which TCA is least hypotensive?
Nortriptyline; therapeutic level 50-150
110
What is cocaine's mechanism?
Prevents reuptake of DA and serotonin
111
What is capgras delusion?
The belief that a close friend/family member was replaced by an imposter
112
What is cotard syndrome?
The belief that one is dear or a zombie
113
What area of the brain is involved in face recognition?
The fusiform gyrus (right and left)
114
What is Xyrem/GHB/sodium oxybate?
Used for the treatment of cataplexy in narcolepsy
115
What is the most commonly diagnosed condition in children?
ADHD
116
Which medications are cholinesterase inhibitors?
Donepezil, rivastigmine, galantamine
117
What is the mechanism of Levodopa? Carbidopa? Entacapone?
Levodopa is converted to DA in the periphery and CNS. Carbidopa blocks peripheral conversion of L-dopa to DA and reduces SEs. Entacapone is a COMT inhibitor which prevents L-dopa from being metabolized to 3-OMD that can't cross the BBB.
118
What are the "z" drugs?
Zolpidem, zaleplon, eszoplicone
119
Onset of tic disorders and OCD in children is associated with what infection?
Group A Strep
120
What is the mechanism of amphetamines?
Release of DA and NE from presynaptic terminals; also blocks DA and NE transporters, inhibits breakdown
121
Where is acetylcholine produced?
Nucleus Basalis of Meynert
122
Where is NE produced?
Locus Ceruleus
123
What happens when CBZ and VPA are co-administered?
VPA level decreases and CBZ level increases
124
What are the stages of play?
Parallel (age 2), associative (age 3) and cooperative (age 4)
125
What is vagal nerve stimulation FDA approved for?
Treatment resistant depression in adults; treatment refractory epilepsy in children and adults
126
What was the CATIE trial?
Patients 18-65 with a dx of schizophrenia were assigned perphenazine, olanzapine, quetiapine, risperidone or ziprasidone. Primary outcome was all-cause discontinuation.
127
What is the most common pathological finding in epilepsy?
Hippocampal sclerosis
128
What is the Hawthorne effect?
When a study participant changes their behavior because they are being observed
129
What are contraindications to selegeline patch?
Pheochromocytoma (risk of HTNsive crisis) and surgery (risk of hypotension when combined with anesthesia)
130
What is Allium Sativum
Garlic; Cholesterol lowering properties; Has anti platelet effects and should be avoided when used with warfarin/anticoagulation medications
131
What is Ego Psychology? Who created it?
Anna Freud; Focuses on ego defenses to achieve conflict-free ego function
132
What is Object Relations? Who created it?
Melanie Klein; Focuses on the paranoid, schizoid and depressive positions and the tension between the true and false self
133
What is Self Psychology? Who created it?
Heinz Kohut; Addresses deficits of the self and self-disintegration; self-object transference phenomenon (mirroring and idealization)
134
What are the sleep changes that occur in depression?
Increased sleep onset, loss of slow wave sleep, increased nocturnal awakenings, reduced REM latency, , total sleep time decreased
135
What is Remeron's mechanism?
5HT2A antagonist, alpha-2 antagonist, H1 antagonism
136
What do lesions to the mammillary bodies cause?
Psychosis, memory deficits, confabulation
137
What is Fragile X syndrome?
Mutation in the FMR1 gene on the X chromosome; mostly male with elongated face, large ears, large testicles; ADHD, autism, anxiety frequently comorbid;
138
What is Freidrich's Ataxia?
Autosomal Recessive trinucleotide (GAA) repeat on chromosome 9; Presents in early childhood/adolescence in girls and boys; ataxia, dysarthria, weakness, high arches, scoliosis, cardiomegaly, DM, dysphagia, absent DTRs
139
What are the criteria for PTSD?
