Biologic Assessment of Patients with Psychiatric Symptoms Flashcards Preview

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Flashcards in Biologic Assessment of Patients with Psychiatric Symptoms Deck (28):
1

In approx. 1/2 of the patients with major depressive disorder, DST is ...?

POSITIVE (ie the suppression is limited or absent).

2

Why does the DST have limited clinical usefulness?

Because positive findings are NOT SPECIFIC and NON-SUPPRESSION is seen in conditions other than major depressive disorder.

3

Hypothyroidism and hyperthyroidism can mimic ...?

Depression and anxiety, respectively.

4

Patients with depression may have other endocrine irregularities, such as ...?

1. Reduced response to a challenge with thyrotropin-releasing hormone.
2. Abnormalities with GH, melatonin, and gonadotropin.

5

Psychiatric symptoms are associated with other endocrine disorders, such as:

1. Addison disease (hypocortisolism).
2. Cushing disease (hypercortisolism).
3. Enzyme disorders such as acute intermittent porphyria (AIP).

6

Addison - Psychiatric symptoms include:

1. Fatigue.
2. Depression.
3. Psychosis.
4. Confusion.

7

Cushing syndrome - Psychiatric symptoms include:

1. Mood.
2. Psychosis.
3. Anxiety.
4. Depression.

8

AIP - Psychiatric symptoms include:

1. Paranoid delusions.
2. Hallucinations.
3. Depression.
4. Anxiety.

9

Neuroimaging and electroencephalography in the biological evaluation of psychiatric patients - CT:

Identifies anatomically based brain changes (eg enlarged brain ventricles) seen in cognitive disorders, such as Alzheimer disease, as well as in schizophrenia.

10

Neuroimaging and electroencephalography in the biological evaluation of psychiatric patients - Nuclear MRI (NMRI):

1. Identifies demyelinating disease (eg MS).
2. Shows the biochemical condition of neural tissues without exposing the patient to ionizing radiation.

11

Neuroimaging and electroencephalography in the biological evaluation of psychiatric patients - PET or fMRI:

1. Localizes areas of the brain that are physiologically active during specific tasks by characterizing and measuring metabolism of glucose in neural tissue.
2. Measures specific neurotransmitter receptors.
3. Requires use of a cyclotron.

12

Neuroimaging and electroencephalography in the biological evaluation of psychiatric patients - SPECT:

Obtains similar data to PET or fMRI but is more practical for clinical use because it uses a standard gamma camera rather than a cyclotron.

13

Neuroimaging and electroencephalography in the biological evaluation of psychiatric patients - EEG:

1. Measures electrical activity in the cortex.
2. Useful in diagnosing epilepsy and in differentiating delirium (abnormal EEG) from dementia (often normal EEG).
3. Shows, in patients with schizophrenia, decr. alpha waves, incr. theta and delta waves, and epileptiform activity.

14

Neuroimaging and electroencephalography in the biological evaluation of psychiatric patients - Evoked EEG:

1. Measures electrical activity in the cortex in response to tactile, auditory, sound, or visual stimulation.
2. Used to evaluate vision and hearing loss in infants and brain responses in comatose and suspected brain-dead patients.

15

Neuropsychological tests used in psychiatry - Halstead-Reitan battery:

Brain lesion localization and effects.

16

Neuropsychological tests used in psychiatry - Luria-Nebraska neuropsychological battery:

1. Cerebral dominance.
2. Types of brain dysfunction, such as dyslexia.

17

Neuropsychological tests used in psychiatry - Bender Visual Motor Gestalt:

Visual and motor ability through the reproduction of designs.

18

Neuropsychological tests used in psychiatry - Digit symbol substitution:

1. Dementia.
2. Depression.
3. Age-related cognitive decline.

19

Neuropsychological tests used in psychiatry - Boston naming:

Dementia.

20

Neuropsychological tests used in psychiatry - Wisconsin card sort:

Executive function.

21

Neuropsychological tests used in psychiatry - Stroop color-word:

Directed attention.

22

Neuropsychological tests used in psychiatry - Folstein MMSE:

Delirium and dementia.

23

Neuropsychological tests used in psychiatry - GCS:

Level of consciousness.

24

Folstein MMSE - Skills evaluated:

1. Orientation (.../10).
2. Language (.../8).
3. Attention and concentration (.../5).
4. Registration (.../3).
5. Recall (.../3).
6. Construction (.../1).

25

MMSE score evaluation?

Max = 30.
>23 suggests high competence.

26

IV administration of sodium lactate may provoke what ...?

PANIC ATTACKS in susceptible patients --> Help identify individuals with panic disorder. (Inhalation with CO can produce the same effect)

27

Galvanic skin response (a component of the "lie detector" test):

1. The electric resistance of skin (galvanic skin response) varies with the patient's psychological state.
2. Higher sweat gland activity, seen with SNS arousal (eg when lying) results in decr. skin resistance and a positive test.

28

Dexamethasone suppression test (DST) - In a normal patient with a normal hypothalamic-adrenal-pituitary axis, dexamethasone, what does a synthetic glucocorticoid do?

Suppresses the secretion of cortisol.