Psychiatry Flashcards
(128 cards)
1
Q
PHENELEZINE, TRANYLCYPROMINE
A
MAO-I
ATYPICAL DEPRESSION
CHEESE REACTION - HTN CRISIS - PRAZOSIN, PHENTOLAMINE, CHLORPROMAZINE
2
Q
RIMA
A
Meclobemide
Broferomine
3
Q
Amirtryptilline
A
TCA
PAIN AND DEPRESSION
S/E
ANTIHISTAMINIC
ANTIMUSCARINIC
ANTIADRENERGIC
ANTICHOINERGIC
Heart arrhythmia
4
Q
Imipramine
A
TCA
Nocturnal enuresis
S/e
Antihistaminic
Antimuscarinic
Anticholinergic
Antiadrenergic
Heart arrythmia
5
Q
Imipramine
A
TCA
Nocturnal enuresis
S/e
Antihistaminic
Antimuscarinic
Anticholinergic
Antiadrenergic
Heart arrythmia
6
Q
Misinterpretation of a stimulus
Perception without a stimulus
False, firm, fixed belief with subjective certainty outside ones socio-cultural background
A
Illusion
Hallucination
Delusion
7
Q
Delusion associated with schizophrenia
A
Delusion of persecution
Delusion of reference
8
Q
Delusion associated with
A. Depression with psychosis
B. Mania with psychosis
A
A. D.o. Nihilism and prosecution
B. D.o. grandiose
9
Q
Who coined the terms
A. Psychiatry
B. Schizophrenia
C. Paranoid pseudo community
D. Folie a deux
A
A. Reilly Johann Christy
B. Eugene Bleuler
C. Norman Cameroon
D. Falret
10
Q
DSM
A
Released by American Psychiatry Association
Followed in America
Current edition is 5th
Changes:
1. MR to ID through Rosa’s law
2. Modification of anorexia nervous criteria
3. Added pathological gambling as an addictive disorder which was earlier impulse control disorder
4. Added PMDD under mood disorders.
5. Introduced OCRD
6. IVLT
11
Q
ICD
A
Released by WHO
Followed in rest of the world
Edition 11th
12
Q
Prevalence of
A. Delusional disorder
B. Schizophrenia
C. Mood disorders
A
A. 0.3%
B. 0.7%
C. 5%
13
Q
A. Only delusion
No hallucination
Normal functioning
B. Delusion and hallucinations are present
Disorganized speech or/and disorganized behaviour
Negative Sx
A
A. Delusional disorder
B. Schizophrenia
14
Q
Othello syndrome
A
. Jealous type of delusional disorder.
. A.k.a pathological jealousy/ morbid jealousy/ marital infidelity.
.Aripiprazole is the treatment of choice
15
Q
A. Psychosis passionale
B. Ekboms syndrome
C. Willis ekboms syndrome
D. Cotards syndrome
A
A. D.o love/ erotomania/ de-clerambault syndrome
Common delusion in females
They are stalkers
B. Delusion of parasitosis/ Delusion of infestation
D/D: Tactile hallucinations
Matchbox sign in elderly
C. Restless leg syndrome
R/f : Iron def anemia, Hypothyroidism.
Rx : Gabapentin, Pregabalin, Pramipexole Ropinirole.
