Random psych facts Flashcards
1
Q
What are symptoms of water intoxication?
A
tremor, ataxia, restlessness, diarrhea, vomiting, polyuria, stupor
2
Q
What is difference between uncomplicated grief and pathological grief?
A
worthlessness, suicidality, excessive guilt, hallucinations, psychomotor retardation
3
Q
pergolide, bromocriptine, pramipexole, and ropinirole are what types of drugs?
A
Dopamine agonist used to treat Parkinson’s disease. They have lower incidence of dyskinesias than levodopa.
Side effects: hallucinations, sedation, othostatic hypotension
4
Q
Buspirone is what of 5HT 1A
A
partial Agonist
5
Q
Abilify is what of 5HT 1A and what at the D2 receptor and what at the 5HT 2A receptor?
A
Partial agonist at 5HT1A and D2
Antagonist at 5HT2A
6
Q
Ziprasidone inhibits serotonin and norepinephrine reuptake, what receptors does it affect?
A
Agonist 5HT1A
Antagonist 5HT2A, D2
7
Q
Are LH and FSH decreased or increased in anorexia?
A
Decreased
8
Q
Eye findings in schizophrenia
A
Disorder of smooth visual pursuit and disinhibition of saccadic eye movements (thought to be due to pathology in frontal lobes)
Also present in first degree relatives
9
Q
What happens when antipsychotic medications block dopamine in the tuberoinfundibular tract?
A
Elevated prolactin which can lead to galactorrhea and amenorrhea
10
Q
What has the greatest comorbidity with pathological gambling?
A
MDD
11
Q
What are some keys to a psychogenic seizure?
A
- lack of aura, no cyanotic skin changes, no self injury, no incontinence, no postictal confusion, asynchronous body movements, absent EEG changes, seizure activity being affected by suggestion of the doctor. prolactin will no be elevated by psychogenic seizure
12
Q
Pathological gambling is in what category of DSM 5?
A
Substance relate and addictive disorders
13
Q
Dissociative fugue
A
travel or wandering that is associated with amnesia for identity or other important biographical information
14
Q
Depersonalization
A
Outside observer with respect to ones own thoughts feeling sensation body or actions
15
Q
Derealization
A
detachment with respect to one’s surroundings
16
Q
what type of metabolic derangement do bulimic patients develop?
A
hypochloremic alkalosis
17
Q
Highest risk of becoming violent?
A
substance abusers
18
Q
How does serotonin affect platelets?
A
evidence suggests that there are serotonin receptors on surface of platelets that can modify and reduce platelet aggregation
- SSRI after MI has been shown to increase body serotonin-making future heart attack less likely
19
Q
What is the treatment for urinary retention?
A
bethanechol
20
Q
What are common side effects for TCAs?
A
- constipation, dry mouth, blurry vision, sweating, orthostatic hypotension, sedation, lethargy, agitation, slowed cardiac conduction (prolonged PR and QRS interval) and tachycardia
21
Q
Which antidepressants can be used for treatment of gastric ulcer because of histamine blockade?
A
Amitriptaline, doxepin, trimipramine
22
Q
in the psychotic pt, the defense mechanism of projection takes the form of what?
A
persecution-a pts own impulses and hostilities are projected onto another
23
Q
Schizophrenia how long must active symptoms be present?
A
1 month-
24
Q
What are amoxapine and maprotiline?
A
tetracyclic antidepressants
amoxapine has significnat dopamine blocking and can produce side effects similar to antipsychotics
maprotiline-one of the most selective inhibitors of NE reuptake- mild sedative and anticholinergic side effects- increased incidence of seizures-long half life of 43 hours
25
Carbamazepine is an inducer of CYP2C19 and 3A4, what levels are not affected by carbamazepine?
clozapine (it is a substrate of CYP 1A2)
26
What does tobacco smoking induce? What medications does this effect?
