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Random psych facts Flashcards

1
Q

What are symptoms of water intoxication?

A

tremor, ataxia, restlessness, diarrhea, vomiting, polyuria, stupor

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2
Q

What is difference between uncomplicated grief and pathological grief?

A

worthlessness, suicidality, excessive guilt, hallucinations, psychomotor retardation

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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

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4
Q

Buspirone is what of 5HT 1A

A

partial Agonist

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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

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6
Q

Ziprasidone inhibits serotonin and norepinephrine reuptake, what receptors does it affect?

A

Agonist 5HT1A
Antagonist 5HT2A, D2

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7
Q

Are LH and FSH decreased or increased in anorexia?

A

Decreased

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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

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9
Q

What happens when antipsychotic medications block dopamine in the tuberoinfundibular tract?

A

Elevated prolactin which can lead to galactorrhea and amenorrhea

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10
Q

What has the greatest comorbidity with pathological gambling?

A

MDD

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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
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12
Q

Pathological gambling is in what category of DSM 5?

A

Substance relate and addictive disorders

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13
Q

Dissociative fugue

A

travel or wandering that is associated with amnesia for identity or other important biographical information

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14
Q

Depersonalization

A

Outside observer with respect to ones own thoughts feeling sensation body or actions

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15
Q

Derealization

A

detachment with respect to one’s surroundings

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16
Q

what type of metabolic derangement do bulimic patients develop?

A

hypochloremic alkalosis

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17
Q

Highest risk of becoming violent?

A

substance abusers

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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

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19
Q

What is the treatment for urinary retention?

A

bethanechol

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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
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21
Q

Which antidepressants can be used for treatment of gastric ulcer because of histamine blockade?

A

Amitriptaline, doxepin, trimipramine

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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

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23
Q

Schizophrenia how long must active symptoms be present?

A

1 month-

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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

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25
Q

Carbamazepine is an inducer of CYP2C19 and 3A4, what levels are not affected by carbamazepine?

A

clozapine (it is a substrate of CYP 1A2)

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26
Q

What does tobacco smoking induce? What medications does this effect?

A

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)

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27
Q

Is depression a risk factor for ischemic stroke?

A

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)

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28
Q

What is part of thought content?

A
  • obsessions
  • delusions
  • ideas of reference
  • phobias
  • SI
  • HI
  • depersonalization
  • derealization
  • neologisms
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29
Q

What is part of thought process?

A

word salad
flight of ideas
circumstantiality
tangential
clang associations
perseveration
goal directed ideas

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30
Q

Which TCAs are tertiary amines?

A

doxepin
imipramine
amitriptaline
clomipramine
trimipramine

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31
Q

TCA secondary amines

A

despiramine
nortriptaline
protriptyline

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32
Q

Are tricyclics metabolized by CYP2D6?

A

yes, and cimetidine is an inhibitor

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33
Q

Treatment of tics in Tourette’s syndrome

A

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

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34
Q

dementia pugilistica, Posttraumatic dementia

A

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

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35
Q

Does downregulation of β-adrenergic receptors correlates most closely with time needed for clinical improvement in patients with TCAs?

A

yes

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36
Q

What are treatments for enuresis in childhood?

A
  • Bell and pad behavior conditioning
    TCAs: amitriptyline and imipramine
    Desmopressin
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37
Q

What is abreaction?

A

emotional release after recalling a painful event, part of psychodynamic therapy

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38
Q

What are the least sedating TCAs?

A

desipramine and protriptyline

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39
Q

What are moderately sedating amitryptalines?

A

imipramine, amoxapine, nortriptyline, maprotilline

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40
Q

What are the most sedating TCAs?

A

amitriptyline
trimipramine
doxepin

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41
Q

Does Cabamazepine lower oral contraceptives?

A

yes

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42
Q

Should cabamazepine be taken with MAOIs?

A

NO

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43
Q

What does combining carbamazepine and clozapine increase the risk for?

