Studying Flashcards
Joseph Breuer
Worked with Freud, 1842-1925. Developed theory of hysteria with Anna O patient with Freud.
Kurt Schneider
1887-1967
“first rank” symptoms of schizophrenia: thought insertion/withdrawal, thought broadcasting, 2 voices with dialogue, delusions of passivity. Narrowed the schizophrenia diagnosis.
”first rank” symptoms of schizophrenia:
thought insertion/withdrawal, thought broadcasting, 2 voices with dialogue, delusions of passivity.
Kurt Schneider 1887-1967
Emil Kraeplin
(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.
Eugene Bleuler
(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.
The 4 As os Schizophrenia
loose associations, affective flattening, autism, ambivalence. Noted disturbance in emotion ad motivation.
Eugene Bleuler 1857-1939
Karl Wernike
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)
Ventral Posterior Medial Nucleus
face sensory (somatic sensation for contralateral face and taste)
Ventral posterior lateral Nucleus:
Leg and arm sensory (somatic sensation to contralateral body)
Ventral Lateral Nucleus:
Coordination and movement (cerebellar)
Medial Geniculate nucleus:
Thalamus nucleii Hearing (auditory impulses)
Lateral Geniculate Body:
Thalamus nucleii for Vision (visual impulses/retina)
Gene with substance use disorder
Alcohol dehydrogenase/Aldehyde dehydrogenase
Gene for carbamazepine
HLA B*1502
Protease inhibitors antidepressant with fatal interaction
Nefazodone (Serotonin modulator) can increase toxicity of protease inhibitors.
Transient HA, quadriplegia, stupor, psychosis and blindness
Basilar migraine
: progressive dementia, dysarthria, tremors, and hypotonia.
Neurosyphillis
Minere’s disease
inner ear dysfxn. Vertigo, tinnitus, and hearing loss
Kluver-Bucy Syndrome:
Lesions to b/l anterior temporal lobes/amygdala
Hyperorality, hypermetamorphisis (preoccupation with minute stimuli) and blunted emotional affect, hyper sexuality, and visual agnosia
Anterior thalamus
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
Amygdala lesion
Hyper sexuality, hyperorality, apathy, hyper fixation
Sx Lesion to Mammillary bodies
Confabulation, memory changes, psychosis. Affected in ETOH encephalpathy
Medial thalamus lesion
Deficits in language
Lesion right thalamus
Visual memory deficits
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%)
Giant Cell Arteritis
MOA Mirtazapine
Alpha-2 adrenergic receptor antagonist -primary
Serotonin 5HT2 antagonist.
- Histamines receptor blockade (H1)—>sedation inc appetite. And weight gain
Bupropion MOA
NE and DA reuptake inhibitor
MOA antipsychotics
D2 antagonists
5HT-2A receptor agonists
LSD, psilocybin
Ventral Posteromedial Nucleus
Face sensory (somatic sensation for contralateral face and taste), projects to somatosensory cortex
Ventral posterolateral Nucleus
Leg and arm sensory (somatic sensation to contralateral body), projects to somatosensory cortex
Lateral-Leg and arm
Ventral Lateral Nucleus:
Coordination and movement. Info from cerebellum and basal ganglia to motor cortex,
Lateral Geniculate Nucleus
Vision (visual impulses/retina), to visual cortex
Medial Geniculate nucleus
Hearing (auditory impulses) to primary auditory cortex.
Ventral Lateral Nucleus:
Coordination and movement. Info from cerebellum and basal ganglia to motor cortex, .
Ventral anterior nucleus
: motor information about movement/tremor eg movement initiation. Basal ganglia to premotor cortex.
Lesion when you see dressing apraxia
R parietal lobe
R/l confusion, acalculia, agraphia, aphasia. Agnosia
Gerstmann syndrome, L parietal lobe lesion
Pathological finding in temporal lobe epilepsy
Mesial or hippocampal sclerosis
What do you think of with aqueduct dilation
NPH
Modafinil MOA
binds to dopamine transporter, inhibits dopamine reuptake.
Also increases activity in the tuberomamillary nucleus (which is primarily histaminergic)
Seizure, adhd, increasingly clumsy, falls, stiff gait, periventricular demyelination in posterior regions of cerebral white matter
Adrenoleukodystrophy
Adrenoleukodystrophy sx
Vision and hearing issues, hyperactivity, paralysis, seizures, muscle weakness, adrenal failure
Adrenoleukodystrophy inheritance and etiology
X linked. So think if you see in males. Accumulation of very long chain fatty acids.
Hypoxanthine-guanine phosphoribosyltransferase, causes _______
Lesch-nyhan syndrome, build up of Uric acid
Leach Nyhan presentation
Presents late in first year of life, psychomotor retardation, choreathetosis, spasticity and severe self injury
Lennox gastaut eeg finding
Slow spike and wave/ poly spike and wave
How does hippocampus store memories
Long term potentiation
MOA TCA
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!
Duloxetine/ Venlafaxine MOA
Serotonin, norepinephrine reuptake inhibitors.