D. Delusion of nihilism in depression with psychosis
Rx : AP + AD
16
Q
Delusion of familiar person replaced by Jon familiar person
A
Capgras Sx
17
Q
- Dementie precoce
- Dementia precox
- Schizophrenia
- FRS
A
- Benedict Morel
- Emil Krepelein
- Eugene Bleuler
- Kurt scneider
18
Q
FRS [First Ranking Syndrome]
A
11 in number
Auditory hallucinations
- 1st person : Thought echo
- 2nd person : Commanding/ commenting
- 3rd person : Discussing
Thought
- insertion
- withdrawal
- broadcast
Made
- affect
- volition
- impulse
Delusional percept
Somatic passivity
19
Q
NT - FORMED FROM - STORED TO / GOES TO
A. Serotonin
B. Melatonin
C. Adrenaline
D. Acetyl choline
E. Dopamine
A
A. Serotonin - Tryptophan - Raphe nucleus
B. Melatonin - Tryptophan - Supra chiasmatic nucleus
C. Adrenaline - Tyrosine - Locus Cereleus
D. Acetyl choline - - Nucleus basilis of Mayornet
E. Dopamine - - Nucleus acuumbens
20
Q
DOPAMINE PATHYWAYS - CENTRE - ACTION
A
A. Tuberounfundibular - Pituitary - Maintains balance with prolactin
B. Nigrostriatal - Basal ganglia - Smoothening and co-ordination of movements
C. Mesolimbic- Limbic System - Controls thoughts and emotions
D. Mesocortical- Prefrontal cortex - Attention, concentration, drive
21
Q
Best to worst prognosis in schizophrenia
A
Catatonia > Paranoid > Undifferentiated > Disorganised[Hebephreniac] > Simple
22
Q
Mutism
Stupor
Negativism
Catalepsy
Waxy flexibility
Echolalia
Echopraxia
Excitement
Rigidity
A
Catatonic Schizophrenia
Rx: Lorazepam challenge test, ECT
23
Q
Silly laughter
Grimacing
Neologism
Loosening of association
A
Hebephreniac / Disorganized schizophrenia
24
Q
A. Van gogh syndrome
B. Propf Schizophrenia
C. Late onset schiz
D. Very late onset schiz
A
A. Self mutilation + Schizophrenia
B. Intellectual disability + “
C. > 40 yrs
D. > 60 yrs
25
Omega sign and Verguath fold
Depression
26
A. Major criteria
B. Minor criteria
C. Becks triad of depression
A. Pervasive and persistent (<2wks) low mood, anhedonia, fatiguability
B. Decreased
- appetite
- sleep
- self confidence
- attention and concentration
C. Helplessness - Hopelessness - Worthlessness
27
Symptoms of schizophrenia
A. Positive - Delusions and Hallucinations
B. Negative - Alogia, Apathy, Asocial, Amotivation
C. Cognitive - Decreased attention and concentration.
28
Female - acute onset - late age of onset - stressor+ - family h/o affective disorders - positive and cognitive sx are more - Rx compliance and response is good
Good prognosis of schizophrenia
29
Insidious onset - early age of onset - family h/o schizophrenia - negative Sx are more - long duration of untreated psychosis
Bad prognosis of Schizophrenia
30
A. ECT
B. Common in
1. Suicidal ideas and suicidal attempts
2. Suicide and completed suicide
A. Ugo Cerletti and Lucio Binni
Indicated in
- severe depression with suicidal ideas
- catatonia
B.
1. Females
2. Males
31
Rx of
1. Mild depression
2. Mod depression
3. Severe depression
4. Sev dep + suicidal ideas
5. Suicidal ideas
6. Severe dep + psychosis
1. CBT
2. AD
3. AD
4. ECT
5. CBT
6. AD + AP
32
A.Depression with
. Intense misery
. Early morning worsening
. Early morning awakening
. Increased guilt
. Increased tiredness
B. Depression with
. Increased appetite
. Increased sleep
. Leaden paralysis ( total psychomotor retardation )
C. Winter depression
A. Melancholic depression - SSRI
B. Atypical depression - MAO-I
C. Seasonal affective disorder [SAD]
. Light therapy
. CBT
. AD
33
A. Circumstantiality
B. Flight of ideas
C. Loosening of association
D. Prolific
A. Organic brain syndrome
B. Mania
C. Schizophrenia
D. Hypomania
34
Duration criteria
A. Depression
B. Mania
C. Hypomania
D. Dysthymia
E. Rapid cycling
A. 14 days/ 2 weeks
B. 7 days / 1 week
C. 4 days
D. 2 Years
E. 4 episodes in 1 year
35
PHQ 9
HAM D
YMRS
BFCRS
PHQ 9 - Patient health questionnaire 9 - Dep screening
HAM D - Hamilton scale for Depression - Dep severity
YMRS - Youngs Mania Rating Scale - Mania severity
BFCRS - Bush Francis Catatonia Rating Scale - Catatonia severity
36
A. IPSRT
B. ERPT
C. EMDR
D. DBT
E. HRT
A. InterPersonal Social Rhythm Therapy - Mania
B. Exposure and Response Prevention Therapy - OCD
C. Eye Movement Desensitisation and Reprocessing - PTSD
