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SGU NB3

Terms in this set (179)

sedatives: alcohol, barbiturate & benzo intoxication sx
sleepy, decr anxiety, stupor, coma, disinhibited, impaired judgement, resp depression bradycardia, slurred speech, uncoordination
sedatives: alcohol, barbiturate & benzo W/D sx
agitated, insomnia, anxiety/extreme panic, tachycardia, HTN, nausea, vomit, hand tremors, seizures, delirium tremens, hallucinations
stimulants: cocaine, amphetamine, ecstasy, bath salts, K2 (lesser caffeine & nicotine) intoxication sx
manic like, auphoria, gradiosity, psychomotor^, stereotypies, paranoia, hallucinations, tachycardia, HTN, chest px, dilated/mydriasis, loss appetite, insomnia seizure
stimulants: cocaine, amphetamine, ecstasy, bath salts, K2 (lesser caffeine & nicotine) w/d sx
MDD w/atypical feat, dysphoric mood, fatigue, psychomotor slowing, hypersomnia, vivid unpleasant dreams, constriction/miosis
LSD intoxication sx
poorly formed visual hallucinations, dilated/mydriasis
LSD, PCP
which substances have NO withdrawal sx?
weed intoxication sx
distorted perceptions, slowed time, intensified senses, red eyes/conjunctival injection, ^appetite, dry mouth, ^thirst
weed W/D sx
irritable, nervous, dysphoric mood, stressed, insomnia, vivid dreams, night sweats, headaches, shakiness, decr appetite, stomach cramps
PCP intoxication sx
depersonalization, agitation, belligerent, confusion, impulsive, unpredictable, nystagmus, hyperacusis, decr px sensation, ataxia, musc rigidity, seizure, coma, violent
opioid intox sx
initial rush followed by euphoria & drowsiness, dysphoria as high dissipates, miosis/constriction, resp depression
opioid w/d sx
dysphoria, severe flu sx, nausea, vomiting, diarrhea, musc aches, lacrimation, rhinorrhea, piloerection, fever, sweating, yawning, dilation/mydriasis
benzodiazepines
diazepam/valium, alprazolam, clonazepam, chlordiazepoxide, lorazepam
SSRI antidepressants
paroxetine, sertraline, fluoxetine, citalopram
1. CBT (modify & exposure)
2. SSRI
3. Benzos
tx for anxiety disorders (3)
1. ERP behavioral
2. SSRI
3. Deep brain stimulation
tx for OCD (3)
CBT - change to mental health
tx for somatic symptom & related disorders
1. Psychotherapy
2/3. Antidepressants & benzos
tx for PTSD & acute stress do (3)
1. Psychotherapy coping strategies, support grps poss crisis intervention
tx for adjustment do
1. Psychotherapy/CBT
2. Hypnosis (false mem syndrome)
tx for dissociative do's (2)
1. CBT
2. Antidepressants - all
3. Esketamine nasal spray
4. Phototherapy
5. Brain stimulation (ECT, rTMS, VNS)
tx for MDD (& dysthymic PDD)
SNRI antidepressant
venlafaxine, duloxetine
TCA antidepressants (anticholinergic, cardiac SE)
imipramine, amitriptyline
MAOI antidepressants (tyramine induced cheese effect HTN)
phenelzine, selegiline
SSRIs
tx for premenstrual dysphoric do PMDD
mood stabilizers
lithium (hand tremor, polyuria, polydipsia)
anticonvulsants
valproate/valproic acid
ATYPICAL antipsychotics
clozaril (agranulocytosis), risperidone, olanzapine
1. Lithium/mood stabilizer
2. Valproate
3. Olanzapine
tx for Bipolar I do (3)
1. Mood stabilizers
2. Lurasidone*
Can be taken alone or w/lithium or valproate
tx for Bipolar II do (2)
Mood stabilizers/lithium
tx for cyclothymic do (1)
Non-benzo hypnotics
Zolpidem
1. sleep hygiene
2. benzos/diazepam
3. non benzo hypnotic/zolpidem
tx for insomnia (3)
Stimulant Rx
methylphenidate/ritalin, dextroamphetamine, lisdexamfetamine, amphetamine/adderall
Stimulant-like Rx
