WEEK 3 Flashcards by Christian Bernardo

what is responsible for extinction of automatic protective or defensive response to non threatening conditioned stimuli associated with threat (or in PTSD)

pre frontal cortex

exerts inhibitiory control over amygdala

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which developmental age can reactive attachment disorder be diagnosed?

at least 9 months

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MSE findings for LBD

deficits in attention (fluctuating cognition)

bradykinesia, cogwheel rigidity (parkinsonism)

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what is usually comorbid with social (pragmatic) communication disorder?

ADHD

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in narcolepsy, what can be used to decrease frequency of cataplexy?

venlafaxine (and other SNRI.antideperessants since they suppress REM)

(modafinil and methylphen increase wakefulness but don’t effect cataplexY)

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diagnostic test for neurosyphilis

treponema pallidum particle agglutination assay and fluorescent treponemal antibody absorption (FTA-ABS)

RPR and VDRL tests are SCREENING

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what to use to help to alleviate symptoms of benzo withdrawal?

carbamazepine/valproate

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rumination disorder

Repeated regurgitation of food for one month or longer

under feeding and eating disorders

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vitamin b3 (niacin) deficiency

pellagra - dermatitis, diarrhea, dementia

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which serotonin receptor antagonist has potential for life threatening hepatic failure

nefazodone (withdrawn from some markets)

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what test to do if concerned about conversion disorder in someone with lower extremity weakness (hips and toes)

Hoover’s sign - hip extensor weakness that returns to strength on contralateral hip flexion

toes - plantar flexion weakness on physical exam yet are able to use tip toes

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difference between internal and external validity

internal validity - needs good experimental design to study desired population

external validity - needs to be GENERALIZABLE TO GENERAL POPULATION and not just population in study

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median age of onset GAD

30 yo

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which atypical does not effect qtc?

lurasidone

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medication for chorea from Huntington’s

tetrabenazine/deutetrabenazine

antipsychotics can be used sometimes too

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huntington gene location

chromosome 4p (autosomia ldominant CAG trinucleotide repeat)

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what lab to get if suspect pica?

iron level (can also do zinc)

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degree that individual factors combined toether results in measuring a REAL disorder

construct validity

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comparing validity to another instrument or measure that has presumed validity

criterion validity

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degree to which individual items in a measurement are related to the disorder being measured

CONTENT validity

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therapy for conduct disorder

multiysystemic therapy with parent, teach,er legal, etc (i.e. parent management training)

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what does brain look like in ASD?

larger brain size due to increase in white matter (causes issues with brain connectivity)

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EEG in REM?

alpha waves and saw tooth pattern

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sleep stages?

NREM (N1, N2, N3) then REM

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theta waves and vertex sharp waves on polysom; stage?

theta waves with k complexes and sleep spindles, stage?

delta waves and high ampitude slow waves on polysom

usual time to get to REM?

90 mins; so if you have decreased REM latency this can indicate MDD

REM sleep in depression

decreased latency to REM <90 min, increased percentage of sleep is REM

antidepressants to REM sleep?

decrase amount of REM sleep = more restful sleep

benzo use disorder does what to sleep?

- reduced REM latency | - disruption to normal sleep, (inc N2, increased sleep spindles, and intrusion of sleep spindles into REM)

Alzheimer's to sleep?

- less N2 sleep | - more poorly formed sleep spindles and K complexes

what stage to patients with sleep terrors usually awakeN?

first third of night during NON REM (pts can't remember these whcih makes sense since you can sometimes remember REM)

polysom in sleep terror

slow waves characteristic of N3, during terror EEG bcomes ambiguous

EPISODIC periods of hypersomnolence (difficult to waken) + cognitive abnormalities (memory disturbances, deralization, apathy, altered eating behaviors, hypersexuality)

Kleine Levin syndrome

metabolic side effect VPA

metabolic acidosis

preventive meds for cluster headaches

verapamil, lithium, methysergide, steroids

what to use in ACUTE attack of cluster headache

oxygen rebreather/sumatriptan

migraine preventitive meds

antihypertensives (BBs) anticonvulstants (topiramte, VPA) TCAs (amitriptyline/nortriptyline)

1st and 2nd line rx restless legs

1st - ropinorole | 2nd - gabapentin/pregalb

best option to treat ACUTE depression in bipolar II (most evidencec)

quetiapine

what can decrease anxiety and depressive symptoms in anorexia?

weight restoration

two highest hierarchy of evidence?

