SAS/Review Flashcards
Which opioids affect serotonin levels?
Why is this important?
Tramadol, fentanyl
Patients on serotoninergic agents should not take!
Can lead to serotonin syndrome
What kind of defense mechanism:
A perosn is angry at their phsysician for cancelling their appointment. They end up cleaning their entire department to avoid thinking about being angry
Sublimation
Channeling anger, discomfort, unpleasant thoughts at productive activities
Which cognitive domain will be affected first in Dementia with Lewy Bodies?
Attention/executive function, visuospatial reasoning
Will also have Parkinsonism
(Parietal lobe)
Which side effect of first-generation antipsychotics is likely to present after decades of use?
Tardive dyskinesia
Due to long term dopamine blockade
Describe the general timeline of symptoms onset during alcohol withdrawal
- 6-48h: ANS hyperactivity
- 12-48h: Seizures
- 12-24h: Hallucinations
- 3-5+ days: Delirium Tremens
Which cognitive domain will be affected first in Frontotemporal Dementia?
Personality changes, language deficits
(Frontal lobe)
What are the risks associated with MAO inhibitors?
- Serotonin Syndrome
- Hypertensive crisis
- Must avoid tyramine-rich foods
- Severe interaction with meperidine
Which drugs increase serum Lithium levels?
- NSAIDs
-
Diuretics
- Thiazides, spironalactone, triamterene
- ACE inhibitors
- Ca2+ channel blockers
- Metronidazole
- Tetracycline
What factors might precipitate delerium?
I-WATCH-DEATH
The slides specifically highlight factors in bold
- Infection - pneumonia
- Withdrawal
- Acute metabolic
- Trauma
- CNS pathology
- Hypoxia/hypercarbia - hypoxia
- Deficiencies
- Endocrine
- Acute vascular
- Toxins - diphenhydramine
- Heavy metal
What is the difference between schizoaffective disorder and schizophrenia?
-
Schizoaffective disorder:
- Mood symptoms regardless of whether psychotic symptoms are present or absent
-
Schizophrenia:
- Mood symptoms only present when psychotic symptoms are present
(Thank you @Nathan Shlobin!)
Which area/circuit of the brain is impaired in Alzheimer’s Disease?
Limbic Network
Abnormal eye movements (nystagmus) are characteristic of which drug intoxication?
Phencyclidine (PCP)
Which antidepressants are contraindicated in patinets with current or history of anorexia nervosa or bulimia nervosa?
Bupropion
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
Serotonin
Wakefullness
Raphe nuclei (pons)
Which antipsychotics are most likely to have side effects of involuntary facial movements, restlessness, and dystonia?
High-potency first-generation antipsychotics
- Haloperidol
- Fluphenazine
- Trifluoperazine
Hoover’s sign provides evidence for which disorder?
Functional Neurological Disorder (aka conversion disorder)
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
Orexin
Wakefulness
Lateral hypothalamus
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
Histamine
Wakefulness
Tuberomamillary nucleus (hypothalamus)
What differentiates Bipolar I from Bipolar II?
- Bipolar I
- At least 1 manic episode lasting 1+ weeks
- Bioplar II
- Hypomania
- Different from mania b/c does not cause marked impairment in social/occupational functioning, does not require hospitalization
- No manic episodes
- Hypomania
E - All of the above
- Bupropion = atypical antidepressant (NE and DA reuptake inhibitor)
- Clonidine, guanfacine = alpha-2 blockers
- Atomoxetine = selective NE reuptake inhibitor
Rapid withdrawal of what hormone can trigger migraine?
Estrogen
- Rapid withdrawal occurs during the following times:
- Perimenopause
- Post-partum
- Perimenstruation
What is the most consistent but non-specific neuroimaging finding in schizophrenia?
Enlarged ventricles
- Almost always found in patients with schizophrenia
- Not specific for schizophrenia
Which seizure medications are prefered in women of childbearing age?
Lamotrigine, levetiracetam
Sometimes carbamazepine
Avoid valproate, topiramate!!
What is the most effective treatment for insomnia?
Cognitive behavioral therapy
Focuses on:
- Sleep hygeine
- Sleep restriction
- Bed is for sleeping and sex only!
- Wake up at the same time every day
- Stimulus control
- Don’t sleep until you’re tired
- If you can’t fall asleep in 20 min, get out of bed and read
- Avoid screens
What is the difference between schizotypal and schizoid personality disorders?
- Schizoid
- Socially withdrawn
- Desire to be left alone
- Limited emotional expression
- Schizotypal
- Also socially withdrawn
- Interpersonal awkwardness
- Magical thinking, eccentricity
Which area/circuit of the brain is impaired in semantic aphasia/dementia?
Central pathway of vision (temporal lobe)
A set of sidely scattered but orchestrated crerebral areas that are activated by a specific task observed on neuroimaging is a…
- State network
- Attention network
- Channel network
- Default mode network
c. Channel network
Schizophrenia is a [developmental/degenerative] disorder
What is the brain pathology?
