Pathology Flashcards
(119 cards)
1
Q
ANXIETY: What are the major neurotransmitters implicated in anxiety disorders?
A
INCREASED: NE + Dopamine
DECREASED: GABA
+/- INCREASED OR DECREASED: 5-HT/SER
2
Q
ANXIETY: Guideline for treatment of anxiety d/o
A
PSYCHOTHERAPY (milder presentations, CBT** + Psychodynamic) +/- pharmacotherapy (mod-severe anxiety)
3
Q
ANXIETY: Which medication is used to temporarily BRIDGE pts until long-term medication is effective? If pt has co-morbid MDD, what medication do we tend to avoid?
A
BZ - used to bridge
Caution if pt also has MDD - worsens depression
4
Q
ANXIETY: What is 1st line?
A
SSRIs and SNRIs + CBT
5
Q
ANXIETY: What is often used as PRN use?
A
1) BZ - Enhance GABA at GABA-A-R. Don’t use in alcoholics due to addictive properties and synergistic action
2) DIPHENHYDRAMINE (Benadryl)
3) HYROXYZINE (atarax)
6
Q
ANXIETY: What other medications may be used that are non-BZ anxiolytics?
A
1) BUSPIRONE - 5-HT1A PARTIAL AGONIST. Not mainly used due to minimal efficacy and only used for augmentation of GAD
2) PROPANOLOL - block Panic attacks + Performance anxiety
3) TCA/MAOIs - Extreme side effect profile makes them undesirable
7
Q
ANXIETY: What is a big risk factor for panic attacks?
A
SMOKING
8
Q
ANXIETY: Which conditions must be ruled out when a pt presents with a panic attack?
A
SUBSTANCE-INDUCED
MI
THYROTOXICOSIS
PE
9
Q
Which psychiatric disorder has the highest GENETIC link?
A
BIPOLAR 1
10
Q
What is the most common pyschiatric d/o in WOMEN? What is the most common psychiatric d/o in MEN?
A
WOMEN: Mc = PHOBIAS
MEN: Mc = SUBSTANCE-ABUSE, 2nd Mc = phobias
Social anxiety occurs equally in men and women
11
Q
ANXIETY: Which d/o do you start with a LOW dose of SSRI/SNRI due to potential worsening of anxiety?
A
Panic disorder, Agoraphobia
12
Q
ANXIETY: Which type of CBT is used for OCD? What is the first-line medication? What other SER-SELECTIVE medication can be used?
A
EXPOSURE + RESPONSE PREVENTION CBT - Prevent the relieving compulsion.
1st line: HIGH doses of SSRI (sertraline, fluoxetine)
Most 5-HT/SER-selective TCA CLOMIPRAMINE
13
Q
ANXIETY: What is used as last resort, treatment-resistant OCD?
A
PSYCHOSURGERY (cingulotomy) or ECT (especially if co-morbid depression)
14
Q
ANXIETY: What is the most effective form of treating HOARDING D/O most common in the elderly?
A
SPECIALIZED FORM OF CBT
SSRIs are not as beneficial unless OCD sx are present
15
Q
ANXIETY: What is the most effective form of treating TRICHOTILLOMANIA/ EXCORIATION?
A
SPECIALIZED CBT (Habit reversal training)
+/- SSRIs
+/- Trichotillomania: second-gen anti-psychotics, N-acetylcys, Lithium
16
Q
ANXIETY: What is the difference between PTSD and ACUTE STRESS D/O?
A
PTSD: Trauma occurred ANY TIME in the past, Sx >1mo
ACUTE STRESS d/o: Trauma occurred <1mo ago, Sx <1mo
17
Q
ANXIETY: What is the first line pharmacological treatment for PTSD? Psychotherapy?
A
**SSRIs or SNRIs = 1st line
CBT (exposure therapy or cognitive processing therapy CPT)
18
Q
ANXIETY: What pharmacological agent may be used to prevent nightmares for PTSD? What tx can be used for severe cases of PTSD?
A
Nightmares - PRAZOSIN
Severe PTSD - second generation anti-psychotics
19
Q
ANXIETY: What is CPT cognitive processing therapy used for PTSD?
A
Thoughts, feelings, meaning of the traumatic event are revisited and questioned
20
Q
ANXIETY: What medications should be avoided in treating PTSD?
