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Psychological Disorders Flashcards

1
Q

What type of paraphilic disorder is described:
Sexual arousal from an inanimate object such as women’s undergarment, glove or shoe that lasts for at least months

A

Fetishism

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2
Q

What type of paraphilic disorder is described:
being sexually aroused by exposing one’s genitals to another

A

Exhibitionistic disorder

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3
Q

What type of paraphilic disorder is described:
pattern of obtaining sexual arousal touching and rubbing against a nonconsenting person

A

Frotteuristic disorder

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4
Q

Enlargement of what part of brain is indicative of Schizophrenia?

A

enlargement of lateral ventricles

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5
Q

What syndrome looks like manic symptoms but results from chronic mercury intoxication?

A

Mad Hatter Syndrome

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6
Q

There are many neurophysiological differences between unipolar and bipolar depression? Answer for the effects on bipolar depression.
INCREASE OR DECREASE
- # of connections between anterior cingulate cortex, amygdala and dorsomedial thalamus
- activation of amygdala
- activation of DLPFC
- activation of caudate nucleus & putamen
- cross-sectional area of corpus callosum

A
  • # of connections between anterior cingulate cortex, amygdala and dorsomedial thalamusREDUCTION
  • activation of amygdala
    INCREASED
  • activation of DLPFC
    INCREASED
  • activation of caudate nucleus & putamen
    INCREASED
  • cross-sectional area of corpus callosum
    INCREASED
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7
Q

Which of the dopaminergic pathways is associated with the positive symptoms of SZ?

A

hyperactivity of dopamine in the mesolimbic pathway

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8
Q

Which of the dopaminergic pathways is associated with the negative symptoms and cognitive dyfxn of SZ?

A

decreased dopamine in the mesocortical pathway

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9
Q

Which of the dopaminergic pathways is associated with development of EPS symptoms?

A

blockage of dopamine in nigrostriatal pathway

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10
Q

Which of the dopaminergic areas is associated with development of hyperprolactinemia?

A

tubero-infundibular pathway

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11
Q

Fill in the blanks of the environmental risks for development of Schizophrenia?
A) Birth in the ________
B) _________ infection in mom during pregnancy
C) Obstetric __________
D) Maternal _________ during pregnancy
E) Advanced ______ age

A

A) Birth in the winter
B) Flue infection in mom during pregnancy
C) Obstetric complications
D) Maternal major stressor during pregnancy
E) Advanced paternal age

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12
Q

What is the difference between Schizoaffective d/o and Bipolar I disorder?

A

In schizoaffective there has to be a hx of hallucinations or delusions that lasted for more than 2 weeks WITHOUT depressive or manic symptoms

In bipolar disorder, patients experience psychotic symptoms only during manic or depressive episodes

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13
Q

What is the lifetime prevalence risk of developing Schizophrenia in the following scenarios:
1) general population
2) monozygotic twins
3) dizygotic twins

A

1) 1%
2) 47%
3) 10-15%

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14
Q

Which MDE specifier REQUIRES mood reactivity as part of its criteria?

A

Major depressive episode w/atypical features

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15
Q

What are the go-to treatments after SSRIs/SNRIs associated with MDE w/melancholic features vs. atypical features?

A

MDE w/melancholic features: TCAs
MDE w/ atypical features: MAO-I

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16
Q

To be diagnosed with persistent depressive disorder, you need depressed mood + at least how many additional symptoms?

A

2 more

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17
Q

What is the age range at which DMDD must have begun onset at?

A

6-10 y/o

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18
Q

What diagnoses cannot be comorbid with DMDD?

A

BIO
-Bipolar disorder
-Intermittent explosive disorder
-ODD

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19
Q

What are the most commonly tested medications associated with causing depression? (Think AIIRS)

A

Anti-hypertensives: B-blockers
Interferon alpha
Isotretinoin
Reserpine
Steroids

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20
Q

What is the one depression susceptibility gene we should know for test?

A

MTHFR
Methylenetetrahydrofolate reductase
remember it look like mother fucker

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20
Q

Why do you order an EKG prior to giving Lithium?

A

risk of supraventricular arrhythmyias (sick sinus syndrome and sinoatrial block)

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21
Q

Why is the use of Carbamezapine discouraged in people who are positive for HLA-B1502 and any HLA-A3101 genotype?

