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221 Cards in this Set
- Front
- Back
What medical causes should be included in the differential diagnosis for ADHD?
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Lead intoxication
Hyperthyroidism |
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What are the four categories of symptoms patients must suffer from to be diagnosed with somatization disorder?
|
Pain syndrome (4)
GI symptoms (2) Sexual symptom (1) Pseudoneurologic (1) |
|
What medical conditions may mimic a panic disorder or other anxiety disorders?
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Dysrhythmias
Mitral Valve Prolapse Hyperthyroidism Asthma Pheochromocytoma |
|
In depression, how are most patients' appetite and sleep pattern affected?
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In typical depression, appetite decreases and sleep decreases
In atypical depression, appetite and sleep both increase |
|
What is the mnemonic for remembering the 8 symptoms of depression?
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SIGECAPS
Sleep, Interest, Guilt, Energy Concentration, Appetite, Pleasure, Suicidality |
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What is mixed mania?
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Co-occurence of manic and depressive symptoms in the same week
|
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What percentage of children with bipolar disorder also have ADHD?
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70%
|
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What is the age requirement in diagnosing ADHD?
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Onset of symptoms must have occurred before the age of 7
|
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Is Lithium indicated in the treatment of children with bipolar?
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Yes, it has been used effectively in children and adolescents for years
|
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What is the most distinctive side effect of lamotrigine?
|
A rash that can progress to Stevens-Johnson syndrome
|
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How is Asperger disorder differentiated from Autistic disorder?
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There is preservation of language development with Asperger
|
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How is "brief psychotic disorder" differentiated from "schizophreniform disorder"?
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BPD - psychotic symptoms present less than a month
Schizophreniform - symptoms present >1month but less than 6months Over 6 months = schizophrenia |
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What is folie a deux?
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Delusional symptoms from one person influencing delusions in another person
|
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What percent of children with Gender identify disorder have symptoms persisting into adulthood?
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10%
2/3 of males become homosexual men |
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What is a pseudohallucination?
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When a hallucination is recognized as unreal
|
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What is Capgras syndrome?
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The false perception that someone has been replaced by a double
|
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What medications are used in treating obsessional thoughts?
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Medications with affinity for serotonin receptors like Clomipramine and SSRIs
|
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What is verbigeration and in what condition is it often seen?
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Constant repetition of syllables and sounds, seen in schizophrenia
|
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What is alexithymia?
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Inability to describe or recognize one's own emotions
|
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What is Charles Bonnet syndrome?
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Visual hallucinations in people who recently developed blindness
|
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What is a doppelganger?
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A visual hallucination of one's own body that leads to the belief that one has a double
|
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What is the concordance rate of schizophrenia in monozygotic twins?
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40-50%
|
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Children born during which season have a higher rate of developing schizophrenia?
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Winter months - possibly a viral cause
|
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Genetic linkage studies have linked schizophrenia to which chromosome?
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6
|
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What is the mechanism of LSD?
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Blocks serotonin receptors in the brain
|
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What is the mechanism of PCP?
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Acts as an antagonist at the NMDA receptors
|
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Through what mechanism does clonidine improve schizophrenic symptoms?
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Acts as an alpha-2 agonist leading to a decrease in the release of norepinephrine
|
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What percentage of people with an acute onset of schizophrenia have a lack of insight?
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97%
|
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Does schizophrenia have a better prognosis if it has an acute or insidious onset?
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Acute onset has better prognosis that responds better to treatment
|
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What is Othello syndrome?
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Delusions of jealousy on the part of husbands about their wives
|
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What body type in men is more prone to schizophrenia?
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Tall, thin asthenic type
|
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What percent of patients with acute schizophrenia show significant depressive symptoms?
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Around 50%
|
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Are structural abnormalities in patients with schizophrenia more common on the right or left side of the brain?
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Left side
|
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What is the most common kind of delusion in patients with delusional disorder?
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Persecution - Present in about 83% of patients
|
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Is erotomania more common in men or women?
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Erotomania is the delusion of having a secret lover and is more common in women
|
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What is another name for the phenomenon of "derailment"?
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Loose associations
Present in about 45% of patients with schizophrenia - most common thought disorder |
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What is the recurrence rate of postpartum psychosis in future pregnancies?
