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Studying Flashcards

1
Q

Joseph Breuer

A

Worked with Freud, 1842-1925. Developed theory of hysteria with Anna O patient with Freud.

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2
Q

Kurt Schneider

A

1887-1967
“first rank” symptoms of schizophrenia: thought insertion/withdrawal, thought broadcasting, 2 voices with dialogue, delusions of passivity. Narrowed the schizophrenia diagnosis.

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3
Q

”first rank” symptoms of schizophrenia:

A

thought insertion/withdrawal, thought broadcasting, 2 voices with dialogue, delusions of passivity.

Kurt Schneider 1887-1967

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4
Q

Emil Kraeplin

A

(1856-1926): classified schizophrenia as a physical disease, that would establish biological identity for mental illness. Differentiated dementia praecox (schizophrenia) from manic-depression, based on age of onset, fam hx, and disease course. Also noted negative sx and cognitive dysfunction as strongest determinants of impairment, treatment resistance, and prognosis.

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5
Q

Eugene Bleuler

A

(1857-1939): Coined Schizoprenia and thought of it as heterogenous group of disorders. The 4 As: loose associations, affective flattening, autism, ambivalence. Noted disturbance in emotion and motivation.

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6
Q

The 4 As os Schizophrenia

A

loose associations, affective flattening, autism, ambivalence. Noted disturbance in emotion ad motivation.

Eugene Bleuler 1857-1939

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7
Q

Karl Wernike

A

1848-1905: focused on language deficits in the l posterior and superior temporal gyrus. Receptive or sensory aphasia, can’t understand or produce meaningful speech. Wernike encephalopathy opthalmoparesis, ataxia, and encephalopathy 2/2 B1 (thiamine deficiency)

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8
Q

Ventral Posterior Medial Nucleus

A

face sensory (somatic sensation for contralateral face and taste)

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9
Q

Ventral posterior lateral Nucleus:

A

Leg and arm sensory (somatic sensation to contralateral body)

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10
Q

Ventral Lateral Nucleus:

A

Coordination and movement (cerebellar)

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11
Q

Medial Geniculate nucleus:

A

Thalamus nucleii Hearing (auditory impulses)

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12
Q

Lateral Geniculate Body:

A

Thalamus nucleii for Vision (visual impulses/retina)

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13
Q

Gene with substance use disorder

A

Alcohol dehydrogenase/Aldehyde dehydrogenase

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14
Q

Gene for carbamazepine

A

HLA B*1502

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15
Q

Protease inhibitors antidepressant with fatal interaction

A

Nefazodone (Serotonin modulator) can increase toxicity of protease inhibitors.

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16
Q

Transient HA, quadriplegia, stupor, psychosis and blindness

A

Basilar migraine

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17
Q

: progressive dementia, dysarthria, tremors, and hypotonia.

A

Neurosyphillis

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18
Q

Minere’s disease

A

inner ear dysfxn. Vertigo, tinnitus, and hearing loss

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19
Q

Kluver-Bucy Syndrome:

A

Lesions to b/l anterior temporal lobes/amygdala
Hyperorality, hypermetamorphisis (preoccupation with minute stimuli) and blunted emotional affect, hyper sexuality, and visual agnosia

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20
Q

Anterior thalamus

A

Anterior and medial thalamus lesion leads to fluctuation in mood.
- Anterior thalamic nucleus gets info from mammilothalamic tract and sends info to cingulate cortex for memory storage and emotion
- mediodorsal thalamic nuclei gets input from temporal lobe and hypothalamus and relays to prefrontal cortex affecting motivation drive and emotion

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21
Q

Amygdala lesion

A

Hyper sexuality, hyperorality, apathy, hyper fixation

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22
Q

Sx Lesion to Mammillary bodies

A

Confabulation, memory changes, psychosis. Affected in ETOH encephalpathy

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23
Q

Medial thalamus lesion

A

Deficits in language

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24
Q

Lesion right thalamus

A

Visual memory deficits

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25
Q

Carries a risk of permanent visual loss in 20-50% if untreated. Associated s/sx include polymyalgia rheumatica, headache (in 40% to 90%), weight loss (16% to 76%), scalp tenderness (28% to 91%), anorexia (14% to 69%), fever, leg claudication (2% to 43%), and jaw claudication (4% to 67%)

A

Giant Cell Arteritis

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26
Q

MOA Mirtazapine

A

Alpha-2 adrenergic receptor antagonist -primary

Serotonin 5HT2 antagonist.

- Histamines receptor blockade (H1)—>sedation inc appetite. And weight gain
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27
Q

Bupropion MOA

A

NE and DA reuptake inhibitor

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28
Q

MOA antipsychotics

A

D2 antagonists

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29
Q

5HT-2A receptor agonists

A

LSD, psilocybin

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30
Q

Ventral Posteromedial Nucleus

A

Face sensory (somatic sensation for contralateral face and taste), projects to somatosensory cortex

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31
Q

Ventral posterolateral Nucleus

A

Leg and arm sensory (somatic sensation to contralateral body), projects to somatosensory cortex

Lateral-Leg and arm

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32
Q

Ventral Lateral Nucleus:

A

Coordination and movement. Info from cerebellum and basal ganglia to motor cortex,

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33
Q

Lateral Geniculate Nucleus

A

Vision (visual impulses/retina), to visual cortex

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34
Q

Medial Geniculate nucleus

A

Hearing (auditory impulses) to primary auditory cortex.

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35
Q

Ventral Lateral Nucleus:

A

Coordination and movement. Info from cerebellum and basal ganglia to motor cortex, .

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36
Q

Ventral anterior nucleus

A

: motor information about movement/tremor eg movement initiation. Basal ganglia to premotor cortex.

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37
Q

Lesion when you see dressing apraxia

A

R parietal lobe

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38
Q

R/l confusion, acalculia, agraphia, aphasia. Agnosia

A

Gerstmann syndrome, L parietal lobe lesion

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39
Q

Pathological finding in temporal lobe epilepsy

A

Mesial or hippocampal sclerosis

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40
Q

What do you think of with aqueduct dilation

A

NPH

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41
Q

Modafinil MOA

A

binds to dopamine transporter, inhibits dopamine reuptake.

Also increases activity in the tuberomamillary nucleus (which is primarily histaminergic)

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42
Q

Seizure, adhd, increasingly clumsy, falls, stiff gait, periventricular demyelination in posterior regions of cerebral white matter

A

Adrenoleukodystrophy

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43
Q

Adrenoleukodystrophy sx

A

Vision and hearing issues, hyperactivity, paralysis, seizures, muscle weakness, adrenal failure

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44
Q

Adrenoleukodystrophy inheritance and etiology

A

X linked. So think if you see in males. Accumulation of very long chain fatty acids.

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45
Q

Hypoxanthine-guanine phosphoribosyltransferase, causes _______

A

Lesch-nyhan syndrome, build up of Uric acid

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46
Q

Leach Nyhan presentation

A

Presents late in first year of life, psychomotor retardation, choreathetosis, spasticity and severe self injury

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47
Q

Lennox gastaut eeg finding

A

Slow spike and wave/ poly spike and wave

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48
Q

How does hippocampus store memories

A

Long term potentiation

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49
Q

MOA TCA

A

Inhibit Reuptake 5Ht and NE

Also have:
1. Antihistaminic properties: sedation
2. Antimuscarinic: dry mouth, constipation, urinary retention, blurred vision, tachycardia
3. Antimuscarinic: Weight gain!

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50
Q

Duloxetine/ Venlafaxine MOA

A

Serotonin, norepinephrine reuptake inhibitors.

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51
Q

What meds are FDA approved for PTSD

A

Fluoxetine and Paroxetine

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52
Q

SSRI with more weight gain than others

A

Paroxetine, due to more anticholinergic activity than others. Also more sedation.

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53
Q

How long to wash out SSRI when switching to MAOi

A

Most SSRI: 2 weeks
Fluoxetine: 5 weeks

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54
Q

What P450 activity of Fluoxetine

A

CYP 2D6 inhibitor

Leads to increased TCA levels (inc cardiac risk), benzos (inc sedation), Carbamazapine (inc toxicity), warfarin (inc toxicity), phenytoin (inc toxicity), warfarin (inc toxicity), bupropion (inc seizure risk)

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55
Q

CYP450 effects of Fluvoxamine

A

Potent 1A2 inhibitor

Moderate 2C19 inhibitor

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56
Q

Side effects SNRI vs SSRI

A

SSRI more weight gain, SNRI hypertension

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57
Q

High dose antidepressant and cough medicine

A

Serotonin syndrome

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58
Q

Contraindications for duloxetine

A

Chronic liver disease.