A

bone marrow suppression

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44
Q

What is IQ

A

mental age divided by chronological age x100

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45
Q

What medications for controlling aggression in antisocial pts?

A
  • valproate and carbamazepine
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46
Q

What medication has been used in narcisstic personality?

A

lithium for mood stabilization and antidepressants (poor rejection tolerance and susceptible to depression)

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47
Q

What is reinforcement in interviewing?

A

consists of brief phrases such as uh-huh okay go on, pt understants encouragement to keep talking

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48
Q

tourette’s syndrome

A
  • 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

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49
Q

caudate neurons have many D2 receptors, blockade of the caudate D2 receptors causes what? overstimulation causes what

A

bradykinesia
overstimulation: tics and extraneous motor movements

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50
Q

gnaser’s syndrome

A

dissociative disorder- giving approx answers or talking past the point
male prisoners most commonly affected

-varient of malingering with possible 2ndary gain

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51
Q

capgras’ syndrome

A

systematized delusion in which the patient feels that a familiar person is an unfamiliar imposter

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52
Q

What can increase lithium levels?

A

ibuprofen
thiazaide diurects
ACEi

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53
Q

what can be used to treat lithium induced nephrogenic diabetes insipidus?

A

amiloride

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54
Q

3 hydroxy benzodiazepines are metabolized by what and have no active metabolites

A

glucuronidation
- oxazepam, lorazepam, temazepam

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55
Q

what is often used to treat aggression in pts with schizophrenia, prisoners, CD, MR

A

lithium
other drugs include anticonvulsants and antipsychotic

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56
Q

where does the mesolimbic-mesocortical pathway project from and to

A

from the ventral tegmental area to many areas of the cortex and limbic system

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57
Q

how does clonidine work

A

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

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58
Q

pts at high risk for ect

A

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.

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59
Q

patient-controlled anlagesia

A

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

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60
Q

intermittent explosive disorder

A
  • 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

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61
Q

habit reversal

A

awareness training and then competing response training-(develop a competing response)

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62
Q

can you do cingulotomy for OCD?

A

yes
complication: seizures

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63
Q

DID

A

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

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64
Q

how often is wbc taken w/ clozapine?

A

weekly for first 6 months then every 2 weeks then month after 1 year
- when treatment stopped WBC taken every week for 4 weeks

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65
Q

lithium toxicity

A

> 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

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66
Q

random reinforcement

A

reward is given only a fraction of the time at random intervals

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67
Q

primary reinforcer vs. secondary reinforcer

A

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

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68
Q

best way to teach a new behavior

A

continuous reinforcement

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69
Q

late-onset schizophrenia

A

more often in women than men
prognosis seems to be more favorable when onset is late
often have more paranoia
beginning age 45

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70
Q

RLS

A

must persist at least 3 months

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71
Q

risperdal consta

A

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

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72
Q

for ECT to be effective the seizure should last ..

A

25 seconds

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73
Q

what are the indications for ECT maintenance

A

severe medication side effects and intolerance
psychotic symptoms or severe symptoms
rapid release after a successful initial round of treatments

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74
Q

What medications should be discontinued prior to ECT?

A

benzos, lithium (postictal delirium and can prolong seizure activity), clozapine, bupropion (late appearing seizures)

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75
Q

What is the most commonly used anesthetic for ECT?

A

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
Q

What diseases have been associated with mania?

A
  • glioma
  • cushing’s disease
  • MS
77
Q

What medications can cause a manic episode

A
  • isoniazid
  • cimetidine
  • metaclopramide
  • steriods
78
Q

social phobia

A

-fear of one or more social or performance situation in which the person is exposed to unfamiliar people or possible scrutiny by others

79
Q

OCD

A

caudate nucleus, thalamus, orbitalfrontal cortex
smaller caudate nucleus on MRI

80
Q

Pseudoseizures can be a common symptom of conversion disorder. What type of personality disorders is conversion disorder associated with?

