Behavioral Flashcards

Question

Diagnosis of Anxiety (3)

Answer 1

1. Be persistent (generally \>6 months) * shorter periods for children 2. Interfere with normal functioning (work, job, marriage, etc...) 3. Cause significant stress

Answer 2

1. Excessive anxiety/worry, occurring more days than nor for ≥ 6 months, 2. Difficult to control worry 3. associated with ≥ 3 of the following symptoms * restlessness * easily fatigued * difficulty concentration * irritability * muscle tension * sleep disturbance 4. causes significant impairment 5. No other explanation for symptoms (physical, chemical, or mental)

Answer 3

The front line treatment for a lot of anxiety disorders. Most evidence based mode of treatment Use of congitive (thinking) and mental techniques as a mode of therapy to basically essentially remove the mind from a current state. Examples: * statistical mental analysis * guided imagery Behavioral techniques * deep breathing * mediatation * self-hypnosis

Answer 4

Cognitive * statistical mental analysis * guided imagery Behavioral techniques * deep breathing * mediatation * self-hypnosis

Answer 5

SSRIs and some SNRIs Increases in SR or NE or both downregulates or desensitizes receptors SSRI - Citalopram/Paroxetine SNRI - venlafaxine / Duloxetine

Answer 6

Increases 5HT and NE or both which downregulates/desensitizes receptors Put so much 5HT/NE into the patient's system that when they do have an anxiety attack, their brain doesn't really see it as much due to the desensitization

Answer 7

1. Antidepressants - SSRIs/SNRIs front line treatment * SSRI - esCitalopram, Paroxetine * SNRIs - Venlafaxine, Duloxetine * Increases 5HT/NE to downregulate/desensitize receptors * Weight gain and sexual side effects 2. Buspirone (5HT1a receptor agonist) * initially lowers 5HT activity as these auto receptors (5HT1a are autoreceptors that downregulate 5HT activity). However overtime, the stimulate of these receptors causes their degradation and ultimately increase 5HT output. * less sexual and weight gain side effects than SSRI/SNRIs * ONLY FDA approved for GAD, nothing else 3. Benzodiazepines (GABA-A receptor modulator -- allows more Cl- channels to open) * 2nd line due to risk of addiction, falls, apnea

Answer 8

* Buspirone (5HT1a receptor agonist) * **Mechanism**: initially lowers 5HT activity as these auto receptors (5HT1a are autoreceptors that downregulate 5HT activity). However overtime, the stimulate of these receptors causes their degradation and ultimately increase 5HT output. * less sexual and weight gain side effects than SSRI/SNRIs

Answer 9

Only performance anxiety. Not used to treat generalized anxiety

Answer 10

1. An **abrupt** surge of intense fear or discomfort, peaks within minutes, that is **unexpected** with ≥ 4 of the following: * palpitations, pounding heart, or accelerated HR * sweating * shaking/trembling * sensation of SOB or smothering * choking feeling * chest pain/discomfort * nausea * dissiness, lightheadedness or fainting * chills or heat * parasthesias * derealization * fear of losing control * fear of dying 2. Recurrent panic attacks 3. ≥ 1 attack followed by ≥ 1 month of ≥ 1 of the following 1. concern about additional panic attacks or consequences 2. significant maladaptive change in behavior related to attacks (typically phobic avoidance --agoraphobia) 4. No other explanations for symptoms (physical, chemical, mental)

Answer 11

An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected with ≥ 4 of the following: * palpitations, pounding heart, or accelerated HR * sweating * shaking/trembling * sensation of SOB or smothering * choking feeling * chest pain/discomfort * nausea * dissiness, lightheadedness or fainting * chills or heat * parasthesias * derealization * fear of losing control * fear of dying

Answer 12

Fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line or being in a crowd. Highly associated with panic disorders/attacks but may be caused by other things

Answer 13

Chronic and recurring increased risk of depression and suicide

Answer 14

1.5-3.5% prevalencein general population Females \> males

Answer 15

Therapy * Cognitive behavioral therapy * **Systemic desensitization**(step by step progression to doing the thing you fear the most) or **flooding** (immerse the person in the environment they fear the most and basically overflood their senses and eventually fine) * Psychodynamic therapy Medication * emergency treatment: fast-acting benzodiazepines (alprazolam) * Long term 1st line: SSRI/SNRI * Intermediate or long acting benzos (not 1st line. 2nd due to addiction potential) Combination treatment

Answer 16

* Systemic desensitization - step by step progression to doing the thing you fear the most * Flooding - immersion of the person in the environment they fear the most and basically overflood their senses and eventually fine A type of cognitive behavioral treatment. (used in panic disorders, although not common)

Answer 17

A type of social anxiety. Technically called "social anxiety - performance type" ONLY associated with performances and the anxiety that develops in any relationship to performances. fear is restricted to public speaking or performing and does not generalize to other social aspects of life

Answer 18

Diagnostic criteria (DSM-V) * ≥ 6 months * causes significant impairment * marked fear/anxiety about a specific object/situation * object/situation almost always provokes fear/anxiety * actively avoids object/situation * fear/anxiety out of proportion to actual danger * no other explanation for symptoms Types of specific phobias: * couirophobia - fear of clowns * ophidiophobia - fear of snakes * aerophobia - fear of airplanes * iatrophobia - fear of going to the doctor * etc...

