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Brain Power: Adam and Victor's Neurology > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

What is a possible genetic basis for thrill seeking personality?

A

Dopamine receptor gene on Chromosome 11

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2
Q

What are the 3 general categories of neuroses?

A
  1. Anxiety d/o: OCD, panic states, phobic
  2. Somatoform d/o: hysterical neuroses, conversion disorder, hypochondriasis
  3. Dissociative d/o
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3
Q

How long does a panic attack usually last?

A

15-30 mins

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4
Q

What are the top 2 ssx of a panic attack according to Cohen and White?

A

97% Palpitation
93% Easy fatigue
90% Breathlessness

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5
Q

What is the prognosis of anxiety neurosis:

Persistence?
Tendency to develop other psychiatric illness?

A

After a 20 year follow-up

88% persisted in being moderately anxious
15% severe and debilitating

Those with uncomplicated anxiety neurosis RARELY commit suicide but have a predisposition to develop psychosomatic illnesses.

In addition, an anxiety state apperating for the first time after the 40th yera usually proves to be primarily a deprssion

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6
Q

What GABA receptor subunit is responsible for:

  1. Sedative amnesic effects?
  2. Anxiolytic effects?
A
  1. alpha 1 subunit

2. alpha 2 subunit

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7
Q

T or F: During the initial weeks of administration of anti-depressants, the underlying anxiety symptoms may worsen and an anxiolytic is sually required until the antidepressant becomes effective.

A

T

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8
Q

What is the fear of being in places or situations from which escape might be difficult or extremely embarrassing?

A

Agoraphobia

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9
Q

How does a phobia differ from an anxiety attack?

A

A phobia always focuses ona specific object or situation

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10
Q

What are imperative and distressing thoughts and impulses that persist in the patient’s mind despite a desire to resist and to get rid of them?

A

Obessions

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11
Q

What are act/s that the patient must carry out in order to put his or her mind at ease? These usually result from obsessions.

A

Compulsions

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12
Q

How to differntiate tics from compulsions?

A

Tics are not usually based directly on obsessive thoughts.

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13
Q

How to differentiate delusion from obsession?

A

In obsession there insight that into the obsessional experience: THE PATIENTS RECOGNIZE THE IRRATIONALITY OF THEIR IDEAS and yet are powerless to control them

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14
Q

What is PANDAS?

A

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

Can result in OCD from acquired striatal damage. Or tics.

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15
Q

T or F: With OCD there should at least be a trial of cognitive behavioral modification techniques.

A

T

ie Systematic Desensitization

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16
Q

What class of drugs has good evidence for OCD? ie?

A

SSRI

Fluoxetine

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17
Q

T or F: Briquet disease or classic hysteria is almost limited to women in their early twenties.

A

T

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18
Q

What is la belle indiferrence?

A

Calm attitude toward a turbulent illness and seemingly disabling physical signs is so common in patients with hysteria

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19
Q

What is the Ganser syndrome?

A

Ganser syndrome is a type of factitious disorder, a mental illness in which a person deliberately and consciously acts as if he or she has amnesia, disturbance of consciousness and hallucinations

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20
Q

What is referred to as a conscious and deliberate feigning of illness or disability in order to attain a desired goal?

A

Malingering

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21
Q

What are the three main points that will distinguish malingering from hysteria?

A
  1. There is a conscious quality of the motivation in malingering
  2. There is an effective persuation in hysteria
  3. The attitude of the patient– hysteria patients are more genuinely ill and invites examination while the malingerer seems less ill and evades examination
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22
Q

What is a particular form of sociopathy or malingering which consists essentially of systematically and specifically deceiving the medical profession?

A

Munchausen’s syndrome

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23
Q

What medication can be given to patients with Intermittent Explosive Disorder?

A

Propranolol

The disorder also has .a heritable tendency– X-linked due to polymorphisms of the androgen receptor

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24
Q

What is the mortality rate of anorexia?

A

5% due to infection or another medical complication

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25
Q

How to differentiate anorexia from hypopituitary cachexia (Simmonds disease)?

A

Pubic hair and breast tissue are normal in anorexia except for loss of fat

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26
Q 
What are the levels of the ff in anorexia?
T3
T4
LH
TSH
GH
Cortisol
A 
T3 L
T4 L
LH L
TSH N
GH N
Cortisol N
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27
Q

What are the two concepts regarding the depression?

Kraepelinian concept
Meyerian concept

A

Kraepelinian concept: Disease state

Meyerian concept: Psychological reaction

28
Q

What are milder forms of mania and bipolar disorder?