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70%
Postpartum depression has a recurrence rate of 50% |
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What is the risk of bipolar illness in a first-degree relative of someone with bipolar?
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7-8%
|
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Which antidepressant class is associated with peripheral neuropathy?
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MAOIs - thought to be due to a pyridoxine deficiency
|
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What causes increased cortisol levels in many depressed patients?
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A disturbance in the HPA axis
|
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How is REM sleep altered in patients with depressive disorders?
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Decrease in latency to the onset of REM
Increase in the total duration of REM sleep |
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What does "double depression" mean?
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Refers to major depressive disorder superimposed on dysthymia
|
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What are typical features of atypical depression?
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Increase in appetite and weight
Hypersomnia Rejection sensitivity Reactive mood |
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How long after delivery can a patient be diagnosed with postpartum depression?
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It must occur in the four weeks after delivery
|
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Is there a higher rate of depression among boys or girls in the prepubertal age group?
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Boys, although there is a higher lifetime prevalence in females
|
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What percent of patients with major depression have a positive dexamethasone suppression test?
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50%
|
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Do cholesterol levels tend to be high or low in patients with major depression disorder?
|
Low levels of cholesterol
|
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How is mania distinguished from hypomania?
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In mania, the person must experience significant social and occupational dysfunction
|
|
What is the treatment of choice in patients suffering from post partum depression?
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ECT is very effective if the patient is refusing to take care of themselves or their baby
|
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What percent of patients diagnosed with bipolar eventually commit suicide?
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10-15%
|
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What is Veraguth's fold?
|
The main fold in the upper eyelid that is angulated upward and backward more commonly in depressed patients
|
|
What are features of benzodiazepine withdrawal?
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Anxiety
Delirium Depression Seizures Constipation and Diarrhea |
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How long does the anxiolytic buspirone take to work?
|
4-6 weeks
|
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What is the mechanism of buspirone?
|
5HT1A agonist - an anxiolytic
|
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Is GABA activity increased or decreased in patients with anxiety disorders?
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Decreased GABA
Increased NE |
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What is the name of the small retropontine structure in the brain that is the source of all the brain's adrenergic innervation?
|
Locus ceruleus
Stimulation causes panic attacks |
|
What is the most common site of pain in women with pain disorder?
In men? |
Women - headache
Men - back ache |
|
Is hypochondriasis more common in men or women?
|
Equal prevalence between 3-13%
|
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What is the average number of personality states in a patient with dissociative identity disorder?
|
13
|
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What is cynophobia?
|
Fear of dogs
|
|
What is mysophobia?
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Fear of dirt and germs
|
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What is the most common psychosurgical procedure performed for treatment-resistant OCD?
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Cingulotomy
|
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Decribe the defense mechanism of sublimation -
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Unacceptable aggressive ideas or wishes are rechanneled into another form that is acceptable to society
|
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Brain imaging studies show pathological involvement of which parts of the brain in patients with panic disorder?
|
Temporal lobes - particularly the hippocampus
|
|
What is the prevalence of depression in the elderly population?
Dementia? |
Depression - 10-15%
Dementia - 5% |
|
What is pseudodementia?
|
Cognitive changes occuring in depression - particularly in the elderly
|
|
What MRI changes may be seen in patients with Alzheimers disease?
|
Periventricular hyperintensities
|
|
What medications may be helpful in treating enuresis?
|
TCA's - imipramine
Desmopressin |
|
What is Kleine Levin syndrome?
|
Characterized by hypersomnia, hyperphagia, sexual disinhibition, and sometimes psychosis.
|
|
At what age do children develop the concept of permanence of death?
|
4-5 years old
|
|
What percentage of intracranial injuries seen in children younger than 1 year are due to physical abuse?
|
Over 95%
|
|
What causes pediatric autoimmune neuropsychiatric disorder?
|
Associated with a Strep A infeciton
Characterized by OCD and tics |
|
What percentage of children diagnosed with conduct disorder will have antisocial personality disorder in adulthood?
|
40%
|
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During what stage of sleep do nightmares occur?
Night terrors? |
Nightmares - REM sleep
Night terrors - non-REM sleep in the first 1/3 of sleep |
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Neuroleptic-induced parkinsonism is caused by blockade of D2 receptors in which part of the brain?
|
The caudate at the termination of the nigrostriatal dopamine neurons
|
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Name some medications that can be used to treat neuroleptic induced parkinsonism-
|
Benztropine
Amantadine Diphenhydramine (benadryl) |
|
What is akathisia?