Answer 19

Also referred to as Social phobia (same diagnostic criteria as specific phobia but for socialization purposes) * ≥ 6 months * causes significant impairment * marked fear/anxiety about a specific object/situation * object/situation almost always provokes fear/anxiety * actively avoids object/situation * fear/anxiety out of proportion to actual danger * no other explanation for symptoms Performance only - fear is restricted to public speaking or performing and does not generalize to other social aspects of life

Answer 20

Therapy (1st line): flooding, systemic desensitization (CBT) Medication: sedatives such as benzos (especially if it is a one time thing/exposure)

Answer 21

Therapy: CBT, assertiveness, training, group therapy Medication * SSRI/SNRI (1st line): paroxetine / venlafaxine * MAOI: Phenetzine, tranylcypromine * ß blockers (propranolol) - 1st line for performance only

Answer 22

**_Criterion A:_** The presence of obsessions and compulsions **_Criterion B:_** These obsessions and compulsions must be either 1. **Time consuming** (\>1hr/day) or 2. Cause clinically **significant distress** *{Either 1 or 2 from Criterion B}* 1. Are not substance-induced 2. Not better explained as symptoms of another mental or medical disorder

Answer 23

_Recurrent_/_persistent_ thoughts, urges, and/or images _Intrusive_ & _unwanted_ * sometimes called ego dystonic (means person recognizes it is wrong and doesn't want to do it) * cause the person anxiety/distress Patient treis to ignore/supress these intrusive thoughts OR they try to neutralize them with a thought or _action_ * this is an undoing ego defense mechanism * a compulsion to do something to reduce the anxiety/distress

Answer 24

Repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that must be strictly adhered to. * A compulsion typically undoes or reduces anxiety (typically an obession) * stopping the compulsion often dramatically increases anxiety

Answer 25

of or relating to aspects of one's behavior or attitudes viewed as inconsistent with one's fundamental beliefs and personality (contrasted with ego-syntonic )

Answer 26

a term referring to behaviors, values, and feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image.

Answer 27

Men & women _equally_ affected Lifetime prevalence: 2-3% 50-70% have onset after a stressful event Mean onset: Men = 19 years / Women = 22 years

Answer 28

Long, but variable course 20-30% have significant improvement 40-50% have moderate improvement 20-40% remain ill or worsen Likely the hardest anxiety to treat

Answer 29

Psychotherapy * CBT: as effective as pharmacotherapy, with longer-lasting effecting * Exposure and response prevention (ERP) - basically step by step controlled exposure to withhold the compulsion, a desensitization protocol * ACT: Acceptance and commitment Therapy for obsessions - putting the image in their head of their compulsion. So a controlled method of basically desensitization to the obsession. * Supportive Psychotherapy? Dynamic Psychotherapy Pharmacotherapy (best results when + psychotherapy) * 1st line: SSRIs, higher-dosage and duration than MDD (major depressive disorder) * 2nd line: clomipramine (a TCA, approved for OCD) * 3rd line: antipsychotics, other antidepressants * Benzodiapeine sedatives do not work.

Answer 30

a step by step controlled exposure to withhold the compulsion, a desensitization protocol. Used in the treatment for OCD

Answer 31

putting the image in their head of their obsession. If it is fear of the death of her family, keep talking to her about the death of her family and conjure images of it in her head until the point that the idea is desensitized. Basically desensitization to the point where the patient no longer cares or just accepts it for what it is and does not have any more compulsions for that obsession Used in treatment for OCD

Answer 32

Clomipramine - a tricyclic antidepressant (TCA) - selective serotonin reuptake inhibitor (200x stronger affinity than for NE) Also has antagonistic properties at the histamine H1 receptor, **muscarinic ACh receptors** and α₁ adrenergic receptor * difference between SSRIs and TCAs is the anti-cholinergic properties --\> dry mouth, blurred vision, tachycardia, constipation * very hard for patients to stay on these drugs due to side effects

Answer 33

Death of a loved one

Answer 34

1. Proximity 2. Harm by another human 3. severity 4. repetition

Answer 35

**_Criterion A_** Exposure to actual or threatened traumatic event: * death * serious injury * sexual violence 1. Symptoms must be present for **\> 1 month** 2. Symptoms must cause significant **distress/impairment** 3. Symptoms must not be the result of a substance or other medical condition **_Criterion B_** ≥ 1 "Intrusion Symptom" associated with event * Reliving of events * distressing memories of the event * distressing dream/nightmares related ot the event * dissocative reaction during which the patient feels and/or acts as if events are recurring (flashbacks) **_Criterion C_** **Avoidance** of stimuli associated with tramuatic event * avoid memories/thoughts/feelings about or associated with event * avoid external reminders (people/places/situations) that may arouse such memories, thoughts or feelings * avoid interpersonal connectivity - estrangement, lack of commitment, unwilling to settle down, reclusiveness **_Criterion D_** Negative changes in cognition and mood associated with event (≥ 2 of the following) * inability to remember an important part of the event, due to **dissociative amnesia or repression** * presistent, **exaggerated** beliefs/expectations of oneslef, others, or the world (ie paranoid stance) * distortion of thoughts/memories of the event, causing the individual to **blame** themselves/others * persistently **negative emotional state** * **decreased interest** in participating in daily activities * feeling of **detachment** from others * **inability** to experience **positive emotions** **_Criterion E_** alterations in arousal/reactivity (≥ 2 of the following) * irritable behavior/angry outbursts, expressed as verbal or physical aggression towards other people/objects * reckless/self-destructive behavior * hypervigilance * exaggerated startle response * problems with concentration * sleep disturbances