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59
Q

Which has longer half life duloxetine, or venlafaxine

A

Duloxetine

Venlafaxine more discontinuation syndrome

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60
Q

MAOI inhibitors MOA

A

Block monoamine oxidase which leads to delaminating of 5ht, NE and DA

  • prevents their inactivation
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61
Q

Dietary restrictions in MAOI, why?

A

MAO is in GI tract and prevents tyramine metabolism. Tyramine levels which are high lead to sever hypertension!

Foods: aged/smoked things, soy, fave and broad beans

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62
Q

Meds to not give with MAOI

A

Meperidine (Demerol)
Epinephrine
Decongestants
Anesthetics with sympathomimetrics

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63
Q

What is the benefit of Selegiline patch

A

No dietary restrictions needed at low dose

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64
Q

Tx MAOI hypertensive crisis

A

Phentolamine

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65
Q

MAO-i in parkinsons

A

Selegiline, b/c more selective to MAO-B inhibition up to 10 mg

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66
Q

What happens in tyramine crisis

A

Buildup of stored catecholamines

Hypertension, headache, diaphoresis, N.V, autonomic changes, chest pain, arrhythmia, death

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67
Q

What medication do you see pyridoxine deficiency

A

MAOI

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68
Q

Pyridoxine deficiency

A

Parathesias and weakness,

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69
Q

MOA Buspirone

A

Agonist and partial agonist of presynaptic receptors 5HT-1A

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70
Q

MOA Aripiprazole

A

Partial DA agonist, partial 5HT agonist

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71
Q

Antipsychotic with highest EPS

A

Haldol

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72
Q

Clozapine
Anticholinergic, Sedation, EPS

A

Anticholinergic, high
Sedation, high
EPS, none

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73
Q

When do you expect Tardive dyskinesia

A

Ppl taking antipsychotic for >2 yrs, more common in older women, or long term antipsychotic use

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74
Q

Positive symptoms pathway

A

Mesolimbic

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75
Q

Negative symptoms pathway

A

Mesocortical

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76
Q

What is the Mesolimbic pathway

A

DA pathway b/w ventral tegmental, nucleus’s accumbens, also includes the fornix, amygdala and hippocampus

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77
Q

Pathway associated with EPS

A

Nigostriatal DA pathway

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78
Q

Pathway associated with hyperprolactinemia

A

Tuberoinfundibular pathway

(Hypothalamus to the anterior pituitary)

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79
Q

Bupropion MOA

A

NE, DA reuptake inhibitor

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80
Q

Lab findings in NMS

A

Increased CPK, INc LFTS, leukocytosis

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81
Q

NMS mneumonic

A

Fever
Autonomic instability
Lleukocytosis
Tremor
Elevated creatinine phosphokinase
Rigidity
Eexcessive sweating
Delirium

  • will NOT HAVE hyperreflexia.
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82
Q

When will you see NMS

A

Initiation or rapid withdrawal

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83
Q

NMS treatment

A

Dopaminergic agents
Dantrolene
Bromocriptine: D2 agonist
AMantadine
Benzos
ECT
Levodopa/Carbidopa

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84
Q

TCA overdose treatment

A

Sodium bicarbonate, lipid emulsion, plasmaphoresis in severe cases

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85
Q

MOA Acamprosate

A

Glutamate Antagonist (via NMDA receptors) Blocks glutamate transmission.

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86
Q

Acamprosate contraindication

A

Renal issues

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87
Q

MOA Naltrexone

A

mu-opioid receptor antagonist.

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88
Q

Naltrexone contraindications

A

Contraindicated in pts on opioids for pain, advanced liver disease, LFTS 3-5X over normal

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89
Q

Naltrexone liver or kidney

A

Liver, can’t give if LFTS >3x expected

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90
Q

Acamprosate liver or kidney

A

Kidney, contraindicated in severe renal disease

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91
Q

Disulfiram MOA

A

In liver blocks conversion of acetaldehyde to acetate by inhibiting aldehyde dehydrogenase so inc acetaldehyde levels.

  • leads to Hypotension, nausea and flushing. (for ETOH use disorder).
  • In brain Blocks dopamine-beta-hydroxylase—> catalyzes DA—> NE; modulates ratio of DA to NE and changes behavioral response to cocaine
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92
Q

Varenicline MOA

A

Nicotine receptor partial agonist.

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93
Q

What is Yohimbine

A

adrenergic agonist for helping SSRI induced sexual dysfunction but can lead to more anxiety

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94
Q

MOA Mirtazapine

A

tetracyclic antidepressant.

  • Presynaptic alpha-2 adrenergic receptor antagonist. Serotonin 5HT2 antagonist.
  • H1 receptor blockade leads to sedation and weight gain
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95
Q

How many non-overlapping symptoms for BPAD with mixed features

A

At least 3 non overlapping symptoms

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96
Q

Weakness if wrist and finger extensor muscles in an adult

A

Lead poisoning

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97
Q

Toluene poisoning

A

Aka Methylbenzene

Encephalopathy, cerebellar, brain stem, basal ganglia, and cranial nerve dysfunction

In paint, adhesives, and pesticides.

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98
Q

Sensory neuropathy w/o weakness

A

Platinum drugs (cisplatin, —platin)
Affect dorsal root ganglion, or large myelinated axons.

Coasting symptoms worsen even after exposure.

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99
Q

Exposure with HA, dizziness, in coordination, irritability, cognitive dysfxn, seizure, coma, and death

A

Carbon Monoxide

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100
Q

Buspirone acts on what receptor primarily

A

5-HT1A

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101
Q

Developed Theory of internal object relations

A

Melanie Klein

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102
Q

Melanie Klein Theory

A

theory of internal object relations based on instinctual drives in children.
- Focus on Projection
- The “bad mother”
- “paranoid-schizopid position”- infant uses to conceptualize parts of the mother as all good or all bad
- “depressive position: infant views mom as ambivalaent and having both positive and negative aspects
- Developed analytic play therapy.

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103
Q

“paranoid-schizopid position”

A
  • infant uses to conceptualize parts of the mother as all good or all bad
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104
Q

“The bad mother”

A

Melanie Klein

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105
Q

“depressive position”

A

: infant views mom as ambivalaent and having both positive and negative aspects

Melanie Klein 1882-1960

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106
Q

Who developed analytic play therapy

A

Melanie Klein

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107
Q

Aldoph Meyer Approach

A

genetic-dynamic approach to psychobiology- blend genetic and environmental
- Emphasized social and interpersonal was most important locus of personas adaptation.
- Chronological life chart with important bio and psychosocial evens, emphasized current events, and importance of human relationship b/w pt and therapist.

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108
Q

Harry Stack Sullivan Theory

A

Interpersonal theory of psychopathology. Focus on relationships rather than drives (Freud) as important in human experience.

- Healthy relationships needed for good mental health. 
- Anxiety passed from infant to mother, then pathological when manifest in other relationships. 
- Security operations: good me, bad me, not me. 
- Thought schizophrenia could be treated through repairing psychological relationships
- Therapist was an active, "participant-observer"
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109
Q

Eriksonian Theory

A

Development of self and identity through social norms and biological drives. (blank) vs (blank)

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110
Q

Eriksonian Stages of Growth and ages

A
  1. Trust vs mistrust: birth to 18 mo
    1. Autonomy vs shame : 18 mo-3 yrs
    2. Initiative vs guilt: 3-6 yrs
    3. Industry vs inferiority:6-12 yrs
    4. Identity vs role confusion: 12-18 yr
    5. Intimacy vs isolation: 18-35 yr
    6. Generativity vs stagnation: 35-65 yr
    7. Ego integrity vs despair: 65 to death
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111
Q

Trust vs mistrust:

A

Birth to 18 mo - Basic trust

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112
Q

Autonomy vs shame :

A

18 mo-3 yrs
- Control and independence

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113
Q

Initiative vs guilt:

A

3-6 yrs
- Taking control of the environment, purpose

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114
Q

Industry vs inferiority:

A

6-12 yrs
- Confidence, competence, social skills

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115
Q

Identity vs role confusion:

A

12-18 yr
- Formation of identity, devotion

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116
Q

Intimacy vs isolation:

A

18-35 yr
- Forming a relationship commitment

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117
Q

Generativity vs stagnation

A

: 35-65 yr
- Building a family, having productive career

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118
Q

Ego integrity vs despair

A

: 65 to death
- Viewing life as meaningful and fulfilling

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119
Q

Karen Horney:

A

: social and cultural influences on psychosexual development, differences in psychology bw men and women.
- Bx caused by libidnal drives from childhood
- Holistic psychology: person strives to be seen as a whole.
- Actual self, real self, and idealized self.
- Allow person to strive for self-realization by understanding distortions that prevent growth.

