• VDRL (venereal disease research laboratory test)
• TSH

FA-P p. 91

• dementia (or preexisting brain damage - CVA, tumor)
• advanced age
• prior hx of delerium
• etOH dependence
• diabetes
• cancer
• sensory impairment or blindness
• malnutrition
• male gender

FA-P p. 91

Inability to shift attention appropriately; repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, or the inability to switch ideas along with the social context.

FA-P p. 92

• impaired ability to carry out motor activities despite intact motor fxn.
• failure to recognize or identify objects despite intact sensory fxn.

FA-P p. 94

Dementia +:

1. stepwise ↑ in severity + focal neurological signs?
2. cogwheel rigidity + resting tremor?
3. gait apraxia + urinary incontinence + dilated cerebral ventricles?
4. obesity + coarse hair + constipation + cold intolerance?
5. diminished position & vibratory sensation + megaloblasts on CBC?
6. tremor + abnormal LFTs + Kaiser-Fleischer rings?
7. diminished position & vibratory sensation + Argyll Robertson pupils (accommodation response present, response to light absent)?

1. Multi-infarct dementia
2. Lewy body dementia/Parkinson disease
3. Normal pressure hydrocephalus
4. Hypothyroidism
5. Vitamin B₁₂ deficiency
6. Wilson disease
7. Neurosyphilis

FA-P p. 94

< 25; perfect score is 30

FA-P p. 95

• basal ceruleus
• choline acetyltransferase is require for Ach synthesis

FA-P p. 96

APOe4

on autopsy, microscopically, senile plaques and neurofibrillary tangles are found; however, neuritic plaques correlate with severity of dementia. These findings are not unique to AD, but can be found in Down syndrome and normal aging.

Tx: tacrine, donepezil, rivastigmine, galantamine, memantine (NMDA antagonist).

FA-P p. 96, 97

• Schizophrenia
• Bipolar I
• Depression

FA-P  p. 97

• Onset of dementia within 12 months of parkinsonism symptoms (LBD).
• Dementia that begins more than 12 months after parkinsonism symptoms is classified as Parkinson disease dementia.
• Core features of LBD: waxing & waning, parkinsonism, visual hallucinations, and sensitivity to neuroleptics.
• Lewy neurites are more closely linked with clinical symptoms than are Lewy bodies.

FA-P p. 98

• infection due to neutropenia and direct effect of virus on cells.
• ↓ in viral load is often accompanied by improvement; therefore, HAART thx improves cognition.

FA-P p. 100

• caudate atrophy (sometimes cortical atrophy)
• trinucleotide repeat (CAG) on short arm of chromosome 4.
• aside from choreoathetoid movements, uncontrollable jerkiness, and dementia, behavioral disorders may be seen (depression, psychosis, paranoia, and irritability).

FA-P p. 100, Kap s2s141m

• Wet (urinary incontinence)
• Wacky (dementia); potentially reversible, but of the triad it is the least likely to improve.
• Wobbly (ataxia; gait disturbance)
• enlarged ventricles with ↑ CSF pressure; idiopathic or secondary to obstruction of CSF reabsorption sites due to trauma, infection, or hemorrhage.

FA-P p. 102

• Symptoms of major depression in elderly often include problems with memory and cognitive fxning.
• onset is more acute
• sundowning is uncommon
• will not confabulate, will just answer "I don't know."
• Patient is aware of problems; concerned.
• cognitive deficits improve with antidepressants.

FA-P p. 105, Kap Q0640m

• Mild: IQ 55-70
• Moderate: IQ 40-55
• Severe: IQ 25-40
• Profound: IQ < 25

FA-P p. 112

sensory deficits

FA-P p. 113

• normal physical and psychomotor development during the first 5 months, followed by ↓ rate of head growth and loss of previously learned purposeful hand skills btw ages 5 & 30 months.
• will develop stereotyped hand movements (hand wringing, hand washing), impaired language, and psychomotor retardation, and problems with gait or trunk movements.
• seen predominantly in girls.
• associated with MECP2 gene mutation on chrom X.
• ↑ risk of sudden death.

FA-P p. 119

• onset after age of 2 years, usually btw 3-4 years, must be before age 10.
• characterized by normal development in first 2 years of life, but loss of previously acquired skills before age 10 in at least 2 areas (language, social skills, adaptive behavior, bowel or bladder control, play, motor skills); and in at least 2 of these areas (impaired social interaction, impaired communication, restricted, repetitive, stereotyped behaviors and interests.
• different from Rett in that head growth does not slow, and unusual hand movements are not present.

FA-P p. 120

encopresis (involuntary or intentional passage of stool in inappropriate places)

constipation with overflow incontinence in 75% of cases

FA-P p. 122

• Defined by loss of memory (amnesia), identity, or sense of self (the normal integration of thoughts, behaviors, perceptions, feelings, and memory intion a unique identity).
• Thought to be related to trauma or abuse.
• Disorders: dissociative amnesia, dissociative fugue, dissociative identity disorder (aka multiple personality disorder), depersonalization disorder, dissociative disorder not otherwise specified (NOS).
• can come on gradually or suddenly, and they can be temporary or chronic.

