RECALL from 2021 + 2022 exams Flashcards
what is the most common cause of hyperthyroidism? what blood test results would you expect in this case?
graves disease
autoimmune process with antibodies against TSH receptor
T3/T4 will be high, TSH will be LOW
what medications can be implicated in hyperthyroidism
lithium
amiodarone
treatment for hyperthyroidism
antithyroid therapy or beta blockers
psychiatric symptoms of hyperthyroidism
anxiety–> panic, GAD
mood–> emotional lability, irritability, hypomania, insomnia
severe–> delirium
what EEG changes are seen in lithium toxicity? is this helpful for diagnosis?
DISORGANIZATION and SLOWING OF BACKGROUND ACTIVITY are the most common in lithium toxicity
severe lithium toxicity–> periodic complexes of SHARP WAVES
yes, its helpful–> the changes seem in EEG in lithium toxicity can be correlated with degree of neurotoxicity
what are two first line drugs for treating clozapine-induced seizures
VPA and lamotrigine
–> Traditional agents, such as phenytoin, have greater efficacy against tonic-clonic seizures, compared with myoclonic seizures, and are probably less effective overall
what type of seizures are seen in clozapine induced seizures
myoclonic seizures
what is the confirmatory test for anti-NMDA encephalopathy
IgG anti-GluN1 antibodies –> CSF antibodies
Confirmatory test is CSF antibodies. MRI and EEG can be part of work-up, but not confirmatory. MRI has no findings in more than half of cases. EEG is abnormal in 90%.
what is “forced normalization”
Forced normalization (FN) is an intriguing phenomenon characterized by the emergence of psychiatric disturbances following the establishment of seizure control or reduction in the epileptic activity in a patient with previous uncontrolled epilepsy.
name a peculiar side effect of keppra
rage and suicidality
(this is the answer on the MCQ where the options are forced normalization vs keppa effect)
is abilify associated with prolonged QT
no
what CYP enzymes are induced by smoking
1A2 and 2B6
what CYP enzymes metabolize olanzapine
1A2
(and i think 3A4)
what causes the physical symptoms of opioid withdrawal
hyperactivity of noradrenergic neurons in the LC
if a kid previously had strep 2 years ago, and now has sudden onset OCD in the context of a psychosocial stressor, what is the likely cause/precipitant of the OCD?
the psychosocial stressor
–> Stessful or traumatic events associated with developing OCD per DSM; Also well known stress/anxiety can exacerbate sx
if it was going to be PANDAS, usually a date range will be given to show the temporal relationship with GAS–> should be “recent” i.e within 6 months or less from onset of PANDAS sx
what is one way to evaluate the bleeding risk associated with a particular antidepressant
An association between the risk of bleeding and increasing affinity for the serotonin transporter (SERT) has been noted in several studies
(basically higher affinity for SERT then higher bleeding risk)
what is “rabbit syndrome”
Rabbit syndrome is an uncommon, TONGUE SPARING oro-facial movement disturbance, RAPID and REGULAR in nature and associated with prolonged use of neuroleptics
antipsychotic induced rhythmic movement of the mouth/lips resembling the chewing of a rabbit
VERTICAL ONLY motion, at about 5 Hz with NO INVOLVEMENT OF THE TONGUE
usually appear after long period of neuroleptic tx
can be typical or atypical neuroleptic
how do you distinguish rabbit syndrome from tardive dyskinesia
TD–> has tongue movements
RS–> no tongue movements
TD–> worsened by anticholinergics often
RS–> treated with anticholinergics
how do you treat rabbit syndrome
FIRST reduce antipsychotics as much as possible
THEN anticholinergics–> i.e benztropine
*does NOT respond to tx w levodopa or dopamine agonists
list 3 common targets for ablative surgery in OCD
anterior CINGULOTOMY–> anterior cingulate gyrus and cingulum bundle
anterior CAPSULOTOMY–> anterior limb of internal capsule
SUBCAUDATE TRACHTOTOMY–> corticostriatal tracts ventral to the head of the caudate nucleus
what is “harm avoidance” trait
personality trait characterized by excessive worrying, pessimism, shyness, and being fearful, doubtful, and easily fatigued, is suggested to be related to low serotonergic activity
what is “reward dependence” trait
tendency to respond markedly to signals of reward, particularly to verbal signals of social approval, social support, and sentiment. The opposite of Reward dependance would be detached/aloof/cold/independent– really touching on core pro-social behaviors
what is “novelty seeking” trait
novelty seeking is a personality trait associated with exploratory activity in response to novel stimulation, impulsive decision making, extravagance in approach to reward cues, quick loss of temper, and avoidance of frustration
what is “high persistence” trait
Persistence is associated to being industrious, determined & ambitious–The opposite of persistence would be lazy, spoiled or practical
what part of the brain is responsible for: learned response to fear, attaching emotions to past experiences, and connecting/interpreting sensory input?
amygdala
“The amygdalae help the body process emotions. They also help attach emotional meaning to memories. “
why might someone on a vega/veg diet get depressed
lacking in vitamin B12
may be low in long chain omega3s
*both of these are important for brain function and lack of either may predispose to depression
what is “introjection”
the unconscious adoption of the thoughts or personality traits of others.
what is cocaine’s mechanism of action for its BEHAVIOURAL symptoms
Competitive at dopamine transporter, prevents reuptake
“Cocaine causes the neurotransmitter dopamine to build up at the interface between VTA cells and NAc cells, triggering pleasurable feelings “
ties up the dopamine transporter, a protein that the dopaminergic cells use to retrieve dopamine molecules from their surroundings”
what is “reaction formation”
reaction formation is a DEFENSE mechanism in which a person unconsciously REPLACES an unwanted or anxiety-provoking IMPULSE with its opposite, often expressed in an exaggerated or showy way. A classic example is a young boy who bullies a young girl because, on a subconscious level, he’s attracted to her.
what are two defense mechanisms associated with OCPD
reaction formation + isolation of affect
An adult woman with history of bipolar type I, with favorable response to lithium. Her mood is stable but long standing history of social anxiety disorder that is significant, how do you treat the social anxiety?
a. Pregabalin
b. Seroquel
c. Lamotrigine
B) Seroquel
A) FALSE - third-line
B) TRUE - first-line is QTP, gabapentin (CANMAT anxiety comorbidity table 2 )
C) FALSE - second-line
what brain differences would you expect to see in the brain of someone with OCD
decreased hippocampus
“OCD is associated with smaller hippocampal volumes and larger pallidum volumes, versus controls, but failed to find any significant differences in the caudate or putamen”
who focused on self psychology and object relations in short term psychodynamic therapy, rather than drive-defense
Mann
what does fMRI look at?
Functional magnetic resonance imaging (fMRI) can detect changes in blood flow and oxygen levels that result from your brain’s activity.
what does PET-FDG detect
glucose metabolism in the brain
what does SPECT and PET detect
radiotracers
Patient in your DBT group comes to group. Didn’t do their diary entry. They have work stressors and at risk of losing job. Cutting last week requiring stitches. They want to talk about interpersonal dynamic with a co-patient. What do you focus on first?
a. Cutting
b. Not doing diary entry homework
c. Job stress
d. Interpersonal issue
A) Cutting
A) TRUE - DBT always focus on suicide/self-harm first
B) FALSE - second is to address therapy interfering behaviour
C) FALSE - third is to focus on improving life
D) FALSE