What meds are FDA approved for PTSD
Fluoxetine and Paroxetine
SSRI with more weight gain than others
Paroxetine, due to more anticholinergic activity than others. Also more sedation.
How long to wash out SSRI when switching to MAOi
Most SSRI: 2 weeks
Fluoxetine: 5 weeks
What P450 activity of Fluoxetine
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)
CYP450 effects of Fluvoxamine
Potent 1A2 inhibitor
Moderate 2C19 inhibitor
Side effects SNRI vs SSRI
SSRI more weight gain, SNRI hypertension
High dose antidepressant and cough medicine
Serotonin syndrome
Contraindications for duloxetine
Chronic liver disease.
Which has longer half life duloxetine, or venlafaxine
Duloxetine
Venlafaxine more discontinuation syndrome
MAOI inhibitors MOA
Block monoamine oxidase which leads to delaminating of 5ht, NE and DA
- prevents their inactivation
Dietary restrictions in MAOI, why?
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
Meds to not give with MAOI
Meperidine (Demerol)
Epinephrine
Decongestants
Anesthetics with sympathomimetrics
What is the benefit of Selegiline patch
No dietary restrictions needed at low dose
Tx MAOI hypertensive crisis
Phentolamine
MAO-i in parkinsons
Selegiline, b/c more selective to MAO-B inhibition up to 10 mg
What happens in tyramine crisis
Buildup of stored catecholamines
Hypertension, headache, diaphoresis, N.V, autonomic changes, chest pain, arrhythmia, death
What medication do you see pyridoxine deficiency
MAOI
Pyridoxine deficiency
Parathesias and weakness,
MOA Buspirone
Agonist and partial agonist of presynaptic receptors 5HT-1A
MOA Aripiprazole
Partial DA agonist, partial 5HT agonist
Antipsychotic with highest EPS
Haldol
Clozapine
Anticholinergic, Sedation, EPS
Anticholinergic, high
Sedation, high
EPS, none
When do you expect Tardive dyskinesia
Ppl taking antipsychotic for >2 yrs, more common in older women, or long term antipsychotic use
Positive symptoms pathway
Mesolimbic
Negative symptoms pathway
Mesocortical
What is the Mesolimbic pathway
DA pathway b/w ventral tegmental, nucleus’s accumbens, also includes the fornix, amygdala and hippocampus
Pathway associated with EPS
Nigostriatal DA pathway
Pathway associated with hyperprolactinemia
Tuberoinfundibular pathway
(Hypothalamus to the anterior pituitary)
Bupropion MOA
NE, DA reuptake inhibitor
Lab findings in NMS
Increased CPK, INc LFTS, leukocytosis
NMS mneumonic
Fever
Autonomic instability
Lleukocytosis
Tremor
Elevated creatinine phosphokinase
Rigidity
Eexcessive sweating
Delirium
- will NOT HAVE hyperreflexia.
When will you see NMS
Initiation or rapid withdrawal
NMS treatment
Dopaminergic agents
Dantrolene
Bromocriptine: D2 agonist
AMantadine
Benzos
ECT
Levodopa/Carbidopa
TCA overdose treatment
Sodium bicarbonate, lipid emulsion, plasmaphoresis in severe cases
MOA Acamprosate
Glutamate Antagonist (via NMDA receptors) Blocks glutamate transmission.
Acamprosate contraindication
Renal issues
MOA Naltrexone
mu-opioid receptor antagonist.
Naltrexone contraindications
Contraindicated in pts on opioids for pain, advanced liver disease, LFTS 3-5X over normal
Naltrexone liver or kidney
Liver, can’t give if LFTS >3x expected
Acamprosate liver or kidney
Kidney, contraindicated in severe renal disease
Disulfiram MOA
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
Varenicline MOA
Nicotine receptor partial agonist.
What is Yohimbine
adrenergic agonist for helping SSRI induced sexual dysfunction but can lead to more anxiety
MOA Mirtazapine
tetracyclic antidepressant.
- Presynaptic alpha-2 adrenergic receptor antagonist. Serotonin 5HT2 antagonist.
- H1 receptor blockade leads to sedation and weight gain
How many non-overlapping symptoms for BPAD with mixed features
At least 3 non overlapping symptoms
Weakness if wrist and finger extensor muscles in an adult
Lead poisoning
Toluene poisoning
Aka Methylbenzene
Encephalopathy, cerebellar, brain stem, basal ganglia, and cranial nerve dysfunction
In paint, adhesives, and pesticides.
Sensory neuropathy w/o weakness
Platinum drugs (cisplatin, —platin)
Affect dorsal root ganglion, or large myelinated axons.
Coasting symptoms worsen even after exposure.
Exposure with HA, dizziness, in coordination, irritability, cognitive dysfxn, seizure, coma, and death
Carbon Monoxide
Buspirone acts on what receptor primarily
5-HT1A
Developed Theory of internal object relations
Melanie Klein
Melanie Klein Theory
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.