CYP1A2
- amitriptyline, fluvoxamine, clozapine, olanzapine, haloperidol, imipramine
NOT RISPERIDONE (substrate of 2D6- can be lowered by dexamethosone and rifampin and increased by buproprion, citalopram, clomipramine, doxepin duloxetine, escitalopram, prozac, paroxetine, sertraline, perphenazine)
27
Is depression a risk factor for ischemic stroke?
Nope
Risk factors: older age, male, low socioeconomic status, DM, obesity, cig, excess alc, family hx, art hypertension, prior stroke or ischemic attack, asymptomatic carotid bruit, dyslipidemai, hyperhomocysteinemia, oral contraceptive use, blood dyscrasias (protein c or s deficiency, antithrombin 3 deficiency, factor 5 leiden deficiency)
28
What is part of thought content?
- obsessions
- delusions
- ideas of reference
- phobias
- SI
- HI
- depersonalization
- derealization
- neologisms
29
What is part of thought process?
word salad
flight of ideas
circumstantiality
tangential
clang associations
perseveration
goal directed ideas
30
Which TCAs are tertiary amines?
doxepin
imipramine
amitriptaline
clomipramine
trimipramine
31
TCA secondary amines
despiramine
nortriptaline
protriptyline
32
Are tricyclics metabolized by CYP2D6?
yes, and cimetidine is an inhibitor
33
Treatment of tics in Tourette's syndrome
best treated by neuroleptics: haloperidol, pimozide
Also atypical antipsychotics.
Also fluphenazine and molinodone
clonidine
botulinum toxin A-blepharospasm and eyelid motor tics
Not protriptyline and other antidpressants
34
dementia pugilistica, Posttraumatic dementia
severe memory and attentional deficits and extrapyramidal signs
-Carriers of apo E4 (which resides on chromosome 19) are at increased risk of posttraumatic dementia as well as Alzheimer's disease
35
Does downregulation of β-adrenergic receptors correlates most closely with time needed for clinical improvement in patients with TCAs?
yes
36
What are treatments for enuresis in childhood?
- Bell and pad behavior conditioning
TCAs: amitriptyline and imipramine
Desmopressin
37
What is abreaction?
emotional release after recalling a painful event, part of psychodynamic therapy
38
What are the least sedating TCAs?
desipramine and protriptyline
39
What are moderately sedating amitryptalines?
imipramine, amoxapine, nortriptyline, maprotilline
40
What are the most sedating TCAs?
amitriptyline
trimipramine
doxepin
41
Does Cabamazepine lower oral contraceptives?
yes
42
Should cabamazepine be taken with MAOIs?
NO
43
What does combining carbamazepine and clozapine increase the risk for?
bone marrow suppression
44
What is IQ
mental age divided by chronological age x100
45
What medications for controlling aggression in antisocial pts?
- valproate and carbamazepine
46
What medication has been used in narcisstic personality?
lithium for mood stabilization and antidepressants (poor rejection tolerance and susceptible to depression)
47
What is reinforcement in interviewing?
consists of brief phrases such as uh-huh okay go on, pt understants encouragement to keep talking
48
tourette's syndrome
- more common in boys than girls 2-10
- both motor and vocal tics must be present to meet criteria for the disorder
- ADHD, OCD, CD
- hereditary
Treatment:
tics: conventional or atypical neuroleptics
guanfacine and clonidine are useful for tics and ADHD
SSRI OCD
49
caudate neurons have many D2 receptors, blockade of the caudate D2 receptors causes what? overstimulation causes what
bradykinesia
overstimulation: tics and extraneous motor movements
50
gnaser's syndrome
dissociative disorder- giving approx answers or talking past the point
male prisoners most commonly affected
-varient of malingering with possible 2ndary gain
51
capgras' syndrome
systematized delusion in which the patient feels that a familiar person is an unfamiliar imposter
52
What can increase lithium levels?
ibuprofen
thiazaide diurects
ACEi
53
what can be used to treat lithium induced nephrogenic diabetes insipidus?