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120
Q

What is Holistic psychology
Who’s theory

A

: person strives to be seen as a whole.
Karen Horney 1885-1952

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121
Q

Actual self, real self, idealized self
Theorist

A

Karen Horney

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122
Q

Who’s theory uses approach to Allow person to strive for self-realization by understanding distortions that prevent growth.

A

Karen Horney

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123
Q

MOA Naltrexone

A

mu-opioid receptor antagonist. Long acting injection (vivitrol)

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124
Q

Disulfram MOA

A

Disulfiram: In liver blocks conversion of acetaldehyde to acetate by inhibiting aldehyde dehydrogenase so acetaldehyde levels. Hypotension, nausea and flushing. (for ETOH use disorder). In brain Blocks dopamine-beta-hydroxylase—> catalyzes DA—> NE; modulates ratio of DA to NE and changes behavioral response to cocaine

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125
Q

1 mg Alprazolam equivalents of the following:
1. Lorazepam
2. Clonazepam
3. Diazepam
4. Chlordiazepoxide
5. Phenobarbital

A
  1. Lorazepam- 2 mg
  2. Clonazepam- 1 mg
  3. Diazepam- 10 mg
  4. Chlordiazepoxide- 25 mg
  5. Phenobarbital- 30 mg
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126
Q

Water intoxication and hyponatremia symptoms

A

Abdominal pain, vomiting, confusion, depressed reflexes, hallucinations, and seizures

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127
Q

Primary progressive aphasia subtypes

A
  1. Non-fluent: difficult speech generation, esp articulation, grammar probs, impaired comprehension
  2. Semantic: word finding difficulty, trouble naming, trouble understanding nouns.
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128
Q

Older person with slowly worsening aphasia, difficulty with naming, and following convos, grammar errors. Mispronounces words

A

Primary progressive aphasia, type of FTD
This is non-fluent subtype

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129
Q

Donepezil MOA

A

Reversible ACHesterase inhibitor

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130
Q

Stroke in Sickle Cell

A

Watershed at border zones, high risk of infarcts at young age.

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131
Q

Carbon monoxide poisoning, would lead to lesion where

A

Globus Pallidus

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132
Q

condition with low coQ10

A

Parkinson’s

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133
Q

Rate of suicide in Body dysmorphic disorder

A

22-24%

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134
Q

Buspirone MOA

A

partial agonist 5ht-1A receptor

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135
Q

Lobe responsible for hearing

A

Temporal lobe

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136
Q

Treatment for complex berevement

A

CBT

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137
Q

DDAVP relapse for primary enuresis

A

60-70%

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138
Q

What receptor leads to sexual side effects of typical antipsychotics

A

alpha-1 receptors
but also DA blockade due to decreased sex drive

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139
Q

Most serious side effect of mirtazapine

A

Agranulocytosis

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140
Q

Minuchin theory of enmeshment notes which boundary issue

A

interpersonal boundary issue

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141
Q

MOA Sumitriptan

A

5HT-1D and 5HT1-B agonist

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142
Q

MOA Aripiprazole

A

Partial D2 agonist
5HT1A partial agonist 5HT2A antagonist

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143
Q

What causes drug induced myopathy

A

corticosteroids

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144
Q

After pharm stabilization of bipolar what is first line adjunctive tx associated with improved adherence

A

Group psychoeducation

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145
Q

Slot machine schedule of reinforcement

A

Variable ratio

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146
Q

Most common psychiatric do in children

A

ADHD- 9.4% of ages 2-17

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147
Q

How long must you have sx for cyclothymic disorder

A

2 years in adults, 1 year in children and adolescents.

cannot have met MDD or mania criteria

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148
Q

Who developed “idealized self” and “real self”

A

Karen horney

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149
Q

What med has insulin like effect

A

Li has insulin like effect that lowers blood sugar, and inc appetite and wt gain.

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150
Q

What test best visualizes seizure focus most precisely

A

ictal PET or FMRI, SPECT

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151
Q

How do adjust depakote from IR to extended release

A

increase IR dose to 15%

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152
Q

Beneficence definition

A

obligation to help patients and relieve suffering.

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153
Q

Autonomy

A

duty to protect a patient’s freedom to choose.

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154
Q

Justice

A

air distribution and application of services.

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155
Q

Metabolic change for bulimia

A

hypokalemic hypochloremic alkalosis

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156
Q

Russell’s sign

A

positive when cuts or scrapes to the backs of the hands are noted, which are a result of the teeth scraping the fingers while vomiting

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157
Q

Types of Specific phobia

A

natural environment
animal
blood-injection injury
situation
other

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158
Q

biological changes resulting from panic attacks

A

increased catecholamines d/t SNS
hypervenitllation, leads to dec Co2 (hypocapnea, respiratory alkalosis),

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159
Q

Bipolar disorder- Rapid cycling:

A

> /= 4 depressive, manic or hypo manic episodes in past year, must have partial remission for at least 2 mo or switch directly to opposite type of mood

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160
Q

Narcolepsy see _______ levels of _______

A

Low csf Hypocretin peptide aka orexin

Low hypocretin/orexin in csf

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161
Q

What chromosome is mutated in Narcolepsy

A

chromosome 6 in narcolepsy-cataplexy in 90-1005 of ppl with narcolepsy but also 50% of ppl w/o.

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162
Q

FDA approved meds for narcolepsy

A

Meds: methylphenidate (daytime sleepiness-FDA), adderall (daytime sleepiness -FDA), modafinil, amodafonil (nuvigil). For cataplexy sodium oxybate (xyrem)

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163
Q

Rate of cataplexy in Narcolepsy

A

Cataplexy in 30-70% often in strong emotion

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164
Q

Rate of suicide attempts on Dissociative Identity Disorder

A

over 70%

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165
Q

Common history of people in DID

A

childhood maltreatment 90%

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166
Q

Substance used disorder: how many criteria for severity scale

A

Substance use disorder 11 total criteria

Mild= 2-3, moderate= 4-5, severe=6

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167
Q

PMDD treatments

A

CBT can reduce Sx
SSRI tx for irregular menses b/c symptoms hard to predict.

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168
Q

PMDD criteria

A

need 5/11 symptoms in final week before menses.

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169
Q

Standard of proof in civil commitment:

A

clear and convincing evidence

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170
Q

Preponderance of evidence:

A

malpractice suit

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171
Q

level of evidence in criminal case

A

Guilt beyond a resonance doubt:

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172
Q

standard of proof for government administrative hearings, and appellate courts.

A

Substantial evidence:

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173
Q

Expert witness:

A

on the stand, specialized knowledge, if court order waiver of privilege is implied. If conflict of interest must identify to the court.

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174
Q

Fact witness:

A

a witness with knowledge about the case, do not offer opinions

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175
Q

Privilege:

A

legal rule that protects certain info from being shared, the individual has privilege not the physician

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176
Q

Gene that interacts with stressful life events

A

BDNF

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177
Q

Specific learning disorders— M:F

A

60-80% are male (reading, writing, or math), not attributable to ID

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178
Q

Etiology Psychosis induced polydipsia:

A
  • Nicotine leads to release of ADH, which fuels thirst, so more likely in heavy cigarette smokers
    • Severe hyponatremia <130mmol/L can occur and h2o intoxication. —>? Leads to cerebral edema, delirium, seizure, coma, and death.
    • Tx: Na replacement and water restriction
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179
Q

Sx B1 deficiency

A

Beriberi”: neuropathy, weakness, muscle
wasting, cardiomegaly, ophthalmoplegia,
confabulation

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180
Q

Sx B3 deficiency

A

Niacin

Pellagra Pigmented rash of sun-exposed areas,
disorientation, and problems with memory,
diarrhea, memory problems, bright red tongue

181
Q

Sx B6 deficiency

A

Seborrhoeic dermatitis, inflamed tongue,
neuropathy, confusion, depressed mood,
microcytic anemia

182
Q

Sx vit b9 deficiency

A

Folate

Shrunken and inflamed tongue, megaloblastic
anemia, high homocysteine

183
Q

Sx vitamin B12 deficiency

A

Cobalamin

Dorsal column loss of vibratory and position
sense, ataxic gait, dementia, loss of control of
bowels, erectile dysfunction, megaloblastic
anemia

184
Q

Locked in syndrome 2 major causes

A
  1. rapid sodium replacement in hyponatremia is This can result in a clinical transection of the pons and a locked-in syndrome.
  2. ventral pontine infarct as a consequence of basilar artery thrombosis
185
Q

sites for drainage of CSF into the blood.