1. meta-analysis (multiple RCTs) | 2. systematic review (summarizes all research with rigorous/predefined search method)

what is also called longitudinal study (followed over time)

cohort study

patient with chorea...infection?

Group A strep (sydenham chorea)

mechanism modafinil

NON-amphetamine wakefulness agent | increases dopamine int he brain

where is hypocretin-1/orexin-A produced

lateral hypothalamus

man gets muscle spasms, stiffness, rigidity triggered by stress/being touched/sudden movement/noise; dx and rx

stiff person/stiff man syndrome rx with Diazepam can also adding bacolfen, or IVIG, ritux

DID with comorbid OCD, rx?

SSRIs

age window to diagnosis DMDD

6-18 yo (school age to before adulthood)

pharmacologic treatment for REM sleep behavior disorder

benzo

most common anxiety disorder in children under 12

separation anxiety

relationships more intimate than they are in reality, overly dramatic, displaying rapidly shifting/shallow emotions

histrionic personality d/o

1st line treatment binge eating disorder

CBT!!!! then lisdexamfetamine is FDA approved

how long without symptoms is considered to be in "full remission" after bipolar disorder

2 months without ANY SYMPTOMS if you are below 2 months without any symptoms or symptoms don't meet criteria for full episode that is PARTIAL remission

more than half of patients with bipolar disorder meet criteria for whcih substance use disorder?

alcohol use d/o

eye involvement in MG

asymmetric; diplopia and ptosis in all other skeletal groups in MG it is symmetric (weird)

What's good to check after starting clozapine within initial 6-8 weeks? besides ANC

troponins and CRP levels

threshold ANC for clozapine initiation

greater than 1,500 microliter (1.5) in benign ethnic neutropenia its 1,000

stuttering aka

childhood-onset fluency d/o

viral causes of congenital hearing loss

CMV, rubella, lymphocytic choriomengitis virus

happy disposition, paroxysymal laughter, ataxia, moderate to severe ID

angelman

which syndrome is recognized phenotype of fragile X?

Prader Willi

long narrow face, prominent ears, enlarged testicles adolescent boy

fragile X

FMR 1 gene mutation

fragile x (x-linked)

sertraline CYP substrate

3A4

two examples of strong 3a4 inducers

Carbamazepine and Phenobarbital "carb and barb"

example of strong 2d6 inhibitors

Buproprion, Fluoxetine, Paroxetine "Big, Freakin, Problems"

interactions between valproate and lamotrigine

Val-hal-la when using VALproate be sure to HALf the dose of LAmotrigine VPA has some inhibitor effect causing higher levels of lamotrigine (risks SJS)

drug drug cigarette, which metbaolizer

1A2, always ask for smoking history

St john's wort

strong 3a4 inducer

which psych drugs are renally metabolized

Gabapentin, acamprosate, litihum GAL

adverse effect of alphla-methyldopa

depression

weird day timefeature of hypersomnolence

AUTOMATIC BEHAVIOR | performs routine behavior such as driving a car without recall of activity after a certain time

atmoxetine better for inattention or hyperactivity?

inattention

mechanism PMDD

- higher sensitivity to proge/estrogen levels | - rapid decline in progesterone level during luteal phase

What is elevated in luteal phase for patients with DMDD

BDNF

What antihypertensive commonly used in patients who are pregnant may cause depressive symptoms as an adverse effect?

alpha-methyldopa

what organism good for prevention of migraines

botulinim toxin A

what is often co-occuring with Prader Willi

OCD

brain finding in schizophrenia

enlarged ventricles (lateral and 3rd ventricles)

SNRI effective in preveenting migraines

Venlafaxine

what study used in DSM III determined prevalance rates of psych disorders and comorbidity of substance use

NCS National Comobidity Survey

treatment for BPD that's psychodynamic + CBT

mentalizationb based therapy

how long must adult patient demonstrate hypomanic and depressive symptoms (but not meet criteria for episode) to be dx with cyclothymic?

2 years

most common cause of Bell's palsy' | pregnancy next

herpes SIMPLEX activation