amiloride
54
3 hydroxy benzodiazepines are metabolized by what and have no active metabolites
glucuronidation
- oxazepam, lorazepam, temazepam
55
what is often used to treat aggression in pts with schizophrenia, prisoners, CD, MR
lithium
other drugs include anticonvulsants and antipsychotic
56
where does the mesolimbic-mesocortical pathway project from and to
from the ventral tegmental area to many areas of the cortex and limbic system
57
how does clonidine work
presynaptic alpha 2 receptor agonist
- reducing the amount of norepinephrine that is released from the synaptic bouton
- decreases sympathetic tone and bodily arousal and activation
58
pts at high risk for ect
those with space-occupying lesions in the CNS, those with increased intracranial pressure, those at risk for cerebral bleed, those who have had a recent myocardial infarction, and those with uncontrolled hypertension.
59
patient-controlled anlagesia
pts who control their won dosing end up using less pain medication than those who have to ask for the medication and wait for the doctor write an order
- they also have far better pain control
60
intermittent explosive disorder
- more common in men
- unpredictable episodes
- predisposing factors: underpriviledged or tempestuous childhood, childhood abuse, and early frustration and depreivation
- decreased cerebral serotonergic transmission and low CSF levels of 5 hydroxyindoleacetic acid and high levels of testosterone in men
treatment: mood stabilizers
SSRI and tcas can also be effective in reducing aggression
- strong comorbidity w/ fire setting, substance abuse and eating disorders
61
habit reversal
awareness training and then competing response training-(develop a competing response)
62
can you do cingulotomy for OCD?
yes
complication: seizures
63
DID
two or more distinct identities or personality states that recurrently take over the person's behavior
- dissociative amnesia- inability to recall important personal information
treatment: insight oriented psychotherapy, hypnotherapy may be helpful
- antipsychotics often unhelpful
- antidpressants/anxiolytics may be helpful in addition to therapy
- anticonvulsant mood stabilizes have shown some efficacy in certain studies
64
how often is wbc taken w/ clozapine?
weekly for first 6 months then every 2 weeks then month after 1 year
- when treatment stopped WBC taken every week for 4 weeks
65
lithium toxicity
>2.5meq/L
-discontinuation and vigorous hydration
>4 or signs of serious lithium toxicity (nephrotoxicity, convulsions, coma)
- hemodialysis every 6-10 hours until level is no longer toxic and pts symptoms remit
66
random reinforcement
reward is given only a fraction of the time at random intervals
67
primary reinforcer vs. secondary reinforcer
primary reinforcer: independent of previous learning-biological need to eat
secondary reinforcer: based on previous learning-rewarding a child w/ a present when does something well
68
best way to teach a new behavior
continuous reinforcement
69
late-onset schizophrenia
more often in women than men
prognosis seems to be more favorable when onset is late
often have more paranoia
beginning age 45
70
RLS
must persist at least 3 months
71
risperdal consta
12.5, 25, 37.5, 50mg
2 week intervals
3-4 oral week overlap
unreconstituted drug must be refigerated then mixed with sterile water then administered in deltoid or gluteous within 6 hours
72
for ECT to be effective the seizure should last ..
25 seconds
73
what are the indications for ECT maintenance
severe medication side effects and intolerance
psychotic symptoms or severe symptoms
rapid release after a successful initial round of treatments
74
What medications should be discontinued prior to ECT?
benzos, lithium (postictal delirium and can prolong seizure activity), clozapine, bupropion (late appearing seizures)
75
What is the most commonly used anesthetic for ECT?
methohexital (Brevital)- short duration of action and lower association of postictal arrhythmias
- Etomidate is sometimes used in elderly pts because it does not increase seizure threshold and it is well understood that seizure threshold increases as pts age
- ketamine is also sometimes used for that reason-however it is associated w/ pscyhotic symptoms following anesthesia
- alfentanil is used concominant w/ barbituates bc it allows for lower dosing of barbituates which lower the seizure threshold further. however increased risk of nausea
----->propofol not generally useful because it raises seizure threshold
76
What diseases have been associated with mania?