A

Hypomania and cyclothymic disorder

29
Q

Which 2 criteria for depression need to be present for the diagnosis of MDD?

At least 1 of two

A

Depressed mood most of the day nearly everyday

Marked diminished interest or pleasure in all or almost all activities most of the day nearly everyday

30
Q

T or F: The timing of treatment for depression/ bipolar disease does not affect prognosis.

A

F. Earlier treatment corresponds to a more favorable prognosis

31
Q

What is the general risk of depression in the general population?

In first degree relatives of patients with depression?

A

1-2%

15%

32
Q

What areas of the brain are involved in depression?

A

Left frontal corex hypometabolism

Others: Cingulate and orbitofrontal cortices, related parts of the medial limbic system and the hippocampus

histologic: Depletion of and changes in the CA3 region of the hippocampus in both depression and stress

33
Q

What substances are depleted in the classic biochemical theory of depression?

A

Norepinephrine
Serotonin
Dopamine

34
Q

How is the level of glucocorticoids like cortisol related to depression?

A

They are elevated. Patients fail the dexamethasone suppression test. Elevated levels have been theorized to impeded neurogenesis in the medial temporal lobe and to exaggerate the loss of hippocampal neurons demonstrated in some studies of the brains of diseases depressed patients.

35
Q

What is the percentage of patients will have clinical improvement that is attributable to anti-depressant medications?

A

50%

36
Q

What are the side effects of fluoxetine? That may be beneficial in a given subset of patients?

A

Insomnia and weight loss

Patients with insmonia and high levels of anxiety may do better with more sedating medication like amitriptyline, a TCA– make sure to take at bed time!

37
Q

When shifting from SSRI to a MAOi?

A

there must be a drug free interval of 1-2 weeks

Also while on MAOi take care to avoid high tyramine content food: aged cheese, pickles, chicken liver, beer, wines, yeast extract and those with L-dopa like amphetamines, decongestants and caffeine

38
Q

How long is treatment continued for depression is successful?

A

6-9 months.

Be sure to combine with psychotherapy as well.

39
Q

What is the desired lithium levels in a bipolar patient? How long before Li becomes effective clinically?

A

0.9-1.4mEq/L

4-5 days

40
Q

How is electroconsulvsive therapy given?

A 
Bitemporal electrodes
400mA
70-120 V
0.1-0.5s
Alternate days over 6-14 sessions
41
Q

What types of depression have previously had dismal outcomes prior to the use of ECT?

A

Catatonia

Agitated depression

42
Q

T or F: For chronic depression, according to the Keller’s study the difference in remission rate with nefadozone only and cognitive behavioral therapy only with combination is 50% VS 85%.

A

T

43
Q

What are the four As that Bleuler pertained to when he spoke of schizophrenia?

A

loose ASSOCIATIONS
flat AFFECT
AMBIVALENCE
AUTISM

44
Q

What are the three clusters of schizophrenia?

A
  1. Negative symptoms: Poverty of speech and movement
  2. Reality distortion: hallucinations, delusions
  3. Disorganization: loss associations, fragmentation of ideas, inappropriate emotional expression
45
Q

Re: Shiz

  1. What are ideas of being under the control of some external agency or being made to speak or act in ways that are dictated by others through telepathy, internet etc.?
  2. What is the notion that external elements external elements in the environment are being controlled by the patient’s mind?
  3. What is the feeling that actions of others are subtly directed to the patient?
  4. What is the persistent feeling that the world is changed or unnatural?
A
  1. What are ideas of being under the control of some external agency or being made to speak or act in ways that are dictated by others through telepathy, internet etc.? Passivity feelings
  2. What is the notion that external elements external elements in the environment are being controlled by the patient’s mind? Thought projections
  3. What is the feeling that actions of others are subtly directed to the patient? Ideas of reference
  4. What is the persistent feeling that the world is changed or unnatural? Derealization
46
Q

What kind of hallucinations are the hallmark of schizophrenia?

A

Auditory hallucinations.

47
Q

What percentage of bipolar and schizophrenic patients commit suicide?

A

10% each

48
Q

What is known as Schneider’s first rank symptoms of active schizophrenia?

A

Auditory hallucinations
Perceptual delusions (Misinterpretation of what the patient hears and feels)
Disturbances of thinking (experience of alienation and influence)

49
Q

What is flexibilitas cerea? What type of schizophrenia is it found in?

