WEEK 4 Flashcards
how long to be diagnosed for persistent depressive disorder?
depressed mood with two other symptoms of depression for majority of days for at least 2 CONSECUTIVE YEARS
first line rx pyromania
CBT
how many instances of deliberate fire setting required for pyromania dx?
at least 2 (more than 1)
can’t be due to monetary gain, politics, conceal criminal activity, express anger/vengenace, to improve one’s living circumstances
needs to be due to curiosity…get tense before act and relief after act
imaging for tourette’s
reduced caudate volume (issue with cortico-striatal-thalamo-cortical circuitry)
cortical thinning in frontal and parietal lobes
which personalities inc risk for suicide?
CLUSTER B!!!, BPD the worst but don’t forget narcissistic, antisocial
rx for female orgasmic disorder
behavioral exercises like masturbation w/ kegel exercises
proposed mechanism for cluster headaches
calcitonin gene-related peptide released from tigeminal nerve which causes pain (vasodilator), subsequent parasympathetic activiation with vasodilation implicated as well
what is the only medication approved by FDA for treatment of schizoaffective d/o?
paliperidone
Mechanism fragile X
expansion of cytosine-guanine-guanine (CGG) trinucledotide repeats on FMR1 gene
GGA un intron 1 of both alleles of frataxin gene
fredreich ataxia (most common hereditary ataxia)
what should NF1 pts be screened for?
AUTISM (high association)
FDA approved medication for alcohol withdraawal that is associated with reduced risk of recurrent withdrawal symptoms/seizures
chlordiazepoxide
diazepam
LONG ACTING AGENTS better if you can
another name for essential tremor?
familial tremor (autosomal dominant)
target for DBS for essential tremor?
ventral intermediate nucleus
which substance intoxication can cause hyperacusis?
PCP
Two scales for stratifying depression symptoms severity
HAM-D (hamilton)
MADRS (Montgomery Asberg)
MADRS < 7?
normal range, no depression
MADRS > 35?
Severe depression
How long to fear something to meet criteria for specific phobia?
6 months
difference between aripiprazole and risperidoen @ dopamine receptor?
Abilify - partial agonist
Risperdal - antagonist
treatment to reduce apneic episodes in central sleep apnea?
oxygen therapy
delusion where you’re convinced something awful/catastrophic might happen
nihilistic
pt with MDD only wanting psychotherapy; how long to determine “adequate trial” of psychotherapy?
8-16 weeks to see a response
(wait 8 weeks)
Which has greater risk for precipitating mania (SSRIs or SNRIs)
SNRIs
14-3-3 protein in CSF?
CKJD
med for rapid eye movement disorder in pt with LBD?
memantine
PTSD with dissociative symptoms = what to risk of suicide?
increase!!! compared to without dissociative
1st line therapy for specific phobia?
exposure based therapy (type of CBT)
incidence vs prevalence
incidence = rate of NEW CASES of a disease occuring in specific population over particular period of time
prevalance = the NUMBER OF CASES of a disease in a specific population at a particular time point (point prevalance) or period of time (period prevalence)
# cases at one time / total population at same point in time
Which CN is affected by increased ICP from psedutumor cerebri and what is effect?
CN VI (abducens)
Double vision ensues
if doing association or correlational studies to match stressors with symptom clusters, what are you trying to increase?
SPECIFICITY
gorssly normal psychomotor development in first 6 months followed by period of regression
Rett’s syndrome
gait abnormalities, partial/complete loss of language, sterotypic hand movements, loss of hand skills; infant
Rett syndrome (x-linked)
decelerated head growth can happen but not required for dx
how to clarify whether a learning disability is present that is interfering with learning particular subject?
psychoeducational testing/intelligence and achievement testing
never use continuous performance testing for ADHD
environmental exposures assocaited with Parkinson’s?
herbicide/pesticide
sensitivity formula
TP / (TP + FN)
specificity formula
TN / (TN + FP)
PPV formula
true positive / all the positives
TP / (TP+ FP)
Negative predictive value formula
true negative / all the negatives
TN / (FN + TN)
utility of mannitol
lowers ICP; good for subdural hematoma)
mechanism lurasidone
blocks both dopamine and serotonin receptors
2nd line phrmacotherapy for MG
immunomdulating medications azathioprine, mycophenolate, cyclosporine
use only if pyridostigmine (ACHE inhibitor) and steroids ineffective
typical age of onset for persistent depressive disorder (dysthymia)
EARLY
(childhood, adolescence, early adulthood)
earliest time that clinical anxiety and depressive disorders can arise?