Answer 36

Exposure of death, serious injury, or sexual violence must have occured in one of the following ways 1. **Directly** experiencing event(s) 2. **Witnessing** event(s) as occured to others 3. **Learning** that a family member/friend experience such an event 4. Directly experiencing **repeated**/extreme exposure to **horrific details** of an event

Answer 37

Basically early PTSD Key is the timeframe. PTSD Only difference: Criteria B-D must persist for 3days - 1 month after exposure (vs \>1 month for PTSD) Earlier treatment can decrease the risk of full PTSD onset

Answer 38

Must be exposed to life-threatening or potentially fatal situation 5 categories of symptoms must be present 1. Re-experiencing the event (dreams, flashbacks, etc...) 2. Avoidance (of thoughts, feelings, memories, people, etc...) 3. Dissociative symptoms (Dissociative amnesia, time slowing, etc...) 4. Negative mood 5. Changes in arousal (Hyper-arousal, hypervigilance, sleep changes, decreased concentration, etc...) ASD: Symptoms present **3 days to 1 month** after exposure PTSD: Symptoms present **\>1 month** after exposure

Answer 39

Lifetime prevalence * PTSD - 8% * ASD - 5-15% Women \> men

Answer 40

Psychotherapy: * Initial support, grounding, validation of feelings * Relive event vs seal over and move on (as in other disorders) Pharmacotherapy * 1st line: SSRIs * 2nd line: TCAs (Amitryptyline & Imipramine), atypical antipsychotics * 3rd: MAOi, trazodone, anticonvulsants, clonidine, propanolol Prazosin (α₁ inhibitor) for nightmares

Answer 41

- sleep disorder characterized by problems in timing, quality, or amount of sleep examples: insomnia, sleep apnea, narcolepsy

Answer 42

- sleep disorder characterized by abnormalities in physiology or behavior associated with sleep examples: Bruxism, nightmare disorder, sleep terror disorder, sleepwalking disorder

Answer 43

1. Complaint of dissatisfaction with sleep quantity or quality associated with at least one of the following symptoms * difficulty initating sleep * difficulty maintaining sleep * early-morning awakening with inability to return to sleep 2. Sleep disturbance causes distress or impairment in social, occupation, educational, academic, behavioral, or other important areas of functioning 3. Disturbance occurs at least 3 nights/week and for \>3 months 4. Not attributable to other substances or disorders

Answer 44

* Norepinephrine from the locus ceruleus (keeps you awake, alert via frontal lobe stimulation) * Serotonin from the raphe nucleus (pushes you into lighter sleep) * Dopamine from the ventral tegmental area * Histamine from the tuberomammillary nucleus

Answer 45

* Loss GABA tone * Loss of melatonergic tone * Loss of adenosinergic tone

Answer 46

Patients have a crystallized, often single delusion They do not have hallucinations or thought disorder like schizophrenia They often have normal lives delusions cannot be substance induced or due to another disease

Answer 47

imposter delusion Delusion where pt feels like someone has been replaced by an imposter

Answer 48

Delusion belief that different people are in fact a single person who changes appearance or is in disguise.

Answer 49

Delusion that one is a vampire

Answer 50

the delusion that one is a werewolf

Answer 51

syndrome in which symptosm of a delusion is transmitted to another Foli imposee - likely has the delusion Folie simultanee - incorporates delusion into his/her life

Answer 52

a rare mental illness, in which an afflicted person holds the delusion that they are dead, either figuratively or literally. Typically occurs with another disease, but can occur by itself.

Answer 53

Heroin-like drug that rots flesh and bone Drug is injected into a user's tissue can turn the skin scaly and green like a crocodile. Festering sores, abscesses and blood poisoning are often seen among users.

Answer 54

aka delusional parasitosis patient believes they are infested, can see and often see or feel parasites in or on them

Answer 55

aka morgellons patient believes they are infested, can see and often see or feel parasites in or on them

Answer 56

type of delusion in which the affected person believes that another person, usually a stranger, high-status or famous person, is in love with him or her Ilness often occurs during psychosis, especially in patients with schizophrenia, delusional disorder or bipolar mania treatment * these are psychotic conditions w/ the assumption that there is too much mesolimbic dopamine activity similar to schizophrenia * antipsychotics are sometimes effective, but often times not * psychotherapy may help patients cope, lower anxiety or agitation * be non-judgemental, nonincredulous, nonchallenging, empathic, facilitate communication

Answer 57

* these are psychotic conditions w/ the assumption that there is too much mesolimbic dopamine activity similar to schizophrenia * antipsychotics are sometimes effective, but often times not * psychotherapy may help patients cope, lower anxiety or agitation * be non-judgemental, nonincredulous, nonchallenging, empathic, facilitate communication

Answer 58

Anything that blocks H1 receptors blocks the satiety center in the brain causing one to continue eating as if they are never full

Answer 59

block H1 -- blocks satiety center anti-muscarinics (ACh) block 5HT2c -- causes fat cells to grow bigger block D2 receptor -- increases in prolactin is associated with weight gain

Answer 60

1. **Amphetamines** - decreases appetite 2. **Orlistat** - lipase inhibitor 3. **Topiramate**/**Phentermine** combo - improved carb metabolism, less gluconeogenesis, appetite suppressant 4. **Naltrexone**/**bupropion** combo - dampens reward of eating, appetite suppressant 5. **Lorcaserin** - blocks 5H2C receptors to increase metabolism, lessen tendency to store fat, improve leptin sensitivity?