A
BZ - Due to addictive potential in PTSD pts who often suffer comorbid substance abuse
21
Q
ANXIETY: What is the difference between ADJUSTMENT d/o and PTSD?
A
Adjustment d/o - Sx occur WITHIN 3MO of event, Sx resolve after 6MO of stressor termination, event is NOT life- threatening
PTSD - Sx occur any time after the event, Sx may not resolve, event IS life-threatening
22
Q
ANXIETY: What is the most effective form of therapy for ADJUSTMENT d/o?
A
SUPPORTIVE PSYCHOTHERAPY (Crisis/emergencies/bereavement)**
Group therapy also helpful
+/- Brief pharmacotherapy
23
Q
DELIRIUM: How does delirium manifest on EEG? Which specific delirium is an exception?
A
DIFFUSE background slowing on EEG
EXCEPTION = DELIRIUM TREMENS - Associated with fast activity
24
Q
DELIRIUM: What is the most common type of delirium based on PSYCHOMOTOR activity?
A
MIXED - Psychomotor activity is stable at baseline or fluctuates rapidly between HYPER + HYPOactivity
25
DELIRIUM: Which polypharmacy medications can induce delirium?
BZ, anti-cholinergics, TCAs, H2 blockers, diphenhydramine, mepiridine, corticosteroids
26
DELIRIUM: What is the treatment for BZ/EtOH-withdrawal induced delirium?
BZ TAPER
| Do NOT use BZ if not this etiology - May cause, worsen, or prolong delirium (paradoxical disinhibition or oversedation)
27
DELIRIUM/DEMENTIA: How can thyroid dysfunction result in neurocognitive d/o?
HYPOTHYROIDISM: Cognitive impairment + FATIGUE/ COLD INTOLERANCE + Constipation, coarse hair
HYPERTHYROIDISM: Apathetic thyrotoxicosis
28
DELIRIUM/DEMENTIA: What is the most common form of MAJOR NEUROCOGNITIVE D/O (dementias)? How is definitive dx made?
ALZHEIMER'S
Dx only made POSTPARTEM AUTOPSY by diffuse cortical atrophy, narrowing of gyri, widening of sulci, hydrocephalus ex vacuo
29
DELIRIUM/DEMENTIA: What are possible pharmacotherapy for ALZHEIMER'S DISEASE?
NO cure or truly effective Tx
1) MILD-MOD AD: Cholinesterase inhibitors (DONEPEZIL, RIVASTIGMINE, GALANTAMINE) - Slows clinical deterioration by 6-12mo in up to 50% pts
2) SEVERE AD: NMDA-R antagonist MEMANTINE
30
DELIRIUM/DEMENTIA: Why should LOW doses of anti-psychotics be prescribed for AD?
Because of blackbox warning of INCREASED MORTALITY in pts with dementia
31
DELIRIUM/DEMENTIA: What is the 2nd most common cause of major NCD?
VASCULAR DEMENTIA after alzheimer's (#1)
32
DELIRIUM/DEMENTIA: What are the cardinal features of LEWY BODY DEMENTIA?
1) EARLY DEMENTIA (cognitive decline) + EPS Sx at least 1 year after cognitive decline
2) VISUAL HALLUCINATIONS - vivid, colorful, well-formed images of animals or small people
3) REM sleep behavior d/o - violent fighting movements during sleep in response to sleep
4) alpha synuclein EOSINOPHILIC inclusions of affected DOPAMINERGIC neurons in basal ganglia
33
DELIRIUM/DEMENTIA: How is the definitive dx of LEWY BODY DEMENTIA made?
POSTMORTEM AUTOPSY (brain - inclusion bodies seen in basal ganglia)
34
DELIRIUM/DEMENTIA: What is the tx for LEWY BODY DEMENTIA?
1) Cognitive sx - CHOLINSTERASE INHIBITORS (donepezil, galantamine, rivastigmine)
2) Psychosis/VH sx - QUETIAPINE, CLOZAPINE (lowest effective dose)
3) Parkinonism features - LEVODOPA-CARBIDOPA (be careful if pt has concurrent psychosis or REM sleep behavior, can be exacerbated)
4) REM sleep d/o - MELATONIN +/- CLONAZEPAM
35
DELIRIUM/DEMENTIA: What is the pathology of Pick's dz? How is definitive dx made?
Marked atrophy of fontal and temporal lobes
Definitive dx only made by POSTMORTEM AUTOPSY
36
DELIRIUM/DEMENTIA: What is the most common infectious agent known to cause cognitive impairment?