- glioma
- cushing's disease
- MS
77
What medications can cause a manic episode
- isoniazid
- cimetidine
- metaclopramide
- steriods
78
social phobia
-fear of one or more social or performance situation in which the person is exposed to unfamiliar people or possible scrutiny by others
79
OCD
caudate nucleus, thalamus, orbitalfrontal cortex
smaller caudate nucleus on MRI
80
Pseudoseizures can be a common symptom of conversion disorder. What type of personality disorders is conversion disorder associated with?
antisocial, histrionic, dependent
81
patients with anorexia have
cachexia, loss of muscle mass, reduced thyroid metabolism, loss of cardiac muslce, arrhythmias, delayed gastric emptying, bloating, abdominal pain, amenhorrhea, lanugo, abnormal taste sesnation
82
purging electrolyte abnormality
hypokalemic, hyperchloremic alkalosis
hypomagnesemia
increased serum amylase
pancreatic inflammation
83
what disorders can mimic anxiety disorder
- carcinoid syndrome- hypertension and elevated 5 hyroxyindoleacetic acid
- hyperthryoidism
- hypoglycemia
- hyperventialtion syndrome- hx of rapid deep respirations, circumoral pallor and anxiety
84
schizotypal
omposed of a pervasive pattern of personal and social deficits characterized by ideas of reference, odd beliefs or magical thinking, unusual perceptual experiences, paranoid ideation, inappropriate affect, eccentric appearance, lack of close friends, and excessive social anxiety that has a paranoid flair.
85
pancreatic cancer has been associated with a higher rate of what?
depression
86
which somatoform disorder has the best prognosis?
conversion idsorder
87
treatment for exhibitionistic disorder
medroxypreogesterone acetate
88
treatment for exhibitionistic disorder
medroxypreogesterone acetate
89
what can you treat diabetes insipidus as a result of lithium with?
amiloride and hydrochlorothiazide
90
treatment of children w/ separation anxiety
- individual therapy
- medication to reduce anxiety
- family therapy and education
- return to school
91
pimozide
dopamine receptor antagonist used for treatment of tourette's
- haldol also used
92
signs of atypical depression
- increased appetite, weight gain, increased sleep, reactive mood, leaden paralysis, interpersonal rejection sensitivity
- MAOI is treatment of choice
93
melancholic
loss of pleasure, lack of reactivity to usually pleasurable stimuli, loss of appetite and sleep , profound despair, worse in the morning, early awakening, psychomotor agitation or retardation, excessive guilt
TCA
94
how do you treat priapism
intracavernosal injection of epinephrine
95
what are the most common defenses used by OCPD
- isolation of affect, undoing, reaction formation, intellectualization, rationalization
96
what do both serotonin syndrome and NMS present with?
mental status changes, autonomic instability, diaphoresis, and mutism, both can have elevated CPK (but high CPK is more common in NMS becuase of muscle rigidity)
97
What are the difference between serotonin syndrome and NMS?
serotonin syndrome-myoclonus, hyperreflexia, and GI symptoms
NMS-muscle rigidity
98
in both brief psychotic disorder and schizophreniform do the pts return to baseline functioning after disturbances
yes
99
mania/hypomania
- if core symptom is euphoria, three additional symptoms are needed
- if core symptom is irritability, four additional symptoms are needed
- grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal directed activity, excessive involvement in pleasurable activities.
100
Pts w/ PTSD
decreased hippocampal volume on neuroimaging
101
carbamazepine will decrease levels of waht?
doxycycline and cyclosporine
102
what decreases carbamazepine levels
pehnobarbitol and theophylline
103
erythromycin does what to carbamazepine
increase it
104
neuroimaging of schizophrenics demonstrates what?
increased size of lateral ventricles
decreased metabolic activity in frontal lobe
105
conversion disorder
highest among rural populations; those with little education, low intelligence, and low socioeconomic status and military personnel who have had combat exposure
106
when should thyroid hormones not be taken for depression?
cardiac disease, angina, or hypertension
- thryotoxicosis, uncorrected adrenal insufficency, acute myocardial infection
- thyroid hormones can potentiate the effects of warfarin
- can increase insulin and digitalis requirements
- ssri, tca, lithium and carb can mildly lower serum thyroxine and raise serum thyrotropine levels
107
Does eszopiclone (Lunesta) lead to tolerance?
no but like zolpidem it can lead to hallucinations, sleep walking
108
What is ramelteon
melatonin agonist
109
How long does it take for GGT to return to normal after alcohol cessation?
