Random Psych Flashcards
Presents with:
Mild depressive symptoms + hypomanic symptoms
lasting ≥ 2 years
cyclothymic disorder
Presents with Diaphoresis, Dilated eyes, Tremors, (hyperreflexia), mental agitation, and even diarrhea
Serotonin syndrome
Emotionally triggered loss of muscle tone
Cataplexy
REM sleep behavior disorder typically occur during the _____ of the sleep period
first third
Anorexia often associated with what 2 illnesses?
OCD
MDD
What 2 elements distinguish Anorexia from Bulimia?
Low BMI (<18.5) Caloric Intake Restriction
Cocaine coronary vasospams can cause (3) complications
MI
stroke
ischemic colitis
Medication that helps reduce self-mutilation
Naltrexone
What is Hypercarotonemia?
yellow pigmentation of the skin (xanthoderma) and increased beta-carotene levels in the blood.
(seen in Anorexia; yellowing skin/palms & low T3)
List S/X of antidepressant discontinuation syndrome
Fatigue
Insomnia
Muscle Aches
Flu like s/x
First thing when a child shows neuro-developmental problems?
Screen for Hearing loss
can cause: Social, Language, Speech delays
Where is Serotonin made?
Raphe Nucleus
Agression, Delusions, paranoia, hyperthermia, dilated pupils, Tachycardia &/or HTN
(Not amphetamines/cocaine)
Bath Salts (Cathinones)
*NEG Urine Tox screen
What is Vaginismus?
involuntary vaginal muscle spasms
*genitopelvic pain disorder
MOA of Tetrabenazine used for Tourettes
VMAT2- Inhibitor
Where is Acetylcholine made
Basal nucleus of Meynert
Where is GABA made?
Nucleus Accumbens
Where is NE made
Locus Cereleus
Where is Dopamine made
Ventral Tegmentum; Substantia Nigra Pars Compacta
Amantadine MOA
For Parkinsonism
weak NMDA receptor
*Orthostatic hypotension/anxiety/ataxia
Cyproheptadine MOA
For Serotonin Syndrome
Anti-5HT2
Anti-Histamine
TCA MOA
Anti- alpha1
Anti-H1
Anti- Ach (Anti-Cholinergic)
NE & 5HT re-uptake inhibitor
Trazadone MOA
Anti-5HT2
Anti- alpha1
Anti-H1
Serotonin re-uptake inhibitor
D2 is linked to what GPCR?
Gi
Anti-psychotics inhibit Gi = increase cAMP
Which Antipsychotics have the strongest Anti-Histamine and Alpha1 effects?
Low Potency TYPICAL Antipsychotics
Linezolid (antibiotic) has ____ activity
MOA-1
Mirtazepine Antidepressant MOA
Anti- alpha2 **
Anti-H1
Anti- 5HT2 & 5HT3 ***
Increase release of NE & Serotonin
Atypical antipsychotics block
D2
Seretonin 2A
H1
Alpha1 (orthostatic hypotension)
Oppositional defiant disorder treatment
Parent Management Therapy
Behavior mod/ conflict management
Benztropine MOA
Inhibition of dopamine transporters
&
antimuscarinic/antihistaminic effects
How can lithium become toxic?
Hypovolemia (diuretics) = ↑ Na+ reabsorption = ↑ lithium = danger of toxicity
Akithesia can be caused by (2)
Antipsychotics or Parkinson treatment
Asterixis (wrist flapping) associated with (3)
Hepatic Encephalopathy
Wilson’s disease
Metabolic Derangements
Athetosis (snake like writhing movements in the fingers especially) seen in what illness?
Huntington
Chorea (purposeless jerking involuntary movements) seen in what illness?
Huntington
Resting tremor in Parkinson is due to a lesion where in the brain?