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The signs or feeling of restlessness including jitteriness, pacing, and rocking motions
|
|
What are the best drugs to treat neuroleptic induced akathisia?
|
Beta blockers
|
|
What is the only antipsychotic to have minimal risk of tardive dyskinesia?
|
Clozapine
|
|
What are some objective signs of neuroleptic malignant syndrome?
|
High fever, sweating, increased blood pressure
Elevated CPK, liver enzymes and plasma myoglobin |
|
What three medications are sometimes used to treat neuroleptic malignant syndrome?
|
Dantrolene
Bromocriptine Amantadine (less common) |
|
What two drugs are common causes of malignant hypertension?
|
Succinylcholine
Halothane |
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What class of drugs are clonidine and guanfacine?
|
Presynaptic a2 agonists
|
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Name some important psychiatric clinical applications for alpha2 agonists-
|
ADHD
Opioid withdrawal Tourette's PTSD |
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Name three classes of drugs used to treat Tourette's disorder-
|
Dopamine blockers
Atypical antipsychotics a2 agonists |
|
What is the primary indication of amantadine use in psychiatry?
|
Treating extrapyramidal signs and symptoms, although not as effective for tardive dyskinesia
|
|
What are the clinical indications for gabapentin?
|
Hypnotic
Anxiolytic Decreases craving for alcohol |
|
What are the psychiatric clincial indications for antihistamines?
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Treatment for extrapyramidal side effects and also used as hypnotics
|
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What are clinical indications for barbiturates?
|
Anesthesia for ECT
Seizures Narcoanalysis (Amytal interview) Sleep aids Withdrawal from sedatives |
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Name the three nonbenzodiazepine GABA agonists-
|
The "Z drugs"
Zolpidem (ambien) Zaleplon (sonata) Eszopiclone (lunesta) |
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What drug is used to reverse the adverse effects of benzodiazepines?
|
Flumazenil
|
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Why was the benzodiazepine triazolam banned in Great Britain?
|
Alleged association with serious aggressive behavior and abnormal thinking
|
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What is the mechanism for the insomina drug ramelteon?
|
Targets the melatonin receptors in the suprachiasmatic nucleus to regulate the sleep-wake cycle
|
|
What drug has the trade name Wellbutrin?
|
Bupropion
|
|
What is the mechanism of action of bupropion?
|
A norepinephrine and dopamine reuptake inhibitor
|
|
What drug has the trade name Zyban used in smoking cessation regimens?
|
Bupropion
|
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What medications might be given to treat an acute agoraphobic episode?
|
Alprazolam
Propanolol |
|
What is the acute management of clozapine-induced agranulocytosis?
|
Discontinue medication
Give Granulocyte Colony Stimulating Factor |
|
What is the treatment for Korsakoff's syndrome
|
No effective treatment
Institutionalization may be necessary |
|
What diagnosis is suggested by psychotic symptoms, dry skin and mouth, mydriasis, tachycardia, restlessness and hallucinations?
|
Anticholinergic intoxication
|
|
What drugs may be useful in treating acute cocaine intoxication?
|
Antipsychotics and benzodiazepines may be helpful
|
|
What may be the psychiatric presentation of L-dopa intoxication?
|
Mania
Depression Schizophreniform disorder |
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What is the ER treatment for a patient presenting with acute dystonia due to an antipsychotic?
|
Decrease dose of antipsychotic
Benztropine or diphenhydramine IM |
|
What is the ER treatment for a patient with a hypertensive crisis on MAOIs?
|
Alpha adrenergic blockers (phentolamine)
or nifedipine |
|
What is the treatment of a patient who has hyperventilation due to anxiety?
|
Breathing into a paper bag
Patient education Antianxiety medication |
|
What is the ER treatment of a patient presenting in a manic episode?
|
Rapid tranquilization with antipsychotics
Restraints if necessary Restore lithium levels |
|
Can opioid withdrawal be life threatening?
|
No
|
|
What is the ER treatment of opioid intoxication?
|
IV naloxone
|
|
How is PCP intoxication treated in the ER?