1+ intrusive symptoms (nightmares, flashbacks); 1+ avoidance (either of external triggers or thoughts/memories); 2+ alterations in mood or cognition (persistent negative state, negative beliefs about oneself, inability to remember trauma); 2+ alterations in arousal (hypervigilance)
140
When is VPA superior to Li?
Mixed episodes; prominent depressive symptoms; multiple prior mood episodes
141
Criteria for Tourette's
Multiple motor and 1+ vocal tics; tics can wax and wane but must be present for >1 year; symptom onset before age 18
142
Which SSRI causes the most weight gain?
Paxil
143
What is Factor Analysis?
Multiple observed variables have similar patterns of responses due to a latent variable (not measured directly)
144
What is Covariance?
The relationship of change between 2 variables
145
When is stranger anxiety observed?
8 months
146
What are the markers of CJD?
14-3-3 in CSF; periodic sharp waves on EEG
147
What is cyproheptadine?
5HT2A antagonist; can be used in severe cases of serotonin syndrome
148
Which TCAs are secondary amines? Which NT do they affect more predominantly?
desipramine, nortriptyline; NE
149
Which TCAs are tertiary amines? Which NT do the affect more predominantly?
imipramine, amitryptyline, clomipramine, doxepin; 5HT
150
What are medullablastomas?
Primative ectodermal tumors in children; infratentorial/originate from the cerebellum; malignant but radiosensitive
151
What is a case-control study?
Analyzes and outcome and looks back at exposures
152
Which dementias are considered alpha-synucleinopathies?
PD, LBD, multiple systems atrophy
153
Which dementias are considered tauopathies?
AD (neurofibrillary tangles) and Pick's Disease (inclusion bodies)
154
What is the mechanism of ethosuximide?
Reduces low-threshold T-type calcium currents
155
Sensitivity
The likelihood of detecting disease when the patient truly has the disease; true positives / (true positives - false negatives)
156
Specificity
The likelihood that a patient has a negative result when they do not have the disease; true negative / (true negative + false positive)
157
Positive Predictive Value
true positives / (true positives + false positives)
158
What is the cause of narcolepsy?
Deficiency in hypocretin aka orexin (made is the dorsolateral hypothalamus);
159
What hormone can be measured following a GTC?
Prolactin
160
Cyclothymic Disorder
Over period of 2 years, multiple episodes of hypomanic symptoms, and periods of depressive episodes not meeting criteria for MDD; must not have a period of time symptom-free >2 months
161
Which medications are FDA approved for bipolar-depression?
Seroquel, Lurasidone, Zyprexa/Fluoxetine
162
Autism Criteria
Deficits in social communication; Restricted/repetitive interests/activities/behaviors with 2+ of the following: stereotypy, ritualized patterns, fixated interests, hyper/hypoactivity
163
Patients with antisocial personality disorder typically experience onset of conduct disorder before what age?
15
164
Treatment of Cluster Headaches
Acute: Sumatriptan/Oxygen; Prophylaxis: Verapamil
165
What are the 2 main types of cells in the brain?
Neurons, Glial Cells (astrocytes, oligodendrocytes, microglia)
166
Which barbiturate is used for induction of anesthesia?
sodium thiopental
167
Lab abnormalities scene with rhabdomyolysis?
hyperK, hyperP, elevated CK, myoglobinuria, hypoCa (deposited in muscle cells), hypoMg, leukocytosis, elevated LFTs
168
What is the criteria for rapid cycling BAD?
>=4 episodes per year
169
When do the teratogenic effects of VPA occur?
~5 weeks gestation
170
What is Li's mechanism of weight gain?
Insulin-like effect lowering glucose
171
How to treat Li-induced polyuria?
Add hydrochlorothiazide (the Li dose will need to be halved because HCTZ increases reabsorption of Li; can cause K depletions); or add amiloride (K sparing diuretic; does not affect Li levels)
172
Which antipsychotic is associated with irreversible retinitis pigmentosa?
Thioridazine
173
What is the subject-expectancy effect?
