Flashcards in Random Deck (88)
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1
Alzheimer
-early, insidious short-term memory loss
-language deficits and spatial disorientation
-LATER personality changes
2
Vascular dementia
-stepwise decline
-executive dysfunction
-cerebral infarction and or deep white matter changes on neuroimaging
--focal neuro findings specific to location of causal infarcts
3
Frontotemporal dementia
-early personality changes
-apathy, disinhibition, compulsive behavior
-frontotemporal atrophy on neuroimaging
-impaired memory
*visuospatial fxn usu INTACT
4
Dementia with Lewy bodies
-early visuospatial and executive dysfunction and at least 2 of 4...
--visual hallucinations
--spontaneous Parkinsonism
--fluctuating cognition
--REM sleep behavior disorder (dream enactment)
*need to meet criteria for dementia (cognitive impairment --> forgetfulness, abnormal MOCA) OR associated impairment in ADLs
*pt extremely sensitive to antipsychotics
5
Normal-pressure hydrocephalus
-ataxia early in disease
-urinary incontinence
-dilated ventricles on neuroimaging
6
Prion disease
-behavior changes
-rapid progression
-myoclonus and/or seizures
14-3-3 protein
7
Maintenance therapy for bipolar disorder for someone with renal disease
valproate
8
tx of PTSD-related nightmares
prazosin (alpha-1 antagonist)
9
anorexia tx
olanzapine if no response to CBT
nutritional rehab
10
eating disorder where pt maintains normal weight
bulimia nervosa
11
bulimia nervosa tx
SSRI (fluoxetine) usu in combo w/ CBT and nutritional rehab
12
binge-eating disorder tx
SSRI (sertraline), Lisdexamfetamine (vyvanse, stimulant), (some evidence that topiramate has benefit)
13
schizoid
detached, loners, NO odd thinking
14
schizotypal
long-standing eccentric behaviors and social anxiety despite familiarity, magical thinking, usual thoughts, perceptual disturbances
15
antisocial
-pervasive pattern of violating others and LACK OF REMORSE
-physically aggressive
-disregard for safety of others
-18 OR OLDER for dx
-h/o sx BEFORE 15
16
oppositional defiant
-irritable or angry mood, argumentativeness, deliberately annoying behavior, vindictiveness
-can precede development of conduct disorder
-can inc risk of adult antisocial behavior, impaired impulse control, substance abuse, anxiety, depression
17
oppositional defiant disorder tx
parent management training, psychotherapy (anger management, social skills training), no pharmacotherapy for ODD but assess for comorbid ADHD and treat if present)
18
conduct disorder
-purposefully violates rights of others and societal norms
-physical aggresio, cruelty to ppl/animals, stealing, destroying, assaulting others
-BEFORE age 15
19
disruptive mood dysregulation disorder
-BEFORE age 10
-repetitive temper outbursts out of proportion to stimulus and inconsistent with developmental age
20
narcissistic
-less impulsive
-usu no violent/illegal activities
-lack of empathy and interpersonal exploitation
21
borderline
-emotional and impulsive
-identity disturbance
-fear of abandonment
-repetitive SELF-HARM
22
borderline tx
psychotherapy with a behavioral focus (dialectical behavioral therapy)
23
paranoid personality disorder
-lifelong pattern of distrust and suspicion of others beginning in early adulthood
-paranoid beliefs generally pervasive not simply dir at one person
-not of delusional intensity
24
obsessive-compulsive personality disorder
-pervasive preoccupation with orderliness, rigid rules, perfectionism, control
-reluctance to work with others unless they agree to his way of doing things
-NO need for praise, just control
25
OCD
-clear obsessions/rituals (>1hr/d)
-struc abnormality in orbitofrontal cortex and basal ganglia
26
OCD tx
exposure and response prevention +SSRI OR clomipramine
27
peds tx of OCD
SSRI (fluoxetine)
CBT
28
Rett syndrome
rare, neurodevelopmental regression (loss of speech, purposeful hand movements, gait disturbance (“lurching gait”), deceleration of head growth) after a period of normal development
-girls 6-18 mo
-seizures common
29
Rett syndrome dx
MECP2 mut on DNA analysis
30
Schizoaffective disorder criteria
lifetime h/o delusions or hallucinations for 2 or more wk in ABSENCE of MD episode or manic episode
31
Schizoaffective vs schizophrenia
schizoaffective: presence of mood sx for significant portion of illness
32
Schizophreniform
-between 1 mo and 6 mo
- impairment in fxn may be present but not req for dx
33
Schizophrenia dx
6 mo or more
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized or catatonic behavior
5. Negative sx (apathy, flat affect, avolition, lack of facial expression, social withdrawal, diminished interest in relationships)
34
Schizophrenia neuro findings
loss of cortical tissue vol w/ ventricular enlargement (lateral ventricular enlargement)
35
family therapy
schizophrenia
36
serotonin syndrome onset/offset
rapid (<24hr)
37
meds --> serotonin syndrome
addnl serotonergic agent (tramadol, MAOi, TCA, linezolid)