|
Serum and urine assay
Medical monitoring Benzos may interfere with excretion Antipsychotics may worsen symptoms |
|
What is the appropriate management of a patient who comes to the ER with panic and terror due to PTSD?
|
Reassurance
Avoid hospitalization and encourage return to work/responsibilities to avoid invalidism Assess suicidality |
|
What medical treatment may be effective in the ER for priapism?
|
Intracorporeal epinephrine
Mechanical or surgical drainage may also be necessary |
|
What is the treatment in the ER for a patient presenting with tardive dyskinesia?
|
None available
|
|
What are the five diagnostic subtypes of schizophrenia?
|
Paranoid
Disorganized Catatonic Undifferentiated Residual |
|
How is schizophrenia differentiated from delusional disorder?
|
In delusional disorder, the delusions are nonbizarre and occur without any other psychotic symptoms
|
|
Can agoraphobia be diagnosed without panic disorder?
|
Yes, agoraphobia without panic disorder is more common that panic disorder with agoraphobia
|
|
What is the lifetime prevalence of a specific phobia?
|
25% lifetime prevalence
|
|
How is GAD treated?
|
SSRIs, buspirone, beta-blockers and relaxation techniques
|
|
What are the symptoms of PTSD?
|
Re-experiencing traumatic event
Dissociation Numbing Avoidance Hyperarousal |
|
What neurotransmitter is most implemented in OCD?
|
Serotonin
|
|
How is OCD treated?
|
Clomipramine, SSRIs
Systematic densitization and flooding |
|
What are the three Cluster A personality disorders?
|
Paranoid
Schizoid Schizotypal |
|
What are the four Cluster B personality disorders?
|
Antisocial
Borderline Histrionic Narcissistic |
|
What are the three Cluster C personality disorders?
|
Avoidant
Dependent Obsessive-compulsive |
|
In which personality disorder is there a paradoxical combination of self-centeredness and feelings of worthlessness?
|
Narcissistic
|
|
What are the signs of substance dependence?
|
Tolerance
Withdrawal Repeated excessive use Failure to cut down Reduction in other activities Lots of time spent obtaining |
|
How does chronic alcohol use affect cholesterol profiles?
|
HDL increases
LDL decreases |
|
Which medication has the best empirical support showing efficacy in alcohol rehabilitation?
|
Naltrexone - an opiate antagonist
|
|
What is the triad of clinical features in Wernicke syndrome?
|
Nystagmus
Ataxia Mental confusion |
|
What are the symptoms of Korsakoff syndrome?
|
Anterograde amnesia
Confabulation |
|
Is pupillary constriction or dialation seen in opioid intoxication?
|
Pupillary constriction
|
|
Is pupillary constriction or dialation seen in cocaine intoxication?
|
Pupillary dialation
|
|
What drugs are useful in treating the autonomic symptoms of opioid withdrawal?
|
Clonidine - alpha 2 agonist
|
|
What are the two subtypes of anorexia nervosa?
|
Restricting type
Binge eating/purging type |
|
What is the IQ range that classifies a person as mild mental retardation?
|
50-70
|
|
What is the IQ range that classifies a person as mild mental retardation?
|
35-50
|
|
What is the triad of symptoms in autistic disorder?
|
Impaired social interactions
Impaired ability to communicate Restricted repertoire of interests |
|
What genetic diseases are associated with an increased risk of autistic disorder?
|
Fragile X
Tuberous sclerosis |
|
What is the estimated prevalence of ADHD in school age children?
|
3-5%
|
|
What is the most common diagnosis in outpatient child psychiatric clinics?
|
Conduct disorder
|
|
What medical therapy may be indicated in Tourette's disorder?
|
Low doses of high-potency neuroleptics - haloperidol or pimozide
|
|
What three disorders are classified as "cognitive disorders"?
|
Delirium
Dementia Amnestic disorders |
|
What are some possible infectious causes of delirium?
|
UTIs
Meningitis Sepsis |
|
What's the name for the worsening of delirium or dementia in the evening?
|
Sundowning
|
|
How is dementia commonly differentiated from delirium?
|
Delirium tends to be more sudden in onset and have an identifiable precipitant
|
|
What is the prevalence of dementia in patients over the age of 85?