3 years old
irreversible severe antero+retrograde amnesia, confabulation, lack of insight, apathy
Korsakoff syndrome (untreated Wernicke’s encephalopathy, didn’t get thiamine)
injury in Korsakoff syndrome location
anterior nuclei of thalamus
how to optimize external validity?
random selection from population of interest
When to complete M-CHAT for autism?
16-30 months (less than 3 yo)
therapy for encopresis?
BEHAVIORAL THERAPY
laxatives
when to diagnosis learning disorder?
ONLY AFTER formal education has begun
gender difference in prevlance of bipolar disorder
equal between men and women
what are good prognostic factors for schizophrenia/schizophreniform?
- CONFUSION OR PERPLEXITY
- onset of symptoms within 4 weeks of noticeable change in behavior/functionig
- normal range of affect
- good pre morbid functioning
effectiveness of SSRIs in specific phobia?
mixed evidence, conflicting
difference in eating between binge-eating disorder and Prader willi
binge eating - distinct episodes of uncontrolled eating, loss of control, distress
Prader Willi - PERSISTENT overeating
dopamine and glutamate in delirium?
INCREASED
which hormone can be used to decrease inflammation and reduce brain swelling?
estrogen
crescent shaped collection on CT that crosses cranial sutures but not midline
subdural
convex, lense shaped pattern on non contrast CT 2/2 skull fracture
epidural hematoma
typical mechanism of injury in subdural hematomas
shearing force that results in tearing of bridging veins leading to subdural hematoma
Commonly inmvolved artery in epidural hematoma
middle meningeal artery (usu. torn by fractured temporal bone)
thunderclap headache, sudden onset, photphobia/nausea
subarachnoid hemhorrage;
more risk with berry aneurysms/vascular malformations
two types of therapy for binge eating disorder
CBT
INTERPERSONAL PSYCHOTHERAPY
most specific tool for diagnosis PTSD
clinician administered PTSD scale (CAPS-5)
FDA approvals for MDD in over 8 and over 12?
over 8 - prozac
over 12 - prozac, lexapro
difference between IED and DMDD
IED - episodes of outbursts
DMDD - PERSISTENT irritability or angry mood
receptor involved in pimavanserin?
serotonin receptors
(inverse agonist and antagonist at 5ht2a receptors)
why is pimavanserin useful in Parkinson’s psychosis
parkinsons = loss of serotonin neurons leads to upregulation of 5ht2a eceptors causing excessive stimulation of receptors leading to psychosis….pimavanserin blocks these excessively stimulated 5ht2a receptors and decreases psychotic symptoms
which neurotransmitter system implicated in ADHD?
noradrenargic
tract involved in OCD
cortico-striato-thalama-cortical circtui (CSTC)
mechanism atmoxetine
selective NE reuptake inhibition
circadian rhythm sleep wake, advanced sleep phase
sleeping TWO OHOURS EARLIER and waking TWO HOURS EARLIER
most common chromosomal cause of ID
Down syndrome
(fragile x is most INHERITED cause of ID)
size of prefrontal cortex in schizophrenia patients?
reduced, smaller
when is the earliest you can get trauma focused CBT for PTSD?
6 yo
how long symptoms needed to dx ODD? conduct?