Answer 61

decreases appetite

Answer 62

lipase inhibitor (fat inhibitor) Coats your gut and essentially prevents the absorption of fat. You poop it out. Feces very oily and will definitely feel accidents when eating high fat diets

Answer 63

Epilepsy medicine improved carb metabolism, less gluconeogenesis, appetite suppressant

Answer 64

Naltrexone - NE reuptake inhibitor. NE goes up --\> curves appetite Dampens reward of eating, appetite suppressant

Answer 65

stimulate 5H2C receptors to increase metabolism, lessen tendency to store fat, improve leptin sensitivity?

Answer 66

DSM-V * Restriction of energy intake requirements --\> low body weight * fear of gaining weight * body image disturbance (dysmorphism) DSM-IV: includes the above 3 and: * refusal to maintain 85% typical weight * Missed menstrual cycles x3 (removed as it does not apply to men) Severity is based off BMI

Answer 67

More rigid, controlling and inflexible high achieving (type A personalities) obsessive compulsive perfectionists

Answer 68

* weight loss * hypothermia * edema - not enough protein to keep water in your blood so it flows into tissues * bradycardia, hypotension, syncope * amenorrhea * electrolyte imbalance, low K+ * ST, T, QT cardiac changes * Lanugo hair (fine white hair) * osteoporosis * delayed gastric emptying * metabolic acidosis * organ failure

Answer 69

mostly behavioral management

Answer 70

* Recurrent binge eating * eating an atypically large amount in discrete period of time disproportionate to typical eating * purging vs non-purging types * **no anorexia present** * loss of control * **compensatory behaviors** necessary for diagnosis. behaviors such as vomiting, laxative use, enemas, diuretics, exercise * **binges 1X/wk for 3 months**

Answer 71

* purging vs non-purging types w/ no anorexia present * compensatory behaviors necessary for diagnosis, such as vomiting, laxative use, enemas, diuretics, exercise * binges 1X/wk for 3 months

Answer 72

erratic emotional chaotic outgoing, angry, impulsive traits

Answer 73

believe to be low serotonin

Answer 74

* poor dentition, enamel loss, cavities -- typically associated with excess vomiting * abraided knuckles (Russell's Sign) - from the afflicted's knuckles making contact with the incisor teeth during the act of inducing the gag reflex at the back of the throat with their finger(s). * Normal/overweight * sexually active * lab changes * low PO4, low Mg * high amylase * salivary enlargement * esophagitis/tears

Answer 75

defined as calluses on the knuckles or back of the hand due to repeated self-induced vomiting over long periods of time (ie abraided knuckles) The condition generally arises from the afflicted's knuckles making contact with the incisor teeth during the act of inducing the gag reflex at the back of the throat with their finger(s).

Answer 76

SSRIs are approved

Answer 77

persistent eating of nonutritive substances x 1 months not developmentally or culturally appropriate not medical or from intellectual disability or autism

Answer 78

repeated regurgitation and re-chewing of food no weight gain not medical or from intellectual disability or autism often before 6 years

Answer 79

* Failure to meet diet/energy needs * weight loss, nutritional deficiency, supplementation needed, psychosocial distress essentially doesn't meet full anorexia criteria

Answer 80

* Binges * do _NOT_ need the compensatory behavior * Lack of congrol * ego dystonic * 1x/wk for 3 months * No purges or compensations * Newest FDA approved treatment is stimulate called lisdexafetamine (a prodrug in the amphetamine class) basically a milder version of bulimia

Answer 81

avoidant/restriction food intake disorder

Answer 82

binge eating disorder only difference is there isn't a requirement for the compensatory behavior

Answer 83

* difficulty retrieving words and names * slower processing speed * difficulty sustaining attention when faced with competing environmental stimuli * learning something new takes a bigger effort * no functional impairment

Answer 84

basically people who have some problems with memory but are otherwise functioning perfectly normally. * NO loss of functional capacity (this is how you distinguish from AD or other types) Not demented.

Answer 85

Memory loss not meeting the criteria for dementia Progresses to AD (alzheimer disease) at rate of 10-15% vs 1-3% incidence in general population may be the earliest phase of AD

Answer 86

X #1 - abnormal presenilin 2 X #14 - abnormal presenilin 1 X #21 - abnormal amyloid precursor protein

Answer 87

Chromosome 19 - apolipoprotein E4 gene implicated

Answer 88

most common form develops after age 60 combination of factors likely responsible Chromosome 19 - apolipoprotein E4 gene implicated

Answer 89

alzheimer disease

Answer 90

atrophy will occur in the frontal, temporal and parietal lobes. occipital lobe spared for unknown reason.

Answer 91

ONLY disease that is both a beta amyloidopathy and a tauopathy * extracellular deposits of beta-amyloid peptide (Aß) associated with dystrophic neurites * Filamentous intracellular inclusions of tau proteins called neurofibrillary tangles (NFTs) and neuropil threats (NTs)

Answer 92

Atrophy in parietal, temporal and frontal lobes with occipital lobe sparring. Atrophy of the **hippocampus** most pronounced over any other part.