“paranoid-schizopid position”
- infant uses to conceptualize parts of the mother as all good or all bad
“The bad mother”
Melanie Klein
“depressive position”
: infant views mom as ambivalaent and having both positive and negative aspects
Melanie Klein 1882-1960
Who developed analytic play therapy
Melanie Klein
Aldoph Meyer Approach
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.
Harry Stack Sullivan Theory
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"
Eriksonian Theory
Development of self and identity through social norms and biological drives. (blank) vs (blank)
Eriksonian Stages of Growth and ages
- Trust vs mistrust: birth to 18 mo
- Autonomy vs shame : 18 mo-3 yrs
- Initiative vs guilt: 3-6 yrs
- Industry vs inferiority:6-12 yrs
- Identity vs role confusion: 12-18 yr
- Intimacy vs isolation: 18-35 yr
- Generativity vs stagnation: 35-65 yr
- Ego integrity vs despair: 65 to death
Trust vs mistrust:
Birth to 18 mo - Basic trust
Autonomy vs shame :
18 mo-3 yrs
- Control and independence
Initiative vs guilt:
3-6 yrs
- Taking control of the environment, purpose
Industry vs inferiority:
6-12 yrs
- Confidence, competence, social skills
Identity vs role confusion:
12-18 yr
- Formation of identity, devotion
Intimacy vs isolation:
18-35 yr
- Forming a relationship commitment
Generativity vs stagnation
: 35-65 yr
- Building a family, having productive career
Ego integrity vs despair
: 65 to death
- Viewing life as meaningful and fulfilling
Karen Horney:
: 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.
What is Holistic psychology
Who’s theory
: person strives to be seen as a whole.
Karen Horney 1885-1952
Actual self, real self, idealized self
Theorist
Karen Horney
Who’s theory uses approach to Allow person to strive for self-realization by understanding distortions that prevent growth.
Karen Horney
MOA Naltrexone
mu-opioid receptor antagonist. Long acting injection (vivitrol)
Disulfram MOA
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
1 mg Alprazolam equivalents of the following:
1. Lorazepam
2. Clonazepam
3. Diazepam
4. Chlordiazepoxide
5. Phenobarbital
- Lorazepam- 2 mg
- Clonazepam- 1 mg
- Diazepam- 10 mg
- Chlordiazepoxide- 25 mg
- Phenobarbital- 30 mg
Water intoxication and hyponatremia symptoms
Abdominal pain, vomiting, confusion, depressed reflexes, hallucinations, and seizures
Primary progressive aphasia subtypes
- Non-fluent: difficult speech generation, esp articulation, grammar probs, impaired comprehension
- Semantic: word finding difficulty, trouble naming, trouble understanding nouns.
Older person with slowly worsening aphasia, difficulty with naming, and following convos, grammar errors. Mispronounces words
Primary progressive aphasia, type of FTD
This is non-fluent subtype
Donepezil MOA
Reversible ACHesterase inhibitor
Stroke in Sickle Cell
Watershed at border zones, high risk of infarcts at young age.
Carbon monoxide poisoning, would lead to lesion where
Globus Pallidus
condition with low coQ10
Parkinson’s
Rate of suicide in Body dysmorphic disorder
22-24%
Buspirone MOA
partial agonist 5ht-1A receptor
Lobe responsible for hearing
Temporal lobe
Treatment for complex berevement
CBT
DDAVP relapse for primary enuresis
60-70%
What receptor leads to sexual side effects of typical antipsychotics
alpha-1 receptors
but also DA blockade due to decreased sex drive
Most serious side effect of mirtazapine
Agranulocytosis
Minuchin theory of enmeshment notes which boundary issue
interpersonal boundary issue
MOA Sumitriptan
5HT-1D and 5HT1-B agonist
MOA Aripiprazole
Partial D2 agonist
5HT1A partial agonist 5HT2A antagonist
What causes drug induced myopathy
corticosteroids
After pharm stabilization of bipolar what is first line adjunctive tx associated with improved adherence
Group psychoeducation
Slot machine schedule of reinforcement
Variable ratio
Most common psychiatric do in children
ADHD- 9.4% of ages 2-17
How long must you have sx for cyclothymic disorder
2 years in adults, 1 year in children and adolescents.
cannot have met MDD or mania criteria
Who developed “idealized self” and “real self”
Karen horney
What med has insulin like effect
Li has insulin like effect that lowers blood sugar, and inc appetite and wt gain.
What test best visualizes seizure focus most precisely
ictal PET or FMRI, SPECT
How do adjust depakote from IR to extended release
increase IR dose to 15%
Beneficence definition
obligation to help patients and relieve suffering.
Autonomy
duty to protect a patient’s freedom to choose.
Justice
air distribution and application of services.
Metabolic change for bulimia
hypokalemic hypochloremic alkalosis
Russell’s sign
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
Types of Specific phobia
natural environment
animal
blood-injection injury
situation
other
biological changes resulting from panic attacks
increased catecholamines d/t SNS
hypervenitllation, leads to dec Co2 (hypocapnea, respiratory alkalosis),
Bipolar disorder- Rapid cycling:
> /= 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
Narcolepsy see _______ levels of _______
Low csf Hypocretin peptide aka orexin
Low hypocretin/orexin in csf
What chromosome is mutated in Narcolepsy
chromosome 6 in narcolepsy-cataplexy in 90-1005 of ppl with narcolepsy but also 50% of ppl w/o.