HIV
37
DELIRIUM/DEMENTIA: What is the pathogenesis of HUNTINGTON'S dementia?
CAG TNR ON Ch4 - Autosomal dominant inheritance pattern, with ANTICIPATION -> Depletion of GABAergic neurons in dorsal striatum
CHOREA, ATHETOSIS, BRADYKINESIA
EXECUTIVE FN = primary cognitive domain affected
38
DELIRIUM/DEMENTIA: What is the treatment for HUNTINGTON'S dementia?
TETRABENZAINE - anti-chorea movement of huntington's
| +/- ATYPICAL ANTIPSYCHOTICS
39
DELIRIUM/DEMENTIA: What is the pathology of PARKINSON'S DEMENTIA?
Loss of dopaminergic neurons in substantia nigra pars compacta (basal ganglia)
40
DELIRIUM/DEMENTIA: Which sx are absolutely required for dx of PARKINSON'S?
1) BRADYKINESIA and either 2) PILL-ROLLING TREMOR or RIGIDITY
41
DELIRIUM/DEMENTIA: What is the major differentiating factor between LEWY BODY DEMENTIA and PARKINSONIAN DEMENTIA
LBD - Early dementia, EPS sx occur AFTER 1 year of cognitive decline
PARKINSON'S - Early motor sx followed by cognitive decline
42
DELIRIUM/DEMENTIA: Cardinal features of CJD
**>90% myoclonus + RAPIDLY PROGRESSIVE cognitive decline**
CSF + 14-3-3 protein
EEG periodic sharp wave complexes
MRI - proteinaceous lesions in putamen/cacudate nucleus
43
DELIRIUM/DEMENTIA: What is the prognosis of CJD?
NO EFFECTIVE TX - usually die within 1 year of dx
44
DELIRIUM/DEMENTIA: LP/Imaging results of NPH
1) LP Elevated CSF pressures
Normal opening pressures - clinical improvement after LP
2) Imaging: Ventriculomegaly out of proportion to cortical atrophy
45
DELIRIUM/DEMENTIA: What is likely the FIRST manifestation of NPH? Which is the LEAST likely to improve?
FIRST = BROAD-BASED GAIT with outwardly rotated feet, shuffling gait
LEAST likely to improve = COGNITIVE DECLINE
46
DELIRIUM/DEMENTIA: Which treatment modality may improve NPH?
VP SHUNT
47
DELIRIUM/DEMENTIA: Of all the TCAs in elderly pts, which is the most favorable?
NORTRIPTYLINE - Bec of fewest anticholinergic effects
48
What are age-related effects of alcohol?
1) DECREASED alcohol dehdydrogenase -> Increased BALs
2) DECREASED free water -> Increased alcohol concentration
3) INCREASED CNS Se to alcohol
49
What are NORMAL age-related sleep changes in geriatric pts?
1) REM sleep - DECREASED REM latency (time btw sleep onset and REM) + DECREASED total rem
2) NON-REM - INCREASED stage 1/2 + DECREASED stage 3/4 (deep sleep)
3) SLEEP EFFICIENCY - DECREASED (frequent nocturnal awakenings)
4) TOTAL SLEEP - DECREASED
5) SLEEP CYCLE - earlier to bed, earlier to rise
50
What is the most common single gene cause of autism spectrum disorder?
FRAGILE X
Other genetic causes: Down's, Rett, TSC
Most common cause of Intellectual disability = Down's
51
What is the RED FLAG sx of ASD?
Rapid deterioration of social +/- language skills during the first 2 years of life
52
Which disorder is one of the psychiatric disorders in which diagnostic criteria do NOT require symptoms to cause significant distress?
TIC DISORDERS
53
Which is the most severe form of tic disorders? Diagnostic criteria?
TOURETTE'S
Multiple MOTOR tics + at least one VOCAL tic for at least 1 year
ONSET prior to age 18yo
54
What are the most common motor tics?
Involving the face and head - eye blinking + throat clearing
55
Examples of vocal tics
COPROLALIA - Utterance of obscene, taboo words such as an abrupt, sharp bark or grunt
ECHOLALIA - Repeating other's words
56
Onset of ADHD?