D. Dialectic Behavioural Therapy - BLPD / EUPD
E. Habit Reversal Training - TICS
37
A. Ego-dystonic
B. Ego-syntonic
C. Thought possession
D. Thought content
A. OCD
B. OCPD [Analastic type of personality]
C. Obsession and Thought alienation
D. Delusion and Overvalued ideas
38
Defence mechanisms in OCD
URI
Undoing
Reaction formation
Isolation of affect
39
Which of the floowing chromosomes is associated with depression
A. Chr 21
B. Chr 18
C. Chr 22
D. Chr 17
1. A and B
2. B
3. A, B, and D
4. A, B and C
A, B and C
Chr 18, 21, 22
40
Which of the following organic conditions are not associated with depression
A. Multiple sclerosis
B. Post CVA
C. Post MI
D. Fever
D
41
Which of the following organic conditions are not associated with depression
A. Multiple sclerosis
B. Post CVA
C. Post MI
D. Fever
D
42
Drugs causing depression
PrOCIE
Propranolol
OC pills
Corticosteroids
Interferon
Efavirenz
43
A. Most common obsession
B. Most common compulsion
C. Type of thinking in OCD
D. Comorbidity asso with OCD
E. Neuro anat of OCD
F. NT asso with OCD
G. Associated movement disorder
H. Management of OCD
A. Contamination
B. Checking
C. Magical thinking
D. Depression
E. Orbits frontal cortex, cingulate gyrus, caudate nucleus
F. Serotonin
G. Tics
H.
1. Pharmacological
SSRI at larger doses [ Fluoxetine (80-100mg), Fluvoxamone (ssri for ocd) ]
TCA - Clomipramine
2. Psychological
ERPT
3. Surgical
Subcaudate tractotomy
Cingulotomy
44
PANDAS
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus
Causative of TICS and OCD following streptococcal Infection
45
Psychoanalysis
Psychosexual stages of development
Pleasure principle
Defence mechanisms
Free association
Interpretation of dreams (symbolization, condensation, displacement, secondary elaboration)
Topographical theory of mind
Structural theory of mind
Psycho dynamic theory
Transference and counter transference
Sigmund Freud
46
Importance of psychosexual stages of development.
Fixation at each stage result in following conditions
A. Oral - Addiction, schizophrenia
B. Anal - OCD
C. Phallic - Oedipus complex, Electra complex
D. Latent and Genital - Nuerotic disorders
47
OCRD
Hoarding
Body dysmorphic disorder
Trichitallomania
Excoriation disorder
Hypochondriasis
48
D/D of Panic attack
1. Heart - MI, Arrythmia
2. Lungs - Asthma, Pulm embolism
3. Endocrine - Hyperthyroidism, Hypoglycemia
4. Substance abuse - Cocaine, Amphetamines, Cannabis
5. Substance withdrawal - Alcohol, BZD
49
Treatment of panic attack
A. Pharmacological
Paroxetine + Alprazolam
B. Non pharmacological
. De-catastrophization
. Introceptive exposure
50
Phobia with hypotension and falls which is highly heritable
Blood - injection Phobia
Prevention of falls by applied tension
51
Fear of
A. Cats
B. Height
C. Crowded spaces / Market
A. Aliurophobia
B. Acrophobia
C. Agoraphobia
52
A. Ophidophibia
B. Nyctophobia
C. Cynophobia
D. Thanatophobia
E. Claustrophobia
F. Xenophobia
A. Snakes
B. Darkness
C. Dogs
D. Death
E. Closed spaces
F. Strangers
53
Treatment for phobias
Systematic desensitization by Joseph Wolpe
Flooding
Modelling
VR Therapy
54
A 40 year old male wakes up with worries about today's day, meetings, family members.
He has constant worries about the events of the day, the food he eats, the people he meets for over 6 months. Since 6 months he has a sense of restlessness, fatigability and is irritable.
He is suffering from?
Treatment?
Generalized anxiety disorder
Rx: Buspirone [5HT1A Partial Agonist]
55
Diagnostic criteria for
A. Adjustment disorder
B. Acute stress disorder
C. PTSD
A. Maladaptive reaction to identifiable stress
Within 3 months [DSM 5] Within 1 month [ ICD 11]
Tendency to dissipate during 6 months
B. Life threatening, near death experience lasting for <1 month
C. Life threatening, near death experience lasting for >1 month
56
Patient has
Flashbacks, autonomic hyperarousal, avoidance and low mood following a car accident for >1month
Dx and Rx
PTSD
Pharmacological - Prazosin, Propranolol, BZD, AD
Non pharmacological - EMDR
57
Dissociative fuge
Patient wanders off and reaches a distant place after a recent stressor, but is not able to remember how he reached there.