FDA approved meds for narcolepsy
Meds: methylphenidate (daytime sleepiness-FDA), adderall (daytime sleepiness -FDA), modafinil, amodafonil (nuvigil). For cataplexy sodium oxybate (xyrem)
Rate of cataplexy in Narcolepsy
Cataplexy in 30-70% often in strong emotion
Rate of suicide attempts on Dissociative Identity Disorder
over 70%
Common history of people in DID
childhood maltreatment 90%
Substance used disorder: how many criteria for severity scale
Substance use disorder 11 total criteria
Mild= 2-3, moderate= 4-5, severe=6
PMDD treatments
CBT can reduce Sx
SSRI tx for irregular menses b/c symptoms hard to predict.
PMDD criteria
need 5/11 symptoms in final week before menses.
Standard of proof in civil commitment:
clear and convincing evidence
Preponderance of evidence:
malpractice suit
level of evidence in criminal case
Guilt beyond a resonance doubt:
standard of proof for government administrative hearings, and appellate courts.
Substantial evidence:
Expert witness:
on the stand, specialized knowledge, if court order waiver of privilege is implied. If conflict of interest must identify to the court.
Fact witness:
a witness with knowledge about the case, do not offer opinions
Privilege:
legal rule that protects certain info from being shared, the individual has privilege not the physician
Gene that interacts with stressful life events
BDNF
Specific learning disorders— M:F
60-80% are male (reading, writing, or math), not attributable to ID
Etiology Psychosis induced polydipsia:
- 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
Sx B1 deficiency
Beriberi”: neuropathy, weakness, muscle
wasting, cardiomegaly, ophthalmoplegia,
confabulation
Sx B3 deficiency
Niacin
Pellagra Pigmented rash of sun-exposed areas,
disorientation, and problems with memory,
diarrhea, memory problems, bright red tongue
Sx B6 deficiency
Seborrhoeic dermatitis, inflamed tongue,
neuropathy, confusion, depressed mood,
microcytic anemia
Sx vit b9 deficiency
Folate
Shrunken and inflamed tongue, megaloblastic
anemia, high homocysteine
Sx vitamin B12 deficiency
Cobalamin
Dorsal column loss of vibratory and position
sense, ataxic gait, dementia, loss of control of
bowels, erectile dysfunction, megaloblastic
anemia
Locked in syndrome 2 major causes
- rapid sodium replacement in hyponatremia is This can result in a clinical transection of the pons and a locked-in syndrome.
- ventral pontine infarct as a consequence of basilar artery thrombosis
sites for drainage of CSF into the blood.
Arachnoid (pacchionian) granulations:
Microglia:
clean up cells (macrophages)
Astrocytes:
glial cells responsible for development and framework of neurons.
Oligodendrocytes:
insulate axons, provide myelin sheath
Ependymal cells
: line ventricles, produce CSF
Radial Glia
primary progenitors
Schwann cells:
myelinate the PNS
Forebrain (prosencephalon):
- Telencephalon- cerebral hemispheres, lateral ventricles
- Diencephalon- Thalamus, hypothalamus, epithalamus, retina, pineal gland, third ventricle
Midbrain (mesencephalon):
- Mesencephalon: midbrain, cerebral aqueduct
Hindbrain (rhombencephalon)
- Metencephalon: pons, cerebellum, upper part of 4th ventricle
- Myelencephalon: medulla, lower part of 4th ventricle.
- Telencephalon-
cerebral hemispheres, lateral ventricles
- Diencephalon-
Thalamus, hypothalamus, epithalamus, retina, pinela gland, third ventricle
- Mesencephalon:
midbrain, cerebral aqueduct
- Metencephalon:
pons, cerebellum, upper part of 4th ventricle
- Myelencephalon:
medulla, lower part of 4th ventricle.
What brain region created the thalamus
diencephalon
What brain region makes limbic system
telencephalon (part of the cerebral hemispheres)
What brain region does medulla develop from
Myelencephalon
What brain region does the basal ganglia arise from
telecephalon (part of the cerebral hemispheres)
What brain region does the cerebellum arise from
Metencephalon
Where neurotransmitters are made: DA
Substantia Nigra
Where neurotransmitters are made: Serotonin
Raphe Nucleus (brain stem)
Part of reticular formation
Where neurotransmitters are made: NE
Locus Ceruleus - nucleus in the pons, blue colored
Where neurotransmitters are made: Aceytlcholine
Nucleus Basalis of Meynert
NT receptors: Acetocholine
Nicotinic,
Muscarinic
NT receptors: Glutamate
AMPA, NMDA, Kainate
NT receptors: GABA
GABA-A: benzos,
GABA-B: GHB
NT receptors: Serotonin
NT receptors: Dopamine
Receptors and side effects: Wt gain and sedation
H1- histamine receptor
Receptors and side effects: constipation, blurred vision, dry mouth, drowsiness
M1
Receptors and side effects: dizziness and decreased BP
Alpha-1
NT responsible for short term memory, attn, executive function, novelty seeking
ACH
Odansetron MOA
5ht-3 receptor antagonist, Anti nausea effect
Rate limiting enzyme in DA synthesis
Tyrosine hydroxylase
Receptor bound by PCP
NMDA (glutamate, excitatory)
NT is excitotoxicity
Glutamate, leads to excessive CA++ and cell death
Neuro imaging in in PTSD:
decreased hippocampal volumes, smaller anterior cingulate cortex volume.