A

Arachnoid (pacchionian) granulations:

186
Q

Microglia:

A

clean up cells (macrophages)

187
Q

Astrocytes:

A

glial cells responsible for development and framework of neurons.

188
Q

Oligodendrocytes:

A

insulate axons, provide myelin sheath

189
Q

Ependymal cells

A

: line ventricles, produce CSF

190
Q

Radial Glia

A

primary progenitors

191
Q

Schwann cells:

A

myelinate the PNS

192
Q

Forebrain (prosencephalon):

A
  • Telencephalon- cerebral hemispheres, lateral ventricles
    • Diencephalon- Thalamus, hypothalamus, epithalamus, retina, pineal gland, third ventricle
193
Q

Midbrain (mesencephalon):

A
  • Mesencephalon: midbrain, cerebral aqueduct
194
Q

Hindbrain (rhombencephalon)

A
  • Metencephalon: pons, cerebellum, upper part of 4th ventricle
    • Myelencephalon: medulla, lower part of 4th ventricle.
195
Q
  • Telencephalon-
A

cerebral hemispheres, lateral ventricles

196
Q
  • Diencephalon-
A

Thalamus, hypothalamus, epithalamus, retina, pinela gland, third ventricle

197
Q
  • Mesencephalon:
A

midbrain, cerebral aqueduct

198
Q
  • Metencephalon:
A

pons, cerebellum, upper part of 4th ventricle

199
Q
  • Myelencephalon:
A

medulla, lower part of 4th ventricle.

200
Q

What brain region created the thalamus

A

diencephalon

201
Q

What brain region makes limbic system

A

telencephalon (part of the cerebral hemispheres)

202
Q

What brain region does medulla develop from

A

Myelencephalon

203
Q

What brain region does the basal ganglia arise from

A

telecephalon (part of the cerebral hemispheres)

204
Q

What brain region does the cerebellum arise from

A

Metencephalon

205
Q

Where neurotransmitters are made: DA

A

Substantia Nigra

206
Q

Where neurotransmitters are made: Serotonin

A

Raphe Nucleus (brain stem)

Part of reticular formation

207
Q

Where neurotransmitters are made: NE

A

Locus Ceruleus - nucleus in the pons, blue colored

208
Q

Where neurotransmitters are made: Aceytlcholine

A

Nucleus Basalis of Meynert

209
Q

NT receptors: Acetocholine

A

Nicotinic,
Muscarinic

210
Q

NT receptors: Glutamate

A

AMPA, NMDA, Kainate

211
Q

NT receptors: GABA

A

GABA-A: benzos,

GABA-B: GHB

212
Q

NT receptors: Serotonin

A
213
Q

NT receptors: Dopamine

A
214
Q

Receptors and side effects: Wt gain and sedation

A

H1- histamine receptor

215
Q

Receptors and side effects: constipation, blurred vision, dry mouth, drowsiness

A

M1

216
Q

Receptors and side effects: dizziness and decreased BP

A

Alpha-1

217
Q

NT responsible for short term memory, attn, executive function, novelty seeking

A

ACH

218
Q

Odansetron MOA

A

5ht-3 receptor antagonist, Anti nausea effect

219
Q

Rate limiting enzyme in DA synthesis

A

Tyrosine hydroxylase

220
Q

Receptor bound by PCP

A

NMDA (glutamate, excitatory)

221
Q

NT is excitotoxicity

A

Glutamate, leads to excessive CA++ and cell death

222
Q

Neuro imaging in in PTSD:

A

decreased hippocampal volumes, smaller anterior cingulate cortex volume.

223
Q
  • waxing and waning headache and intermittent visual obscurations. Neurologic examination can reveal papilledema on funduscopic examination and enlargement of the blind spot on visual field testing. Brain imaging is usually normal, although some scans reveal slit-like ventricles.
A

Pseudotumor cererbri

224
Q

pseudotumor cerebri aka

A

benign intracranial hypertension

225
Q

DX benign intracranial hypertension

A

lumbar puncture with measurement of the opening pressure, which is elevated over 20 cm H2O.

226
Q

Tx benign intracranial hypertension

A

acetazolamide or with prednisone. Can do lumbar punctures to siphon off fluid to maintain normal CSF pressure.

Surgery: ventriculoperitoneal shunting, or lumboperitoneal shunting if the ventricles are too small, and optic nerve sheath fenestration, which can siphon off CSF.

227
Q

Nerve associated with Migraines

A

Trigeminal nerve (CNV)

228
Q

Duration of HA in cluster HA

A

15min-3 hrs

229
Q

Frequency of headaches for migraine

A

At least 5 lasting 4-72 hrs

230
Q

Migraine characteristics. How many to meet migraine criteria

A

Two of the following characteristics:

	1 unilateral location, 
	2 pulsating quality,
	3  moderate or severe intensity, or
	4  aggravated by walking stairs or similar routine physical activity.

During the headache at least one of the two following symptoms occurs: phonophobia and photophobia, nausea and/or vomiting.

231
Q

Optic neuritis (ON)
Describe
Seen in what disease?

A

ON usually presents with eye pain that increases with eye movement followed by central visual loss (scotoma) in the affected eye.

is a common sign of MS and is frequently the cause of initial presenting symptoms.

232
Q

What is included in the basal ganglia

A

Globes pallidus, Caudate, putamen, substantia nigra, Subthalamic nucleus

233
Q

What is the function of the pons

A

Arousal, sleep/wake cycles

234
Q

Paroxysmal Hemicrania: female:male

A

2:1

235
Q

Paroxysmal Hemicrania:
Duration and symptoms

A
  • 2-30 min duration, can happen multiple times per day. Autonomic symptoms (lacrimation, conjunctival injection, and Horner syndrome), Neck movement trigger episodes.
236
Q
  • New onset change in HA, fever, fatigue, myalgias, night sweats, wt loss, and jaw claudication
A

Giant Cell Arteritis

237
Q

Feared complication of giant cell arteritis

A

Vision loss d/t central retinal artery occlusion

238
Q

Dx of Giant cell arteritis

A

Golds standard: temporal artery biopsy

Screen: elevated ESR

239
Q

progressive dementia, dysarthria, tremors, and hypotonia.

A

Neurosyphillis: progressive dementia, dysarthria, tremors, and hypotonia.

240
Q

What area is linked to Tourette’s

A

Caudate nucleus

241
Q

Lobes affected by Herpes encephilitis

A

Temporal, inferomedial temporal lobes

242
Q

EEG finding in Herpes encephalitis

A

Periodic lateralized epileptiform discharges (PLEDs)

243
Q

Tx herpes encephalitis

A

IV acyclovir

244
Q

Best treatment of heroin abuse in pregnancy

A

Methadone most extensively studied
Buprenoprhine also okayed

245
Q

Medications which are FDA approved to treat fibromyalgia include

A

milnacipran (SNRI), duloxetine, and pregabalin.

246
Q

Criteria for fibromyalgia include

A

pain for greater than 3 months or more without another identified cause. Although widespread tenderness is present, there is a lack of joint swelling or inflammation. Often soft tissue sites are more painful than joints. In addition, fatigue, waking unrefreshed, and cognitive symptoms are also included criteria.