Commonly seen in children and women
58
Briquettes syndrome
Somatisation disorder
Characterized by psychological pain all over the body [stomach, legs, hand,...]
59
A. Feels that he has an illness but calms down when proven wrong but comes back after a fee (6) months
B. Produces symptom to get a sick role
C. Produces symptoms in others [usually children] to get a sick role.
D. Produces symptoms to get benefits of some kind.
E. Seen in prisoners, exhibits vorbigehanism.
A. Illness anxiety disorder [hypochondriasis]
B. Munchausens Sx / Factitious disorder/ Pseudologia fantastica/ Peregrination
C. Munchausens by proxy. Is a form of child abuse.
D. Malingering
E. Gansers syndrome
60
Culture bound syndrome
India - Dhat
China - Koro
61
20 year old female
Restricted food intake, exercising, body image disturbances, BMI=16.5
Dx, Rx, Lab Inv, Complications
Dx : Anorexia Nervosa
Rx :
Pharmacological - SSRI, low dose Olenzapine, Cyproheptadine [ in bulimic type]
Non pharmacological- Dynamic psychotherapy, CBT, Family therapy
Lab inv
Increased GH, LFT, Cholesterol, CSH, ACTH, Cortisol
Decreased - Leucopenia, Anaemia, Thrombocytopenia, Osteopenia, Osteoporosis, Hypothyroidism, decreased FH and LSH, hypokalemia, hypophosphatemia
Compications
. Lanugo hair
. Emaciated -> flattened/inerted T wave, ST depression, prolonged QT interval
. Swelling of salivary glands
. Bradycardia
. Hypotension
. Deficiencies
62
Binge eating
Self induced vomiting
Abuse of laxatives
Guilt due to eating
Has characteristic marks on knuckles [Russell sign]
Dx, Rx, complications
Dx : Bulimia Nervosa
Rx : Psychotherapy, Fluoxetine
Complications
Alkalosis, hypochloraemia, hypokalemia, hyponatremia, hypocalcemia, Mallory Weiss tears
63
Anti obesity drugs
1. Orlistat - pancreatic lipase inhibitor
2. Topiramate - anticonvulsant
3. Sibutramine - SNRI
64
LOT Drugs
Lorazepam
Oxazepam
Temazepam
LOT drugs undergo direct glucorinadation in liver and is hence useful to be administered in patients with hepatic dysfunction
65
Oligophrenia
Group of non progressing psychic disorders of organic nature
Eg: Downs syndrome
66
Stereotypical movements
Repetitive, non functional movements that have no specific goals or purpose.
Eg: Head banging, arm waving, self biting.
67
Primary Insomnia
Non restorative sleep
Difficulty in Initiating / maintaining sleep
Repeated awakening
>1 month
68
MMSE
. Mini mental state examination
. In patients with dementia
5 cognition are assessed [ORRAL]
1. Orientation(10)
2. Registration(3)
3. Recall(3)
4. Attention(5)
5. Language(9)
69
Criteria for Erectile Dysfunction
1.Atleast one of the three on almost all or all sexual activity.
A. Difficulty in obtaining an Erection during sexual activity
B. Difficulty in maintaining the Erection till the end of the serial activity
C. Decrease in erectile rigidity
2. Criterion A for minm duration of atleast 6 months.
3. Criterion A has caused significant distress in the individual
70
Chronic Fatigue Syndrome
Unexplained fatigue over 6 months that is
1. Of a new / definite onset
2. Not due to continuing exertion
3. Not resolved by rest
4. Functionally impairing
71
Night eating syndrome - criteria, Rx
Criteria
. Consumption of large amounts of food after evening meals
. Decreased appetite during day
. Insomnia +
. > 3 months of duration
. Begins in early adult hood
Rx - SSRI, Topiramate, CBT, Bright Light Therapy
72
Newer drugs in post partym depression
Brexanolone
Zuranolone
73
Bupropion
NDRI
A.K.A Zyban
Used in smoking cessation, Hypoactive Sexual Desire Disorder
Less sexual side effects, and weight gain
Can cause seizures
C/I in Bulimia nervosa where seizure may occur due to already present electrolyte abnormalities I the patient.
