WEEK 3 Flashcards
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
which developmental age can reactive attachment disorder be diagnosed?
at least 9 months
MSE findings for LBD
deficits in attention (fluctuating cognition)
bradykinesia, cogwheel rigidity (parkinsonism)
what is usually comorbid with social (pragmatic) communication disorder?
ADHD
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)
diagnostic test for neurosyphilis
treponema pallidum particle agglutination assay and fluorescent treponemal antibody absorption (FTA-ABS)
RPR and VDRL tests are SCREENING
what to use to help to alleviate symptoms of benzo withdrawal?
carbamazepine/valproate
rumination disorder
Repeated regurgitation of food for one month or longer
under feeding and eating disorders
vitamin b3 (niacin) deficiency
pellagra - dermatitis, diarrhea, dementia
which serotonin receptor antagonist has potential for life threatening hepatic failure
nefazodone (withdrawn from some markets)
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
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
median age of onset GAD
30 yo
which atypical does not effect qtc?
lurasidone
medication for chorea from Huntington’s
tetrabenazine/deutetrabenazine
antipsychotics can be used sometimes too
huntington gene location
chromosome 4p (autosomia ldominant CAG trinucleotide repeat)
what lab to get if suspect pica?
iron level (can also do zinc)
degree that individual factors combined toether results in measuring a REAL disorder
construct validity
comparing validity to another instrument or measure that has presumed validity
criterion validity
degree to which individual items in a measurement are related to the disorder being measured
CONTENT validity
therapy for conduct disorder
multiysystemic therapy with parent, teach,er legal, etc (i.e. parent management training)
what does brain look like in ASD?
larger brain size due to increase in white matter (causes issues with brain connectivity)
EEG in REM?
alpha waves and saw tooth pattern
sleep stages?
NREM (N1, N2, N3) then REM
theta waves and vertex sharp waves on polysom; stage?
n1
theta waves with k complexes and sleep spindles, stage?
N2
delta waves and high ampitude slow waves on polysom
N3
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?
- 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