A

Higher risk for developing carbamazepine-induced toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS).

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21
Q

What are the 3 SRI modulator anti-depressants?

A

1) Trazodone
2) Vilazodone (Viibryd)
3) Vortioxetine (Trintellix)

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22
Q

Why do you order an EKG prior to giving Lithium?

A

risk of supraventricular arrhythmyias (sick sinus syndrome and sinoatrial block)

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23
Q

What differentiates Serotonin syndrome from NMS and anti-cholinergic syndrome?

A

SS vs. NMS: no sweating and no severe rigidity

SS vs. anti-cholinergic: anti-cholinergics will be “dry as a bone” and “full as a flask”

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24
Q

If someone develops fever , sore throat and fatigue and you recently started them on Mirtazapine, what would your biggest worry be?

A

Possible development of neutropenia/agranulocytosis

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25
Q

Brexanolone, an IV formulation of allopregnanolone (metabolite of progesterone), that modulates GABA receptors, is used to treat what psychiatric disorder?

A

Post partum depression

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26
Q

After someone receives ECT to start maintenance treatment one can do ECT titration or start what classic medication combination?

A

Lithium PLUS nortriptyline

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27
Q

In order for someone to be a candidate for Vagus nerve stimulation as adjunctive long-term treatment for treatment resistant depression, how many medications must they have failed?

A

Failed 4 med trials

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28
Q

Which SSRI should you avoid in pregnancy given its associated risk for cardiac defects?

A

Paroxetine (Paxil)

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29
Q

Brief psychotic disorder, with postpartum onset, is only applicable if the symptoms occur during pregnancy or within ______ weeks postpartum.

A

4 weeks

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30
Q

What CBT technique refers to taking part in some sort of behavior (ie stealing) and then imagining the negative consequences of that action or behavior in order to reduce that behavior.

A

covert sensitization

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31
Q

Answer question with men or women.

A) Highest rate of suicide attempts
B) Highest rate of suicide completion

A

A) Women
B) Men

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32
Q

Which races have the highest and lowest rate of suicide?

A

Highest: American Indian/Alaska native

Lowest: Hispanic, Black & Asian/Pacific Islander males

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33
Q

Low concentrations of 5-HIAA (serotonin metabolite) in lumbar CSF is associated with what behaviors?

A

suicidal behaviors

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34
Q

People with the L allele of Tryptophan hydroxylase (TPH) are associated with increased risk of what psychological issue?

A

Increased risk of SUICIDE

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35
Q

What 3 medications are effective for suicide prevention?

A
  1. Lithium: in Bipolar and MDD
  2. Clozapine: in SZ and SZA
  3. Antidepressants: pts > 75y/o
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36
Q

Aggression can be split into proactive vs. reactive aggression. What respective disorders would you expect to see them in.

A

Proactive aggression: manipulative and intentional, want to feel dominant
- conduct d/o
-Anti-social PD

Reactive aggression: emotional, hot-blooded, response to provocation, treatable
-mood d/o
-substance d/o
-impulsivity

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37
Q

The median age of onset of select disorders

7yo. Specific phobia
Separation anxiety d/o
20yo Social anxiety d/o
24yo Panic disorder
31yo GAD

A
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38
Q

What is the main assessment tool that is a 7 item self-report scale for BDD called?

A

Dysmorphic Concern Questionnaire

39
Q

A patient comes in with Trichotillomania and also eats her hair what is that called?

A

tricophagia (10-30% of cases)
-can cause trichobezoars (“hair balls in stomach”

40
Q

Hair pulling is best treated by habit reversal training but what are the 3 most effective meds used to treat hair pulling?

A

1) Clomipramine
2) N-acetylcysteine (NAC)
3) Olanzapine

41
Q

Excoriation disorder (skin-picking) is best treated with habit reversal training or CBT. What are the 2 most effective meds used to treat it?

A

1) SSRI
2) Lamictal

42
Q

A patient comes in with skin-picking d/o and is only getting partial benefit from an SSRI what 4 med options could you use to augment?

A

1) NAC
2) Clomipramine
3) Naltrexone
4) inositol

43
Q

What bacterial infection is thought to be associated with OCD-like symptoms?

A

Group A strep infection —–caused PANDAS syndrome

44
Q

Most anxiety disorders have higher prevalence in females, which has has equal prevalence in men and women?

