psychiatry – lange q&a – Flashcards
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most likely mode of suicide in kids?
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- ingestion of toxic substance
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% comorbidity between anxiety and MDD
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- 50%
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rett disorder
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- almost always female - neurodevelopmental disorder - small hands and feet and a deceleration of the rate of head growth (including microcephaly in some). - Repetitive stereotyped hand movements, such as wringing and/or repeatedly putting hands into the mouth
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what % of kids will develop adjustment disorder after getting an axis I diagnosis?
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33%
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tourette's syndrome
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- multiple motor tics and at least one vocal tic - treat with clonidine (alpha agonist)
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what % of children with learning disorder also have a comorbid psychiatric disorder?
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50%
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what % of children with enuresis have a comorbid psych disorder?
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20%
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treatment for ADHD
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- stimulants - atomoxetine (SNRI)
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what metabolic disturbance occurs in anorexia?
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- hypercholesterolemia - electrolyte abnormalities
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how many words should kids know by age 3?
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200 words
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when is stranger anxiety normal in childhood? which children often do not exhibit stranger anxiety?
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- age 7-8 months - stranger anxiety is often absent in children with autism spectrum disorder
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is acute or insidious onset of symptoms correlated with better prognosis in schizophrenia?
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acute onset of symptoms (positive)
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Which children benefit from therapeutic day school programs?
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children with psychiatric disorders who cannot be managed in regular schools
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Starting a child on a stimulant for ADHD might reveal what?
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tics
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What is identification?
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An immature defense mechanism whereby the child adopts another person's characteristics, often someone the child looks up to
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what is the most common sequelae of childhood abuse?
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depression
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what is agnosia? anomia? apraxia?
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- agnosia is an inability to recognize objects - anomia is an inability to name objects despite recognizing them (pt can describe the object and what it is used for) - apraxia is inability to perform a previously learned motor skill
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IQ for severe mental retardation
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IQ 20 - 34
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IQ for moderate mental retardation
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IQ 35-49
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IQ for mild mental retardation
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IQ 50-70
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Normal IQ
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100 +/- 15
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overall schizophrenia prevalence in the population
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1%; 50% concordance between twins
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Cotard syndrome
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- delusional disorder in which delusions are of a nihilistic nature
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Capgras syndrome
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- delusions of doubles/identical impostors
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Fregoli delusion
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belief that familiar people are assuming the role/guise of stranger (different from Capgras syndrome where delusion is that people are presenting as someone's double)
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Folie a deux
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- shared delusional disorder
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postpartum psychosis usually leads to what psychiatric diagnosis later in life?
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bipolar DO
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what are two examples of neurotic defense mechanisms?
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- intellectualization and undoing
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how do you treat catatonia? which two major psychiatric illnesses can present with catatonia?
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- treat with benzos or ECT - see catatonia in MDD and schizophrenia
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what are relative contraindications to ECT? what are absolute contraindications?
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- no real absolute contraindications - relative contraindications are space occupying lesions, recent MI
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what are the sleep disturbances seen in depression?
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- early morning insomnia - decrease in REM sleep latency (experience REM sleep earlier in the night) - slow wave sleep deficits (deep sleep suffers)
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which hormone is increased in depression?
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- cortisol
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which antidepressants are most likely to precipitate a manic episode in a bipolar pt?
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- all, but TCA > SSRI/SNRI
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when is an alcoholic patient at greatest risk for DT?
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- 3-5 days after last drink
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which benzodiazapine is most suitable for preventing DT?
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- oxazepam, lorazepam, and Chlordiazepoxide (librium) bc they have longer half lives
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kluver-bucy syndrome
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- docility, lack of fear, anterograde amnesia, hyperphagia, hypersexuality - bilateral lesions in amygdala
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mobius syndrome
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- congenital absence of facial nerves and facial nuclei in brain stem - bilateral facial palsy
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punchdrunk syndrome
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- also known as dementia puglistica - often due to repeated trauma (ex: boxing) - movement disorder due to trauma to substantia nigra
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eating disorders - associated personality characteristics
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- pts often have strong drives for perfection - need to exert control over something (food, body) when faced with perceived loss of control in another part of their life - many pts have OCD tendencies
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buprenorphine
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- partial opiate agonist - used in maintenance treatment for heroin abusers
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hypomania
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- no occupational dysfunction - no psychiatric hospitalization - no psychosis
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binswanger disease
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- subcortical arteriosclerotic encephalopathy - multiple small infarcts of white matter (sparing cortical regions)
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which drug has been shown to decrease suicide ideations in schizophrenic patients?
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- clozapine
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countertransference
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- feelings and attitudes originating from the clinician and evoked by the patient
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best psychotherapy for borderline patients?