Answer 93

NFTs arise due to hyperphosphoyrlation of tau, a microtubule-associated protein. They are dangerous because they conform the neuron structure and are insoluble. When the neuron dies due to aggregation of the tau protein, the body cannot clear it (insoluble)

Answer 94

Depression in old people can often lead to AD. The symptoms of depression and dementia often overlap * Patients with primary depression * demonstrate less motivation during cognitive testing * express cognitive complaints that exceed measured deficits * maintain language and motor skills * People with dementia on the other hand will: * try very hard to do well * positive review of systems

Answer 95

Also known as Pick's Disease Characterized by emotional blunting resulting in decline in social interpersonal conduct --\> worldwind of inappropriateness. * Insidious onset, gradual progression * early impairment in regulation of personal conduct with loss of insight * early decline in social interpersonal conduct * early emotional blunting * characterized by behavioral abnormalities * memory loss and dementia occurs later

Answer 96

Also known as frontotemporal dementia Characterized by emotional blunting resulting in decline in social interpersonal conduct --\> worldwind of inappropriateness. * Insidious onset, gradual progression * early impairment in regulation of personal conduct with loss of insight * early decline in social interpersonal conduct * early emotional blunting * characterized by behavioral abnormalities * memory loss and dementia occurs later

Answer 97

No role for cholinesterase inhibitors Careful use of atypical antipsychotics (quetiapine, risperdol etc..) Divalproex for behavior control SSRIs for irritability, depression, impulsive behaviors.

Answer 98

stains amyloid fibrils (assoicated with Alzheimer Disease)

Answer 99

Cholinergic therapy (rivastigmine, donepezil, galantamine) NMDA receptor antagonists (memantine) Investigational agents Treatment of neuropsychiatric symptoms in AD patients

Answer 100

There is a degeneration of the basal nucleus of Meynert (aka nucleus basalis) in AD that is normally responsible for ACh production --\> ACh deficiency. This contributes to memory deficits that characterize this disorder

Answer 101

Typically associated with GI --\> N&V Sleep disturbance also associated

Answer 102

Mech: inhibits AChE Metabolims: Cyt P450 Therapeutics: all stages of Alzheimer Disease (only drug approved for all stages) SE: N&V, sleep disturbance

Answer 103

Mech: Inhibits AChE and BuChE Metabolism: hydrolysis by cholinesterases Therapeutics: only drug in transdermal-patch form. Used in treatment for AD. SE: N&V, sleep disturbance

Answer 104

Mech: inhibits AChE and allosteric modulator of nicotinic receptors Metabolism: Cyp450 Therapeutics: Alzheimer disease. Not used as commonly as donepezil and rivastgimine SE: N&V, sleep disturbance

Answer 105

Mechanism: NMDA receptor antagonist SE: dizziness, confusion, headache, constipation Metabolism: mostly excreted unchanged in urine Therapeutics: Alzheimer disease * in AD, there is abnormal (increased) NMDAR activity. Excessive activity --\> excitotoxicity --\> neuronal damage/death * This drug aims to reduce that excessive activity. Side effects are associated with downregulation activity

Answer 106

fibriller deposits of a presynaptic terminal protein call α-synuclein (Lewy body) Most commonly found in * Parkinson's Disease * Dementia with Lewy Bodies Oversimplification: 1. if disease happened first in cortex --\> dementia w/ lewy bodies 2. if disease happened first in substantia nigra --\> Parkinson

Answer 107

1-2% of people over 65 Most cases sporadic Cardinal symptoms * resting tremor * difficulty initiating movement (akinesia) * slowed movement (bradykinesia) * rigidity * shuffling gait * postural instability * dementia occurs in some cases Dopaminergic deficit Response to L-Dopa therapy

Answer 108

resting tremor * difficulty initiating movement (akinesia) * slowed movement (bradykinesia) * rigidity * shuffling gait * postural instability * dementia occurs in some cases

Answer 109

Lewy bodies in substantia nigra

Answer 110

Parkingson disease

Answer 111

Progressive supranuclear palsy or Cortical basilar degeneration MUST have Lewy bodies to diagnose Parkinson

Answer 112

Gross: pallor of the substantia nigra Microscopic: * degeneration and loss of the pigmented, dopaminergic neurons of the substantia nigra pars compacta and other pigmented neurosn of the brainstem such as locus ceruleus * Neurons contain eosinophilic inclusions called Lewy Bodies * Other nuceli such as the cholinergic nucleus basalis of Meynert are also affected * Striatum, thalamus and other cortical regions are functionally affected due to the loss of dopaminergic input

Answer 113

Sporadic, primarily late-onset Memory frequently less affected compared to AD Frontal and subcortical features -- deficits in attention and alertness are prominent pronounced fluctuations and variations in symptoms Neuropsychiatric symptoms -- vivid visual hallucinations, delusions Motors symptoms of PD are variably present

Answer 114

Gross: Nigral pallor. Cortical atrophy is less severe than in AD. Atrophy of limbic areas is often significant. Microscopic: 1) “Cortical”-type Lewy bodies (LBs) in frontal, temporal, and insular cortex, and in limbic areas (**amygdala**, **cingulate gyrus** -- the first places where LBs form in this disease). 2) Nigral LBs. 3) LNs (lewy neurites), especially in hippocampus and striatum. 4) DLB patients usually have plaques and tangles, and a dual diagnosis of DLB and AD applies in most cases.