Prior to 12yo
| But dx can also be made retrospectively
57
Psychiatric disorders with increasing paternal age as risk factor
AUTISM, TOURETTES, SCHIZOPHRENIA
58
What is the most effective form of treatment for TOURETTES'S? Which medication can be used if tics become impairing?
HABIT REVERSAL THERAPY
Alpha-2 agonists - GUANFACINE>>CLONIDINE (more sedating)
59
Tic d/o with SINGLE or MULTIPLE MOTOR or VOCAL tics that never met criteria for TOURETTES
PERSISTENT CHRONIC MOTOR OR VOCAL TIC D/O
60
Tic d/o with SINGLE or MULTIPLE MOTOR +/- VOCAL tics <1yr
PROVISIONAL TIC D/O
61
Male preschool who has NO DIFFICULTY getting along with peers but will NOT COMPLY with rules from parents or teachers. What is the dx?
OPPOSITIONAL DEFIANT D/O
Often precedes conduct d/o but MOST do NOT develop into conduct d/o
62
What is the difference between OPPOSITIONAL DEFIANT D/O and CONDUCT D/O?
ODD - Does NOT involve physical aggression or violating other's basic rights, at least 6mo
CONDUCT D/o - Does violate (e.g. cruelty towards animals), LACK remorse/empathy for victims, at least 6mo
63
What is the treatment for OPPOSITIONAL DEFIANT D/O and CONDUCT D/O?
BEHAVIOR MODIFICATION - conflict mgmt training, improving problem solving skills
PARENT MANAGEMENT TRAINING (PMT)
64
Which personality d/o is most commonly associated with CONDUCT D/O?
ANTISOCIAL PERSONALITY D/O
65
What treatment is offered to children with enuresis d/o (at least 4yo developmentally) if PSYCHOEDUCATION and BEHAVIORAL (bell and pad) programs fail?
DESMOPRESSIN (DDAVP) - ADH ANALOGUE
IMIPRAMINE - TCA, used for refractory cases
66
What is the differentiating factor between DISSOCIATIVE AMNESIA and NEUROCOGNITIVE DEMENTIA D/O?
DISSOCIATIVE AMNESIA - Preserves procedural memory, whereas NCD does not
67
What are the dissociative fugue sx of DISSOCIATIVE AMNESIA?
SUDDEN, UNEXPECTED travel away from home + amnesia for identity or other autobiographical info + gaps in recollection of particular events (usually traumatic incidents) + PRESERVED PROCEDURAL MEMORY
68
What is the treatment for DISSOCIATIVE AMNESIA?
SUPPORTIVE PSYCHOTHERAPY, CBT, HYPNOSIS
| Removal from traumatic situation will often bring back memories
69
What is the type of strong emotional reaction patients may experience when retrieving traumatic memories in DISSOCIATIVE AMNESIA pts?
ABREACTION
70
DISSOCIATION ELEMENTS: What is DEPERSONALIZATION? What is DEREALIZATION?
DEPERSONALIZATION: Experiences of unreality/detachment from one's BODY, THOUGHTS, FEELINGS, ACTIONS - outerbody experience observing themselves
DEREALIZATION: Experiences of unreality or detachment from one's SURROUNDINGS - in a dream or movie
71
FEMALE pt with childhood physical/sexual abuse or neglect with MDD, eating disorder, BPD, and substance use claims to have more than one distinct personality state at different times with extensive memory lapses of autobiographical info. What is the dx? What is the standard Tx?
DISSOCIATIVE IDENTITY DISORDER
PSYCHOTHERAPY = standard treatment - focus on safety, stabilization, symptom reduction, traumatic memories, identity integration
+/- SSRIs
72
IMPULSE CONTROL: What is the main associated lab finding of INTERMITTENT EXPLOSIVE D/O "anger management"
LOW 5-HIAA (SER METABOLITE) in CSF
Non-specific EEG findings, abnormalities on neuropsychological testing
LOW 5-HT/SER in CSF shown to be related to AGGRESSION + IMPULSIVENESS
Tx - SSRI (mainly FLUOXETINE)
73
IMPULSE CONTROL: Which d/o has the highest co-morbidity with KLEPTOMANIA?
BULIMIA NERVOSA (65% PTS)
74
IMPULSE CONTROL: What is the most effective form of treatment of KLEPTOMANIA?
CBT (Systematic desensitization + aversive conditioning)
| Won't fully remit without treatment
75
What is REFEEDING SYNDROME? Cardinal sx? Lab findings? Tx?