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- individual psychotherapy for DBT plus group therapy, but no group therapy at the expense of individual therapy
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ECT for depression versus mania
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- depression usually required 6-12 sessions - mania and psychosis usually require 20 sessions or more
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what do you give to an agitated patient who is experiencing delirium?
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antipsychotics (avoid anti-cholinergics because they worsen delirium symptoms)
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what is the 3 month mortality of patients after they experience 1 episode of delirium?
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23-33%
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what percentage of pts with MDD attempt suicide? successful?
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- 30% attempt - 15% are successful
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sexual masochism
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- sexual arousal derived from physical pain
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sexual sadism
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- sexual arousal derived from inflicting pain on another
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frotteurism
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pt is sexually aroused by rubbing up against strangers
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narcolepsy triad
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- cataplexy - hypnopompic/hypnagogic hallucinations - sleep paralysis
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avg length of MDD episode treated v untreated
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- untreated is 6-13 months - treated is 3 months
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facticious disorder
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- unconscious desire to assume sick role, but symptom production is fully conscious
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l frontal hemisphere stroke presents with what kind of mood symptoms?
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depression
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R frontal hemisphere stroke presents with what kind of mood symptoms?
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similar to manic symptoms: inappropriate behavior and affect
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psychiatric effect of steroids on some patients?
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- steroids may cause psychosis in some patients, usually at high dose but can happen at chronic low dose as well; psychotic episode subsides when pt is tapered off steroids - more commonly steroids cause mood symptoms in pts
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impotence in patients aged 30-50?
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- 90% are due to psychiatric/psychological problem
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in what kind of patients will CSF sampling show lower 5HIAA (serotonin metabolite)?
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- suicidal, impulsive, violent patients
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neurological stigmata in schizophrenic patients
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- short term memory loss - unstable smooth-pursuit eye movements - decreased ability to habituate to repeated sensory stimuli - difficulty conceptualizing complex visual composition
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pt who is depressed and has migraines - which anti-depressant do you use?
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- TCA antidepressant
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localized amnesia
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- loss of memory surrounding a discrete period of time, often the time right after a traumatic event
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continuous amnesia
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- loss of all memory after a traumatic event except immediate past
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selective amnesia
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- selectively forgetting certain aspects of a traumatic events but able to recall other memories about event
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pseudo seizure
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- psychogenically induced behavior that resembles an epileptic seizure in some ways but is usually more complex and is not associated with epileptic brain activity at the time of seizure - poor prognosis
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rabbit syndrome
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- late onset effect of neuroleptic - fine rhythmic movements of the lips (and nose?)
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derealization
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- sensation that one's surroundings are strange or unreal - seen in anxiety DOs, especially during a panic attack
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OCD - where is there increased activity in the brain?
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- increased activity in the caudate nucleus, frontal lobes, and cingulum
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which are the first sx to response to antidepressants in MDD?
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- sleep, energy, appetite - this is why MDD pts are at higher risk for suicide right after starting pharmacotherapy (they have the energy to commit suicide)
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koro
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- fear that penis is shrinking in to the abdomen (asian cultural delusion)
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taijinkyofusho
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belief that one's body is offensive to others
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zar
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delusional belief that one is possessed by a spirit
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kuru
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CJ like neuro disease
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voyeurism
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deriving sexual pleasure in watching another person undress or perform a sexual act
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where is serotonin made?
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dorsal/medial raphe nucleus
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locus ceruleus
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- NE-containing neurons - alarm center of brain - hyperactive in anxiety DO
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amygdala
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- fear center
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hippocampus
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- memory
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basal ganglia
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- motor activity
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somatization disorder
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- 4 pain symptoms - 1 neuro symptom - 1 sexual symptom
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brief psychotic disorder
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- 1day-1month
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conversion disorder
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- primary symptom is neurologic with motor or sensory deficits - due to underlying unconscious psychological stressor or conflict
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common psychotic feature of post-partum depression
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- hearing a child crying
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wernicke encephalopathy
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- due to B1 (thiamine) deficiency - bilateral 6th nerve palsy (abducens) - horizontal nystagmus - ataxia - global confusion - apathy
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folate deficiency presentation
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- diarrhea, cheilosis, glossitis, w/o neuro abnormalities
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delusional disorder treatment?
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- antipsychotics (pimozide)
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acute stress disorder (time frame)
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- <4 wks following a traumatic event that involved threat to self or others
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oculogyric crisis
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- example of a dystonic reaction (Spasm of EOM) seen w/ typical antipsychotics
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torticollis/retrocollis
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- abnormal positioning of the head - ex of dystonic reaction seen w/ typical antipsychotics - difficult to treat
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panic attacks and loss of consciousness?