Answer 115

amygdala, and cingulate gyrus

Answer 116

No. Barely any cortical atrophy. Biggest prominence is the pallor that develops in the substantia nigra.

Answer 117

Short term memory loss, gradual onset **Visual hallucinations** - more so than any of the other diseases Cognitive fluctuations REM sleep disorder is common - will pantomime (act out) their dreams Frequent falls Autonomic dysfunction

Answer 118

* Cholinesterase inhibitors may provide symptomatic support * Trial of carbidopa/levodopa for severe movement symptoms * AVOID antipsychotic drugs due to increased sensitivity * enhance any Parkinson symptoms * REM Sleep Disorder: Clonazepam

Answer 119

Lewy Body Dementia * Onset of dementia **within** 12 months of parkinsonism Parkinson’s disease and dementia * Onset of dementia **more than** 12 months after the diagnosis of PD

Answer 120

If you can't do ADLs - you pretty much die... acronym DEATH D - Dressing E - eating A - ambulating T - toileting H - hygiene

Answer 121

If you can't do iADLs, you don't die but you get "SHAFT"ed S - Shopping H - housekeeping A - Accounting F - Food preparation T - Transportation

Answer 122

Birth - 1.5 years Sucking and dependent Adult "oral" traits: enjoy food, chew gum, smoke, drink * passive, dependent

Answer 123

* Libidoà Anal: 1 ½ - 3 years * Crawling, exploring * “No!” * Potty training * (holding on, letting go) * terrible twos (paradise lost!)

Answer 124

Between 3 to 5/6 years This is the period when children are curious about their sexual difference close to parent of the opposite sex * Oedipal complex in boys * electra complex in girls

Answer 125

between 6 years and adolescent. Not much happens. Girls scouts and boy scouts

Answer 126

Adolescent to adult and onwards This is the phase where children acquire and develop for capacity for true intimacy

Answer 127

This refers to the "child" within someone or the childish characteristics

Answer 128

Id = child Ego = adult (growing, evolving and has to do with "I") Superego = parent (rules, morales, values -- develops based on input from authorities)

Answer 129

Occurs when ego is under stress. "can't deal with this" --\> anxiety --\> ego defense mechanisms Purpose: to decrease distress; make reality better Level I - Psychotic mechanisms Level II - Immature mechanisms Level III - Neurotic defenses Level IV - Mature mechanisms

Answer 130

1. Delusional projection - frank delusions about external reality, usually of a presecutory type 2. Psychotic denial - denial of external reality 3. distortion - grossly reshaping external reality to suit inner needs Common in "healthy" individuals before age 5 Common in adult dreams and fantasy * For the user -- these mechanisms alter reality * To the beholder, they appear "crazy"

Answer 131

Frank delusions about external reality, usually of a presecutory type Class: Psychotic Defense Mechanisms Common in "healthy" individuals before age 5 Common in adult dreams and fantasy * For the user -- these mechanisms alter reality * To the beholder, they appear "crazy"

Answer 132

Class: Psychotic Defense Mechanisms denial of external reality Common in "healthy" individuals before age 5 Common in adult dreams and fantasy * For the user -- these mechanisms alter reality * To the beholder, they appear "crazy"

Answer 133

Class: Psychotic Defense Mechanisms Grossly reshaping external reality to suit inner needs Common in "healthy" individuals before age 5 Common in adult dreams and fantasy * For the user -- these mechanisms alter reality * To the beholder, they appear "crazy"

Answer 134

1. Projection - attributing one's own unacknowledged feelings to others * includes severe prejudice, rejections of intimacy through unwarranted suspicion, marked hypervigilance to external danger and injustice-collecting * behavior may be eccentric and abrasive but within the 'letter of the law'. * assoicated with paranoid personality 2. Somatization - turning an unacceptable impulse or feeling from bereavement, lonelinees, fear or anger into complaints of pain or somatic illness * ie 'My chest hurts' rather than ' please pay attention to me' or 'please care about me' * associated with hypochondriac, and psychosomatic disorders 3. Acting out - direct expression of an unconscious wish or impulse in order to avoid being conscious of the affect that accompanies it * deliquent or impulsive act to avoid being aware of one's feelings (ie of anger or sadness) * doing instead of think or feeling Common in "healthy" individuals ages 3 to 15 Seen in personality disorders * For the *user*, alter distress due to the threat of interpersonal intimacy or its loss * For the *beholder*, they appear socially undesirable

Answer 135

Projection - attributing one's own unacknowledged feelings to others * includes severe prejudice, rejections of intimacy through unwarranted suspicion, marked hypervigilance to external danger and injustice-collecting * behavior may be eccentric and abrasive but within the 'letter of the law'. * assoicated with paranoid personality Class: Immature defense mechanisms Common in "healthy" individuals ages 3 to 15 Seen in personality disorders * For the user, alter distress due to the threat of interpersonal intimacy or its loss * For the beholder, they appear socially undesirable

Answer 136

Class: Immature defense mechanisms Somatization - turning an unacceptable impulse or feeling from bereavement, lonelinees, fear or anger into complaints of pain or somatic illness * ie 'My chest hurts' rather than ' please pay attention to me' or 'please care about me' * associated with hypochondriac, and psychosomatic disorders Common in "healthy" individuals ages 3 to 15 Seen in personality disorders * For the user, alter distress due to the threat of interpersonal intimacy or its loss * For the beholder, they appear socially undesirable