- 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.
Pseudotumor cererbri
pseudotumor cerebri aka
benign intracranial hypertension
DX benign intracranial hypertension
lumbar puncture with measurement of the opening pressure, which is elevated over 20 cm H2O.
Tx benign intracranial hypertension
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.
Nerve associated with Migraines
Trigeminal nerve (CNV)
Duration of HA in cluster HA
15min-3 hrs
Frequency of headaches for migraine
At least 5 lasting 4-72 hrs
Migraine characteristics. How many to meet migraine criteria
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.
Optic neuritis (ON)
Describe
Seen in what disease?
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.
What is included in the basal ganglia
Globes pallidus, Caudate, putamen, substantia nigra, Subthalamic nucleus
What is the function of the pons
Arousal, sleep/wake cycles
Paroxysmal Hemicrania: female:male
2:1
Paroxysmal Hemicrania:
Duration and symptoms
- 2-30 min duration, can happen multiple times per day. Autonomic symptoms (lacrimation, conjunctival injection, and Horner syndrome), Neck movement trigger episodes.
- New onset change in HA, fever, fatigue, myalgias, night sweats, wt loss, and jaw claudication
Giant Cell Arteritis
Feared complication of giant cell arteritis
Vision loss d/t central retinal artery occlusion
Dx of Giant cell arteritis
Golds standard: temporal artery biopsy
Screen: elevated ESR
progressive dementia, dysarthria, tremors, and hypotonia.
Neurosyphillis: progressive dementia, dysarthria, tremors, and hypotonia.
What area is linked to Tourette’s
Caudate nucleus
Lobes affected by Herpes encephilitis
Temporal, inferomedial temporal lobes
EEG finding in Herpes encephalitis
Periodic lateralized epileptiform discharges (PLEDs)
Tx herpes encephalitis
IV acyclovir
Best treatment of heroin abuse in pregnancy
Methadone most extensively studied
Buprenoprhine also okayed
Medications which are FDA approved to treat fibromyalgia include
milnacipran (SNRI), duloxetine, and pregabalin.
Criteria for fibromyalgia include
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.
Sleep changes in older people >65
- 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.
Duration of sx in restless legs
At least 3 mo
HLA associated with narcolepsy
HLA-DR2
Amount of time in REM sleep for typical young adults
25%
Unified detachment
Examining a situation from distance and more objectively.
Associated with mindfulness
Genetic cause of MD1 vs MD2
MD1- trinucleotide repeat in DMPK, chromosome 19
MD2- tetranucleotide repeat in zinc finger protein 9 gene (ZNF9 or CNBP) chromosome 3
PET findings when imaging area of sz focus, indicate what
Decreased glucose uptake on affected side
Geschwind syndrome
Behavioral syndrome: hyperreligiosity, circumstantiality, hyper graphic, hypo sexuality and intense emotional response
Associated with temporal lobe seizures, particularly complex partial seizures
Most common etiological cause of temporal lobe epilepsy
Prolonged febrile convulsions of childhood, or anoxia at birth
(Of note less common are tumors (eg astrocytomas), and infections (eg herpes)
Most common glial tumor
Astrocytoma
Most common astrocytomas
Glioblastoma and anaplastic astrocytoma
Most common form of epilepsy in childhood
Benign rolandic seizures
Benign rolandic seizures in adulthood
Most outgrow by adulthood
Seizure type with high risk of fatal aspiration
Benign rolandic seizures
Involvement of tongue and possible respiratory spasm
What is subclavian steal syndrome and what do you see
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.
Glasgow coma score
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
Which enzyme metabolizes methylphenidate
CES1A1 by ritalinic acid in the liver
Percent of children with ODD that develop CD
30%
Neurobiological abnormality associated with ASD
Decreased formation of Purkinje cells in cerebellum
Prevalence of childhood onset fluency disorder
5%
FDA approved use of duloxetine for what type of pain
Diabetic peripheral neuropathy
Fibromyalgia
Psychiatric SE of interferon alpha
Depression
Where is neurotransmitter made: histamine
Tuberomamillary nucleus
Incidence of depression from isoretinoin
4-11%
Isoretinoin and vision
Can cause decreased night vision and corneal opacities
DM1: Inheritance, gene, mutation
Autosomal dominant
Trinucleotide CTG repeat in DMPK (Dystrophia myotonica protein Kinase gene) >100,000s repeated vs normal 5-35
Chromosome 19
DM1 Severity, symptoms
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
Myotonic Dystrophy 2: inheritance, gene, mutation
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
myotonic dystrophy 2 (DM2): severity and symptoms
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
Adrenoleukodystrophy: inheritance, mutation, gene
X linked disorder with accumulation of very-long-chain fatty acids
Adrenoleukodystrophy symptoms
Sx: vision and hearing impairment, aphasia, hyperactivity, paralysis, seizures, muscle weakness, adrenal failure, and coma
Duchenne Muscular Dystrophy: gene, inheritance, mutation
Dystrophiniopathy- lack dystrophin
X-linked
Duchenne Muscular Dystrophy: clincal findings
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
William’s Syndrome: Chromosome
Chromosome 7q
William’s syndrome: gene, mutation, inheritance
Microdeletion of 7q, loss of elastin gene, AD inheritance
Hemizygous deletion including the elastin locus on chromosome 7q11–q23.