6 months for ODD
1 year for conduct disorder
which atypical needs dose increase in cigarette smoking?
olanzapine
melatonin agonist helpful in sleep wake cycle disorder
ramelteon
mechanism Fabry disease
deficincy in lysosomal enzyme alpha-galactosidase A
dopamine pathway responsible for positive symptoms
mesoLIMBIC (omggg did i grow another limb?!?!)
dopamine pathway for negative symptoms
mesocortical
location of episodic memory
MEDIAL TEMPORAL LOBES (hippocampus, entorhinal cortex, perihinal cortex, parahippocampal cortex)
how to dx mitochondrial myopathy?
subsarcolemmal accumulation of mitochondria on Gomori trichome stain of muscle biopsy
muscle biopsy shows antisynthetase antibodies…dx?
polymyositis
what part damaged in frontotemporal dementia?
frontal lobes (fronto insular region, ANTERIOR temporal lobes, ANTERIOR cingulate and cingulate cortex
which antidepressant liquid formulation (non tablet) contains alcohol and contraindicated with disulfiram?
sertraline
what is partialism?
sexual arousal from NONGENITAL body part (hair, feet, toes); seen in fetish disorder
symptoms of Bell’s palsy
decreased tearing, hyperacusis, decreased taste sensation of anterior 2/3rds of tongue, acute onset one-sided facial weakness involving BOTH UPPER AND LOWER part of face; can also have BELL PHENOMENON (eye tursn up vertically when attempts to close eye on paralyzed side of face)
besides amyloid beta plaques and neurofib tangles, what other things can be found in Alz?
LEWY BODIES
FDA approved med for seasonal affective d/o
buproprion (dual norepi/dopamine reuptake inhibition)
lab markers for ongoing alcohol use or to assess for abstinence? also good to identify chronic alcohol use disorder
CDT (carbohydrate-deficient transferrin)
GGT (gamma glutamyl transferase)
ethyl glucoronide (heavy alcohol use within past 5 days; helpful for relapse)
mode of inheritance Wilson/s dx?
autosomal recessive
what does kappa statistic measure?
test-retest reliability, inter-rater reliability, and intra-rater reliability are most commonly measured by the Cohen kappa statistic. Reliability refers to the degree that two measurements agree with each other.
timeline for Persistent complex bereavement disorder (how long after loved one passes away)
at least 12 months
what kind of study reports prevalence or incidence of disease at a specific point or period of time and may also report associated factors such as demographics, exposures, and risk factors
cross sectional study
what kind of study is retrospective
case control (starts with disease and people without disease, retrospects to see who had risk factor)
first line treatment for acute mania in adolescents
olanzapine (or atypical like risperidone)
What medication may improve cognitive function and apathy in patients who have major neurocognitive disorder with Lewy bodies?
rivastigmine
contraindications stimulant
EATING DISRODER
contraindications stimulant
EATING DISRODER
What antidepressant may be less likely to precipitate hypomanic or manic symptoms?
which is a norepinephrine and dopamine reuptake inhibitor.
how to tell prion disease from other major NCDs?
insidious and RAPID ONSET
MOTOR deficits including ataxia/myoclonus
timeline for partial and sustained remission for tobacco use disorder
partial - no symptoms in 3 months
sustained - no symptoms in 12 months
difference in criteria for MDD and persistent depressive (dysthymia)
MDD = 2 weeks 5 symptoms
dysthymia = 2 years persistent symptoms, does not usually reach 5 SIGECAPS
hallucinogen persisting perception disorder (i.e. after LSD)
high potency benzo like CLONAZEPAM
which stage theta waves? (sleep)
N1
not accomplishing initiative vs guilt stage can result in what?
inhibition, phobia, or psychosomatic symptoms and conversion disorder
anxiety does what to medial prefrontal cortex
decreased activity
stimulation of medial prefrontal cortex does what to fear response?
diminishes; also reduces anxiety
Kluver-Bucy syndrome results from lesions to what area?
bilateral amygdala
where does jacksonian march affeect?