Answer 137

Class: Immature defense mechanisms Acting out - direct expression of an unconscious wish or impulse in order to avoid being conscious of the affect that accompanies it * deliquent or impulsive act to avoid being aware of one's feelings (ie of anger or sadness) * doing instead of think or feeling Common in "healthy" individuals ages 3 to 15 Seen in personality disorders * For the user, alter distress due to the threat of interpersonal intimacy or its loss * For the beholder, they appear socially undesirable

Answer 138

1. Denial - unable to accept (therefore seems to ignore/be unaware of / denies) intolerable facts about relation * the commonest defense seen in medical practice 2. Displacement - the redirection of feelings toward a relatively less cared for object than the person or stiutation arousing the feelings * If angry at your boss but unable to say anything, you replace her by a thing (kick a chair) or a stranger (road rage) * Most phobias, many hysterial conversion reactions and prejudice involve displacement 3. Dissociation - temporary but drastic modification of one's character or of one's sense of personal identity to avoid emotional distress * acute reaction to trauma, multiple personality disorder 4. Identification - unconscioous patterning of one's behavior after a power, influential person * adopting the habits of a parent or coach * behaviors/parenting style "runs in families" * Stockholm syndrome 'identification with the aggressor' 5. Intellectualization - thinking about instinctual wishes in formal, affectively bland terms, and *not* acting on them. The idea is in consciousness, but the feeling is missing (ie rationalization, magical thinking) 6. Reaction formation - behavior in a fashion diametrically opposed to an unacceptable instinctual response * overtly caring for someone else when one wishes to be cared for oneself * 'hating' someone or something one really likes; 'loving' a hated rival or unpleasant duty 7. Regression - appearance of child-like behavior during periods of stress 8. Undoing - Protecting against a negative past event by acceptable "corrective" behavior (ie superstitious rituals or formal atonement or confession) Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the *user*, these alter private feelings or instinctual expression * For the *beholder*, they are quirks or "hang-ups"

Answer 139

Denial - unable to accept (therefore seems to ignore/be unaware of / denies) intolerable facts about relation the commonest defense seen in medical practice Class: Neurotic Mechanisms Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the user, these alter private feelings or instinctual expression * For the beholder, they are quirks or "hang-ups"

Answer 140

Class: Neurotic Mechanisms Displacement - the redirection of feelings toward a relatively less cared for object than the person or stiutation arousing the feelings * If angry at your boss but unable to say anything, you replace her by a thing (kick a chair) or a stranger (road rage) * Seen in most phobias, many hysterial conversion reactions and prejudice involve displacement Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the user, these alter private feelings or instinctual expression * For the beholder, they are quirks or "hang-ups"

Answer 141

Class: Neurotic Mechanisms Dissociation - temporary but drastic modification of one's character or of one's sense of personal identity to avoid emotional distress * acute reaction to trauma, multiple personality disorder Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the user, these alter private feelings or instinctual expression * For the beholder, they are quirks or "hang-ups"

Answer 142

Class: Neurotic Mechanisms Identification - unconscioous patterning of one's behavior after a power, influential person * adopting the habits of a parent or coach * behaviors/parenting style "runs in families" * Stockholm syndrome 'identification with the aggressor' Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the user, these alter private feelings or instinctual expression * For the beholder, they are quirks or "hang-ups"

Answer 143

Psychological phenomenon where the hostage identifies with the aggressor. Expression of sympathy and empathy and positive feelings toward their captors sometimes to the point of defending and identifying with the them Associated with identification - a neurotic mechanism that is normally seen in healthy humans

Answer 144

Class: Neurotic Mechanisms Intellectualization - thinking about instinctual wishes in formal, affectively bland terms, and not acting on them. The idea is in consciousness, but the feeling is missing (ie rationalization, magical thinking) Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the user, these alter private feelings or instinctual expression * For the beholder, they are quirks or "hang-ups"

Answer 145

Class: Neurotic Mechanisms Reaction formation - behavior in a fashion diametrically opposed to an unacceptable instinctual response * overtly caring for someone else when one wishes to be cared for oneself * 'hating' someone or something one really likes; 'loving' a hated rival or unpleasant duty Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the user, these alter private feelings or instinctual expression * For the beholder, they are quirks or "hang-ups"

Answer 146

Class: Neurotic Mechanisms Regression - appearance of child-like behavior during periods of stress Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the user, these alter private feelings or instinctual expression * For the beholder, they are quirks or "hang-ups"

Answer 147

Class: Neurotic Mechanisms Undoing - Protecting against a negative past event by acceptable "corrective" behavior (ie superstitious rituals or formal atonement or confession) Common in "healthy" individuals ages 3-90 Seen in neurotic disorder and in acute stress * For the user, these alter private feelings or instinctual expression * For the beholder, they are quirks or "hang-ups"