8 weeks
110
What is adrenal insufficiency (addison's disease) ?
decreased production of mineralocorticoids, glucocorticoids and sex hormones by the adreanl gland
- primary=damage to adrenal gland
- secondary=pituitary disease
- tertiary=hypothalamus
111
what are psychiatric symptoms for (adreanl insufficiency) addison's disease
most commonly depression, apathy, irritability
psychosis and delirium can also happen
112
what are symptoms of adrenal insuffiency (addisons disease)?
What will lab work show?
Treatment
fatigue, weight loss, hyperpigmentation, hypotension, nausea, vomiting, salt craving, dizziness, joint and muscle pain
- low serum cortisol
- IV hydrocortisone acutely w/ prednisone or hydrocortisone in chronic cases or dexamethasone
113
lamotrigine and valproic acid
- elevated lamotrigine
- decreased valproic acid
114
lamotrigine and carbamazepine
lamotrigine levels decreased
115
valproic acid and carbamazepine
increased carbamazepine
116
will lithium affect levels of lamotrigine, valproic acid or carbamazepine
no
117
for most anxiety disorders the rates are higher in women than men except for which?
OCD- equal rates
118
clonazepam has slow or fast absorption
fast absorption
- half life 34 hours and is considered long acting
119
alprazolam rate of absorption and half life
medium rate of absorption
half life of 12 hours, short acting
120
diazepam, absorption, half life
rapid absorption
- half life of 100 hours, long acting
121
lorazpeam absorption, half life
medium rate of absorption
15 hour half life, short acting
122
On average how many ECT treatments to treat depression?
6-12
3 times per week
123
How long can it take for atomoxatine to reach max effect?
10 weeks
- most common side effects dizzizness, reduced appetite, dyspepsia
metabolized primary by liver
- reports suggest that combination of atomoxetine with stimulants is well tolerated and effective
124
what is the most significant risk factor for PTSD and the best predictor of symptom developement
The nature, severity, and duration of exposure to the trauma
125
predisposing vulnerabilities to PTSD
Presence of childhood trauma.
Borderline, paranoid, dependent, or antisocial personality disorder traits.
Inadequate family or peer supports.
Female gender.
Genetic predisposition to mental illness.
Recent life stressors.
Perception of an external locus of control to the trauma (natural cause) as opposed to an internal one (human cause).
Recent alcohol abuse.
126
DSM post partum depression time
onset must be within 4 weeks of birth
127
these pts tend to be indifferent to praise or criticism
schizoid
128
acute intermittent porphyria
disorder of heme synthesis which leads to build up of porphyria
- abdominal pain, peripheral neuropahty, and psychiatric disturbances
- delirium, psychosis, depression, anxiety
- hyponatremia, N/V/renal damage/dermatolgic manifestations
testing: porphobilinogen in blood urine or stool
129
varenciline (chantix)
partial nicotine agonist
triples quit rates
-warning for behavior changes such as hostility, agitation, depression and suicidal thoughts during or after stopping treatment
most common side effect nausea
130
does atropine have effects at nicotinic receptors?
