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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

disulfiram

inhib alc metab

c:i: EtOH, metronidazole use, CAD or myocardial disease