A

OCD

45
Q

What 2 seasons are those with Schizophrenia more likely to be born in?

A

Winter and early spring

46
Q

What 2 TCAs are least likely to result in orthostatic BP changes and are less anticholinergic overall because they are secondary amine TCAs?

A

Nortryptiline
Desipiramine

47
Q

What is the only antidepressant that has been approved for preventative treatment of major depressive disorder with seasonal pattern by the Food and Drug Administration (FDA)?

A

Buproprion

48
Q

Name the brain structure that is most involved in the following types of anxiety.
A) Anticipatory anxiety
B) Phobia
C) Obsessions, compulsions, emotional regulation
D) general anxiety

A

A) amygdala
B) pre-frontal cortex
C) cingulate gyrus
D) brain stem: locus ceruleus (NE), Raphe nucleus (5-HT)

49
Q

What 2 areas of the brain have greater brain activity on neuroimaging in ppl suffering from an anxiety disorder when compared to controls?

A

1) amygdala
2) insula

50
Q

What area of the brain has decreased brain activity on neuroimaging in those suffering from PTSD?

A

anterior cingulate gyrus

51
Q

What is the most common mental health disorder in women vs men?

A

women: specific phobia
men: substance use disorders

52
Q

What is the peak of age of onset of schizophrenia in males vs females?

A

males: early to mid 20s
females: late 20s (smaller peak at 45-50y/o)

53
Q

What is the prevalence of Schizophrenia?

A

1%

54
Q

What does CBT-psychosis work on modifying?

A

—delusions
reduce positive symptoms severity

55
Q

What percent of Schizophrenic patient have comorbid substance use ?

A

40-50%

55
Q
A
56
Q

What brain region is implicated in a patient with schizophrenia experiencing auditory hallucinations?

A

Arcuate fasciculus

57
Q

Vagus nerve stimulation (VNS) is FDA approved for the treatment of chronic depression in adults who have failed _______ or more trials of antidepressants,

A

4

58
Q

T/F: Prior to puberty boys are diagnosed with MDD more than girls.

A

T

59
Q

DMDD is more commonly seen in males or females?

A

males

60
Q

What leads to the metabolic disturbance of metabolic acidosis in someone with an eating disorder?

A

Laxative abuse
Hyperchloremic, hyponatremic

61
Q

What leads to the metabolic disturbance of metabolic alkalosis in someone with an eating disorder?

A

Vomiting
Hypokalemic, hypochloremic

62
Q

What drugs are FDA approved for treatment of Bulimia?

A

1st: Prozac
2nd: Zoloft

63
Q

What drugs are FDA approved for treatment of Binge eating disorder?

A

1st: Vyvanze
2nd: Zoloft, topiramate

64
Q

What meds can be used to reduce binging and purging?

A

Topiramate, Ondansetron

65
Q

There is a _______ in the 5-HT1A and 5-HT2A serotonin receptors subtypes as well as ______ in the protein expression of 5-HT2A receptor in the prefrontal cortex and hippocampus is seen in pts who have committed suicide.

A

INCREASE, INCREASE

65
Q

What childhood disorder has the following neuropathogenesis: Disturbed amygdala–prefrontal cortex circuitry function during face emotion processing

A

DMDD

66
Q

What disease is associated with the following neuropathogenesis: decreased expression and function of growth factors. These growth factors include BDNF in the pre-frontal cortex and hippocampus.

A

Depression

67
Q

Desmopressin (DDAVP) __________ (dec or inc) nighttime production of urine and can be combined w/other treatment to improve efficacy.

A

decrease

68
Q

What drug class is used to help treat enuresis that has following MOA;
- decrease amount of time spent in REM sleep
- stimulates vasopressin secretion
- relaxes detrusor muscle

A

TCAs Imipramine most common

69
Q

What is encopresis?

A

repeated passage of feces into inappropriate places

69
Q

What specifier would be indicated if a patient with Bipolar I or Bipolar II disorders, had at least four episodes of a mood disturbance in the previous 12 months that meet criteria for a major depressive, manic, mixed, or hypomanic episode. AND the episodes were demarcated either by partial or full remission for at least 2 months or by a switch to an episode of opposite polarity.

A

rapid cycling

70
Q

What drug can be used to chorea developed from Huntington’s dx?