FA-P p. 126

The strong reaction a patient often experience when retrieving traumatic events; when repressed memories surface.

FA-P p. 127

Although controversial IV benzodiapepine, sodium amobarbital, or other short-acting sedatives.

Hypnosis might be helpful in retrieving memories in a patient with persistent dissociative fugue.

FA-P p. 127

• unconcerned (la belle indifference)
• shifting paralysis
• blindness
• mutism
• parasthesias
• seizures
• globus hystericus (sensation of lump in throat)
• Note: conversion-like disorder in an elderly patient has a higher likelihood of representing a real neurological deficit.

FA-P p. 134

• aka Munchhausen syndrome
• Psychiatric: hallucinations, depression, pseudologia fantastica (mythomania or pathologic lying)
• Medical: fever (by heating thermometer), abdominal pain, seizures, skin lesions, and hematuria.
• The difference btw factitious and malingering is in the intetion of the patient. factitious - motivation is internal, malingering - motivation is external.

FA-P p. 137

low levels of serotonin (5-HIAA) in CSF

FA-P p. 141

• bradycardia, orthostatic hypotension, arrhythmias
• Qtc prolongation and ST-T waves Δs in ECG
• ACS, cardiomyopathy, mitral valve prolapse
• ↑ cholesterol & carotene levels
• anemia & leukopenia
• osteopenia, osteoporosis
• hypothyroidism (according to uptodate, TSH is normal, T₃ & T₄ may be normal or slightly ↓, ↑ reverseT₃; euthyroid sick syndrome).
• depression-like symptoms 2° to malnutrition
• cognitive impairment, evidence of enlarged ventricles, ↓ grey & white matter, peripheral neuropathy.
• lanugo
• muscle wasting
• amenorrhea (key for differentiating b/w bulimia), loss of libido
• in patients who regularly vomit: parotid enlargement, ↑ amylase levels, electrolyte imbalance (hypokalemia).
• hyponatremia 2° to polydypsia
• GH & cortisol are frequently ↑; ↓ LH/FSH
• 2 subtypes: restrictive type & binge-eating/purging type (different from bulimia in that low body weight and hormonal imbalances distinguishes the 2).
• pharmacologic thx not helpful; Food is the best medicine! tx as outpatient unless they are more than 20% below their ideal body weight.
• if patient recovers and manages to get pregnant → premature or small for gestational age baby 2° ↓ nutritional reserves; also intellectually impaired infant.

FA-P p. 147, q. 3-24, 4-26, UW3953

fluoxetine (SSRI)

however, bulimia often requires multiple medications (avoid buproprion due to its potential to lower seizure threshold).

FA-P p. 150, q. 4-25, Kap Q0404m

Capacity is a clinical term and may be assessed by physicians.

Competence is a legal term and can be decided only by a judge. Competence (Court).

FA-P p. 203

• awakening from REM sleep
• REM EEG patterns resemble those of an aroused person; REM → ↑ BP, HR, & RR
• About every 90 minutes, NREM alternates with REM sleep.
• Progression through NREM sleep results in slower brain wave patterns and higher arousal thresholds.

FA-P p.154

1. daytime sleepiness or "sleep attacks" + REM-related sleep phenomena including inability to move during the transition from sleep to wakefulness
2. hypnogognic or hypnopompic hallucinations
3. cataplexy - sudden loss of muscle tone evoked by strong emotion w/o LOC; may be mild affecting only the voice, face, or arms, or generalized, causing pt to fall to the ground, and occurs in 60-100% of those dx w/ narcolepsy.
4. Linked to loss of hypothalamic neurons that contain hypocretin; may have autoimmune component.
5. Tx - schedule daytime naps & maintain regular sleep schedule at night; get at least 8 hours per night and keep consistent times for sleeping & awakening. Rx - stimulants and antidepressants. Modafinil (stimulant) & Sodium Oxybate (effective in tx cataplexy).

FA-P p. 157

• sleep terror - returns to sleep w/o awakening, and usually amnestic about episode.
• nightmare disorder - recurrent frightening dreams that tend to terminate in awakening with vivid recall; no confusion or disorientation upon awakening. 50% of pt w/ PTSD. Imagery Rehearsal Thx (IRT) - mental imagery/rehearsal to modify outcome of a recurrent nightmare.

FA-P p. 160, 161

What are the symptoms of serotonin syndrome?

Neuroleptic malignant syndrome?

• SS - confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, renal failure, and death.
• occurs when too much serotonin is present - SSRIs + MAOIs
• Tx - stop drugs
• NMS - fever, tachycardia, HTN, tremor, ↑ CPK, "lead pipe" rigidity.
• can be cause by ALL antiψ after short or long time (↑ w/ typical antiψ)

FA-P p.183

• MOAI + foods w/ tyramine (red wine, cheese, chicken liver, cured meats) or + sympathomimetics, or meperidine.
• caused by a build-up of stored catecholamines.
• tx with α-blockers

FA-P p. 183, q. 8-17, 51

P450 inhibitors

P450 inducers

• ↓ P450 - SSRI/SNRI (fluoxetine, fluvoxetine, paroxetine, sertraline, duloxetine)
• ↑ P450 - smoking, carbamazepine, barbiturates, st. john's wort.