William’s Syndrome: clinical findings
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.
Fragile X: gene, mutation, inheritance
FMR1 gene, most common form inherited ID. Males more impaired than females.
The chromosomal anomaly lies at Xq28
Trinucleotide repeat
Fragile X: clinical presentation
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.
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
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
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
Trisomy 21
Cri-du-chat syndrome:Chromosome
deletion at the short arm of chromosome 5p15.2.
severe MR, microcephaly, round face, hypertelorism, micrognathia, epicanthal folds, hypotonia, and low-set ears. Newborns present with a cat-like high-pitched cry
Cri-du-chat syndrome
most common non inherited form of ID
Fetal alcohol syndrome:
Flat upper lip, flat middling face, flat philtrum, cardiac defects, behavior and learning problems
Fetal alcohol syndrome:
Tuberous sclerosis: gene, inheritance, mutation
TSC1 or TSC2 gene
Tuberous sclerosis is an autosomal dominant neurocutaneous d/o
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.
Tuberous sclerosis:
ash leaf spot
Tuberous sclerosis:
Shagreen spots
(irregularly shaped, often raised or textured skin lesion on the back or flank).
Tuberous sclerosis
Vonhippel Lindau chromosome
Chromosome 3
Narcalepsy/cataplexy chromosome
chromosome 6
ApoE4 gene chromosome
Chromosome 19
Thymoma- 10%
Myasthenia Gravis
Treatment Myasthenia Gravis
Pyridostigmine
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.
Rett syndrome
NF1 (von Recklinghausen’s disease): chromosome
mutation of the 60-exon NF1 gene on chromosome 17q
NF1 (von Recklinghausen’s disease): symptoms
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.
NF2: Chromosome
mutation of the NF2 gene on chromosome 22.
bilateral vestibular (nerve VIII) schwannomas.
NF2
deficiency in arylsulfatase A
Metachormoatic leukodystrophy:
Metachromatic leukodystrophy: Chromosome
Chromosome 22q13
Metachormoatic leukodystrophy: inheritance, gene, mutation
Myelin disorder, deficiency in arylsulfatase A
Chromosome 22q13
Inheritance is autosomal recessive.
Leads to progressive demyelination
Hexosaminidase A Deficiency
Tay Sachs:
Tay Sachs: chromosome
AR
HEXA gene on chromosome 15
Developmental retardation, paralysis, dementia, and blindness.
Cherry red spot on fundoscoptic exam.
Hyperactivity to startle, and sensitive to loud noises
Tay Sachs
deficiency in galactocerebrosidase beta-galactosidase.
Krabbes disease: (aka globoid cell leukodystrophy)
Krabbes disease: (aka globoid cell leukodystrophy): inheritance, gene
autosomal recessive deficiency in galactocerebrosidase beta-galactosidase.
Chromosome 14q31
Krabbe disease chromosome
Chromosome 14q31
Rapid deterioration in motor and intellectual fxn, hypertonicitity, optic atrophy, seizures, swallowing difficulties
Krabbes disease (aka globoid cell leukodystrophy)
Alpha galactosidase A deficiency
Fabry disease:
Minuchin:
Structural family therapy, roll of structural family imbalances
Integrative behavioral couples therapy:
Unified detachment:
Empathic joining:
Tolerance building:
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
Family therapy Schools of thought:
Psychodynamic:
looks at the past, and how causing present problems. Multigenerational transmission and encourages change through insight.
Family therapy Schools of thought:
Structural:
Structural: looks at blueprint of ”healthy” family, well defined subsystems, clear boundaries, and parents in charge. Minuchin
Family therapy Schools of thought:
Strategic:
Strategic: change that interrupts maladaptive bx sequences
Family therapy Schools of thought:
Experiential:
Experiential: focuses on the present and encourages change through growth experiences
Family therapy Schools of thought:
Systemic:
Systemic: change occurring due to changes beliefs.
Heinz Kohut Theory
: diagnosed narcissistic personality based on self object transference of mirroring and idealization. Self-psychology.
Kernberg:
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.
Stella Chess and Alexander Thomas:
9 dimensions of temperament
9 dimensions of temperament
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.
Lazarus theory
transactional theory of stress and coping. Stress is a product of person and environment.