Substantia Nigra
Restless leg syndrome worsens at night/ with rest and improves with movement associated with (4)
Pregnancy
Parkinson
CKD
Iron deficiency
*treat with Pramipexole/Ropinirole D2 agonist
Dementia can be cause by ____ deficiency or ____-thyroidism
Vit B12 (Cobalamin)
hypothyroidism
Inhibition of the ____ in the brain causes Parkinson
Thalamus
2 Histological findings of Parkinson
Depigmentation of Substantia Nigra (loss of dopaminergic neurons)
Lewy bodies (Eosinophilic inclusions of alpha syn)
Can present with Agression, Depression, Dementia
Huntington
Huntington is due to a lesion(s) where in the brain?
Caudate/ Putamen
Huntington has what imbalance of Neurotransmitters
↑ Dopamine
↓ GABA
↓ Ach
List 3 histological findings in Alzheimer’s
Hirano bodies (hippocampus- pink rods)
Senile Plaques (amyloid Beta)
Neurofibrillary tangles (Hyper Phosphorylated Tau-microtubules)
List 4 Gross histological findings in Alzheimer’s
Cortical Atrophy
Hipocampus Atrophy
Narrowing Gyri
Widening Sulci
List 2 histological findings in Pick’s Frontal-temporal dementia
Round silver stain Hyper Phosphorylated Tau protein
(pick bodies)
Ubiquitinated TDP-43
Histological finding associated with HIV dementia?
Macrophages (Oligodendrocytes) fuse to make
GIANT CELLS
Brain imaging shows Focal demyelinated plaques, periventricular calcifications, and axonal sparing
Multiple Sclerosis
Ataxia, Myoclonus, ↓ school performance
Demyelination, Gliosis, Oligoclonal bands IgG in CSF.
Subacute Sclerosing Pan Encephalitis (SSPE)
2/2 Measels (viral capsid accumulates)
Idiopathic cranial HTN (aka Pseudotumor cerebri) is an
↑ICP usually seen in Obese women with recurrent Headaches, Papilledema +/- Recurrent Infections.
Associated with ____
Cerebral Venous Sinus Stenosis
*LP puncture relieves HA
NPH presents with NORMAL ICP, magnetic/shuffling gait, incontinence, and Cognitive Impairment (Delirious, Depressed, Psychotic, Memory worsening, etc.) What is a gross finding and why?
VENTRICULAR ENLARGEMENT
which distorts corona radiata fibers and compresses arachnoid villi.
Ex-Vacuo ventriculomegaly looks like it has an ↑ CSF, but is due to ↓ brain tissue. ICP is NORMAL. This is associated with what diseases (5)?
Dementia Alzheimer's Huntington Pick's (FTD) HIV assoc. Dementia
Alcoholics and other malnourished people are deficient in what key vitamin?
Thiamine (B1)
List 3 neurological causing Mental Retardation + Seizures
Sturge Weber (Non-hereditary)→ Glaucoma & Port-Wine
Tuberous Sclerosis (9/16)→ Murmur, Nodules, Ash leaf
Neurofimbromatosis I (17)→ Pheochroma, Cafe-au-lait, Lisch eye stains, Nodules (skin)
How can Von Hipple Lindau Disease cause psych problems?
can cause Pheochromacytoma (5Ps) and/or RCC Pain- HA Pressure- HTN Palpitations- Tachycardia Perspirations Panicking- Anxiety
Causes of Enurisis in kids
Voluntary (kid is purposely acting out)
Involuntary (Regression due to abuse/new sibling.)
Anatomic/ illness/ Meds
On the SHELF if you see regression in a kid think of ____
abuse
may or may not be the answer though could be stress
Management of Enuresis
Less than 7 y/o can still be normal if they have been drinking water.
If not, use + reinforcement, water restriction, Desmopressin (not the first line though) or imipramine
If no drinking, stressors, or abuse then get a UA and US.