FA-P p. 183, 184

• SSRI
• currently approved only for use in OCD (also TCA - clomipramine is effective); patients have ↓ serotonin → impulsivity.
• N&V more common
• also used to tx panic disorder

FA-P p. 185, q. 4-33, Kap Qs2s128m

• SSRI
• longest half-life; active metabolites; therefore no need to taper; weekly dosing available.
• safe in pregnancy and children
• side effects: N&V, insomnia, agitation, HA
• SSRIs are the treatment of choice for panic disorder w or w/o agoraphobia.
• Fluoxetine is the only FDA approved tx for bulimia.
• Paroxetine has been shown to ↑ suicidal ideation in children.

FA-P p. 185, q. 3-26, 2-22

• sexual dysfxn - ↓ libido, anorgasmia, delayed ejaculation.
• N & Diarrhea
• insomnia; vivid dreams, often resolves over time
• HA
• anorexia, weight loss
• akathisia-like state (restlessness)
• seizures
• SSRI discontiunation syndrome - dizziness, N&V, fatigue, lethargy, flu-like symptoms.

q. 4-27

• SNRI
• used in patients w/ depression & neuropathic pain, diabetic neuropathy, or in fibromyalgia.

FA-P p. 186, q. 4-100

• Norepi/DA reuptake inhibitor
• lower seizure threshold
• some efficacy in tx adult ADHD
• helps quit smoking; pt should ↓ smoking gradually during the 2nd week of tx.

FA-P p. 186, Kap s2s145

• serotonin receptor antagonist and agonist
• useful in tx refractory major depression, major depression w/ anxiety, and insomnia (secondary to sedative effects).
• does not effect REM sleep.
• tRAZodone will RAISE the bone (priapism).

FA-P p. 186

• α₂-adrenergic receptor antagonist
• tx refractory major depression, esp in patients that need to gain weight.
• weight gain, sedation (helps w/ insomnia), dizziness, somnolence, tremor, dry mouth, constipation, and rare agranulocytosis.

FA-P p. 187

• IV sodium bicarbonate
• 3 C's of TCAs - cardiotoxicity, convulsions, coma

FA-P p. 187

• Lithium levels, creatinine, thyroid levels
• T-wave flattening can occur w/ Li thx
• If NSAIDs are required by patient recommend ASA or sulindac instead, as it does not ↑ Li levels like NSAIDs.

FA-P p. 189, q. 4-16, 31

• atypical antiψ
• agranulocytosis (1-2% risk), seizures (2-5%)
• hypersalivation & tachycardia
• must stop if absolute nø count < 1500/μl
• only antiψ shown to ↓ risk of suicide; FYI - with long-term  use, Li⁺ reduces suicide risk as well.
• only medication known to improve tardive dyskinesia 2º to typical antiψ use.

FA-P p. 193

• ECG, BMP, TFT, CBC, pregnancy test (teratogen; Ebstein's anomoly  - congenital heart defect in which the septal leaflet of tricuspid valve is displaced towards the apex of the right ventricle of the heart; risk is 7.7%; Do not use Li during 1st trimester; however, Li can be used during 2nd & 3rd trimester, but stop peripartum b/c of rapid fluid shifts and Δ in glomerular filtration).
• onset 5-7 days; blood levels correlate w/ clinical efficacy and should be checked after 5 days, and then every 2-3 days until therapeutic.
• narrow therapeutic index: 0.6-1.2, toxic: > 1.5, lethal > 2.0.
• toxic levels → AMS, coarse tremors, GI distress, convulsions, death.
• metabolized by kidney
• benign leukocytosis; if combined with clozapine, it can offset agranulocytosis.

FA-P p. 194, q. 4-39, Kap m000571m

• efficacy for bipolar depression, though little efficacy for acute mania or prevention of mania.
• risk of Stevens-Johnson syndrome, most likely during the first 4-6 weeks; risk minimized by starting at a low dose and slowly ↑; carbamazepine is also approved in tx of bipolar disorder and is associated with S-J.
• valproate will ↑ lamotrigine levels & lamotrigine will ↓ valproate levels.

FA-P p. 195, Kap Q0465m

What are the long acting benzodiazines?

intermediate? short?

• (> 20 hours) diazepam, clonazepam
• (6-20 hrs) alprazolam, lorazepam, oxazepam, temazepam
• (< 6 hrs) triazolam (tx insomnia), midazolam
• flumazenil reverses effects of benzo; life threatening if reversed too quickly.

FA-P p. 196, 197

• zolpidem (ambien), zaleplon (sonata), eszopiclone (lunesta)
• selective receptor binding to benzodiazepine receptor 1 → sedation.