74
A. Organic Erectile Dysfunction
B. Psychogenic erectile dysfunction
A.
1. Rx : PDE5 inhibitors - Sildenafil, Tadalafil, Vardanafil
S/E
- NAION - Non Arteritic Ischemic Optical Neuropathy
- Blue tinged vision
C/I
- Nitrates
- Recent MI
B.
Rx : Master and Johnson tech/ Dual sex therapy/ Sensuate focus therapy.
A v/s B
1. Early morning Erection A- B+
2. Erection outside the room A- B+
75
PME
A. Organic
Rx: Dapoxetine
B. Psychological
Rx: Sex education, squeeze technique, start and stop technique.
76
1. Paraphilias
2. Exhibitionism
3. Voyeurism / Scotophilia
4. Frotteurism
5. Fetishism
6. Sadism and Masochism
7. Transvestism / Eonism
8. Necrophilia
9. Telephone scatalogia
1. Deviant sexual behaviour
2. Undresses in public places in front of strangers
3. Peeping tom
4. Pleasure by rubbing penis on clothed women
5. Sexual inclination to non sexual and I animate objects
6. Sadism - Hurt others Masochism - Self hurt
7. Cross dressing within the room
8. Dead bodies
9. Obscene words through phone
77
1. Nymphomaniac
2. Frigidity
3. Satyriasis/ Donjuanism
1. INCREASED sex drive/ Addiction in FEMALES
2. DECREASED sex drive/ Addiction in FEMALES
3. Increased sex drive / Addiction in MALES
78
REM Sleep
. Late stage of sleep
. Dreams +
. Muscle hypotonia [ Exc - Ocular, Cardiorespiratory and penile ]
. Parodoxical sleep
. Nightmares
. REM Behavioural Disorder ( in Schiz and other neuro degenerative cond like Lewy Body dementia)
. REM latency is decreased in DEPRESSION
. SAW TOOTH waveform in EEG
79
N-REM Sleep
. Early stage of sleep
. Dreams -
. Muscle tone +
. Orthodoxical sleep
. Night terrors
. Somnambulism
. Hypnic jerks
. Bruxism
. 3 stages
- S I - Theta waves - Hypnic jerks
- S II - Sleep Spindle with K complex - Bruxism
- S III - Delta waves - RESTORATIVE SLEEP
80
Narcolepsy
1. Features - Cataplexy, Hypnogogic hallucinations, sleep paralysis, Hypnopompic Hallucinations, Day time sleepiness.
2. Cause : REM Spillage, Deficiency of Hypocretin and Orexin
3. Rx : Modafinil, Psychostimulants
81
Hypersomnia
Hyperphagia
Irritability
Klein - Levin Syndrome
82
Cluster of personalities
A. Cluster A - Paranoid, Schizoid, Schizotypal
B. Cluster B - Histirionic, Narcisstic, Anti social, EUPD/BLPD
C. Cluster C - Anxious avoidant, Dependent, Anakastic
83
Schizotypal
Odd dressing
Odd behaviour
Odd thoughts
Delusion like thoughts
Hallucination like perception
84
Histirionic
Attention
Affection
Appreciation
Centre of stage
Dramatic
Multiple superficial relations
Seductive
Ass with Somatization and alcohol use disorders
Defence mech : Repression and Dissociation
85
Antisocial
Dis-social
No guilt / shame
Doesnot learn from mistakes
Does anti social activities [criminal]
Substance use
Low resting heart rate in adolescent males is consider a marker to Anti social personality
86
BLPD / EUPD
Intense and deep relations
Impulsivity that are self damaging
- Spending
- Sex
- Reckless driving
- substance use
- Binge eating
Suicidal attempts
Black and white thinking
Defence mechanisms: Idealization, Devaluation
Rx: Dialectic Behavioural Therapy (Marsha Lienhan)
Mentalization based therapy
Transference focused Psychotherapy
Anti depressants
MAO-I
87
Types of personality