Suzanne Kobasa theory
: personality style and hardiness (good health under stress)
Lazarus and Folkman: theory
primary and secondary appraisal. One is stress a threat, second evaluating coping skills during stress.
Malan: theory
triangle of conflict and triangle of persons theory
Sifneos: theory
anxiety provoking therapy, therapist acts as teacher
Davanloo: theory
intense short term dynamic psychotherapy
Mann:
Existential Therapy, therapist as empathic helper
good enough mothering
Winnicot
Transitional object
Winnicot, reminds of mother
Winnicott: theory
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
Mahler: theory
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.
Operant conditioning theorist
Skinner
Seligman: theory
Learned helplessness is a model for depression developed by Seligman, in which an organism learns that no behavioral change can influence the environment.
Bandura theory
social learning theory, which says we learn through modeling others and through social interaction
Kandel studies
habituation and sensitization in snails. Habituation theory says that an animal can learn to stop responding to a repeated stimulus.
classical conditioning theorist
pavlov
pavlov theory
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.
Freud:
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
Oral stage
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.
Anal Stage:
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.
Phallic Stage:
2-6, genitals
Difference b/w male and female
Oedipal complex boys see fathers as rivals, for moms affection
Electra complex for girls
Latent period:
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.
Genital stage:
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.
Ginkgo balboa:
Avoid with anti-platelets and anticoagulants.
Can take with SSRI for sexual side effects (largely anecdotal data).
blood flow and cognitive enhancement.
Echinacea Purpurea:
anti inflammatory. No known drug intxns. Avoid in immune related conditions
St John’s Wort (aka ______)
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.
Kava-Kava (aka____)
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
Allium sativum:
(Garlic) mild cholesterol lowering effects. Should be used cautiously with anti platelet and anticogulants. Avoid in warfarin duper to risk of bleeding.
Ginseng:
can cause insomnia, mania, and irritability. People take to improve mental and physical performance.
Fish oil
(omega 3 FA): adjunctive tx for depression
Caffeine: max dose
should take <250 mg /day
L-trypotophan:
can lead to serotonin syndrome, used as OTC hypnotic.
False positive drug tests:
Fales positive Cannabinoids-
False positive Opiates:
False positive for amphetamines:
False positive drug tests:
Fales positive Cannabinoids- ?NSAIDS
False positive Opiates: Poppy seeds, verapimil, quetiapine, and diphenhydramine
False positive for amphetamines: Selegiline
Duration in drug testing:
PCP:
Cannabis:
Cocaine:
Heroin:
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
Mees lines (lines on nails)
Arsenic poisoning:
Gene with psychosis cannabis:
AKT1 (more consistent data), also COMT (Val/Val and Val/Met/ Val158Met) in homozygous and heterozygous genetic set ups
Serotonin syndrome with drug
MDMA (ecstasy)
FDA Approved Meds for cocaine use D/O
None
stocking glove distribution decreased light touch sensation, walking and balance problems. Impaired propriocetion and balance/cerebellaR fxn.
Nitrous oxide inhalation
vitamin deficiency in nitrous oxide use
B12 deficiency, inactivates cobalamin by oxidation
Drug with Depressed reflexes
Inhalants
inhalants intoxication signs
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.
Drug with vertical nystagmus
PCP
_____ intoxication = Hypertension, tachycardia, numbness or less responsive to pain, ataxia, muscle rigidity, seizures, coma. Aggression.
PCP
Ketamine
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.
ETOH: inheritance
30% with chronic ETOH have family member with chronic ETOH
ETOH sleep effects
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
indicators of ETOH use
GGT and CDT
Recreational methamphetamines: physical findings
poor dentition
skin picking and formication
Recreational methamphetamines: clinical presentation, electrolytes
euphoria, anxiety, anger, hypervigilance, and impaired judgment and functioning
Can have psychosis—paranoia
Visual hallucinations, hyperactivity, confusion and incoherence
Muscle cramps, hypoMg, and hypokalemia
GHB withdrawal:
Early signs:
Later signs;
GHB withdrawal:
Early signs:
Later signs;
More common in chronic users using every 3-4 hrs
GHB receptor
GABA-B
Methamphetamine recreational - neurotransmitter effect
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)
MDMA presentation
Disorientation then rush, euphoria, tachycardia, hypertension, hyperthermia, increased risk for seizures. Decreased appetite. Dilated pupils.
Sleep:
4 stages:
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.
What sleep abnormality in MDD:
Decreased slow wave sleep (phase 3). Increased sleep latency, decreased total sleep time. REM latency is shorter, and decreased eye movement when in REM.
Newborns sleep:
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
sleep changes in schizophrenia exacerbation
Decreased REM latency in schizophrenia exacerbation, decreased sleep time total and decreased slow wave sleep
Terminal insomnia- definition and pathology
depression; waking too early and can’t fall back to sleep
PErcent of children with somnambulism
10-30%
FDA approval for Vagus Nerve Stimulation
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
Maudsley Model:
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.
Interpersonal therapy:
Four main focus areas:
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.)