• Buspirone, an anxiolytic
• slower onset than BDZ (takes 1-2 weeks)

FA-P p. 198

• isoniazid, cimetidine (H₂ blocker for GERD), steroids
• may be caused by sympathomimetics, analgesics, abx, anticholinergics, anticonvulsants, antihistamines, corticosteroids, and anti-parkinsonian agents.

FA-P p. 199

• propranolol, tetracycline, nifedipine, verapamil, cimetidine, glucocorticoids.

FA-P p. 199

• narcolepsy
• it is a psychostimulant

FA-P p. 198

• BP and watch for weight loss & insomnia
• dextroamphetamine, amphetamine, and methylphenidate (aka Ritalin, watch for leukopenia, anemia, ↑ LFTs)
• atomoxetine is a presynaptic NE transporter inhibitor; less appetite suppression and insomnia, but possible ↑ suicidal ideation in children/adolescents; rare liver toxicity.
• patients respond to tx in 70% of cases

FA-P p. 198, q. 2-47

• depression (6-12x), especially with psychotic features, acute mania or psychosis (> 20x), and catatonia (2-4x; state of neurogenic motor immobility or stupor).
• side effects: muscle soreness, HA, amnesia, confusion.
• bilateral eletrode placement ↓ # of tx needed, but ↑ memory impairment and confusion.
• MI in the past 6 months is a contraindication; remember the paraympathetic & sympathetic response during tx.

FA-P p. 200, q. 3-45, 4-94

1. Distractability
2. Inflated self-esteem or grandiosity
3. ↑ in goal-directed activity (socially, at work, sexually)
4. ↓ need for sleep
5. Flight of ideas or racing thoughts
6. More talkative or pressured speech (rapid & uinterruptable)
7. Excessive involvement in pleasurable activities that have a high risk of negative consequences (shopping spree, gambling, sexual indiscretions)

• a period of abnormally & persistently elevated, expansive, or irritable mood, lasting at least 1 week and including 3 of the above to dx.
• mania is Ψ emergency; severely impaired judgement makes pt dangerous to self and others.
• tx w/ haloperidol in acute setting!
• 75% of manic pt have psychotic symptoms
• symptoms - DIGFAST (distractability, insomnia/impulsivity, grandiosity, flight of ideas, acitivity/agitation, speech, thoughtlessness).

FA-P p. 37, Kap Q0187m

Bipolar I (delusions or hallucinations); these can occur during mjor depressive or manic episodes.

FA-P p. 42

• The only requirement for dx is the occurence of one manic or mixed episode.
• Between episodes there may be interpersed euthymia, major depressive episodes, dysthymia, or hypomanic episodes, but none of these are required for dx.
• Cannot be bipolar II if the pt has EVER experienced a manic episode; even if pt is currently hypomanic.
• Mixed = when criteria are met for both manic & major depressive episode. These criteria must be present everyday for at least 1 week. 

What is the prevalence of schizophrenia?

What is cotard syndrome? capgras?

• 1% with 50% monozygotic concordance; 10% risk if parent has schizo, 40% if both parents.
• 10% lifetime incidence of suicide.
• cotard - delusion that they are dead/do not exist/lost their blood or internal organs; cotard, corpse.
• capgras - belief that people have been replaced by imposters.
• some non DSM stigmata - short-term memory loss, unstable smooth-pursuit of eye, ↓ ability to habituate to repeated sensory stimuli (sensory-gating abnormalities).
• ↓ in size of hippocampus, parahippocampal gyrus, and amygdala.

q. 3-1, 3, 74, 76, 106

• bipolar disorder is the most likely cause of post-partum psychosis (the pt does not need to have a psychiatric hx; can be new onset).
• MDD is less frequent.

q. 3-5

• negativism (resistance/refusal of suggestions or instructions)
• non-verbal forms a communication (eg, facial expressions).
• hypomotorism, waxy flexibility
• echolalia
• echopraxia (repeat another's gestures)
• the least prevalent subtype of schizophrenia

q. 3-9, 51

• ↑ cortisol (one of the earliest observations in biological psychiatry; 50% of patients will not experience cortisol blunting w/ an overnight dexamethasone suppression test, 2° to abnormal feed-back control of hypothalamic-pituitary-adrenal axis in MDD).
• ↓ catecholamines, sex hormones, and immune fxn.
• early morning awakening is a common sleep disturbance in depression; ↓ REM sleep latency &     ↑ phasic REM sleep (portion of REM w/ phasic burst of REM; tonic REM = REM period between phasic REM).
• about 30% do not show an ↑ of TSH w/ admin of TRH.
• ↑ core body temperature.
• ↓ blood flow & metabolic activity in frontal lobe.
• Hamilton Depression Scale is used to measure depressive symptoms.
• Beck Depression Inventory allows clinicians to follow severity of previously dx depression.

q. 3-13, 14, 27, 28, 134, 1-1

What is double depression?

cyclothymia?