Schizophrenia is a developmental disorder
Results from abnormal neuronal migration during development
What are the classic features of MDD, melancholic subtype?
- Anhedonia and/or lack of reactivity
- Early morning awakening
- Significant anorexia or weight loss
- Excessive or inappropriate guilt
A - Methylphenidate
- Bupropion can also be used for ADHD, but not first line
- Guanfacine is an alpha-2 agonist that is 2nd line or ad-junct to the stimulants
- Tranylcypromine is a MAO inibitor - not indicated for ADHD
Which antipsychotic may cause neutropenia?
Clozapine
- Atypical anti-psychotic
- Blocks serotonin and norepinephrine
- Used as a 3rd line agent
- But must register in database
- Track any neutropenia resulting so it is not prescribed in the future
What kind of seizure is associated wtih tongue biting?
Generalized tonic/clonic seizure
What time period constitutes persistent depressive disorder?
2+ years of depressed mood for most of the day, more days than not
Which area/circuit of the brain is impaired in Lewy Body Dementia?
Dorsal Pathway of Vision (parietal lobe)
What syndrome is associated with thamine deficiency?
Which population is at particular risk?
Wernicke-Korsakoff Syndrome
People with alcohol-use disorder
- Wernicke
- Ataxia, abnormal eye movmement
- Korsakoff
- Amnesia, poor judgement, confabulation, spurious answers to questions
Automatisms and aura of a funny taste in one’s mouth before a seizure are characteristic of which kind of epilepsy?
Temporal lobe epilepsy
Automatism = fumbling with clothing/button, cannot stop
Which type of reinforcement schedule has the fastest extinction?
Which types have the slowest extinction?
Fastest extinction = continuous (also has fastest learning)
Slowest extinction = variable interval or variable ratio
(Fixed interval and fixed ratio have the fastest conditioning)
Which antipsychotics are likely to cause abnormal lactation?
- Low-potency first-generation
- Chlorpromazine
- Thioridazine
- Second-generation - lower risk than FGA, but can still happen
- Quetiapine
- Olanzapine
- Risperidone
- Aripiprazole
- Ziprasodone
- Clozapine
List the parts of the Papez circuit, in order
- Entorhinal cortex (anterior part of the parahippocampal gyrus)
- Via perforant (through dentate) or alvear pathways to the…
- Hippocampus
- Fornix
- Mammillary bodies (hypothalamus)
- Via mammilothalamic tract to the…
- Anterior thalamic nuclei
- Via internal capsule to the…
- Cingulate
- Back to the parahippocampal gyrus
What kind of medication is cyclobenzaprine?
Muscle relaxant
Which sleep disorder is associated with low orexin levels in the CSF?
Describe 3 associated symptoms
Narcolepsy
- Cataplexy
- Knees buckle in response to emotion
- Vivid dreams
- Sleep paralysis
Which area/circuit of the brain is impaired in frontal type dementia?
Frontal cortex
What kind of defense mechanism:
A perosn is angry at their psysician for cancelling their appointment. Next time they see their physician, they compliment the physician on their shirt
Reaction formation
(Doing the opposite of what you feel)
Which class of antidepressants is most likely to have cardiac effects?
What are the effects?
TCAs
Long QT -> Torsades (potentially fatal arrhythmia)
- Amitriptyline
- Nortriptilyine
- Desipraime
- Amoxapine
- Imipramine
- Clomipramine
- Doxepin
How is lithium metabolized?
Excreted unchanged by the kidney
(No hepatic metabolism)
Which cognitive domain will be affected first in Alzheimer’s Disease?
Memory
(Limbic system)
What are the indications for haloperidol in a patient with delerium?
- Psychosis
- Hallucinations
- Agitation
But remember, the focus of the treatment should always be the underlying cause!!
What further testing is indicated when a child presents with signs and symptoms of autism spectrum disorder?
- Genetic testing
- Lead levels (if reasonable environmental risk)
- EEG
- Hearing and vision
- Wood’s lamp (for Tuberous Sclerosis)
How are abscence seizures differentiated from focal seiziures without loss of consciousness?
No post-ictal period (confusion) after abscence seizure
According to Robins and Guze (1970), what 5 steps can help achieve diagnostic validity for psychiatric disorders?
- Clinical description
- Delimitation from other disorders
- Follow-up study (including treatment response)
- Family study
- Laboratory studies
Which kind of reinforcement schedule results in the fastest conditioning?
Fixed schedules - type of partial reinforcement
(Continuous reinforcement has the fastest learning)
What are the classic features of MDD, atypical subtype?
- Mood reactivity
- Significant weight gain
- Hypersomnia
- Leaden paralysis
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
Norepinephrine
Wakefulness
Locus ceruleus (pons)
Which medication can be used to augment the effects of SSRIs and is known for reducing the risk of suicide?
Lithium
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
GABA
Sleep
Ventrolateral peroptic nucleus (VLPO)
What is a “homeopathic” treatment?
Like treating like
Ex: using seizures in ECT to help treat patients with seizures