|
20%
|
|
What are the three A's of diagnosing dementia?
|
Aphasia
Apraxia Agnosia (Disturbance of executive function) |
|
What part of the brain may be abnormal on autopsy in a patient with Huntington's disease?
|
Atrophy of the caudate
|
|
What changes are typical on neuroimaging in a patient with Pick's dementia?
|
Frontal and temporal atrophy
|
|
What is the clinical triad of Creutzfeldt-Jakob?
|
Dementia
Myoclonus Abnormal EEG |
|
What is the mechanism of action of Tacrine?
|
Acetylcholinesterase inhibitor
|
|
How are amnestic disorders differentiated from dementia?
|
Amnestic disorders have isolated memory loss without impairment of other cognitive function
|
|
What brain structures are often damaged in patients with amnestic disorders?
|
Mammillary bodies
Fornix Hippocampus |
|
What's the difference between Dissociative identity disorder and Depersonalization disorder?
|
Dissociative identity is aka multiple personality disorder
Depersonalization is recurrent experiences of feeling detatched from the body |
|
What are the two basic categories of sleep disorders?
|
Dyssomnias
Parasomnias |
|
What are the four classic stages of the sexual response cycle?
|
Desire
Excitement Orgasm Resolution |
|
Which stage of sleep occupies about half of the night in adults?
|
Stage 2
|
|
What is Delta sleep?
|
Slow wave sleep composed of stages 3 and 4
|
|
In what stage of sleep does nightmare disorder occur?
|
REM sleep
|
|
In what stage of sleep does sleep terror disorder occur?
|
Delta sleep (stages 3 and 4)
|
|
What are the elements of Freud's topographic model of the mind?
|
Unconscious
Preconscious Conscious |
|
What are the elements of Freud's structural model of the mind?
|
Id
Ego Superego |
|
Which psychologist said the most important process of human development is the gradual individuation and separation of the infant from the mother?
|
Mahler
|
|
What psychologist developed attachment theory?
|
Bowlby
|
|
What is the male:female ratio of autistic disorder?
|
5:1 male predominance
|
|
What percent of patients with autistic disorder have mental retardation?
|
75%
|
|
What percent of school age children have conduct disorder?
|
10%
9:1 male predominance |
|
What is the male:female ratio of school age children with oppositional defiant disorder?
|
1:1
|
|
What is the diagnosis for a child with excessive shyness with strangers but normal social involvement with familiar people?
|
Social phobia in childhood
|
|
What are the characteristic features of "cortical dementia"?
|
Early appearance of aphasia with difficulties in memory and calculation
|
|
What are the early features of "subcortical dementia"?
|
Characterized by an early appearance of dysarthria, motor symptoms, slowed cognition and personality changes
|
|
What parts of the brain are effected by Pick disease?
|
Neurodegernation of the frontal and temporal lobes
|
|
What is the clinical presentation of Pick disease?
|
Personality and language changes around the age of 50
|
|
Are people who are innately tolerant to alcohol more or less likely to develop alcohol abuse?
|
More likely
|
|
Which substance induced disorder may present with flu like symptoms - nausea, muscle aches, sweating, diarrhea, fever, rhinorrhea?
|
Opioid withdrawal
|
|
How is PCP ingested?
|
Inhalation of smoke from other drugs laced with PCP
|
|
What is the concordance rate of schizophrenia in monozygotic twins?
|
A little over 50%
|
|
In the glutamate hypothesis of schizophrenia, is there hyperfunction or hypofunction of the NMDA receptors?
|
Hypofunction
|
|
What are the subtypes of Delusional Disorder?
|
Persecutory
Grandiose Erotomanic Jealous Somatic Mixed |
|
What is the criteria for diagnosing a mixed mood episode?
|
Presnece of both manic and depressive symptoms for at least 1 week
|
|
What symptoms characterize a mood episode with Melancholic features?
|
Loss of pleasure
Anorexia Psychomotor retardation/agitation Excessive guilt Depressive symptoms worse in the morning |
|
What is the diagnostic criteria for rapid cycling?
|
Having four or more mood episodes yearly
|
|
What is the diagnostic difference between Bipolar II and Cyclothymic disorder?
|
Bipolar II: Hypomania and Major depressive episode
Cyclothymic: Hypomania and depressive features without Major Depression diagnosis |
|
What is the male:female ratio of major depressive disorder?