38
alpha-2 agonists for child/adolescents ADHD
clonidine, guanfacine
39
ADHD tx if substance use disorder
atomoxetine
40
impaired development of joint attention
autism
(spot attempt to share interests w/ others by eye gazing and pointing at objects)
41
tx of bipolar major depression
lurasidone and quetiapine
42
bipolar II dx
A. HYPOMANIA
4 or more consecutive days of elevated/irritable mood, increased energy
3 or more:
-inflated self-esteem
-overactive mental thoughts, but organized
-quick, creative thinking --> goal-dir activities
-rapid, loud speech but easier to interrupt
-improved psychosocial fxn
-mild-mod risk-taking behavior
*sx not severe enough for marked impairment/hospitalization
B. 1 or more MD episodes
43
cyclothymic disorder
-2 or more years of fluctuation, mld hypomanic and depressive sx that do not meet criteria for hypomanic or MD episodes
44
cyclothymic disorder tx
MOOD STABLIZER
45
depression + weight loss + new-onset DM
pancreatic cancer
get CT
46
MDD dx
2 or more weeks
5/9 sx (depressed mood + SIGECAPS)
47
MDD sleep
dec REM latency (dec time from sleep onset --> first REM)
dec slow wave sleep
inc REM duration
inc REM sleep density
48
inc cortisol
MDD
hyperactivity of hypothalamic-pit-adrenal axis
49
atypical depression
mood reactivity (positive responsiveness to pleasant events)
inc appetite or weight gain, hypersomnia, leaden paralysis (heavy limbs), hypersensitivity to rejection
50
pt w/ single episode of MDD
continue antidepressants for addnl 6 mo following acute response to reduce risk of relapse
51
peds depression tx
fluoxetine
52
causes of NMS
antipsychotics
antiemetics (promethazine)
parkinson med w/d
53
NMS labs
inc CK
hypOCa
met acid
inc BUN, Cr
Leukocytosis w/ L shift
54
NMS tx
discontinue antipsychotic
start bromocriptine or amantadine
OR dantrolene if refractory
55
malignant hyperthermia
tachypnea, tachycardia, hyperthermia, MYOGLOBIINURIA
56
PNES
-eye closure or glittering
-side-side head shaking
-asynchronous limb movement
-lack of postictal period
57
mature defense mechanisms
sublimation (channel unacceptable impulses into acceptable behavior)
suppression
58
reaction formation
transforming unacceptable feelings into the extreme opposite
(immature)
59
splitting
Unable to integrate mixed feelings. Sees others as "all bad" or "all good"
(immature)
60
psychogenic (fxnl) tremors
-dec w/ distraction
-changeable or inconsistent features
61
physiologic tremors
-via SSRI, enhanced w/ Li
-not normally visible
-can be visible w/ inc sympathetic activity
-usu symmetric, lim to hands and upper limbs, occurs when med is started or dose inc
62
dystonic tremors
-via lithium
-irreg tremors exacerbated by stress
-occur w/ sustained m. contractions (wrist spasms, torticollis) usu in same area as tremor
63
essential tremor
-hands SUPPRESSED AT REST
-worsened by anxiety
-exacerbated by outstretched arms, more pronounced at end of goal-directed movements
64
cerebellar tremors
-low freq, high amp
-inc as action approaches target
65
parkinson tremor
-resting tremor, improves w/ intentional movement
66
pt's extremely sensitive to antipsychotics
dementia w/ Lewy bodies
If needed, give low-potency 2nd gen (quetiapine)
67
slowing on EEG
Creutzfeld-Jakob
68
hyperventilation syndrome
acute onset deep breathing and/or tachypnea (often + neuro sx (fingertips tingling))
normal lung exam
tx: reassurance with breathing retraining. Small dose short-acting Benz if no improvement
69
avoid which SSRI post-MI
venlafaxine
70
meds that inc Li levels
NSAIDs
thiazide diuretics
ACEi
tetracyclines
metronidazole
71
tx of Li--induced hypOthyroidism
T4
continue Li
72
venlafaxine mechanism
SNRI
but acts as SSRI at lower doses
73
acute dystonia tx
benztropine (anti-ACh)
diphenhydramine
(torticollis, opisthotonus, oculogyric crisis)
74
drug-induced Parkinsonism
benztropine (anti-ACh)
amantadine (DA-releasing agent)
75
tardive dyskinesia
reduce antipsychotic
valbenazine
deutetrabenazine (VMAT2 inhibitor)
or switch to clozapine or quetiapine
76
akathisia
beta blockers
benztropine
benzo (*inc mortality in schizophrenia)
(can't sit still)
77
short-acting benzos
alprazolam
lorazepam
78
long-acting benzos
chlordiazepoxide
diazepam
79
Benzos for pt w/ liver disease
lorazepam
oxazepam
temazepam
80
can cause false positive for PCP
dextromethorphan
diphenhydramine
doxylamine
ketamine
tramadol
venlafaxine
81
can cause false positive for amphetamines
atenolol
propanolol
buproprion
nasal decongestants
82
synthetic opioids
fentanyl
meperidine
methadone
tramadol
83
pregnant opioid user
methadone or buprenorphine
84
opioid use med management req complete detox and opioid free pt
naltrexone
85
EtOH med tx that can be started while pt is still drinking
naltrexone
86
naltrexone
opioid antagonist
XR (vivitrol)
AE: N/V GI
c/I: current opioid use, acute hepatitis, liver failure
87
acamprosate
stabilizes glutamate and GABA
AE: diarrhea, somnolence
c/I: renal disease
88