• When a major depressive episode is superimposed on dysthymic disorder.
• cycling btw hypomania & dysthymia; tx same as bipolar disorder.

q. 3-17

• porphyria (manic or psychotic appearing)

q. 3-20

• docility
• lack of fear response
• anterograde amnesia
• hyperphagia
• hypersexuality
• associated w/ severe bilateral damage to amygdala.

q. 3-22, 23

• Brown-Peterson Task
• eg, ETC patient

q. 1-2

• SSRI/SNRI
• antiΨ (including atypicals) & mood stabilizers (Li, valp) can be used to supplement above.
• Avoid benzo (addictive & ineffective)
• neither meds nor thx has been proven to be superior
• eye movement desensitization and reprocessing is a specific thx that has been developed for PTSD.

q. 3-62, 63

• a state in which critical judgement is suspended and a person experiences alterations in perception, memory, or mood in response to suggestions.
• it is not psychothx.

q. 3-68

• non-specific physical manifestations of an underlying Ψ condition.
• intentional production of symptoms to assume the sick role.
• unreasonable fear of having an illness; interpret somatic complaints as signifying definite serious illness; more prominent during periods of ↑ psychological stress.

q. 3-120,121,122, UW3845

• cataplexy - transient loss of motor tone associated with strong emotions; can't-a-flex-y.
• catalepsy - state of immobility sometimes seen in catatonic states.

q. 3-87

• Micropsia and macropsia are the misperceptions of objects being smaller or larger than they really are.
• Palinopsia is the persistence of the visual image after the stimulus has been removed.

q. 3-97 

• Delusional - fixed, encapusulated delusion; most often of the persecutory sort, but can be somatic, jealous, grandiose, etc.
• PPD - does not present as a fixed, isolated delusion. It is a more pervasive paranoia permeating many aspects of the patient's life.

q. 3-125

• OCD

q. 3-98

• locus ceruleus; the alarm center of the brain.
• center of most of the NE containing neurons of the brain.

q. 3-112

• previous suicide attempt(s)
• age > 45; most predictive
• etOH dependence
• rage or violence
• prior suicidal behavior
• male gender

q. 3-128, check other sources to confirm.

• etOH
• benzodiazepam (short acting is most dangerous; eg, alprazolam)
• they have near identical actions on GABA modulation.
• Barbiturate withdrawal has the highest mortality rate! Alkalinize urine with NaHCO₃ to ↑ urinary excretion.

q. 3-133, FA-P p. 83

• sudden ability to speak a new language
• repetetive and meaningless talking "wong, wong, wong," "raizon, raizon, raizon."

q. 3-138

• MAOI
• tranylcypromine & phenelzine
• atypical - mood reactivity + 2 of: weight gain, hypersomnia, leaden paralysis, rejection sensitivity.

q. 4-3, 8-43

• disorders are ego-syntonic

1. Intermittent Explosive Disorder (linked to ↓ levels of 5-HIAA; degree of aggressive act is out of proportion to stressor - someone takes potato chips, pt responds by beating transgressor)
2. Kleptomania (act of stealing is goal; ↑ anxiety prior to act, release of anxiety after).
3. Pyromania (no treatment has been proven beneficial; incarceration may be indicated).
4. Pathologic Gambling
5. Trichotillomania (may present w/ abdominal obstruction 2° to eating hair → bezoar.

Kap p. 63

• D₂ antagonist (high potency TYPICAL antiψ)
• eg. haloperidol, pimozide, risperidone
• eye tics (blinking & eye rolling) are the most common initial symptoms, followed by facial tics & vocal tics.

q. 4-19, 20, 2-33 (contradicting info), KapLec p. 16

• Panic Disorder (panic attack)
• phobic disorder (agoraphobia, specific phobia, social phobia)
• OCD
• Acute Stress Disorder/PTSD
• Generalized Anxiety Disorder

Kap p. 33

• psychiatric & physiologic components; think of the feeling you get when you are about to check your grades.
• intense anxiety/nervousness (worry, hypervigilence, restlessness, difficutly concentrating, sleep disturbances).
• autonomic hyperactivity/motor tension (tachycardia, hyperventilation, dizziness, sweating); L.O.C. is not consistent w/ panic attack, consider organic cause (ie, cardiovascular).
• severity of symptoms wax & wane, and may be associated with intercurrent stressors.
• attacks usually last a few minutes; attacks occur out of the blue → intense distress → agoraphobia; just don't know when the attacks are going to occur.
• you'll see N&V, chest pain, parasthesias and the pt will end up in ED.
• hx associated w/ disorder includes separations during childhood and interpersonal loss during adulthood.
• tx - SSRI (long-term), benzo for acute (alprazolam)
• commonly associate with depression, agoraphobia, GAD, substance abuse.
• r/o pheochromocytoma

Kap p. 33, Q0394m, q. 7-19, UW4285

• fear or avoidance from places from which escape would be difficult in the event of panic symptoms (public places, being outside alone, public transporation, crowds); fear that panic attack will occur, and won't be able to escape.
• in contrast social phobia is the fear of humiliation or embarassment in either a generl or specific social situation (public speaking, stage fright, urinating in public restrooms).