UA (+) but US (-)
UTI bed wetting
Mostly seen in little girls wiping back to front causing
*If STI is present then it’s probably abuse
UA (-) but US (+) anatomical needs surgery
UA (-) & US (-)
No drinking
REGRESSION think abuse
Criminal behavior <18
vs
Teen acting out
Conduct disorder
vs
Oppositional Defiant
Fights with authority. Gets along with peers
Oppositional Defiant
*Bullying/ Fist fights Destruction Theft Truancy Running away from home Liars Cheaters Hurt Animals Torture Force Sex
Conduct disorder
Treatment is Juvenile Detention
Lie Cheat Steal Defiant NO Bullying NO Fist Fights Incongruent parenting
Oppositional Defiant
Treatment is Parental Management Training
4 types of exposure that can cause PTSD
Experienced trauma
Witnessed trauma
Learned of a loved one’s trauma
Witnessed repeated aftermath of trauma (1st responders)
(Trauma not witnessed through media, pictures, television or movies unless work-related)
Diagnosing OSA criteria (2)
15+ apneas/hr
or
5+ apneas/hr + snoring
can lead to Cor Promonale
Central Sleep Apnea increase in serum CO2 seen in (5)
opioid users
COPD w/over oxygenation
Stroke victims
CHF
idiopathic
Central Sleep Apnea treatment
Bi (level) pap
Narcoleptics have rapid ____
REM
low REM sleep latency
People with Narcolepsy wake up feeling
Refreshed due to increased REM sleep
sleep study aka
polysomnography
First line treatment of narcolepsy
schedule naps
if fails, stimulants
Primary insomnia not secondary to mood disorder is treated via
Sleep Hygiene or Diphenhydramine Trazadone Quetiapine (last) Zolpidem (last)
Paranoid personality disorder uses what ego defense
Projection
Schizoid personality disorder work what type of jobs
alone, night, or distant from others
Promiscuous or emotional emptiness
possibly…
Boderline
attention seeking, superficial, dramatic, not suicidal or unempathetic
Histrionic
self-centered, wants to talk to the boss only, wants to be prioritized over other people, may dress lavishly because they think they are important
Narcissistic
inadequate feeling, scared of being rejected, passes up on opportunities like promotions/presentations out of fear for failing. Fearful of making decisions
Avoidant
Cluster A,B,C are all ego-____
systonic
one simple question to screen for sleep apnea
do you wake up gasping for air or out of breath?
Blocking the D2 receptors too fast causes
acute dystonia
what SSRI is safest for pregnancy?
Sertraline
an antidepressant that can treat erectile dysfunction
Buspirone
Most common delusion associated w/ dementia
Theft/ Persecution
Most common hallucination associated w/parkinson
Figures of peoples or animals
Parkinson is caused by decreased _____
Dopamine
Beta 1 selective Beta blockers letters __- __
A-M
O-M → B1 & B2 non-selective
Competitive inhibition of histamine at H2-receptors of the gastric parietal cells, which inhibits gastric acid secretion, gastric volume, and hydrogen ion concentration are reduced.
Does not affect pepsin secretion, intrinsic factor secretion, or serum gastrin.
Ranitidine
(GERD)
*contraindicated in acute porphyria (causes attacks), renal/hepatic disease
The first-line treatment for binge eating disorder
Psychotherapy (eg, cognitive-behavioral therapy)
- However, pharmacotherapy may require less time. It is ok to use SSRI as first-line treatment for patients who prefer medication over therapy
- Additional treatment options for patients who are overweight or OBESE include behavioral weight loss therapy and Lisdexamfetamine (Vyvanse) or Topirimate
1st line Treatment of delusional disorder
Antipsychotic + adjunctive CBT
Presents with:
hepatic problems
Low level of serum ceruloplasmin + splenomegaly
neurologic problems
Dysarthria, Ataxia, Tremors, Drooling, Dystonia, Parkinson
Behavioral and psychiatric problems
Depression, Declining school performance, Personality changes, Irritability, impulsiveness, Labile mood,, Inappropriate behavior, Psychosis
Wilson disease
- Children: more likely to present with hepatic problems
- Older (mid-teens +): more likely to present with neurologic problems
Presents with periods of sudden
Stomach ache/problems
Pain in the extremities + patchy numbness/paresthesias extremity weakness (upper to lower)
Dark or reddish-brown urine (neg dipstick)
Dysuria, retention, incontinence, bladder distention
Insomnia, anxiety, restlessness, hallucinations, delirium, depression, phobias, altered consciousness
Acute Intermittent Porphyria
Treatment of Delirium agitation
Haloperidol
Treatment of anticholinergic induced delirium agitation
Benzos
Chronic opioid use for pain management can be indicated in certain cases of
Acute Intermittent Porphyria
QRS >100ms = how many little squares?