247
Q

Sleep changes in older people >65

A
  • more REM episodes noted.
  • REM episodes are shorter
    -less total REM sleep.
  • NREM sleep there is a decreased amplitude of delta waves.
    -lower percentage of N3 sleep.
  • higher percentage of N1 and N2 sleep.
  • increased awakening after sleep onset.
248
Q

Duration of sx in restless legs

A

At least 3 mo

249
Q

HLA associated with narcolepsy

A

HLA-DR2

250
Q

Amount of time in REM sleep for typical young adults

A

25%

251
Q

Unified detachment

A

Examining a situation from distance and more objectively.
Associated with mindfulness

252
Q

Genetic cause of MD1 vs MD2

A

MD1- trinucleotide repeat in DMPK, chromosome 19

MD2- tetranucleotide repeat in zinc finger protein 9 gene (ZNF9 or CNBP) chromosome 3

253
Q

PET findings when imaging area of sz focus, indicate what

A

Decreased glucose uptake on affected side

254
Q

Geschwind syndrome

A

Behavioral syndrome: hyperreligiosity, circumstantiality, hyper graphic, hypo sexuality and intense emotional response

Associated with temporal lobe seizures, particularly complex partial seizures

255
Q

Most common etiological cause of temporal lobe epilepsy

A

Prolonged febrile convulsions of childhood, or anoxia at birth

(Of note less common are tumors (eg astrocytomas), and infections (eg herpes)

256
Q

Most common glial tumor

A

Astrocytoma

257
Q

Most common astrocytomas

A

Glioblastoma and anaplastic astrocytoma

258
Q

Most common form of epilepsy in childhood

A

Benign rolandic seizures

259
Q

Benign rolandic seizures in adulthood

A

Most outgrow by adulthood

260
Q

Seizure type with high risk of fatal aspiration

A

Benign rolandic seizures

Involvement of tongue and possible respiratory spasm

261
Q

What is subclavian steal syndrome and what do you see

A

Stenosis of subclavian near the vertebral artery, more common on the L b/c branc from aorta. Leads to vertebrobasilar insufficiency due to decreased/reversal fo blood flow

See l arm cluadication, numbness, down L arm, dec BP/HR in L arm

Neuro sx: Dizziness, double vision, dysphasia, numbness of ipsilateral face and contra lateral limbs.

262
Q

Glasgow coma score

A

Eye Opening Response
• Spontaneous–open with blinking at baseline 4 points
• To verbal stimuli, command, speech 3 points
• To pain only (not applied to face) 2 points
• No response 1 point

Verbal Response
• Oriented 5 points
• Confused conversation, but able to answer questions 4 points
• Inappropriate words 3 points
• Incomprehensible speech 2 points
• No response 1 point

Motor Response
• Obeys commands for movement 6 points
• Purposeful movement to painful stimulus 5 points
• Withdraws in response to pain 4 points
• Flexion in response to pain (decorticate posturing) 3 points
• Extension response in response to pain (decerebrate posturing) 2 points
• No response 1 point

263
Q

Which enzyme metabolizes methylphenidate

A

CES1A1 by ritalinic acid in the liver

264
Q

Percent of children with ODD that develop CD

A

30%

265
Q

Neurobiological abnormality associated with ASD

A

Decreased formation of Purkinje cells in cerebellum

266
Q

Prevalence of childhood onset fluency disorder

A

5%

267
Q

FDA approved use of duloxetine for what type of pain

A

Diabetic peripheral neuropathy
Fibromyalgia

268
Q

Psychiatric SE of interferon alpha

A

Depression

269
Q

Where is neurotransmitter made: histamine

A

Tuberomamillary nucleus

270
Q

Incidence of depression from isoretinoin

A

4-11%

271
Q

Isoretinoin and vision

A

Can cause decreased night vision and corneal opacities

272
Q

DM1: Inheritance, gene, mutation

A

Autosomal dominant

Trinucleotide CTG repeat in DMPK (Dystrophia myotonica protein Kinase gene) >100,000s repeated vs normal 5-35
Chromosome 19

273
Q

DM1 Severity, symptoms

A

More severe (aka Steinert’s Disease)

DISTAL weakness/wasting

Percussion grip myotonia, muscle weakness of face, neck, forearm, and hand and foot dorsiflexors.

Muscle pain dysphasia, respiratory muscle involvement, dysarthria

Cataracts cardiac conduction issues infertility, insulin resistance

274
Q

Myotonic Dystrophy 2: inheritance, gene, mutation

A

Autosomal Dominant

Tetranucleotide repeat CCTG on zinc finger protein 9 gene (ZNF9 or CNBP genes); 75-11,000 repeats vs 11-26 normal

Chromosome 3

275
Q

myotonic dystrophy 2 (DM2): severity and symptoms

A

PROXIMAL weakness

Milder, grip and percussion myotonia (tap on the air emenance leads to thumb abduction and slow relaxation) and weakness in neck flexors elbow extensors, finger flexors, and hip flexors

276
Q

Adrenoleukodystrophy: inheritance, mutation, gene

A

X linked disorder with accumulation of very-long-chain fatty acids

277
Q

Adrenoleukodystrophy symptoms

A

Sx: vision and hearing impairment, aphasia, hyperactivity, paralysis, seizures, muscle weakness, adrenal failure, and coma

278
Q

Duchenne Muscular Dystrophy: gene, inheritance, mutation

A

Dystrophiniopathy- lack dystrophin

X-linked

279
Q

Duchenne Muscular Dystrophy: clincal findings

A

Gower maneuver

Most commoon childhood childhood muscular dystrophy

Diminished DTR, muscle weakness proximal>distal

Elevated Creatinine phosphokinase (CPK)

ID in 1/3 cases

Enlarged muscles (fat infiltration) esp calves

280
Q

William’s Syndrome: Chromosome

A

Chromosome 7q

281
Q

William’s syndrome: gene, mutation, inheritance

A

Microdeletion of 7q, loss of elastin gene, AD inheritance

Hemizygous deletion including the elastin locus on chromosome 7q11–q23.

282
Q

William’s Syndrome: clinical findings

A

Short stature, unusual facial features that include depressed nasal bridge (an upturned nose), broad forehead, widely spaced teeth, broad forehead, full/wide lips, and elfin-like facies, as well as thyroid, renal, and cardiovascular anomalies.

Psychiatric symptoms include anxiety, hyperactivity, and hypermusicality.

283
Q

Fragile X: gene, mutation, inheritance

A

FMR1 gene, most common form inherited ID. Males more impaired than females.
The chromosomal anomaly lies at Xq28
Trinucleotide repeat

284
Q

Fragile X: clinical presentation

A

moderate to severe MR, macro-orchidism, prominent jaw, large ears, narrow face, arched palate, autistic features and high-pitched speech.

Hyperactivity and inattention are characteristic in affected males with fragile X syndrome.

285
Q

frontal lobe and subcortical dementia sx (Memory, executive fxn, psychomotor slowing) with motor issues (rigidity, tremor, ataxia) in the grandfathers of children with X linked disease

A

Fragile X-associated tremor/ataxia syndrome:

Progressive neurological decline.
FMR1 gene at Xq27.3 on southern blot or PCR.
MRI:generalized cortical and cerebellar atrophy with increased signal intensity.
Jacksonian March: type of focal seizure. Begins in finger or toe or corner of mouth the. Spreads to ipsilateral area of body

286
Q

infantile hypotonia, hyperlaxity of the joints, brachycephaly, flattened occiput, MR, upslanting palpebral fissures, flattened nasal bridge, epicanthal folds, small ears, hypoplastic teeth, short neck, lenticular cataracts, speckling of the iris (Brushfield’s spots), brachydactyly, simian creases, and congenital cardiac anomalies (in 30% to 40% of cases). Thyroid dysfunction

A

Trisomy 21

287
Q

Cri-du-chat syndrome:Chromosome

A

deletion at the short arm of chromosome 5p15.2.

288
Q

severe MR, microcephaly, round face, hypertelorism, micrognathia, epicanthal folds, hypotonia, and low-set ears. Newborns present with a cat-like high-pitched cry

A

Cri-du-chat syndrome

289
Q

most common non inherited form of ID

A

Fetal alcohol syndrome:

290
Q

Flat upper lip, flat middling face, flat philtrum, cardiac defects, behavior and learning problems

A

Fetal alcohol syndrome:

291
Q

Tuberous sclerosis: gene, inheritance, mutation

A

TSC1 or TSC2 gene

Tuberous sclerosis is an autosomal dominant neurocutaneous d/o

292
Q

seizures, mental retardation, and behavioral problems.

Cutaneous lesions include the ash leaf spot (hypomelanotic macule), adenoma sebaceum (facial angiofibromas), and shagreen spots (irregularly shaped, often raised or textured skin lesion on the back or flank).

Retinal hamartomas can be observed in many patients.

Neuropathologic lesions include subependymal nodules and cortical hamartomas. 

A

Tuberous sclerosis:

293
Q

ash leaf spot

A

Tuberous sclerosis:

294
Q

Shagreen spots

A

(irregularly shaped, often raised or textured skin lesion on the back or flank).

Tuberous sclerosis

295
Q

Vonhippel Lindau chromosome

A

Chromosome 3

296
Q

Narcalepsy/cataplexy chromosome

A

chromosome 6

297
Q

ApoE4 gene chromosome

A

Chromosome 19

298
Q

Thymoma- 10%

A

Myasthenia Gravis

299
Q

Treatment Myasthenia Gravis

A

Pyridostigmine

300
Q

deceleration of head growth from ages 5 months to 4 years,

loss of purposeful hand skills and development of stereotyped hand movements between ages 5 months and 2.5 years,

loss of social engagement, and acquired impairment in expressive and receptive language skills.