4 types
1. Type A
. Born warriors
. Achievement oriented / Ambitious, Time oriented
. INCREASED RISK FOR OCCURENCE OF CAD
2. Type B
. Relaxed, laid back, and easy going
3. Type C
. Detail oriented
. Analytical
. Logic and precision
. Orderliness
. INCREASED RISK FOR CANCER
4. Type D
. Born worriers
. Increased self confidence
. INCREASED RISK FOR RECURRENCE OF CAD
88
Alcohol levels and impediment
20-30 > Dec motor performance & thinking ability
30-80 > Inc motor and cognitive problems
80-200 > Inc co.ord and judgement errors
200-300> NYSTAGMUS, BLACK OUTS, SLURRING OF SPEECH
>300 - IMPAIRED VITALS -> DEATH
89
Alcohol withdrawal
6-8 hrs -> Tremors
12-18/24/48 -> GTCS ( Rum Fits )
>72 hrs -> Delirium Tremens
Delirium tremens
* Altered sensorium
* Clouding of consciousness
* Disorientation to time, place and person
* Visual Hall -> LILLIPUTIAN HALLUCINATIONS
* Sun - Downing phenomenon
CAUSES OF DELIRIUM TREMENS
. Sudden Withdrawal
. Infections
. Electrolyte abnormalities
. Deranged lft / rft
90
A known alcoholic pt presents with
Global confusion, Ophthalmoplegia and Ataxia
Dx, Rx
Dx : Wernickes Encephalopathy
Rx : 100% curable by thiamine
W.E + ComONFABULATION & ANTEROGRADE / RETROGRADE AMNESIA = KORDAKOFF PSYCHOSIS
91
Fetal Alcohol Syndrome
Learning disability
Epicanthal folds
Depressed nasal bridge
Short nose
Smoothened / undifferentiated philtrum
Micrognathia
Ear abnormalities
92
Alcohol detoxification and deaddiction
Detox - LFT normal - Chlordiazepoxide
- LFT > 5 times normal - Lorazepam
Deaddiction
. Disulfiram- blocks aldehyde dehydrogenase - initial dose 250 MG- no anti craving property
. Naltrexone - blocks opioid receptors- decreases craving for alcohol and opioid - c/I in liver damage
. Acarbaprost - Afeecrs GABA and Glutamate receptors - c/I in kidney damage
93
1. SCOFF
2. OCEAN
3. PLISSIT
4. SPIKES
5. CAGE
6. RAPS4
7. AUDIT
8. FTND
1. Questionnaire to assess EATING DISORDER
2. " to assess PERSONALITY DISORDER
3. Protocol to give SEX EDUCATION [ Permission, Limited Information, Specific Strategies, Intensive Therapy ]
4. Protocol to break bad news [ Setting, Perception, Invitation, Knowledge, Empathic response, Summarization ]
5. Questionnaire to assess ALCOHOL ADDICITION [ Cut down, Annoyed, Guilt, Eye opener ]
6. Questionnaire to assess Alcohol Addiction
[ Remorse, Amnesia, Performance after drinking, Starter ]
7. Alcohol Use Disorder Identification Test
8. Fagerstrom tmTest for Nicotine Dependence
94
Nicotine replacement therapy
Nicotine gums - Chew > Park > Chew - no jot beverages for 30 mins
Nicotine patches (upto 12 hrs)
Nicotine inhalants
Bupropion [Zyban] - NDRI
VARENCILINE [Nicotine receptor partial agonist (alpha4beta2)] - Starting dose 0.5 MG, set a fate and start 1 week before the date - Rx of choice -
S/E -> Agitation, psychosis, aggression, change in mood, hostility, panic, Anxiety, SUICIDAL IDEATION
95
Cannabis
Available as Bhang, Oil, and Joint
Causes Vasodilation resulting in redness of eye and Increased appetite due to presence of cannabinoid receptor in feeding centre.
Known as gateway drug
Causes hemp insanity, RUN AMOK
Can mimic panic sx during intoxication
Anandamide is an endogenous produced cannabinoid.