A

When a limb is lifted by the examiner it will be held in that position for hours– this is found in catatonic schizophrenia

50
Q

What type of schizophrenia is characterized by:

  1. Occurring at an earlier age, dominated by incoherence of ideas and grossly inappropriate affect with frequent hallucinations and delusions? With schizoid personality in the pre morbid period, with history of tantrums being overly pious or shy– ODD person
  2. Central feature is preoccupation with one or more delusions related to a single theme accompanied by auditory hallucinations– usually persecutory but it may also be religious, depressive, grandiose or bizarrely hypochondriacal? With NO premorbid schizoid traits
A
  1. Disorganized or hebephrenic schizophrenia

2. Paranoid

51
Q

What is known as an exotic form of delusional disorder in which two closely related persons share a delusional system?

A

Folie à deux

52
Q

What is the frequency of schiz in siblings?

Dizygotic twins?

Monozygotic twins?

A

What is the frequency of schiz in siblings? 11%

Dizygotic twins? 11

Monozygotic twins? 68%

53
Q

What cortical neurons are few in schizophrenia patients?

A

GABAergic neurons

54
Q

What are the key findings of in the neuroimaging of patients with schizophrenia?

A

Ventricular enlargement and sulcal widening

Smaller anterior hippocampi

Reduction in gray matter of the left superior temporal gyrus

55
Q

What are the NT systems involved in schizophrenia?

A
  1. Dopamine: Excess dopamine in the mesolimbic system and diminished activity (positive sxs) in the mesocortical system (negative sxs)
  2. Serotonin
  3. Glutamate
56
Q

Which anti depressants are most likely to

  1. Cause sexual dysfunction?
  2. Cause weight gain?
  3. Cause anticholinergic effects?
  4. Cause hypotension?
  5. Cause insomnia and agitation?
A
  1. cause sexual dysfunction?: SSRI (fluoxetine, escitalopram) and MAOI (Phenelzine)
  2. Cause weight gain: TCAs (Amitriptyline) and the most is MIRTAZAPINE
  3. Which anti depressant has the most anticholinergic effect? TCAs (imipramine) but amitriptyline is the WORST
  4. Cause hypotension: TCAs (amitriptyline)
  5. Cause insomnia and agitation: MAOIs (Phenelzine, tranylcypromine)
57
Q

What class of anti-psychotics are considered “classic” dopamine antagonists?

A

Phenothiazenes and butyrophenones

58
Q

What percentage of schizophrenic patients will have little or no response to medication?

A

10-20%

59
Q

What is the mechanism for lesser extrapyramidal effects of the new generation anti-psychotics?

A

They bind and inhibit the serotonin receptors and to some extent to dopamine receptors but have much lower affinity for striatal dopamine receptors

60
Q

In the CATIE study which antipsychotic was slightly more effective?

Which old generation anti-psychotic was equivalent in efficacy and tolerability to the last three second generation drugs (quetiapine, risperidone, and ziprasidone)?

A

Olanzapine was slightly more effective than: quetiapine, risperidone, and ziprasidone

Phenothiazine: PERPHENAZINE

61
Q

What is the main adverse effect with clozapine?

A

Leukopenia

62
Q

How to prevent extrapyramidal symptoms of haloperidol?

A

Antihistamines: Diphenhydramine
Anticholinergic: Benztropine

63
Q

Which antipsychotic has the ff side effects?

  1. OH, cataracts
  2. OH, hyperprolactinemia
  3. Agranulocytosis, hyperglycemia, transient fever
A
  1. OH, cataracts: Quetiapine
  2. OH, hyperprolactinemia: Olanzapine
  3. Agranulocytosis, hyperglycemia, transient fever: Clozapine
64
Q

What is the treatment for the ff extrapyramidal syndromes?

  1. Acute dystonia
  2. PD
  3. Malignant syndrome
  4. Rabbit syndrome
  5. Akisthesia
  6. Tardive dyskinesia
A
  1. Acute dystonia: Injected antiPD agents
  2. PD: Amantadine, anticholinergics NOT DOPAMINERGICS
  3. Malignant syndrome: Dantrolene or bromocriptine
  4. Rabbit syndrome: Anticholinergic
  5. Akisthesia: Reduce dosage or change drug; propranolol
  6. Tardive dyskinesia: Vitamin E? Tx is unsatisfactory; BEST TO PREVENT
65
Q

What is defined as a persistent delusion that is not part of any other mental disorder?

A

Delusional (paranoid) disorder

66
Q

What are the most frequent features of steroid induced psychosis?

A

Depression and insomnia can develop after a week of cortisone

Brain Power: Adam and Victor's Neurology (19 decks)

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