Answer 148

1. Altruism - vicarious but constructive and instinctually gratifying service to others 2. Sublimation - indirect or attenuated expression of instincts w/o either adverse consequences or marked loss of pleasure * expressing aggression through pleasurable games, sports and hobbies * romantic attentuation of instinctual expression during a real courtship * instincts are channeled rather than dammed or diverted. Successful artistic expression remains the classic example * feelings are acknowledged, modified, and directed toward a relatively significant person or goal so that modest instinctual satisfaction results 3. Anticipation - realistic anticipation of or planning for future inner discomfort * includes goal-directed but overly careful planning or worrying (premature but realistic affective anticipation of death or surgery or separation) 4. Suppression - the conscious or semiconscious decision to postpone paying attention to a conscious impulse or conflict * deliberately postponing but not avoiding. "I will think about it tomorrow"; and the next day one remembers to think about it 5. Humor - overt expression of ideas and feelings without individual discomfort or immobilization and w/o unpleasant effect on others * like hope, humor permits one ot beat and yet to focus upon what is too terrible to be borne Common in "healthy" individuals ages 12-90 * For the *user*, they integrate reality, interpersonal realationships, and private feelings * For the *beholder*, they appear as convenient virtues

Answer 149

Class: Mature defense mechanisms Altruism - vicarious but constructive and instinctually gratifying service to others Common in "healthy" individuals ages 12-90 * For the user, they integrate reality, interpersonal realationships, and private feelings * For the beholder, they appear as convenient virtues

Answer 150

Class: Mature defense mechanisms Sublimation - indirect or attenuated expression of instincts w/o either adverse consequences or marked loss of pleasure * expressing aggression through pleasurable games, sports and hobbies * romantic attentuation of instinctual expression during a real courtship * instincts are channeled rather than dammed or diverted. Successful artistic expression remains the classic example * feelings are acknowledged, modified, and directed toward a relatively significant person or goal so that modest instinctual satisfaction results Common in "healthy" individuals ages 12-90 * For the user, they integrate reality, interpersonal realationships, and private feelings * For the beholder, they appear as convenient virtues

Answer 151

Class: Mature defense mechanisms Anticipation - realistic anticipation of or planning for future inner discomfort * includes goal-directed but overly careful planning or worrying (premature but realistic affective anticipation of death or surgery or separation) Common in "healthy" individuals ages 12-90 * For the user, they integrate reality, interpersonal realationships, and private feelings * For the beholder, they appear as convenient virtues

Answer 152

Class: Mature defense mechanisms Suppression - the conscious or semiconscious decision to postpone paying attention to a conscious impulse or conflict * deliberately postponing but not avoiding. "I will think about it tomorrow"; and the next day one remembers to think about it Common in "healthy" individuals ages 12-90 * For the user, they integrate reality, interpersonal realationships, and private feelings * For the beholder, they appear as convenient virtues

Answer 153

Class: mature defense mechanisms Humor - overt expression of ideas and feelings without individual discomfort or immobilization and w/o unpleasant effect on others * like hope, humor permits one ot beat and yet to focus upon what is too terrible to be borne Common in "healthy" individuals ages 12-90 * For the user, they integrate reality, interpersonal realationships, and private feelings * For the beholder, they appear as convenient virtues

Answer 154

Patient's unconscious "transfer" and replay of relationship with influential figures from the past. More likely w/ physicians. Positive: unrealistic expectations Negative: Mistrust, missed appointments, non-adherence, poor outcomes

Answer 155

The MD's transference to the patient - positive or negative.

Answer 156

Acute - 1 week or less chronic - considered an autonmous disease. present for at least 6 months

Answer 157

Inflammatory - typically refers to acute pain caused by the onset of trauma or inflammation which causes the release of prostaglandins that can mediate pain. Can be reduced with NSAIDs Neuropathic pain - refers to chronic pain typically caused by miscellaneous nerve firings (or memory of pain potentiated via glutamate activation of NMDA receptors).

Answer 158

Opiates - derivates fo poppy plant: heroin, morphine Opioids - any drugs that occupies opioid receptors: fentanyl, methadone

Answer 159

Inhibit COX - enzyme that converts arachidonic acid to prostaglandins and thromboxane which provoke tissue inflammation

Answer 160

Prostaglandins protect the stomach lining from acid. COX-2 specific inhibitors; celecoxib and low dose meloxicam (7.5 mg/day) cause less gastric irritation

Answer 161

Fever is caused by prostaglandin E2. PGE2 signals hypothalamus to increase body’s thermal set point

Answer 162

endogenous morphine

Answer 163

anticovulsants tricyclics Opioids doesn't really tone down the pain, but rather makes the patient less concernd about the pain

Answer 164

Epilepsy is a condition where cortical neurons kindle and then fire in synchrony causing a neuromuscular seizure to occur. All antiepileptic drugs (AEDs) function by lowering a neuron’s ability to fire by hyperpolarization

Answer 165

All antiepileptic drugs (AEDs) function by lowering a neuron’s ability to fire by hyperpolarization. They primarily dampen sodium and potassium influx. There are drugs targeted for chloride influx and also glutamate.

Answer 166

Na+ channel blocker Anti-epileptic SE: aplastic anemia, requires blood levels, CYP3A4 inducer causing drug interactions

Answer 167

Na+ channel blocker Anti-epileptic SE: StevensJohnson Syndrome rash, No pain approvals

Answer 168

Na+ channel blocker SE: Weight loss, acidosis, oligohydrosis, glaucoma ·For migraines

Answer 169

carbamazepine lamotrigine topiramate

Answer 170

·Ca++ channel blockers SE: Weight gain, sedation ·For Diabetic neuropathy

Answer 171

·Ca++ channel blockers SE: Mild addiction, weight gain, sedation ·For Diabetic neuropathy, fibromyalgia