no such as neuromuscular cholinergic blockade with weakness and respiratory depression
131
what does chelation therapy with dimercaporol or penicillamine treat
arsenic poisoning
132
how is lead encephalopathy treated
supportively, corticosteriods for cerebral edema and chelating agents (dimercaprol or DMPS)
133
medical complications of anorexia
bradycardia, pancytopenia, lanugo, osteopenia, metabolic encephalopathy, arrhythmias, elevated liver functions tests (LFT), elevated blood urea nitrogen (BUN), decreased T3/T4, parotid gland enlargement, seizures, peripheral neuropathy
134
Indications that anorexia should be managed inpatient
- hypokalemia
- weight loss to under 75% expected weight
- growth arrest
- risk of self harm or development of psychosis
- rapid weight loss
- outpatient management failure
135
BMI
weight(kg)/height (m)^2
136
what are complications of self-induced vomiting
esophagitis, scars or abrasion on back of hand (russells sign), mallory weiss syndrome(bleeding from tears in the esophageal mucosa), barretts esophagus, erosion of tooth enamel, parotid gland swelling, increased serum amylase, hyokalemia, increased rate of spontaneous abortion and low birth weight
137
what can abuse of ipecac result in?
skeletal muscle atrophy, prolonged qt, cardiomyopathy, tachy
138
humor, altruism, anticipation, and suppression are what type of defenses
mature
139
causes for anorgasima
alcohol, SSRI, marijuana, TCA, benzos, diabetes, spinal cord damage, hormones, pelvic injury, cardiac problems, liver disease, kidney disease
140
substance induced anxiety dosrder includes what as specifiers
with onset during intoxication
with onset after medication use
141
what age are pts more likely to develop td
over 50
142
what should you use for MAO-I induced hypertensive crisis
alpha adrenergic antagonist such as phentolamine or chlorpromazine
143
what is treatment for NMS
dantroline and bromocriptine
144
what factor correlates most with childhood physical abuse
poverty, psychosocial stress
145
pathological gambling is believed to be associated with what biological markers
- low plasma MHPG (3-methoxy-4-hydroxyphenylglycol) concentrations and high CSF MHPG concentrations
- increased urinary output of neorepinephrine
- decreased platelet MAO activity (marker of sertonergic dysfunction)
146
conduct disorder
3 or more present in the past 12 months with at least one criterion present in the past 6 months
- aggression to people and animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
*problems must begin to manifest before 13
= low plasma levels of dopamine b hydroxylase -->decreased noreadrenergic functioning
- greater right frontal EEG activity- correlated with violent and aggressive behavior in children
147
best treatment panics
CBT + SSRI
148
what is the gold standard theraapy for OCD
exposure with response prevention
149
panic disorder
pt must have recurrent attacks of which at least one attack is followed by 1 month or more persistent concern about having more attacks or worry about the implication of the attack or its consequences or a significant change in behavior related to the attacks
150
GAD
anxiety more days than not for a t least 6 months about a number of events or acitvities
151
social anxiety disorder treatment
combining cbt and SSRI does not show clear benefit over using just one or the other for most intial tretmantes
152
what doses of methadone are twice as likely to lead to scuessful outcomes compared to 50mg or less
80mg
153
tics treatment
dopamine blocker
154
hyperparathyroidism symptoms
- constipation, polydipsia, nausea, depression, paranoia, and confusion
155
compared to the general public patients with social phobia have what?
fewer friendships, lower levels of education, higher rates of suicide and less success in career advancement, and poor marital funciton
156
what increases the chances an elderly pt will commit suicide?
alcohol dep, widowed, unemployed, soically isolated, male genser, chronic illness, dep, irritation, rage violence, affective instability
157
what anc can you stop and then retry clozapine if improves?
if anc between 500 and 999 then can stop and may try again if improves
- if anc between 1000 and 1499 cans witch to 3 times weekly monitoring until over 1500
if anc lower then 500 pt can be rechallened following heme consult and risk benefit analysis
158
Klein-levin syndrome
hypersomnia and hyperphagia
- lack of sexual inhibitions, confusion, mood changes, hallucinations, disorientation, memory impairment and incoherent speech, excessive sleeping lasting days to months
159
sleep apnea is considered what?