ELECTROLYTE/FLUID SHIFTS when severely malnourished pts are refed too quickly
Cardinal sx - fluid retention
Lab findings : LOW Ca/Mg/phosphorus
Tx: Replete electrolytes, slow feedings
76
What is the only FDA approved pharmacotherapy for BULIMIA NERVOSA?
What other therapy? Which medication should you AVOID?
SSRIs: FLUOXETINE**
THERAPY: CBT, INTERPERSONAL PSYCHODYNAMIC
Avoid BUPROPRION - lowers seizure threshold in pts with eating d/o
77
What is the difference between ANOREXIA/BULIMIA and BINGE EATING D/O?
BINGE EATING D/O - Has NO compensatory behaviors (vomiting, laxative use)
78
What is the adjunctive pharmacotherapy to CBT/interpersonal psychotherapy/diet/exercise program to BINGE EATING D/O?
1) Stimulants (amphetamine, phentermine) - decrease appetite
2) TOPIRAMATE, ZONISIMIDE - Anti-epileptics associated with weight loss
3) ORLISTAT - Inhibits pancreatic lipase -> Decreases fat absorption in GI tract
79
SLEEP: What is considered first line therapy of CHRONIC INSOMNIA (at least 3 mo)?
CBT
| Most common reason pts are put on long-term BZ
80
SLEEP: What happens to VS during REM SLEEP?
REM EEG pattern same as that of aroused person
| INCREASED HR, BP, RR
81
SLEEP: TETRAD OF NARCOLEPSY
1) SLEEP ATTACKS - Excessive daytime sleepiness
2) REM-related SLEEP PHENOMENA - Inability to move during transition from sleep to wakefulness
3) HYPNAGOGIC (going to sleep hallucination) or HYPNOPOMPIC (transitioning from sleep)
4) NARCOLEPTIC CATAPLEXY - SUDDEN LOSS of BILATERAL muscle tone EVOKED by strong emotion WITHOUT LOSS OF CONSCIOUSNESS
82
SLEEP: What is the pharmacotherapy for sleep attacks/excessive daytime sleepiness of NARCOLEPSY?
1) STIMULANTS - amphetamines
| 2) Non-stimulant - MODAFINIL, METHYLPHENIDATE, SODIUM OXYBATE
83
SLEEP: What is the pharmacotherapy for CATAPLEXY of NARCOLEPSY?
1) SODIUM OXYBATE***
2) TCA - Imipramine, desipramine, clomipramine
3) SSRI/SNRI
84
SLEEP: What is the pathology of NARCOLEPSY?
HYPOCRETIN DEFICIENCY in CSF
| DECREASED REM SLEEP latency on polysomnography
85
SLEEP: What is the difference between NARCOLEPTIC cataplexy and CATATONIC cataplexy?
CATATONIC - UNPROVOKED muscular rigidity
| NARCOLPETIC - PROVOKED by strong emotion without loss of consciousness
86
SLEEP: Which sleep d/o has a pattern of PERIODIC CRESCENDO-DECRESCENDO VARIATION in tidal volume due to Heart fialure, stroke, or renal failure, or opioid use?
CHEYNE STOKES BREATHING- CENTRAL SLEEP APNEA
87
SLEEP: Which structure coordinates 24hr or circadian rhythmicity for sleep?
SUPRACHIASMIC NUCLEUS of HYPOTHALAMUS
88
SLEEP: Which type of therapy involves the use of mental imagery to modify the outcome of a recurrent nightmare, writing down the improved outcome and then mentally rehearsing it in a relaxed state?
IMAGERY REHEARSAL THERAPY (IRT)/DESENSITIZATION
| Useful for treating recurrent nightmares in PTSD pts in NIGHTMARE DISORDER pts
89
SLEEP: What is the 1st line treatment for RESTLESS LEG SYNDROME?
1) IRON REPLACEMENT if low FER (Fe deficiency) as a cause of RLS
2) DOPAMINE AGONSITS - pramipexole, ropinirole + BZs
90
SLEEP: What is the pharmacotherapy for RESTLESS LEG SYNDROME refractory to BZ/DOPAMINE AGONISTS?
LOW-POTENCY OPIOIDS
91
Difference between PANIC DISORDER-related depersonalization/derealization and DEPERSONALIZATION/DEREALIZATION DISORDER?