A

antisocial, histrionic, dependent

81
Q

patients with anorexia have

A

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
Q

purging electrolyte abnormality

A

hypokalemic, hyperchloremic alkalosis
hypomagnesemia
increased serum amylase
pancreatic inflammation

83
Q

what disorders can mimic anxiety disorder

A
  • carcinoid syndrome- hypertension and elevated 5 hyroxyindoleacetic acid
  • hyperthryoidism
  • hypoglycemia
  • hyperventialtion syndrome- hx of rapid deep respirations, circumoral pallor and anxiety
84
Q

schizotypal

A

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
Q

pancreatic cancer has been associated with a higher rate of what?

A

depression

86
Q

which somatoform disorder has the best prognosis?

A

conversion idsorder

87
Q

treatment for exhibitionistic disorder

A

medroxypreogesterone acetate

88
Q

treatment for exhibitionistic disorder

A

medroxypreogesterone acetate

89
Q

what can you treat diabetes insipidus as a result of lithium with?

A

amiloride and hydrochlorothiazide

90
Q

treatment of children w/ separation anxiety

A
  • individual therapy
  • medication to reduce anxiety
  • family therapy and education
  • return to school
91
Q

pimozide

A

dopamine receptor antagonist used for treatment of tourette’s
- haldol also used

92
Q

signs of atypical depression

A
  • increased appetite, weight gain, increased sleep, reactive mood, leaden paralysis, interpersonal rejection sensitivity
  • MAOI is treatment of choice
93
Q

melancholic

A

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
Q

how do you treat priapism

A

intracavernosal injection of epinephrine

95
Q

what are the most common defenses used by OCPD

A
  • isolation of affect, undoing, reaction formation, intellectualization, rationalization
96
Q

what do both serotonin syndrome and NMS present with?

A

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
Q

What are the difference between serotonin syndrome and NMS?

A

serotonin syndrome-myoclonus, hyperreflexia, and GI symptoms
NMS-muscle rigidity

98
Q

in both brief psychotic disorder and schizophreniform do the pts return to baseline functioning after disturbances

A

yes

99
Q

mania/hypomania

A
  • 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
Q

Pts w/ PTSD

A

decreased hippocampal volume on neuroimaging

101
Q

carbamazepine will decrease levels of waht?

A

doxycycline and cyclosporine

102
Q

what decreases carbamazepine levels

A

pehnobarbitol and theophylline

103
Q

erythromycin does what to carbamazepine

A

increase it

104
Q

neuroimaging of schizophrenics demonstrates what?

A

increased size of lateral ventricles
decreased metabolic activity in frontal lobe

105
Q

conversion disorder

A

highest among rural populations; those with little education, low intelligence, and low socioeconomic status and military personnel who have had combat exposure

106
Q

when should thyroid hormones not be taken for depression?

A

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
Q

Does eszopiclone (Lunesta) lead to tolerance?

A

no but like zolpidem it can lead to hallucinations, sleep walking

108
Q

What is ramelteon

A

melatonin agonist

109
Q

How long does it take for GGT to return to normal after alcohol cessation?

A

8 weeks

110
Q

What is adrenal insufficiency (addison’s disease) ?

A

decreased production of mineralocorticoids, glucocorticoids and sex hormones by the adreanl gland
- primary=damage to adrenal gland
- secondary=pituitary disease
- tertiary=hypothalamus

111
Q

what are psychiatric symptoms for (adreanl insufficiency) addison’s disease

A

most commonly depression, apathy, irritability
psychosis and delirium can also happen

112
Q

what are symptoms of adrenal insuffiency (addisons disease)?
What will lab work show?
Treatment

A

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
Q

lamotrigine and valproic acid

A
  • elevated lamotrigine
  • decreased valproic acid
114
Q

lamotrigine and carbamazepine

A

lamotrigine levels decreased

115
Q

valproic acid and carbamazepine

A

increased carbamazepine

116
Q

will lithium affect levels of lamotrigine, valproic acid or carbamazepine

A

no

117
Q

for most anxiety disorders the rates are higher in women than men except for which?