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panic attacks should not result in loss of consciousness - explore CV etiologies in these patients
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paraphilia
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- intense sexual fantasies/urges toward nonhuman objects or non-consensual humans often involving pain or humiliation
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which benzos should you use in persons with liver damage? why?
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- lorazepam and oxazepam are renally excreted and do not need metabolic activation via oxidation in the liver
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EtOH withdrawal
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- tremors followed by psychotic/perceptual abnormalities followed by seizures - DT has a 20% mortality rate
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opiate withdrawal
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- yawning, muscle aches, diarrhea, lacrimation, rhinorrhea, fever, w/ mildly elevated vital signs (markedly elevated vital signs such as HTN and tachycardia should raise suspicion for alcohol withdrawal) - treat opiate withdrawal with clonidine (alpha agonist), methadone, lorazepam, and lopiramide (for diarrhea)
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first line treatment for panic attacks?
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- SSRIs - well tolerated and fewer side effects than MAOIs and TCAs - propranolol can be used in social phobia
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indications for psychodynamic psychotherapy?
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- pts wishing to better understand the nature of their relationship with others
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factitious disorder
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- unconscious need to assume sick role - conscious production of symptoms
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malingering
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- conscious secondary gain - conscious production of symptoms to achieve secondary gain
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anorexia nervosa
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- pt is unable to maintain body weight above 85% of expected for height and frame structure
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WISC/stanford binnet intelligence scale assess what?
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IQ
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MMPI-2 test is used when?
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when assessing personality structure
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Goodenough-Harris Draw-A-Person test and Kohs Block Test are used when?
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when assessing visual-motor coordination
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the peabody vocabulary test is used when?
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when assessing patient who have a language barrier
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1st line treatment for Tourette disorder?
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- clonidine (most common side effect is sedation, which usually subsides after a few weeks) - second line is anti-psychotic - can use atomoxetine for children who develop tics after using stimulants (For ADHD for example)
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complex partial seizures
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- often due to temporal lobe epilepsy - sensory auras, automatic behaviors that may look like tics - LOC
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which tumor often mimics symptoms seen in GAD/panic disorder?
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- pheochromocytoma - get HTN, with frequent paroxysmal exacerbations - anxiety, flushing, racing heart
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neurologic and psychiatric signs of hepatic encephalitis
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- asterixis, 6-9hz tremors, mildly increased deep tendon reflexes, altered sensorium - psychiatric symptoms - changes in personality, abrupt mood swings, changes in cognitive abilities (depression, catatonia, psychosis in acute exacerbation)
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dementia criteria
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- memory impairments plus at least one cognitive disturbance (aphasia, agnosia, apraxia, or disturbance in higher executive functioning)
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HIV dementia - common presentation
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- weakness, imbalance, ataxia, irritability, apathy along w/ normal dementia criteria
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hyperthyroidism presentation
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- depression, anxiety, psychosis, mania, delirium (extreme), hot flashes, mild cognitive deficits in calculation/recent memory, 8-12 hz tremor, lid lag, brisk tendon reflexes, myalgia
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standard delirium w/u
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- CBC w/ differential - electrolytes - BUN/creatinine - VRDL, vitamin B12, folate - urinalysis, TSH, calcium, Mg, phos - glucose - urine tox screen - LFTs, O2 sat - CXR, ECG
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Lewy body dementia
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- well-formed visual hallucinations late in life without prior psychiatric history - motor disturbances similar to parkinson's disease that occur at the same time as cognitive deficits (cogwheel rigidity, shuffling gait, reduced arm swing, usually no typical pill rolling tremor of parkinson)
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pick disease
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- changes in personality early in illness - primitive reflexes seen (suck, babinski, sout) - other features of dementia (aphasia, apraxia, agnosia) occur late in disease - preferential atrophy of frontal and temporal lobes
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Huntington disease psychiatric symptoms
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- depression, anxiety, hallucinations, memory problems, choreiform movemements - CAG repeat on short arm of chrm 4
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defense mechanism used by alcoholics
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- denial
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Beck cognitive triad
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- negative thoughts regarding self, the world, and the future (seen in depression) - helpful in cognitive therapy used to treat depression
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depression in alcoholics abstaining from alcohol (%)
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- 40% will become depressed in 1st week of abstinence - only 5% will continue to have depressed mood after 4 weeks of abstinence (wait 4 weeks after abstinence to diagnose mood disorder in someone with substance abuse)
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Korsakoff syndrome - caused by damage to which part of the brain?
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- mammillary bodies
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genetic component in bipolar disorder?
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- has one of the greatest genetic components - 80-90% risk for developing bipolar disorder if your monozygotic twin has bipolar disorder