PANIC DISORDER - Depersonal/dereal occurs ONLY DURING panic attacks
DEPERSONALIZAITON/DEREALIZATION - Occurs by baseline in no relation to panic attacks
92
Similarities and Differences between SOMATIC SYMPTOM DISORDER and PANIC DISORDER
SIMILARITIES - Multiple physical sx, extensive workup (high health care use), preoccupation with symptoms
DIFFERENCES - SOMATIC D/O symptoms are more PERSISTENT over time, chronic and PANIC DISORDER symptoms are more ACUTE and do NOT persist btw panic attacks
93
What is 2nd line medication adjunctive treatment for ANOREXIA NERVOSA?
1) OLANZAPINE: anti-psychotic that helps with weight gain + decreases obsessive preoccupations with eating
2) FLUOXETINE - ONLY if there's comorbid depression or anxiety sx, fluoxetine is first line tx for bulimia
94
How may other hormones be affected by ANOREXIA NERVOSA? Should it be repleted like electrolyte imbalances are fixed?
EUTHYROID SICK SYNDROME - Depletion of T3 and T4 due to chronic nutritional depletion
NO, should not replete like you would replete Ca+, K+, M, Phos bec it can precipitate arrhythmias or cause osteopenia
95
IMMOBILITY + MUTISM + POSTURING (resistance to movement/positioning) = ___
What confirms dx?
First line tx?
Refractory cases?
CATATONIA
LORAZEPAM CHALLENGE TEST - partial, temporary relief within 5-10mins of IV lorazepam 1-2mg
FIRST LINE - BZs (respond within a week)
REFRACTORY - ECT
96
DEMENTIA/DELIRIUM: Specific memory loss, word-finding difficulty, independence differences in NORMAL AGING vs DEMENTIA (MAJOR NCD)?
MEMORY LOSS: Normal aging - Recent memory intact. Dementia - Recent memory DECLINE/ remote memory is intact
WORD FINDING DIFFICULTY: Normal aging - Occasional expressive aphasia (broca's) + NO receptive aphasia (wernicke's). Dementia - FREQUENT word finding difficulty with RECEPTIVE APHASIA wernicke's
INDEPENDENCE: Normal aging - Has interpersonal skills, independent ADLs, doesn't get lost in familiar territory, if he/she does, just pauses to reorient. Dementia - Dependent for ADLs, gets lost in familiar territory while driving/walking
97
What are three possible medications for ADHD?
1) FIRST LINE: METHYLPHENIDATE, amphetamine - Stimulant
2) ATOMOXETINE: NE reuptake inhibitor
3) ALPHA-2 agonist
+/- behavioral therapy
98
BASELINE LABS before starting LITHIUM therapy for BIPOLAR DISORDER?
1) CREATININE, BUN, U/A - Due to AE of nephrogenic DI, polyuria, polydipsia
2) THYROID FUNCTION TESTS - due to AE of HYPOTHYROIDISM
3) CALCIUM - Due to tremor, ataxia, weakness, HYPERPARATHYROIDISM AE
4) EKG - In pts with coronary risk factors
99
What are the absolute contra-indications of LITHIUM USE?
What medications increase LITHIUM TOXICITY by decreasing renal excretion?
How is LITHIUM TOXICITY managed?
CKD, CAD, Hyponatremia/diuretic use
MEDS: Concurrent use of NSAIDs (not ASA), ACE inhibitors, THIAZIDE diuretics, TETRACYCLINES, METRONIDAZOLE
MGMT: HEMODIALYSIS
100
How long does pt need to take LITHIUM for BIPOLAR DISORDER?
LIFETIME
BIPOLAR DISORDER = HIGHLY recurrent d/o that requires lifetime maintenance treatment of lithium. High rate of relapse within the year if discontinued
101
What is the most widely replicated CT/MRI finding on pts with SCHIZOPHRENIA?
1) ENLARGEMENT of LATERAL VENTRICLES = most common**
| 2) Due to loss of cortical frontal lobe (DECREASED HIPPOCAMPUS/AMYGDALA VOLUME) -> ventricular enlargement
102
What is the most widely replicated CT/MRI finding of AUTISM? What about head size?
1) INCREASED TOTAL BRAIN VOLUME
| 2) ACCELERATED HEAD GROWTH during infancy
103
What is the most widely replicated CT/MRI finding of OCD?