A

Rett syndrome

301
Q

NF1 (von Recklinghausen’s disease): chromosome

A

mutation of the 60-exon NF1 gene on chromosome 17q

302
Q

NF1 (von Recklinghausen’s disease): symptoms

A

café au lait spots [six or more to make the diagnosis], subcutaneous neurofibromas, axillary freckling, Lisch nodules [pigmented iris hamartomas], optic nerve glioma, neurofibromas, and schwannomas)

any two of the following seven criteria to carry the diagnosis: six or more café au lait spots and over 15 mm if after puberty, axillary or inguinal freckling, optic glioma, two or more neurofibromas or one plexiform neurofibroma, a first-degree relative with NF1, two or more Lisch nodules (hamartomas of the iris), and characteristic bony lesion such as thinning of long bones or sphenoid dysplasia.

303
Q

NF2: Chromosome

A

mutation of the NF2  gene on chromosome 22.

304
Q

bilateral vestibular (nerve VIII) schwannomas. 

A

NF2

305
Q

deficiency in arylsulfatase A

A

Metachormoatic leukodystrophy:

306
Q

Metachromatic leukodystrophy: Chromosome

A

Chromosome 22q13

307
Q

Metachormoatic leukodystrophy: inheritance, gene, mutation

A

Myelin disorder, deficiency in arylsulfatase A

Chromosome 22q13

Inheritance is autosomal recessive.

Leads to progressive demyelination

308
Q

Hexosaminidase A Deficiency

A

Tay Sachs:

309
Q

Tay Sachs: chromosome

A

AR

HEXA gene on chromosome 15

310
Q

Developmental retardation, paralysis, dementia, and blindness.

Cherry red spot on fundoscoptic exam.

Hyperactivity to startle, and sensitive to loud noises

A

Tay Sachs

311
Q

deficiency in galactocerebrosidase beta-galactosidase.

A

Krabbes disease: (aka globoid cell leukodystrophy)

312
Q

Krabbes disease: (aka globoid cell leukodystrophy): inheritance, gene

A

autosomal recessive deficiency in galactocerebrosidase beta-galactosidase.

Chromosome 14q31

313
Q

Krabbe disease chromosome

A

Chromosome 14q31

314
Q

Rapid deterioration in motor and intellectual fxn, hypertonicitity, optic atrophy, seizures, swallowing difficulties

A

Krabbes disease (aka globoid cell leukodystrophy)

315
Q

Alpha galactosidase A deficiency

A

Fabry disease:

316
Q

Minuchin:

A

Structural family therapy, roll of structural family imbalances

317
Q

Integrative behavioral couples therapy:

Unified detachment:
Empathic joining:
Tolerance building:

A

Unified detachment: examining problem from an emotional distance with greater objective focus. Comes from mindfulness, immersion in the present moment.

Empathic joining: evocation of strong emotions in the dyad

Tolerance building: helping dyad become more tolerant of upsetting behaviors

318
Q

Family therapy Schools of thought:

Psychodynamic:

A

looks at the past, and how causing present problems. Multigenerational transmission and encourages change through insight.

319
Q

Family therapy Schools of thought:

Structural:

A

Structural: looks at blueprint of ”healthy” family, well defined subsystems, clear boundaries, and parents in charge. Minuchin

320
Q

Family therapy Schools of thought:

Strategic:

A

Strategic: change that interrupts maladaptive bx sequences

321
Q

Family therapy Schools of thought:

Experiential:

A

Experiential: focuses on the present and encourages change through growth experiences

322
Q

Family therapy Schools of thought:

Systemic:

A

Systemic: change occurring due to changes beliefs.

323
Q

Heinz Kohut Theory

A

: diagnosed narcissistic personality based on self object transference of mirroring and idealization. Self-psychology.

324
Q

Kernberg:

A

more confrontational to defenses.
Dx of narcissism based on defenses pt uses.
Main defenses are Splitting, projective identification, and primitive idealization.
Borderline and narcissistic share borderline personality structures.
Narcissistic ppl suffer from pathological fusion of aspects of ideal self, real self and idealized objects.

325
Q

Stella Chess and Alexander Thomas:

A

9 dimensions of temperament

326
Q

9 dimensions of temperament

A

Activity level: how physically active a person is
Biological rhythms: regularity of someone’s internal drives, like eating, sleeping and toileting.
Sensitivity: How children react to their environment, inc sensory
Intensity of reaction: how strongly they react to situations
Adaptability: how easily someone can adjust to change or new situations.
Approach/withdrawal: how quickly and easily a person adjusts to changes or new situations.
Persistence: how long you are able and willing to stick to a task, even when it is challenging
Distractibility: how easily someone is distracted by their environment.
Mood: overall tone of a person’s feelings, interactions and behaviors.

327
Q

Lazarus theory

A

transactional theory of stress and coping. Stress is a product of person and environment.

328
Q

Suzanne Kobasa theory

A

: personality style and hardiness (good health under stress)

329
Q

Lazarus and Folkman: theory

A

primary and secondary appraisal. One is stress a threat, second evaluating coping skills during stress.

330
Q

Malan: theory

A

triangle of conflict and triangle of persons theory

331
Q

Sifneos: theory

A

anxiety provoking therapy, therapist acts as teacher

332
Q

Davanloo: theory

A

intense short term dynamic psychotherapy

333
Q

Mann:

A

Existential Therapy, therapist as empathic helper

334
Q

good enough mothering

A

Winnicot

335
Q

Transitional object

A

Winnicot, reminds of mother

336
Q

Winnicott: theory

A

mother plays a vital role in bringing the world to the infant and offering empathic anticipation of the infant’s needs. If she does these things well enough the baby will move toward the development of a healthy sense of self. 

Good enough

337
Q

Mahler: theory

A

developed stages of separation–individuation to describe how children develop identity that is separate from their mothers.
Her stages were normal autism, symbiosis, differentiation, practicing, rapprochement, and object constancy. 

338
Q

Operant conditioning theorist

A

Skinner

339
Q

Seligman: theory

A

 Learned helplessness is a model for depression developed by Seligman, in which an organism learns that no behavioral change can influence the environment.

340
Q

Bandura theory

A

social learning theory, which says we learn through modeling others and through social interaction

341
Q

Kandel studies

A

habituation and sensitization in snails. Habituation theory says that an animal can learn to stop responding to a repeated stimulus. 

342
Q

classical conditioning theorist

A

pavlov

343
Q

pavlov theory

A

developed classical conditioning. In classical conditioning, a neutral stimulus is paired with one that evokes a response so that eventually the neutral stimulus comes to evoke the same response.

344
Q

Freud:

A

classical psychoanalysis, drive theory. Libido and aggression.

Four parts of the drive:

Source: where it comes from in the body

Impetus: amount or intensity of drive

Aim: action that discharges tension

Object: target of the action

345
Q

Oral stage

A

birth-1, erogenous zone=mouth

primary source of interaction occurs through the mouth, ex rooting and sucking reflex is especially important.

derives pleasure from oral stimulation through gratifying activities such as tasting and sucking.

infant is entirely dependent upon caretakers (who are responsible for feeding the child),

the child also develops a sense of trust and comfort through this oral stimulation.

primary conflict: weaning process–the child must become less dependent upon caretakers.

If fixation occurs at this stage, issues with dependency or aggression. Oral fixation can result in problems with drinking, eating, smoking, or nail-biting.

346
Q

Anal Stage:

A

1-3 years, erogenous zone: bowel and bladder control

Focus of libido controlling bladder and bowel.

Conflict: toilet training- learnt o control bodily needs

Achieving leads to accomplishment and independence

If parents take an approach that is too lenient, Freud suggested that an anal-expulsive personality could develop in which the individual has a messy, wasteful, or destructive personality.

If parents are too strict or begin toilet training too early, Freud believed that an anal-retentive personality develops in which the individual is stringent, orderly, rigid, and obsessive.

347
Q

Phallic Stage:

A

2-6, genitals

Difference b/w male and female

Oedipal complex boys see fathers as rivals, for moms affection

Electra complex for girls

348
Q

Latent period:

A

6 to puberty, sexual feelings inactive

Ego and Super ego develops and ids energies are suppressed

Children develop social skills, values and relationships with peers and adults outside of the family.

stage is important in the development of social and communication skills and self-confidence.