distal limb all the way to ipsilateral face (on same side as injury to primary motor cortex)
body integrity identity disorder vs body dysmorphic
body integrity - would rather live without ear
body dysmorphic - don’t like how my ear works, i’d rather have another hear
friedrich ataxia gene
9, trinucleotide repeat GAA
CSF guillan barre
elevaed protein, normal WBC (cytoalbuminologic dissociation)
NMS without muscle rigidity or tremors what can cause
clozapine (atypical NMS)
tetrabenazine
insomnia, akathisa,
hypersomnia, always eating (hyperphagia), irritbaility, loss of sexual inhibitions
Klein Levin syndrome (resolves itself)
mechanism grave’s disease
stimulation of thyroid gland but autobodies to thyrotropin receptor = inc secretion of T4, T3
blepharospasm (blinking), mouth jerking, almost TD like
Meige’s syndrome; rx with botulinum toxin
rx TMJ
mouth guard/splint alignment
three alpha saynuclein opathies
LBD
parkinson’s
multiple system atrophy
klismaphilia
sexual arousal from enema
when a patient feels that they are dead or a zombie (severely depressed)
cotard syndrome
belief is soul is gone after being frightened
susto
psychological distress after losing semen
dhat syndrome
in vivo CKJD, (not eating cow), what chromosome?
short arm chromosome 20
what causes denaturing during spongiform enceph
alpha helix turning into beta sheets
de clarambault syndrome
erotomania
triad of Horner’s syndrome
miosis
anhydrosis
ptosis
weird words but intact intonation and rhythm
wernicke’s aphasia
raaaaare side effect mirtazapine
agranulocytosis
Internuclear ophthalmoplegia is associated with a lesion in which anatomical site
MLF (medial longitudinal fasciculus)
personality disorder with temporal lobe abnoramility, difference corpus collosum
schizotypal
PET scan during and after a seizure (post ictal)
during - metabolism increased, will light up
after (post ictal) - low metabolism of glucose at origin of seizure
antipsychotics most likely to cause seizure
chlorpromazine
clozapine
relational model, relationships are central to life
Miller
interpersonal psychology, focus on relationships rather than drive
Sullivan (Harry
object relations theory, paranoid schizoid (all good or all bed), depressed position (ambivalent towards mom)
Melanie klein
who termed hysteria/anti woman
Breuer and Freud
4 As of schizophrenia, theorist
Bueler
who coined term schizophrenia
Bueller (blew bugle with name of schizophrenia)
Kraeplin terms
dementia praecox
bipolar
4 As of Bueler
loosening Associations
blunted Affect
Ambivalence
Autism (loss of awareness of external events, preoccupation with internal thoughts)
who coined first break symptoms of schizohprenia
Snyder (1st Rank nazi)
genetic diad theorist (genetics and environment play a role, nature nurture)
Adolf Meyer
H A R P syndrome
congenital issue causing neurology
which serotonin receptor upregulation causes sexual side effects
5HT2A (2A bad for sex)
Why does mirtazapine good for sexual side effects
blocks 5ht2a
yohimbe good for what not so good for what
good for sexual side effects but bad for anxiety (ANXIOGENIC)
pure motor hemiparesis; location lesion?
internal capsule
receptor assocaited with constipation, blurred vision, dry mouth, drowsiness
M1 / muscarininc
L hemiballismus, location of lesion?
RIGHT/CONTRALATERAL subthal nucleus
what are the sex biogenic amine NTs?
dopamine
epinephrine
norepi
ach
histamine
serotonin
what structure mediates drainage of CSF into blood?
arachnoid granules
what is a duct for substances in subarachnoid space to enter brain?
virchow-robin
method of predicting value of one varibale in relation to another variable?
regression analysis
personality/cognitive changes in child , myoclonic seizures, chorea, leading to coma and death; rare complication of what disease
subacute sclerosing panencephaliits (SSPE)
rare severe complication of MEASLES
deficiency in hypoxanthine-guanine phosphoribosyltransferace
Lesch-Nyhan (hyperuricemia)
deficiency in hexosaminidase A
Tay Sachs (AR, chromosome 15)
deficiency in lysosomal enzyme galactocerbroside B galactosidase
Krabbe disease
deficiency in B-glucosidase, chromosome 1
Gaucher’s disease