STRUCTURAL abnormalities in ORBITOFRONTAL CORTEX + BASAL GANGLIA
104
UNEXPLAINED acute ABDOMINAL pain + psychosis/mood/neuropathy changes + FHx of unknown pscyhosis = ___
DX by?
ACUTE INTERMITTENT PORPHYRIA
| DX by URINARY PORPHOBILINOGEN
105
Cardinal sx of HIV DEMENTIA:
UNTREATED, LONG-STANDING HIV
EARLY signs of subcortical (nigrostriatal/basal ganglia) dysfn: SLOWED MVMT/SUBTLE JERKING/DIFFICULTY WITH SMOOTH LIMB MVMT
CD4Ct <200 - Increased apathy, impaired attention
106
Treatment of choice for ADJUSTMENT D/O:
PSYCHOTHERAPY - Develop Coping skills
107
Management of TARDIVE DYSKINESIA 2/2 first-generation anti-psychotic OR risperidone (SGA):
1) DISCONTINUE AGENT if possible
| 2) Switch to CLOZAPINE if continued anti-psychotic is necessary
108
How to differentiate between NMS and SER SYNDROME:
NMS: Fever is higher (>104), Muscular RIGIDITY
| SER SYNDROME: Neuromuscular irritability (Tremor, HYPERREFLEXIA, MYOCLONUS), More common GI Sx (N/V/diarrhea)
109
POSTPARTUM BLUES vs. PPD
BLUES: Peak at day 5 and resolve within 2 weeks, REASSURANCE and monitoring = tx
PPD: Within 4 weeks, SSRI (sertraline preferred in breastfeeding moms), psychotherapy = tx
110
ACUTE and LONG-TERM TREATMENTS of PANIC DISORDER
ACUTE: LORAZEPAM IV
| LONG-TERM: CBT + SSRI/SNRI
111
FIRST LINE TX for BIPOLAR DISORDER:
What medications should be AVOIDED for pts with BIPOLAR DISORDER?
MONOTHERAPY: Lithium, valproate, lamotrigine, quetiapine, lurasidone (SGA)
NOT ADEQUATELY controlled with monotherapy: LITHIUM or VALPROATE combined with QUETIAPINE (SGA)
ANTIDEPRESSANTS (SSRI/SNRI) should be avoided in bipolar d/o pts due to risk of MOOD DESTABILIZATION
112
Which dx must be ruled out before making the dx of INTERMITTENT EXPLOSIVE DISORDER?
IED can only be ruled in in the ABSENCE of ANTISOCIAL PERSONALITY DISORDER
Usually IED pts will NOT have hx of childhood conduct d/o
113
SLEEP: What is the dx when pt has difficulty initiating sleep (>=2hrs) OR wakes up later than desired time?
DELAYED SLEEP PHASE DISORDER
114
SLEEP: What is the dx when persistent daytime sleepiness can NOT be accounted for by another disorder?
HYPERSOMNOLENCE D/O
115
SLEEP: How do you differentiate between NIGHTMARE DISORDER and REM SLEEP BEHAVIOR DISORDER?
Both are fully oriented when they wake up. REM SLEEP BEHAVIOR D/O - Has associated motor activity or sleep injury whereas NIGHTMARE d/o does NOT
116
What is the treatment for CONVERSION D/O?
FIRST LINE - education + self-help techniques
SECOND LINE - CBT
+/- physical therapy for motor sx
117
How long should patient with SINGLE EPISODE MDD be on anti-depressants?
What about RECURRENT MDD, strong FHx, severe episodes of SI/attempts?
1) SINGLE: MAINTAIN WORKING DOSE for an additional 4-9 months with sustained remission to reduce relapse risk -> GRADUAL TAPER
2) RECURRENT: Keep dose for 1-3yrs OR indefinitely
118
ACUTE BIPOLAR 1 disorder mania treatment:
1) SGA** - RISPERIDONE more rapid onset of action
REST need gradual titration over a several days, NOT rapid onset
2) LITHIUM - Can't use in renal dz
3) VALPROATE - Can't use in liver dz
4) +/- BZ - For acute severe agitation
119
What is the most efficacious treatment for ACUTE BIPOLAR 1 DEPRESSIVE (not manic) episodes? What's the MOST SIGNIFICANT adverse effect of this drug?
LAMOTRIGINE
| MOST SIG AD = STEVENS JOHNSON SYNDROME