Fixation at this stage can result in immaturity and an inability to form fulfilling relationships as an adult.

349
Q

Genital stage:

A

puberty to death, maturing sexual interests

onset of puberty causes the libido to become active once again.

The goal of this stage is to establish a balance between the various life areas.

350
Q

Ginkgo balboa:

A

Avoid with anti-platelets and anticoagulants.
Can take with SSRI for sexual side effects (largely anecdotal data).
blood flow and cognitive enhancement.

351
Q

Echinacea Purpurea:

A

anti inflammatory. No known drug intxns. Avoid in immune related conditions

352
Q

St John’s Wort (aka ______)

A

Aka Hypericum perforatum

: herbal TX for depression, CYP induction and lowers levels of many drugs, including warfarin and digoxin. RCT showed some effectiveness in somatoform d/os. SSRI effects so can lead to serotonin syndrome.

353
Q

Kava-Kava (aka____)

A

aka piper methysticum

sedative, and anesthetic qualities in beverages. Some use in helping with anxiety and adjustment disorders in a RCT. Acts on GABA receptors. Can lead to liver toxicity in long-term use. Don’t take with ETOH, be so, or barbituates due to GABA effects

354
Q

Allium sativum:

A

(Garlic) mild cholesterol lowering effects. Should be used cautiously with anti platelet and anticogulants. Avoid in warfarin duper to risk of bleeding.

355
Q

Ginseng:

A

can cause insomnia, mania, and irritability. People take to improve mental and physical performance.

356
Q

Fish oil

A

(omega 3 FA): adjunctive tx for depression

357
Q

Caffeine: max dose

A

should take <250 mg /day

358
Q

L-trypotophan:

A

can lead to serotonin syndrome, used as OTC hypnotic.

359
Q

False positive drug tests:

Fales positive Cannabinoids-

False positive Opiates:

False positive for amphetamines:

A

False positive drug tests:

Fales positive Cannabinoids- ?NSAIDS

False positive Opiates: Poppy seeds, verapimil, quetiapine, and diphenhydramine

False positive for amphetamines: Selegiline

360
Q

Duration in drug testing:

PCP:

Cannabis:

Cocaine:

Heroin:

A

Duration in drug testing:

PCP in urine for up to 8 days

Cannabis: up to 4 weeks

Cocaine: up to 8 hrs

Heroin: up to 72 hr

361
Q

Mees lines (lines on nails)

A

Arsenic poisoning:

362
Q

Gene with psychosis cannabis:

A

AKT1 (more consistent data), also COMT (Val/Val and Val/Met/ Val158Met) in homozygous and heterozygous genetic set ups

363
Q

Serotonin syndrome with drug

A

MDMA (ecstasy)

364
Q

FDA Approved Meds for cocaine use D/O

A

None

365
Q

stocking glove distribution decreased light touch sensation, walking and balance problems. Impaired propriocetion and balance/cerebellaR fxn.

A

Nitrous oxide inhalation

366
Q

vitamin deficiency in nitrous oxide use

A

B12 deficiency, inactivates cobalamin by oxidation

367
Q

Drug with Depressed reflexes

A

Inhalants

368
Q

inhalants intoxication signs

A

maladaptive behavior such as assaultiveness, impaired judgment, and neurological signs such as dizziness, slurred speech, ataxia, tremor, blurred vision, stupor, and coma.

Can see depressed reflexes when intoxicated.

369
Q

Drug with vertical nystagmus

A

PCP

370
Q

_____ intoxication = Hypertension, tachycardia, numbness or less responsive to pain, ataxia, muscle rigidity, seizures, coma. Aggression.

A

PCP

371
Q

Ketamine

A

relative of PCP.

Intoxication presents as belligerence, impulsivity, psychomotor agitation, and impaired judgment. Physical signs include nystagmus, hypertension, ataxia, dysarthria, or muscle rigidity. Psychosis may be present and can persist for up to 2 weeks after intoxication.

372
Q

ETOH: inheritance

A

30% with chronic ETOH have family member with chronic ETOH

373
Q

ETOH sleep effects

A

Sleep wake disorder: insomnia type- dif falling./staying asleep and nighttime awakening.
Restless sleep.
Increased nrem sleep, decreased rem sleep.
Can increase apneic episodes in OSA

374
Q

indicators of ETOH use

A

GGT and CDT

375
Q

Recreational methamphetamines: physical findings

A

poor dentition
skin picking and formication

376
Q

Recreational methamphetamines: clinical presentation, electrolytes

A

euphoria, anxiety, anger, hypervigilance, and impaired judgment and functioning

Can have psychosis—paranoia

Visual hallucinations, hyperactivity, confusion and incoherence

Muscle cramps, hypoMg, and hypokalemia

377
Q

GHB withdrawal:

Early signs:

Later signs;

A

GHB withdrawal:

Early signs:

Later signs;

More common in chronic users using every 3-4 hrs

378
Q

GHB receptor

A

GABA-B

379
Q

Methamphetamine recreational - neurotransmitter effect

A

causes monoamines to be released from storage vesicles into the cytoplasm.
It also leads to dopamine, norepinephrine and serotonin to release into the synaptic cleft. (inc NE, DA, and 5HT)

380
Q

MDMA presentation

A

Disorientation then rush, euphoria, tachycardia, hypertension, hyperthermia, increased risk for seizures. Decreased appetite. Dilated pupils.

381
Q

Sleep:

4 stages:

A

Stage 1: Transition phase (5%)- light sleep, alpha and theta waves EEG

Stage 2: Sleep spindles and K complexed on EEG (50%),dec temp RR, and BP

Stage 3: Slow-Wave sleep (10-20%)- occurs more frequently in the first half of the night. Slow wave/delta waves on EEG

REM (20-50%)- Dreams during this phase, increases in length and frequency as approaching morning. Atonic skeletal muscle, EEG looks like awake. inc RR, HR,BP.

382
Q

What sleep abnormality in MDD:

A

Decreased slow wave sleep (phase 3). Increased sleep latency, decreased total sleep time. REM latency is shorter, and decreased eye movement when in REM.

383
Q

Newborns sleep:

A

Newborns sleep longer but shorter intervals, at rem sleep at sleep onset, and increased REM sleep time. As they mature they shift to adult sleep patterns. 3 months start To develop Circadian pattern And start sleep in NREM

384
Q

sleep changes in schizophrenia exacerbation

A

Decreased REM latency in schizophrenia exacerbation, decreased sleep time total and decreased slow wave sleep

385
Q

Terminal insomnia- definition and pathology

A

depression; waking too early and can’t fall back to sleep

386
Q

PErcent of children with somnambulism

A

10-30%

387
Q

FDA approval for Vagus Nerve Stimulation

A

Refractory epilepsy (12+)

Treatment resistant depression in adults

Treatment resistant depression in kids 12-17

Placed around L vagus nerve in carotid sheath (less cardiac innervation than R) maybe by stimulation of locus coeruleus and median raphe nucleus to stimulate 5ht and NE release maybe

388
Q

Maudsley Model:

A

Maudsley Model: Anorexia, family based therapy for pts up to 19. Family plays an active role in tx, goal of weight restoration, then the eventual return of control of eating habits.

389
Q

Interpersonal therapy:

Four main focus areas:

A

Complicated bereavement (grief after loss of loved one)

Role dispute (conflict in significant relationship)

Role transition (difficulties adapting to change in relationships/life circumstances)

Interpersonal deficits (difficulties stemming form social isolation and lack of life events.)

390
Q

TMS location for depression

A

Dorsolateral prefrontal cortex

391
Q

indications for TMS

A

Failed one SSRI at appropriate dose with ongoing sx

392
Q

ECT: How long should maintenance be

A

6 months

393
Q

erotomania, celebrity communications and. Special relationship/love through communications.

A

De Clerambault syndrome:

394
Q

people are replaced with body double

A

Capgras:

395
Q

feels that they are actually dead (or zombie); sometimes in severe depression

A

Cotard syndrome:

396
Q

Eating disorder inpt admission : adults and children

A

Adults: wt <75% EBW, BP <80/60 mmhg, HR <50bpm, T <97F

K <3 mEq/L, Glucose <60, Electrolyte derangements

Dehydration

Liver, Kidney, or cardiac complications

Poorly controlled diabetes

Children:

Wt <85% EBW, BP <80/50 mmhg, orthostatic hypotn, HR around 40 bpm

HypoK (<4)Treatment of board, Hypophos, HypoMg (<2)

397
Q

ADHD: prevalence and M:F ratio

A

abt 9% of kids in most cultures. 2:1 male to female ratio in kids, and 1.6:1 in adults.