More than 2 little squares (Wide QRS)
Bipolar + agranulocytosis
Carbamazepine
Bipolar h/x + ↑AFP in a 20wk pregnant woman.
What meds is she using
Valproate
Carbamazepine
Dexamethasone suppression test = failure to suppress
Cushings DZ
No psychosis (other than hearing/seeing loved one)
Okay in bereavement or complex bereavement
Antipsychotic
Prolonged QTc and
pigmentary retinopathy?
Thioridazine
Pt wakes up with eyes
“stuck” looking up or head
“stuck” turned to the side.
Acute Dystonia
Pt reports feeling like they
“always have to move”.
Akathesia. (30-90 days).
Tx w/ propranolol (1st line) or benzo
Remember that metoclopramide (anti-emetic) can cause (2)
NMS or EPS
Weight neutral but increases
akathesia?
Aripripazole
Antipsychotic causes orthostasis and
cataracts?
Quetiapine
Patient comes in with panic attack syndromes what labs do you get
EKG, cardiac enzymes, echocardiogram,
TSH or T4, urine drug screen
Hx of anxiety or insomnia
currently w/ fever
convulsions, confusion and
hypertension. Dx
Benzo withdrawal
OCD has a high incidence of
Tourettes
A 54 y/o RN presents w/ a history of 2mo of diarrhea and abd pain. He has presented to 4 other hospitals w/ the same complaint. Colonoscopy reveals pigmentation in the wall of the colon
Laxative abuse
Factitious disorder
Malingering associated with what personality disorder
Antisocial
medications that can help paranoid behavior.
Low dose antipsychotics
Associated with Histrionic personality d/o
2
Eating d/o
SUD
Old lady altered mental status (agitation worsens at night, stupor in the day), having visual hallucinations and dysuria. Diagnosis?
Delirium 2/2 Cystitis
(fluctuating cognition, hallucination, agitation)
*get a UA, treat infection give antipsychotic (not benzo) for acute agitation
Give ____ for severe disinhibition in FTD
Olanzepine
DLB treated with
AchE inhhibitors
Memory loss, Loss of vibration sense, labile
affect. Pupil that accommodates
but doesn’t react. Dx?
3 syphilis
confusion, ataxia, and nystagmus (gaze fixed to one side)
Dx
Wernike’s
Pt presents with horizontal
nystagmus, dilated pupils,
ataxia and acute psychosis
Dx/ treatment.
PCP
Benzo > Haldol
Child w/ Mental retardation, Hypotonia, hypogonadism,
hyperphagia, skin picking, agression.
Prader Willi
Elfin-appearance, friendly, increased
empathy and verbal reasoning ability.
Deletion on Chr7.
Williams
ADHD-like sxs, microcephaly, smooth
philtrum.
Fetal Alcohol syndrome
A newborn baby has decreased tone, oblique
palpebral fissures, singular palmar crease, big tongue,
white spots on his iris
Down Syndrome
Child w/ abnormal muscle tone, unsteady gait,
seizures, mental retardation or
learning disability.
Cerebral palsy (birth asphyxia)
Autism spectrum sxs, heart disease,
palate defects, hypopastic thymus,
hypoCa. Possible psychosis/depression/anxiety
Digeorge
Stops just short of breaking the law or physically harming
others, but still annoying, blames others, defiant, liar, cheater
Oppositional defiant (not conduct d/o)
In Rumination Disorder
Check ___ levels
lead
6y/o stools in her clothes once every 2 weeks.
What must you check next. How to treat?
Fecal retention
Behavioral modification that only rewards