a dyssomnia- disorders relating to duration, quality or timing of sleep
ex: narcolepsy, sleep apnea, circadian rhythm disorder
160
parasomnias
undesired behaviors occur during sleep or sleep transitions
Ex: nightmare, sleep terrors, sleepwalking
161
pavor nocturnus
sleep terror disorder
162
somnambulism
sleepwalking disorder
163
jactatio capitis nocturna
rhythmic movement disorder that includes head banging during sleep
164
what should differential diagnosis for sleep apnea include
insufficient sleep, gerd, nighttime panic attacks
165
sleep apnea to be diagnosed
apneic episodes must last for 10 seconds or longer and occur at a minimum of 30 times per night
166
REM sleep behavior disorder
chronic progressive condition that is often seen in men
loss of atonia during rem which leads to sometimes violent behaviors in which the pts act out their dreams
- worse with use of stimulants, tricyclics and fluoxetine
- clonazepam and carbamazepine have proven effective in decreasing the symptoms
167
can AH be present in delusional disorder
no but olfactory, tactile and gustatory may be seen
168
DID psychotropic treatment
Not lithium!
- anticonvulsants and antipscyhotic mood stabilizing agents
- depakote, lamictal, gaba, topiramat, carbamazepine, risperiodne, quetiapine, olanzapine, ziparsadone
-SSRI
169
risk factors for delirium
older age
preexisting brain damage or disease
hx of alcohol or tobacco smoking
diabetes, cancer, blindness and malnutrition
male gender
intoxication or withdrawal
medications-narcotics, steriods, anesthetics, antineoplastic agents, anticholinergic, antibiotics, antifungal, antiviral
170
what is the major neuroanatomical area of delirium
reticular formation
dorsal tegmental pathway that projects from the mesencephalic reticular formation to the tectum and thalamus
171
delirium neurotransmitters
decrease in acetylcholine activity
delirium associated w/ alcohol withdrawal: hyperactivity of noradrenergic neurons in locus ceruleous
serotonin and glutamate
172
Is delirium known to increase patient mortality within the first year following an episode?
yes
- also delirium may lead to symptoms of depression or PTSD in the aftermath of the episode
173
body dysmorphic disorder
- women slightly more than men
- unmarried
- 90% of BDD suffers have had MDD episode
treatment: serotonergic agents
174
does somatic symptom disorder tend to run in families
yes
175
is somatic symptom disorder prevalence in men vs women
women outnumber men 5-20 times
- also more common in low income little education
- typically beofre 30
- no more likely to develop another medical illness
176
what is treatment for somatic disorder
therapy
probs dont give psychotropics unless comorbid but still be scurd
177
post partum psychosis
50% have family hx of mood disorders
- highest risk w/ prior diagnosis of bipolar disorder
178
chronic pain syndromes like chronic fatigue syndrome and fibromyalgia can have comorbidity with what?
major depression
179
Lupus symptoms
fatigue, arthralgias, arthritis, headache, neuropathy, depressed mood, cognitive difficulties, psychosis, delirium
-up to 80% of pts with SLE have cognitive dysfunction
- can present with fatigue and pain across multiple joints
180
fibromyalgia
fatigue, decreased sleep, and pain all over the body
- at least 3 months
- fatigue, waking unrefreshed, cognitive symptoms
-80-90% of fibromyalgia cases are female
181
chronic fatigue syndrome
post exertive malaise lasting more than 24 hours and orthostatic intolerance (symptoms improve when pt is lying down)
182
FDA approved treatments for fibromyalgia
milnacipran
duloxetine
pregabalin
183
Treatment of ODD
cognitive behavioral therapy, family therapy, and conflict resolution, individual therapy
184
what is habit reversal therapy used for
trichotillomania and ticss
185
medications to treat aggression in children
antihypertensives: clonidine guanfacine
antipsychotics: 2nd gen and haldol and chlorpromazine
mood stabilizeers: depakote lithium oxcarbazepine, lamictal
186
What can be a marker of symptoms severity in bulemia?
serum amylase
- associated with increased salivary gland size and self induced vomiting
(binging also leads to these elevated levels?)
187
what is treatment for bulimia
antidperessants -fluoxeitne