Kap p. 34

• onset w/in 3 months of stressor
• lasts ≤ 6 months once the stressor is resolved; can be chronic if stressor continues and new ways of coping w/ stressors are not developed.
• symptoms - overwhelming anxiety, depression, or emotional turmoil; impaired functioning.
• stressor MUST be present; otherwise, it is not an adjustment disorder (loss of job, fight w/ spouse, divorce, etc.).
• If symptoms meet criteria for MDD or PTSD it is NOT adjustment disorder! even if timeframe is correct.
• tx: psychodynamic thx or brief cognitive psychothx.

Kap p. 55, UW3382/4883

• SSRIs (fluoxetine) + antiψ (haloperidol)
• shown to reduce the impulsiveness (both) and affective instability (SSRI), and ψ-thinking (antiψ).

q. 4-24

• hypotension/orthostatic hypotension via α₁ blockade.

q. 4-37

• clonidine (α₂ agonist suppresses sympathetic response to heroin withdrawal).
• methadone should not be used in patients who have never detox'ed before b/c of success with clonidine.

q. 4-53

• used to tx impotence
• can cause elevated BP and HR, and should not be used in pt with cardiac or renal disease, glaucoma, or hx of ulcers.
• α₂ antagonist; directly opposes clonidine.

q. 4-62, 63

• lorazepam and oxazepam
• these are minimally metabolized by the liver

q. 4-74

• pancreatitis
• birth defects (neural tube)
• hepatic failure

q. 4-78

• minimum of 6 months, but usually 8-12 months.

q. 4-85

• Buproprion; can even be added to other antidepressive meds to reverse sexual dysfxn.
• Mirtazapine
• Nefazodone

q. 4-101, 104

• based on model of neural activity in which repeated subthreshold stimulation of a given neuron results in discharge of an action potential, is a theory that suggests that one decompensation can lead to a second episode.
• eg, A 32-year-old woman with bipolar disorder suffers a severe depressive decompensation 1 month after a minor decompensation.

• ↓ dose
• add β-blocker
• or add benzodiazepine
• Δ to atypical antiψ

KapLectVideo

• seizures, usually complex-partial
• 20% of complex-partial epilepsy experience psychotic symptoms at some time.
• 90% of complex-partial originate in temporal lobe.

KapLec, q. 9-79

During what state of sleep does sleep terror occur?

Sleep walking? bed-wetting? bruxism?

• first 3 during stage 3-4
• bruxism - stage 2
• waves: awake (β, α), stage 1 - 4 (θ, K-complex, δ), REM (sawtooth).

q. 2-4

• substance-induced psychotic disorder

q. 2-11

• psychomotor agitation
• substance ingestion is the most common method in children when attempting suicide; in adolescents it is the same method to attempt suicide. Firearms is the most common method adolescents die from suicide.

q. 2-17, 2

• 1st line - Desmopressin (DDAVP/ADH)
• 2nd line - imipramine (TCA)
• more common in boys than girls; occurs in otherwise normal boys.
• desmopressin should be tried first b/c of better safety profile.

UW2513

• the ability to have a meaningful conversation.

q. 2-51

• common scenario is patient that takes short acting benzo regularly has surgery → withdrawal; tx w/ another shortacting benzo (lorazepam).
• anxiety
• diaphoresis
• irritability
• insomnia
• fatigue
• HA
• myalgias
• nausea
• perceptual disturbances
• tremors
• seizures

Kap Q0079m

• 2 years of depressed mood.
• may be associated w/ Δ in appetite, sleep, and concentration, and with fatigue and hopelessness.
• tx w/ psychothx and antidepressants.

Kap Q0754m

• psychosis > 1 day & < 1 month
• it may be preceded by a stressor, and is self-limited.

Kap Q0744m

• prevented w/ IV lorazepam during administration of neuroleptic.

Kap Q0168m

• DA antagonism → ↑ prolactin → ↓ FSH & LH
• this is the case for typical antiΨ; this does not occur in the newer atypical except for risperidone.
• determine w/ morning prolactin levels.

Kap Q0857m

• A catatonic symptom, which is a motiveless resistance to all attempts to be moved or to all instructions.
• signs of catatonia include stupor, negativism, rigidity, posturing, mutism, stereotypies, mannerisms, waxy flexibility, and catatonic excitement.

Kap Q0456

• Influence - delusion where pt believes he is being controlled by another person or external force.
• Reference - other people are talking about him (referring to him).
• Magical thinking - belief that thoughts affect the course of events.

Kap Q0635

• TCA
• very lethal in overdose; pt can attempt OD.
• overdose → QTc prolongation → arrhythmia

Kap Q0161m

• when lithium is contraindicated valproate is the drug of choice.
• carbamazepine is used in treating bipolar disorder when both Li and valproate are contraindicated.