96
Lacrimation Rhinorrhea Vomiting Sweating Piloerection Diarrhoea Tachycardia Yawning Mydriasis
Opiate withdrawal
97
Euphoria Miosis Respiratory depression Analgesia Constipation
Opioid Intoxication
Rx : IV Naloxone
1st step in Rx is securing airway then medication
98
Opioid detox and opioid Addiction
Detox : Methadone, Buprenorphin, Suboxone
Deaddict: Nalaoxone, Naltrexone, Nalmefene
99
Medical uses of cannabis
Glaucoma
Cancer cachexia and hiv ( incr appetite )
Anti emetic, epileptic, spasmodic
Analgesic
100
Main lining
Snorting
Chasing the dragon
Huffing / Bagging
Methods of Cocaine abuse
101
Septal perforation, MI, Blood borne viral infection is seen in which sub abuse
Psychiatric relevance of the substance
Seen in cocaine abuse
High potent cocaine is called CRACK
Post cocaine depression is called CRASH
It causes Tactile Hallucinations, CRASH and Panic attack like symptoms
Can cause aspiration and death in Huffing / Bagging
Can cause temporal lobe epilepsy which may lead to Gustatory and Olfactory Hallucinations
102
Hallucinogens
1. LSD - Lysergic Acid Diethylamine - YELLOW SUNSHINE
2. PCP - Phencyclidine - ANGEL DUST
3. Ketamine - SPECIAL K - RAPE DATE DRUG
4. Psilocybin- Naturally occurring Hallucinogen
Causes Bad trip, Flashbacks, Synesthesia [ reflex Hallucinations ]
103
Anabolic Androgenic Steroids
100 x Normal Testosterone
S/E
. Alopecia
. Gynaecomastia
. Roid rage
. Testicular Atrophy
104
Rape date drugs
Cause amnesia and lack of awareness
1. Flunitrazepam [ Rophynol ]
2. Ketamine
3. Gamma hydroxy butyrate
4. MDMA [ Ecstasy ]
105
Risk factors of PATHOLOGICAL GAMBLING
Males
<45 years
H/o violence, family mental illnesses, no parents
Alcohol use
Comorbid anxiety or depression
Now classified under Addiction disorder according to DSM 5
106
Intellectual disability
. Formerly MR, changed by Rosas law in DSM 5
. Iq = MA/CA X 100 [ MA - Mental Age CA - Chronological age ]
90-110 : Normal
70-90 : Borderline
50-70 : Mild
35-50 : Moderate
20-35 : Severe
<20 : Profound
107
Pervasive Developmental Disorders / Autism Spectrum Disorders
. Include - Autism, Retts syndrome, Hellers syndrome [Childhood Disintegrative Disorder]
. Triad of Autism- Decreased verbal and nonverbal communication + Decreased social interaction + RRBI [Restricted Range of Behavior and Interests]
108
Autism + Normal verbal communication
Aspergers Sx or Savants Sx or Little Proffessors
109
Retts syndrome
Seen in - Females, MeCP2 Mutation, Hyperammonemia
Symp: Autism triad + Seizures + Scoliosis + Irregular Respiration + Ataxia
Rx : TROFINETIDE
110
Hellers Sx or Childhood Disintegrative Disorder
Normal till 2 years of age
Shows REGRESSION of milestones and triad of Autism after age of 2
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ADHD Criteria and Rx
Criteria
. Minimal Brain Dysfunction characterized by INATTENTION - HYPERACTIVITY - IMPULSIVITY
. <12 years of age
. In more than 2 settings(places)
. For a duration of 6 months
Assessed by CONTINUOUS PERFORMANCE TEST
<5 YEARS - Only Behavioural Therapy
>5 years
- Stimulant drugs : Dextroamphetamine, Methyphenidate
- Non Stimulant : Clonidine, Atomoxetine
Stimulant drugs S/E:
Growth suppression, Rebound hyperactivity, TICS, drug abuse
METHYLPHENIDATE - Tachycardia, incr BP, and sweating
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Specific Learning Disorders
Dyslexia - Neurobiological deficit, Phonological deficit
Dysgraphia
Dyscalculia
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Rapid, briefed, stereotyped, involuntary movements
TICS
Properties of TICS - Premonitory urge, Suppressible
Types
1. Simple vocal - Throat clearing
2. Complex vocal - Echolalia, Coprolalia
3. Simple motor - Shoulder shrugging, Eye blinking
4. Complex motor - Echopraxia
Tourettes Disorder : 1 motor + 1 Vocal + 1yr + <18 yrs onset
Rx : Risperidone, Clonidine, Habit Reversal Therapy
Asso with OCD (PANDAS and Caudate Nucleus)
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Impulse Control Disorder
1. Pyromania - common in boys
2. Kleptomania - common in girls, the act of stealing gives satisfaction, stolen things are generally of no value to the person
3. Trichitallomania
4. Intermittent Explosive Disorder
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1. Oppositional Defiant Disorder
2. Conduct Disorder
1. Mostly in 8 Yr old children.
Annoyed, annoys others, argumentative.