A

OCD- equal rates

118
Q

clonazepam has slow or fast absorption

A

fast absorption
- half life 34 hours and is considered long acting

119
Q

alprazolam rate of absorption and half life

A

medium rate of absorption
half life of 12 hours, short acting

120
Q

diazepam, absorption, half life

A

rapid absorption
- half life of 100 hours, long acting

121
Q

lorazpeam absorption, half life

A

medium rate of absorption
15 hour half life, short acting

122
Q

On average how many ECT treatments to treat depression?

A

6-12
3 times per week

123
Q

How long can it take for atomoxatine to reach max effect?

A

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
Q

what is the most significant risk factor for PTSD and the best predictor of symptom developement

A

The nature, severity, and duration of exposure to the trauma

125
Q

predisposing vulnerabilities to PTSD

A

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
Q

DSM post partum depression time

A

onset must be within 4 weeks of birth

127
Q

these pts tend to be indifferent to praise or criticism

A

schizoid

128
Q

acute intermittent porphyria

A

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
Q

varenciline (chantix)

A

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
Q

does atropine have effects at nicotinic receptors?

A

no such as neuromuscular cholinergic blockade with weakness and respiratory depression

131
Q

what does chelation therapy with dimercaporol or penicillamine treat

A

arsenic poisoning

132
Q

how is lead encephalopathy treated

A

supportively, corticosteriods for cerebral edema and chelating agents (dimercaprol or DMPS)

133
Q

medical complications of anorexia

A

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
Q

Indications that anorexia should be managed inpatient

A
  • 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
Q

BMI

A

weight(kg)/height (m)^2

136
Q

what are complications of self-induced vomiting

A

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
Q

what can abuse of ipecac result in?

A

skeletal muscle atrophy, prolonged qt, cardiomyopathy, tachy

138
Q

humor, altruism, anticipation, and suppression are what type of defenses

A

mature

139
Q

causes for anorgasima

A

alcohol, SSRI, marijuana, TCA, benzos, diabetes, spinal cord damage, hormones, pelvic injury, cardiac problems, liver disease, kidney disease

140
Q

substance induced anxiety dosrder includes what as specifiers

A

with onset during intoxication
with onset after medication use

141
Q

what age are pts more likely to develop td

A

over 50

142
Q

what should you use for MAO-I induced hypertensive crisis

A

alpha adrenergic antagonist such as phentolamine or chlorpromazine

143
Q

what is treatment for NMS

A

dantroline and bromocriptine

144
Q

what factor correlates most with childhood physical abuse

A

poverty, psychosocial stress

145
Q

pathological gambling is believed to be associated with what biological markers

A
  • 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
Q

conduct disorder

A

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
Q

best treatment panics

A

CBT + SSRI

148
Q

what is the gold standard theraapy for OCD

A

exposure with response prevention

149
Q

panic disorder

A

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
Q

GAD

A

anxiety more days than not for a t least 6 months about a number of events or acitvities

151
Q

social anxiety disorder treatment

A

combining cbt and SSRI does not show clear benefit over using just one or the other for most intial tretmantes

152
Q

what doses of methadone are twice as likely to lead to scuessful outcomes compared to 50mg or less

A

80mg

153
Q

tics treatment

A

dopamine blocker

154
Q

hyperparathyroidism symptoms

A
  • constipation, polydipsia, nausea, depression, paranoia, and confusion
155
Q

compared to the general public patients with social phobia have what?

A

fewer friendships, lower levels of education, higher rates of suicide and less success in career advancement, and poor marital funciton

156
Q

what increases the chances an elderly pt will commit suicide?