Kap Q0297m

• strengthening of current defense mechanisms → ability to cope with difficult problems.

q. 5-7

• borderline personality disorder
• b/c of intense transference and countertransference that develops in a single mode of tx.

q. 5-13

• a set of procedures designed to enhance the learning of adaptive behaviors and the unlearning of maladaptive behaviors.
• attempts to Δ maladaptive behaviors seen in a particular syndrome.

q. 5-19, 20

• clarifying communication patterns.

q. 5-22

• interpretation of transference.

q. 5-25

• psychotic disorder
• psychoanalysis is also not indicated in psychotic disorder.

q. 5-29, 37

What is the work up for enuresis?

What is the difference btw primary and secondary enuresis?

• history, physical exam, urinalysis (for occult UTI, DKA, and diabetes inspipidus).
• primary - never achieved a satisfactory period of nighttime dryness.
• secondary - children had a period of dryness before onset of bed-wetting; usually 2° to stress (parental divorce, birth of sibling).
• Management - 1) nonpharmacalogic (behavioral) thx 3-6 months, 2) escalate to more active intervention (enuresis alarm), 3) pharm desmopressin or imipramine.

Kap Q0413m 

• OCD, borderline, and depressive disorders
• must rule out before tx.
• tx w/ SSRI

Kap s2s158

• → depressive symptoms
• propranolol is a common cause

Kap Q0264m

• DPD has low self-esteem
• Masochistic traits include long suffering, complaining, and a self-deprecatory character w/ an excessive demand for love (e.g. individual works hard, sacrifices a lot, loves helping others).

Kap Q0466

• anticholinergics - benztropine, diphenhydramine, trihexyphenidyl.

Kap Q0464m

• 4 pain symptoms
• 2 GI symptoms
• 1 sexual symptom
• 1 pseudoneurologic symptom
• comorbid conditions - anxiety, depression, personality disorders.

Kap s2s166, q. 8-3

• 25% chance of developing antisocial personality disorder.
• ADHD persists into adulthood in approx 30% of affected individuals.
• as the child grows older his impulsivity and hyperactivity will ↓, but inattention will remain the same.
• The prevalence of ADHD declines by 50% every 5 years until the mid-20s; so the older the children get w/o symptoms the less likely that they have the disorder; generally dx before age 7.

Kap Q0274m

• generalized muscle aches
• abdominal cramps w/ loose stools
• chills
• clear nasal discharge
• dilated pupils
• relieve autonomic symptoms w/ diphenhydramine.

Kap s2s155m

• Hallucinations that occur in the absence of mood symptoms makes depression induced psychosis unlikely.
• In schizoaffective both psychotic and mood symptoms  must be treated; antiΨ and SSRI.

q. 7-1, 2

• neuroleptic & antidepressant
• antidepressant alone should take care of the symptoms; however, it will take time for it to take effect, so adding a neuroleptic is helpful.

q. 7-12

• ADHD & OCD
• currently unknown if these disorders are separate entities from Tourette or if these behaviors are always comorbid.

q. 7-57

• QT prolongation and ↑ risk of ventricular arrhythmias.
• ECG prior to tx.

q. 7-58

• sensory auras (bad smell, unusual taste)
• GI symptoms
• patient may look dazed or frightened.
• automatisms such as lip smacking, eye blinking, fumbling with clothes.
• impairment of conciousness
• complex-partial seizures are usually associated with temporal lobe epilepsy.

q. 7-59

1. feeling ineffectual
2. belief that world is hostile towards self
3. knowing that nothing will ever change
4. This is the triad for depressive disorders

q. 7-76

What drug characteristic is associated with the severity of the withdrawal symptoms?

Addictive potential?

1. short half-life →↑ severity of withdrawal
2. shorter onset of action → ↑ addictive potential

q. 7-78, 79

• absence of positive symptoms and a preponderance of negative symptoms.

q. 7-86

• destruction of property
• cruelty to animals and people
• deceitfulness or theft (lying/stealing)
• serious violation of rules

Kap Q0080m

• It is a medical emergency
• eg, withdrawal from alprazolam → admit to medical unit and tx.
• seizures can precipitate!

Kap s2s157m

• clozapine
• proven to be more effective than conventional antiΨ in tx of patients with resistant schizophrenia.
• antagonist on D1 & D4 receptors, as well as on α-adrenergic, histaminergic, serotonergic, and cholinergic receptors.

Kap Q0431m

• belligerence, assaultiveness, psychomotor agitation
• nystagmus
• HTN
• muscle rigidity
• seizures and coma
• hyperacusis (↑ sensitivity to some sounds)
• tx of choice is benzodiazepine; haloperidol is second line, but can amplify hyperthermia, dystonic rxns, anticholinergic effects, and can lower seizure threshold.
• tx: if patient is not extremely agitated only supportive care is necessary.

Kap s2s152m

• dantrolene or bromocriptine
• supportive - cooling blankets, hydration

Kap s2s162m

• Benztropine, diphenhydramine, trihexyphenidyl
• these can be taken prophylactically when a pt is on an antiψ.
• if patient develops anti-cholinergic toxicity switch to amantadine.

Kap Q0370m

• Kegel exercises & dilators
• vaginismus is one of the sexual pain disorder; involuntary muscle contraction of the outer third of the vagina that interferes with intercourse.
• prevalent in women with a hx of sexual trauma, emotional abuse, rigid religious upbringing, or psychosexual conflicts.