Problem against authority or someone controlling them (parents, teachers...)
2. Features of antisocial personality in children <18 years of age.
Bullying, stealing, not following rules, harming animals, truancy.
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1. Operant conditioning
2. Classical conditioning
1. B F SKINNER - Punishment and Reinforcement
2. IVAN PAVLOV - Bell and Pad technique
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Nocturnal Enuresis
1. Boys > Girls
2. Not before 5 yrs of age
3. Associated with daytime incontinence (diurnal wetting)
4. Local cause maybe UTI
5. Rx
. Psychological - Bell and pad technique
. Pharmacological - Imipramine, Desmopressin
6. Occurs 30 minutes to 3 hours after onset of sleep
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1. Selective Mutism
2. Separation Anxiety
1. Can be caused by childhood Anxiety
Child does not talk in a new setting for >1 month
2. Anxious to be separated from parents, thinking something might happen to then if the child is away.
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Dementia
2 types, Reversible and Non reversible
2 types of non reversible are CORTICAL & SUBCORTICAL
Cortical include - Alzheimers Demetia, Picks [fronto temporal] dementia, Cruzfeldt Jakob Dementia [prion/kuru]
Subcortical include - Dementia due to lewy body, Huntington dementia, Parkinson dementia, Wilson dementia
Reversible dementia include
- deficiencies if vit B1, B12 and Niacin
- Hypothyroidism
- Normal pressure Hydrocephalus [Dementia-Ataxia-Urinary Incontinence]
Rx
Pharmacological [MeGaDoRiTa]
. Memantine [NMDA antagonist]
. Galantamine [Rest all are Acetyl choline esterase inhibitors]
. Donepezil
. Rivastigmine
. Tacrine
Newer advance - LECANUMAB, ADACANUMAB, BREXIPRAZOLE
Non pharmacological - Rennaisanve Psychotherapy
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Alzheimers Dementia
Cortical
Gradual progression of dementia
Neuron with tangles
Amyloid plaques - also seeing in downs and normal aging - increasing number and density with increasing severity of disease
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Dementia with
Altered sensorium, Visual Hallucinations and increased sensitivity to anti psychotic with parkinsonism features
Demetia with lewy bodies
Only dementia with alt sens, vis hall, and incr sens to AP
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Dementia with
Altered sensorium, Visual Hallucinations and increased sensitivity to anti psychotic with parkinsonism features
Demetia with lewy bodies
Only dementia with alt sens, vis hall, and incr sens to AP
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Dementia
Depression
Death by suicide
Chorea
Huntington dementia
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ECT
. Electrolyte Convulsive Therapy
. By UGO CERLETTI AND LUCIO BINNI
. Used in severe depression with suicidal ideas and Catatonia
. Now modified ECT under MHCA
- Anaesthetic + Muscle Relaxant + Atropine
. S/E : Retrograde Amnesia, Myalgia, Headache
. NO absolute C/I
. Electrode placement
- Bifrontal - Less common - less cognitive s/E
- Bitemporal - more common - more cognitive s/e
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rTMS
. Repetitive Transcranial Magnetic Stimulation
. Uses eddy currents to stimulate cerebral cortex
. Used in treatment of Treatment Resistant Depression
. S/E : UNINTENDED Seizures.
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Vagus Nerve Stimulation
. Stimulates vagus nerve -> excites nucleus ambiguous-> excites locus cereleus -> Inc adr/NA
-> excites Raphe Nucleus -> Inc 5HT
. Used in Treatment Resistant Depression and Intractable Seizures
. S/E : voice change
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Father of Psycho surgery
Egaz Moniz - performed Prefrontal leucotomy
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Neuromodulation
. A.k.a Deep Brain Stimulation
. Makes use of 2 neurostimulators near the clavicle.
. Used in Parkinsons and Rx Resis Depression