Describing a medications mechanism increases the medications perceived effect
174
Childhood Metabolism Development
GFR reaches adult values by ~1 year of age; Adult values of P450 enzymes reaches adult values by ~1 year of age
175
NO Poisoning
Can cause B12 deficiency causing sensory neuropathy, myelopathy, encephalopathy
176
What is ketamine's mechanism?
NMDA receptor antagonist; considered a dissociative agent; related to PCP
177
Which MAOs are nonselective inhibitors? (Importantly, they inhibit MAO-A which disrupts Tyramine metabolism)
Tranylcypromine, isocarboxazid, phenelzine
178
Which hypnotic has the shortest half-life?
Zaleplon (1-2 hrs); Zolpidem (2-3 hrs)
179
What type of imagine study can identify a seizure focus?
fMRI, PET, SPECT
180
Which area of the brain is involved in visual processing and object recognition?
Temporal Lobe
181
What are the criteria for remission of depression?
Absence of sad mood/anhedonia x3 weeks and no more than 3 symptoms of depression
182
What is disulfiram's role in cocaine use disorder?
In the brain, it blocks DA metabolism to NE.
183
What is pregabalin's mechanism?
Ca channel antagonist
184
What is acamprosate's mechanism?
Antagonizes glutamatergic function via NMDA receptors
185
What is baclofen's mechanism?
GABA-B agonist
186
False positives for venlafaxine, amitryptyline, sertraline, trazodone?
venlafaxine - PCP; amitryptyline - LSD; sertraline - benzos; trazodone - amphetamines
187
What was the COMBINE trial?
Examined naltrexone, acamprosate and CBI for alcohol use disorder; found that CBI, naltrexone or both was superior
188
Acamprosate Metabolism
Not protein bound; Levels decrease when administered with food; low bioavailability of ~11%; levels increase when co-administered with naltrexone
189
Tx for epilepsy-associated aggression?
CBZ; second line is BZDs
190
Brain changes in SCZ
Smaller volumes of hippocampus; smaller volumes in medial temporal lobe
191
What deficiency can MAOs cause?
Pyridoxine
192
Fetal Phenytoin Syndrome
Hypertelorism, cleft lip/palate, finger/toe hypoplasia, long philtrum, hirsutism
193
Nocturnal Enuresis
Alarm interruption demonstrated more sustained benefit than desmopressin; Desmopressin better than placebo but not sustained; Alarm was inferior to desmopressin; combination had best results;
194
Ziprasidone Mechanism
Block D2 receptors and 5HT/NE reuptake inhibitor
195
Abilify Mechanism
Partial D2 agonist; partial 5HT1A agonist; antagonist of 5HT2A
196
What is the reward circuit affected in cocaine use?
The mesolimbic pathway from the VTA to the nucleus accumbens
197
What is beneficence?
The duty to do no harm
198
What is Tarasoff's?
The duty to warn and protect
199
What is amantadine used to Tx?
Psuedoparkinsonism associated with antipsychotics
200
Damage to what area causes depression? Activation of what areas causes depression?
Damage to the L prefrontal cortex; Activation of the R prefrontal cortex
201
What is the mesolimbic pathway of DA neurons?
Begins in the VTA (in the pons) and projects to the nucleus accumbens; associated with positive symptoms of SCZ
202
What is low levels of 5-HIAA/serotonin in the CSF associated with?
Aggression
203
What are the 3 receptors associated with glutamate?
AMPA, NMDA and kainate
204
DA action in which area is associated with tics?
Caudate
205
What is the tuberinfundibular pathway?
From the hypothalamus to the anterior pituitary
206
What is the nigrostriatal pathway?
From the substantia nigra to the basal ganglia
207
What is the mesocortical pathway?
From the VTA to the frontal cortex; associated with negative symptoms of SCZ
208
What is central pontine myelenosis caused by?
Too rapid overcorrection of hyponatremia; can cause locked-in syndrome