398
Q

Sensitivity:

A

prob that person with condition will test positive TP/TP+FN

399
Q

Specificity:

A

prob that a person without condition will test negative TN/FP+TN

400
Q

NPV:

A

likelihood that individual with a neg result is truest negative for condition TN/all negatives

401
Q

Attributable risk:

A

risk of exposed group-non exposed group

402
Q

PPV:

A

likelihood individual without a positive result has the disease. TP/All positives

403
Q

Factor Analysis

A

multiple variables have similar patters bc all associated with “latent” variable (a variable that is note measured directly). Can do factor analysis to asses things that are not measured directly

404
Q

measure of relationship b/w the change of two variables.

A

Covariance:

405
Q

chance of result occurring by chance

A

P value

406
Q

rejecting null when it is true (ie there is no difference and you say there is, but this was only bc of chance)

A

Type I error

407
Q

no noted statistical significance when there should have been, keep the null but your wrong

A

Type II error
Denoted by study power

408
Q

probability of finding the difference between two samples. It is the probability of rejecting the null hypothesis when it should be rejected.

A

Power

409
Q

The correlation coefficient

A

sa measurement of the direction and strength of the relationship between two variables.

The Pearson correlation coefficient is on a scale from −1 to +1.

A positive correlation means that one variable moves the other in the same direction.

A negative value means that one moves the other in the opposite direction.

A correlation close to −1 or +1 shows a strong relationship. A correlation close to 0 shows a weak relationship.

410
Q

test is used for one binary predictor variable and one binary outcome variable.

A

χ2 Test

411
Q

test is used for one binary predictor variable and one continuous outcome variable.

A

The T   test

412
Q

test used for two or more binary predictor variables and one continuous outcome variable.

A

ANOVA

413
Q

compares one continuous predictor variable and one continuous outcome variable.

A

Correlation

414
Q

Used to compare two or more continuous or binary variables and one continuous outcome variable.

A

Regression analysis

415
Q

Face validity

A

a diagnosis is based on a general consensus among experienced clinicians and researchers.

416
Q

Descriptive validity

A

diagnosis is based on characteristic features that distinguish it from other disorders.

417
Q

Predictive validity

A

a diagnosis will allow clinicians to accurately predict treatment response and clinical course.

418
Q

Construct validity

A

means that a diagnosis is based on an understanding of the underlying pathophysiology.

419
Q

TADS study

A

Treatment for Adolescents With Depression Study (TADS)

60% of youth respond to tx with meds (fluoxetine - FDA for depression 8-17). 71% in combination group improved. 43% CBT alone improved.

420
Q

COMBINE trial

A

ETOH substance use

Naltrexone and therapy together or separate better than acamprosate

421
Q

CSF in violent criminal

A

Lower brain serotonin turnover

5-hydroxyindoleacetic acid (5-HIAA)

422
Q

Amnesia in ECT

A

Amnesia mostly anterograde, usually resolves in 2-4 wks. Retrograde amnesia most persistent memory adverse effect, can persist weeks to months.

423
Q

How to vary dosage of ECT

A

Varied by time

Also can change frequency of treatment and unilateral from bilateral

424
Q

Fixed ratio

A

: reinforcement after set number of times of behavior (one free meal every 10)

425
Q

Variable ratio

A

: reinforcement after various amount of performed behavior (gambling, like slots)

426
Q

Fixed interval:

A

reinforcement for bx at constant time (getting reward every 10 mins)

427
Q

Variable interval

A

reinforcement for responses at various amounts of time (around a certain average) checking email

428
Q

Variable time:

A

reinforcement in varied times, regardless if bx is performed.

429
Q

Piaget stages of development

A

Sensorimotor (up to 2)
Preoperational (2-7)
Concrete operational (7-11)
Formal operational (12+)

430
Q

Sensorimotor (age, major development/approach)

A

up to 2 yrs:

learning object permanance

Know the world through movements and sensations

Learn about the world through basic actions such as sucking, grasping, looking, and listening

Learn that things continue to exist even when they cannot be seen (object permanence)

Realize that they are separate beings from the people and objects around them

Realize that their actions can cause things to happen in the world around them

Piaget believed that developing object permanence or object constancy, the understanding that objects continue to exist even when they cannot be seen, was an important element at this point of development.

431
Q

Preoperational

A

2-7: symbolic play

think symbolically and learn to use words and pictures to represent objects

Egocentric and struggle to see things from the perspective of others

Getting better with language and thinking, but still concrete terms

Children become much more skilled at pretend play during this stage of development, yet they continue to think very concretely about the world around them. 

432
Q

Concrete operational

A

7-11: conservation

Begin to think logically about concrete events

Begin to understand the concept of conservation

Thinking becomes more logical and organized, but still very concrete

Thinking is still rigid. Struggle with abstract and hypothetical concepts.

Less egocentric and begin to think about how other people might think and feel. Begin to understand that their thoughts are unique to them and that not everyone else necessarily shares their thoughts, feelings, and opinions (theory of mind).

433
Q

Formal Operational

A

12+:

Begins to think abstractly and reason about hypothetical problems

Begins to think more about moral, philosophical, ethical, social, and political issues that require theoretical and abstract reasoning

Begins to use deductive logic, or reasoning from a general principle to specific information

434
Q

Types of Play in (Piaget preoperational stage)

A

Parallel: usually around 2years old, play with similar things near each other.

Associative: 3 y.o. share same toys but play separately. Play begins to overlap

Cooperative: around 4 y.o. Play with toys and interact together

435
Q

Margaret Mahler:

A

Psychoanalytic observation of children b/w 6 mo and 3 yrs.

Autistic phase - first 3 weeks, separation and self absorption. Mostly sleeping

Symbiotic phase: until 5 months recognizes caregiver, but lacks sense of individuality.

Separation-individiation (3 stages)

  1. Hatching: increased interest in outside world
  2. Practicing (9-16 months: physical ability to separate from caregiver
  3. Rapprochement (15-24 months): infant explores outside world but requires mother to be present for emotional support of completing the task.
  4. Object constancy: (24+ months) the development of an internalized mental model of the mother, which unconsciously accompanies and supports the child even when they are physically separated. In addition, a sense of individuality begins to develop. The degree of ambivalence in the internalized model implicates the formation of a healthy self concept and self-confidence.
436
Q

Separation-individiation (3 stages)

A
  1. Hatching/Differentiaton (5-9 mo): increased interest in outside world
  2. Practicing (9-16 months: physical ability to separate from caregiver
  3. Rapprochement (15-24 months): infant explores outside world but requires mother to be present for emotional support of completing the task.
  4. Object constancy: (24+ months) the development of an internalized mental model of the mother, which unconsciously accompanies and supports the child even when they are physically separated. In addition, a sense of individuality begins to develop. The degree of ambivalence in the internalized model implicates the formation of a healthy self concept and self-confidence.
437
Q

Pathology in Mahler stages

A

Disruption in rapprochement: borderline
disruption in symbiotic: narcissistic PD

438
Q

cystothianine b- synthase deficiency

A

Homocystinuria

439
Q

Ataque de nervios

A

: Latin American cultures. In response to stressful event (Eg sudden loss of loved one). Similar to panic attacks, but also crying, shouting, anger, possible suicidal or violent bx. Seizure like features and fainting can happen.

440
Q

Nervios:

A

ongoing illness related to stressful circumstances. Associated it’s depression, anxiety, and somatoform sx.

441
Q

Susto:

A

Described in Mexico, Central America, South America. Believes soul has left the body in response to fearful event.

442
Q

Taijin Kyofusho:

A

condition in Japan culture. Fear or appearance may be offensive to others. Fear of offending others lead to social avoidance.

443
Q

Amok:

A

Malaysian. Sudden rampage including homicide and/or suicide, which ends in exhaustion and amnesia.

444
Q

Koro:

A

Asian delusion that the penis will disappear into the abdomen and cause death. genitalia retract into abdomen

445
Q

Piblokto:

A

female Eskimos of northern Greenland. It involves anxiety, depression, confusion, depersonalization, and derealization, ending in stuporous sleep and amnesia.

446
Q

Wihtigo:

A

Native American Indians . Fear of being turned into a cannibal through possession by a supernatural monster, the Wihtigo.

447
Q

Mal de ojo:

A

Mediterranean descent . Vomiting, fever, and restless sleep. It is thought to be caused by the evil eye.

448
Q

Dhat syndrome

A

: loss of semen

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