|
1:2 male:female
|
|
When is ECT indicated for major depressive disorder?
|
Unresponsive to antidepressants
Contraindications to antidepressants Immediate risk of suicide History of good response to ECT |
|
What is the diagnosis for a patient with an almost continuous depressed mood for at least 2 years?
|
Dysthymic disorder
|
|
How long do manic episodes typically last without treatment?
|
3 months
|
|
What infections should be on the differential diagnosis for mood disorders?
|
Neurosyphilis
Hepatitis Mononucleosis HIV |
|
Are mood disorders more common after a left sided or right sided CVA?
|
Left sided CVA
|
|
What is the lifetime prevalence of panic disorder?
|
3%
|
|
Which two personality disorders are most associated with somatization disorder?
|
Borderline and antisocial
|
|
Is hypochondriasis more common in men or women?
|
Equal prevalence
|
|
Is factitious disorder more common in men or women?
|
Men
|
|
Which two personality disorders are most common in patients exhibiting factitious disorder?
|
Antisocial and Dependent
|
|
What is jamais vu?
|
A sense of familiar things being strange
|
|
What medications might be given to treat paraphilias?
|
Antiandrogens
GnRH analogues |
|
Do increases in serotonin levels promote sleep or disrupt sleep?
|
Promotes sleep
|
|
What is the name of the brain structure that influences sleep through serotonergic systems?
|
Dorsal raphe nucleus
|
|
What is the name of vivid hallucinations when falling asleep?
|
Hypnagogic hallucinations
|
|
What is the name of vivid hallucinations when awakening?
|
Hypnopompic hallucinations
|
|
What pharmacotherapy may be used to treat circadian rhythm sleep disorder?
|
Short-term use of benzodiazepines
Melatonin |
|
What are treatment options for adjustment disorder?
|
Remove or reduce stressors
Cognitive or psychodynamic phsychotherapy Anxiolytic or antidepressant medication |
|
Which three personality disorders tend to remit over lifetime?
|
Borderline
Antisocial Avoidant |
|
Which two personality disorders tend to exacerbate over lifetime?
|
Paranoid
Schizoid |
|
What are the primary side effects of the low-potency antipsychotics?
|
Sedation and anticholinergic
|
|
What is the appropriate treatment of acute dystonia due to antipsychotic medication?
|
IM or IV anticholinergic medication like benztropine
|
|
Does alprazolam have a long or brief duration of action?
|
Brief
|
|
Which two benzodiazepines have good efficacy for long-term treatment of panic disorder?
|
Alprazolam and Clonazepam
|
|
What are the clinical indications for Buspirone?
|
GAD
Social phobia |
|
What medication should you switch to if the sedative side effects of diazepam are especially bothersome for someone being treated for GAD?
|
Buspirone
|
|
Which are generally less sedating - tertiary or secondary amine tricyclic antidepressants?
|
Secondary amines like desipramine and nortriptyline
|
|
What is the mechanism of venlafaxine?
|
Norepinephrine and serotonin reuptake inhibitor
|
|
Which class of antidepressants is most likely to cause cardiac arhythmias?
|
TCAs
|
|
Which antidepressant medication may cause priapism in males?
|
Trazodone (an MAOI)
|
|
What is the purpose of administering atropine during ECT?
|
Reduces airway secretions
|
|
What is the alternative medicine kava used for?
|
Mild anxiety and insomnia
|
|
What is the alternative medicine Valerian used for?
|
Insomnia
|
|
What alternative medicine treatment has the possible effect of mood stabilization in bipolar disorder?
|
Omega-3 fatty acids
|
|
A patient is taking an herbal medication as an anxiolytic and develops dermatitis over the flexor surfaces of the hands and feet. What medicine was most likely used?
|
Kava
|
|
Which defense mechanism is defined as an unacceptable thought or feeling that is transformed into its opposite (like fear being transformed into bravado)?
|
Reaction formation
|
|
What is the requirement for a mental patient to be deemed competent to stand trial?
|
Must be able to understand charges and rationally consult with an attorney
|
|
What is meant by "therapeutic privilege"?
|
When a clinician elects not to divulge information about a procedure because the information would be extremely harmful for the patient to know
|