A

Tetrabenazine (VMAT inhibitor, blocking dopamine release)

71
Q

T/F: Risk of recurrence for postpartum depression is around 30%-50%.

A

True

72
Q

What type of paraphilic disorder is being described?
Sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity (can only be given if person is 18y/o)

A

Voyeuristic disorder

73
Q

What type of paraphilic disorder is being described?
Sexual arousal from act of being humiliated, beaten bound or otherwise made to suffer?

A

Sexual masochism disorder

74
Q

what type of paraphilic disorder is being described?
sexual arousal from physical and psychological suffering of another person

A

sexual sadism disorder

75
Q

2 Prevention meds for delirium in ICU and before and after surgery?

A

Ramelteon
suvorexant (orexin antagonist)

76
Q

Epidural hematoma vs subdural hematoma
Which is arterial bleed?
Which leads to death in a few hours?

A

Epidural hematoma is an arterial bleed —> pressure —> can lead to brain herniation.

77
Q

What drugs/poison leads to cholinergic toxicity by mechanism of being acetylcholinesterase inhibitors?

A

Organophosphate poisoning (think farming)

78
Q

How do you treat cholinergic poisoning? Looks like DUMBELS(like parasympathetic response, everything relaxed)

A

Atropine: acetylcholine (muscarinic) antagonism
Pralidoxime: reverses paralysis

79
Q

How do you treat anti-cholinergic toxicity?
Red as a beet, dry as a bone, mad as a hatter and hot as a hare

A

D/c offending meds
First line: Activated charcoal

Physostigmine (ach-esterase inhibitor)

80
Q

What is the sequel as of Wernickes encaphalopathy on heart and brain?

A

heart: heart failure —- wet beri beri
brain: amnesia with confabulation (Korsakoff syndrome)

81
Q

What is the sequel as of Wernickes encaphalopathy on heart and brain?

A

heart: heart failure —- wet beri beri
brain: amnesia with confabulation (Korsakoff syndrome)

82
Q

What are the 3 FDA approved med combos to treat Bipolar depression?

A
  1. Olanzapine and fluoxetine
  2. Latuda
  3. Seroquel
83
Q

How does time play a role in differentiation of
Other specified depressive disorder-short duration depressive episode
VS
Other Specified Depressive- Recurrent brief depression

A

Recurrent brief depression requires depressed mood is present for 2-13 days EVERY month, not coinciding with the menstrual cycle, for AT LEAST 12 consecutive months.

84
Q

What is recommended treatment for major depressive disorder (MDD) with a seasonal pattern?

A

light therapy

85
Q

Paraphilias that do not place other individuals at risk, such as through violent, abusive, or non-consensual behaviors, may be initially treated with what?

A

SSRIs or SNRIs

86
Q

First-line medication intervention for paraphilics who are violent offenders or those at high risk of repeating with serious consequences (such as pedophilic disorder).

A

Antiandrogen hormone treatments

87
Q

What disease has the following neuropathogenesis:
Polymorphisms in contactin-associated protein-like 2-gene (CNTNAP2)

A

selective mutism and in social anxiety symptoms and traits

88
Q

Which Antibody should you test for that can cause paraneoplastic cerebellar degeneration with subacute ataxia that may be associated with downbeat nystagmus and normal MRI?

A

Anti-Purkinje cell (anti-Yo) antibodies

occur especially with ovarian, fallopian tube, endometrial, surface capillary, and breast carcinomas

89
Q

Out of low mood and anhedonia which is associated with poor response to antidepressants?

A

anhedonia

90
Q

The prevalence of schizophrenia is 1% in the general population, 8% in non-twin siblings of a schizophrenic patient, 12% in children with 1 schizophrenic parent, 12% in dizygotic twins of schizophrenic patients, 40% in children with 2 schizophrenic parents, and 47% in monozygotic twins of a schizophrenic patient.

A
91
Q

What eating disorder is associated with highest frequency of substance use?

A

Bulimia nervosa

92
Q

In rapid cycling types of bipolar I and bipolar II disorder, patients experience at least ______ (#) episodes of manic, hypomanic, or depressive episodes in 12 months. This patient did not experience a manic or hypomanic episode.

A

4

93
Q

What 2 vitamins have research supportive of possible benefit in the treatment of tardive dyskinesia.

A

Vitamin B6 (pyridoxine)
Vitamin E

Psychiatry Boards (13 decks)

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