Kap Q0786m

• Wisconsin Card Sorting Test (WCST)
• they have poor executive function (reason abstractly, problem solving, switch sets).
• they have abnormalities of the frontal lobes (dorsolateral prefrontal cortex).

q. 1-5

• Temporal Orientation Test
• day, month, day of week, current time
• separates patients into 2 groups: those w/ brain damage & those w/o brain damage.
• the test is also sensitive to cognitive abnormalities in dementing illnesses.

q. 1-11

• MMPI & now the MMPI-2
• Minnesota Multiphasic Personality Inventory

q. 1-13

• organic brain disease

q. 1-14

• has pt copy a complex figure. the figure is then removed and the pt must recreate the image from memory immediately, and at 5 and 30 minutes; tests for visual non-verbal memory.
• right parietal lesion → neglect of left portion of figure.
• right temporal lobectomy → ability to copy image, but unable to recreate from memory.

q. 1-16

ocular pigment changes

FA-P p. 190

Exner Comprehensive System

q. 1-26

• Random Letter Test
• relies on concentration, cooperation, and ability to hear.
• serial 7's, serial 3's, counting by 2's relies too much on calculation abilities and educational level.

q. 1-27

• assesses hemispheric language dominance
• prior to surgical amelioration of seizure focus
• sodium amytal is injected into the carotid artery and observing transient effects on speech.

q. 1-35

• tool that asks friends or family of the patient to assess the ability of the patient to function in his usual environment.

q. 1-30

Tarasoff v Regents of University of California

q. 6-2

What is the legal basis for establishing the insanity defense?

What is mens rea? actus reus?

• Durham Rule
• criminal intent
• criminal act

q. 6-7, 8

• borderline, histrionic, depressive

q. 8-14 

• short course of low-dose antiΨ for brief psychotic events; eg, 2° to stress.
• schizotypal is a premorbid personality type for a patient with schizophrenia; therefore, schizotypal is usually chronic and may develop into schizophrenia.

FA-P p. 59-63

• gingival hyperplasia
• nystagmus, dizziness
• slurred speech
• ataxia
• AMS

q. 8-24

• the patient responds to a question with an approximate or outright ridiculous answer.
• additional features include altered conciousness, hallucinations, conversion phenomenon, and amnesia for the episode.

q. 8-29

• culturally bound disorder w/ 4 defining characteristics; usually 2° to young man's self-esteem being injured.

1. prodromal brooding
2. homicidal outburst
3. persistence in reckless killing w/o apparent motive
4. claim of amnesia

q. 8-29

• EEG normal
• nystagmus with cold water in ear
• saccadic eye movements

q. 8-37

• blue-grey skin discoloration
• deposits in lens & cornea

FA-P p.192

orthostatic hypotension & sedation

FA-P p. 194

• existence of premorbid personality disorder
• presence of comorbid Axis I dx

q. 9-77

• intermittent explosive disorder
• 55% have EEG abnormalities

• both cling to relationships; however, avoidants are slow to get involved, while dependents actively & aggressively pursue relationships.
• Social phobia often seen in AvoidPD
• Regression seen in DPD
• Avoidant - unwilling to interact unless certain of being liked; fears criticism and rejection.
• Dependent - difficulty making decisions w/o reassurance; cannot express disagreement b/c of fear of loss of approval.

FA-P p. 67-69

• Rationalization
• Reaction-Formation
• Dissociation
• Intellectualization
• Controlling
• Displacement
• Isolation of affect
• Repression

UW3799

1. Married
2. In the military
3. Lives separately from paresnts and manages own finances.

UW3623

• hx of 3 or more relapses into a manic episode.
• following an acute episode maintenance thx should be continued for at least a year; if no relapses taper and d/c.
• abrupt cessation → suicide & relapse.

UW4043

• Assertiveness training and SSRI (paroxetine)
• patients w/ this condition tend to view themselves as inferior and will blame themselves for any failure or negative outcomes in social situations.
• assertiveness training = subset of CBT.

UW3839

1. Acting out
2. Denial
3. Regression
4. Projection

Other Defense not in any other category: Splitting, undoing

FA-P p. 174

1. orbitofrontal → disinhibition, irritability, lability, euphoria, lack of remorse.
2. dorsolateral → deficiencies of planning, monitoring, flexibility, and motivation; ↓ attention.
3. R. prefrontal → laughter, euphoria, joke and make puns.
4. L. prefrontal → depression and uncontrollable crying.

PT p. 73

Guidelines state that such a pt should be discontinued from antiΨ medication; gradual ↓ coupled with↑ visits to pscyhiatrist to prevent/monitor for relapse.

Pretest (ed.12) p. 138

• venlafixine or buproprion

PT12 p. 183

• there is a precipitating event (eg, car accident), but the pain continues. The intensity and duration of pain are out of proportion to the physical findings.
• usually presents in women (2:1) that are in their 4th or 5th decade of life.

PreTest12 p. 198