A

alcohol dep, widowed, unemployed, soically isolated, male genser, chronic illness, dep, irritation, rage violence, affective instability

157
Q

what anc can you stop and then retry clozapine if improves?

A

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
Q

Klein-levin syndrome

A

hypersomnia and hyperphagia
- lack of sexual inhibitions, confusion, mood changes, hallucinations, disorientation, memory impairment and incoherent speech, excessive sleeping lasting days to months

159
Q

sleep apnea is considered what?

A

a dyssomnia- disorders relating to duration, quality or timing of sleep

ex: narcolepsy, sleep apnea, circadian rhythm disorder

160
Q

parasomnias

A

undesired behaviors occur during sleep or sleep transitions

Ex: nightmare, sleep terrors, sleepwalking

161
Q

pavor nocturnus

A

sleep terror disorder

162
Q

somnambulism

A

sleepwalking disorder

163
Q

jactatio capitis nocturna

A

rhythmic movement disorder that includes head banging during sleep

164
Q

what should differential diagnosis for sleep apnea include

A

insufficient sleep, gerd, nighttime panic attacks

165
Q

sleep apnea to be diagnosed

A

apneic episodes must last for 10 seconds or longer and occur at a minimum of 30 times per night

166
Q

REM sleep behavior disorder

A

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
Q

can AH be present in delusional disorder

A

no but olfactory, tactile and gustatory may be seen

168
Q

DID psychotropic treatment

A

Not lithium!
- anticonvulsants and antipscyhotic mood stabilizing agents
- depakote, lamictal, gaba, topiramat, carbamazepine, risperiodne, quetiapine, olanzapine, ziparsadone
-SSRI

169
Q

risk factors for delirium

A

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
Q

what is the major neuroanatomical area of delirium

A

reticular formation
dorsal tegmental pathway that projects from the mesencephalic reticular formation to the tectum and thalamus

171
Q

delirium neurotransmitters

A

decrease in acetylcholine activity
delirium associated w/ alcohol withdrawal: hyperactivity of noradrenergic neurons in locus ceruleous
serotonin and glutamate

172
Q

Is delirium known to increase patient mortality within the first year following an episode?

A

yes
- also delirium may lead to symptoms of depression or PTSD in the aftermath of the episode

173
Q

body dysmorphic disorder

A
  • women slightly more than men
  • unmarried
  • 90% of BDD suffers have had MDD episode
    treatment: serotonergic agents
174
Q

does somatic symptom disorder tend to run in families

A

yes

175
Q

is somatic symptom disorder prevalence in men vs women

A

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
Q

what is treatment for somatic disorder

A

therapy
probs dont give psychotropics unless comorbid but still be scurd

177
Q

post partum psychosis

A

50% have family hx of mood disorders
- highest risk w/ prior diagnosis of bipolar disorder

178
Q

chronic pain syndromes like chronic fatigue syndrome and fibromyalgia can have comorbidity with what?

A

major depression

179
Q

Lupus symptoms

A

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
Q

fibromyalgia

A

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
Q

chronic fatigue syndrome

A

post exertive malaise lasting more than 24 hours and orthostatic intolerance (symptoms improve when pt is lying down)

182
Q

FDA approved treatments for fibromyalgia

A

milnacipran
duloxetine
pregabalin

183
Q

Treatment of ODD

A

cognitive behavioral therapy, family therapy, and conflict resolution, individual therapy

184
Q

what is habit reversal therapy used for

A

trichotillomania and ticss

185
Q

medications to treat aggression in children

A

antihypertensives: clonidine guanfacine
antipsychotics: 2nd gen and haldol and chlorpromazine
mood stabilizeers: depakote lithium oxcarbazepine, lamictal

186
Q

What can be a marker of symptoms severity in bulemia?

A

serum amylase
- associated with increased salivary gland size and self induced vomiting
(binging also leads to these elevated levels?)

187
Q

what is treatment for bulimia

A

antidperessants -fluoxeitne

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