TMS location for depression
Dorsolateral prefrontal cortex
indications for TMS
Failed one SSRI at appropriate dose with ongoing sx
ECT: How long should maintenance be
6 months
erotomania, celebrity communications and. Special relationship/love through communications.
De Clerambault syndrome:
people are replaced with body double
Capgras:
feels that they are actually dead (or zombie); sometimes in severe depression
Cotard syndrome:
Eating disorder inpt admission : adults and children
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)
ADHD: prevalence and M:F ratio
abt 9% of kids in most cultures. 2:1 male to female ratio in kids, and 1.6:1 in adults.
Sensitivity:
prob that person with condition will test positive TP/TP+FN
Specificity:
prob that a person without condition will test negative TN/FP+TN
NPV:
likelihood that individual with a neg result is truest negative for condition TN/all negatives
Attributable risk:
risk of exposed group-non exposed group
PPV:
likelihood individual without a positive result has the disease. TP/All positives
Factor Analysis
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
measure of relationship b/w the change of two variables.
Covariance:
chance of result occurring by chance
P value
rejecting null when it is true (ie there is no difference and you say there is, but this was only bc of chance)
Type I error
no noted statistical significance when there should have been, keep the null but your wrong
Type II error
Denoted by study power
probability of finding the difference between two samples. It is the probability of rejecting the null hypothesis when it should be rejected.
Power
The correlation coefficient
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.
test is used for one binary predictor variable and one binary outcome variable.
χ2 Test
test is used for one binary predictor variable and one continuous outcome variable.
The T test
test used for two or more binary predictor variables and one continuous outcome variable.
ANOVA
compares one continuous predictor variable and one continuous outcome variable.
Correlation
Used to compare two or more continuous or binary variables and one continuous outcome variable.
Regression analysis
Face validity
a diagnosis is based on a general consensus among experienced clinicians and researchers.
Descriptive validity
diagnosis is based on characteristic features that distinguish it from other disorders.
Predictive validity
a diagnosis will allow clinicians to accurately predict treatment response and clinical course.
Construct validity
means that a diagnosis is based on an understanding of the underlying pathophysiology.
TADS study
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.
COMBINE trial
ETOH substance use
Naltrexone and therapy together or separate better than acamprosate
CSF in violent criminal
Lower brain serotonin turnover
5-hydroxyindoleacetic acid (5-HIAA)
Amnesia in ECT
Amnesia mostly anterograde, usually resolves in 2-4 wks. Retrograde amnesia most persistent memory adverse effect, can persist weeks to months.
How to vary dosage of ECT
Varied by time
Also can change frequency of treatment and unilateral from bilateral
Fixed ratio
: reinforcement after set number of times of behavior (one free meal every 10)
Variable ratio
: reinforcement after various amount of performed behavior (gambling, like slots)
Fixed interval:
reinforcement for bx at constant time (getting reward every 10 mins)
Variable interval
reinforcement for responses at various amounts of time (around a certain average) checking email
Variable time:
reinforcement in varied times, regardless if bx is performed.
Piaget stages of development
Sensorimotor (up to 2)
Preoperational (2-7)
Concrete operational (7-11)
Formal operational (12+)
Sensorimotor (age, major development/approach)
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.
Preoperational
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.
Concrete operational
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).
Formal Operational
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
Types of Play in (Piaget preoperational stage)
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
Margaret Mahler:
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)
- Hatching: increased interest in outside world
- Practicing (9-16 months: physical ability to separate from caregiver
- Rapprochement (15-24 months): infant explores outside world but requires mother to be present for emotional support of completing the task.
- 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.
Separation-individiation (3 stages)
- Hatching/Differentiaton (5-9 mo): increased interest in outside world
- Practicing (9-16 months: physical ability to separate from caregiver
- Rapprochement (15-24 months): infant explores outside world but requires mother to be present for emotional support of completing the task.
- 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.
Pathology in Mahler stages
Disruption in rapprochement: borderline
disruption in symbiotic: narcissistic PD
cystothianine b- synthase deficiency
Homocystinuria
Ataque de nervios
: 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.
Nervios:
ongoing illness related to stressful circumstances. Associated it’s depression, anxiety, and somatoform sx.
Susto:
Described in Mexico, Central America, South America. Believes soul has left the body in response to fearful event.
Taijin Kyofusho:
condition in Japan culture. Fear or appearance may be offensive to others. Fear of offending others lead to social avoidance.
Amok:
Malaysian. Sudden rampage including homicide and/or suicide, which ends in exhaustion and amnesia.
Koro:
Asian delusion that the penis will disappear into the abdomen and cause death. genitalia retract into abdomen
Piblokto:
female Eskimos of northern Greenland. It involves anxiety, depression, confusion, depersonalization, and derealization, ending in stuporous sleep and amnesia.
Wihtigo:
Native American Indians . Fear of being turned into a cannibal through possession by a supernatural monster, the Wihtigo.
Mal de ojo:
Mediterranean descent . Vomiting, fever, and restless sleep. It is thought to be caused by the evil eye.
Dhat syndrome
: loss of semen