Modafinil, atomoxetine/strattera
1. Stimulants/methylphenidate
2. Stimulant like/modafinil
tx for Hypersomnia (2)
1. Stimulants/dextro & stim-like/modafinil (somnolence)
2. Antidepressants (cataplexy)
3. Sodium oxybate/Xyrem (cataplexy & somnolence)
tx for Narcolepsy (3)
monotherapy for cataplexy & somnolence in narcolepsy
Sodium oxybate/xyrem
1. CPAP
2. wt loss, avoid sleeping on back, ortho devices, surgery etc
tx for obstructive sleep apnea (2)
VARIES
1. Resp stimulant/acetazolamide
2. Nocturnal oxygen
tx for central sleep apnea (2)
Phototherapy @ strategic times
tx for Circadian rhythm S-W do
if needed, benzos (decr SWS) & sleep environ if sleep walker
tx for Non-REM Sleep Arousal do N-RSAD (parasomnia)
if needed, antidepressants to decr REM
tx for nightmare disorder (parasomnia)
Clonazepam/modify environ
tx for REM Sleep Behavior Do RSBD (parasomnia)
1. Parkinson's drugs
2. Benzos
3. anticonvulsants
tx for restless leg syndrome & periodic limb mvmt (parasomnia) - (3)
1. in patient hospitilization - nutritional refeeding,
2. CBT
3. meds tx med complications/comorbid dx
tx for anorexia (3)
1. out pt
2. CBT
3. antidepressants/SSRI for impulse control
tx for bulimia (3)
1. CBT
2. Antidepressants/SSRI impulse
3. Stimulants/lisdexamfetamine appetite
tx for binge eating do (3)
1. Support/help facilitate gender change/suppress puberty
2. Psychotherapy
3. Hormone tx/puberty blocking GnRH agonists
4. Surgery (phalloplasty/vaginoplasty)
tx for gender dysphoria (4)
1. dual/couple sex therapy
2. psychotherapy
3. orgasm - squeeze glans, stop & go, SSRI delays
4. pain - dilators, relaxors
tx for sexual dysfcn (4)
1. CBT/behavioral aversion therapy
2. Antiandrogens/chem castration to reduce drives (cyproterone acetate, medroxyprogesterone acetate)
3. tx comorbid dos
4. external control eliminate opportunities
tx for Paraphilias (4)
TYPICAL antipsychotics - pos sx
chlorpromazine, haloperidol lurasidone (BPII only)
1. typical antipsych
2. atypical antipsych
3. supportive, vocational rehab, family, psychotherapy
4. ECT augmentation (not common)
tx for schizophrenia (4)
1. antipsychotics
2. trial separation from partner
3. increase sources of reality testing
tx for delusional do (3)
ALWAYS tx psychotic sx before mood sx (more dangerous/harmful)
1. antipsychotics
2. mood sx
tx for schizoaffective do
1. CBT*
2. Medications - usually disinterested in tx
tx for personality dos
1. DBT dialectical - become aware of emotions to stop behavior before it happens
tx for Borderline PD
1. behavioral (avoid triggers, aversion, ERP)
2. SSRIs
tx for impulse control do's
1. Meds + psychotherapy (only use psychotherapy if child <6 yrs)
2. Stimulants adderall/ritalin
3. Non-stimulant/atomoxetine/strattera (NE uptake, cannot use w/tics/anxiety, ^suicide ideations)
tx for ADHD
1. tx underlying cause
2. antipsychotics to manage sx (risperidone)
3. supportive environment
tx for delirium (non alcohol based)
benzos
tx for alcohol based delirum
1. cholinesterase inhibitors = donepezil, galantamine, rivastigmine
2. NMDA recept blocker = memantine
3. tx sx
*antipsychotics for sx off label have increased mortality risk
tx for alzheimers
1. benign neglect of hallucinations (bc pts tend to have severe NMS to antipsychs)
-note parkinsons rx rel ineffective & may worsen psychosis bc ^DA
tx for Lewy body dementia
1. Naltrexons (opioid recept antag)
2. Acamprosate (NDMA antag)
3. Disulfiram (inhibits aldehyde DH for aversion/causes nausea)
tx for alcohol addiction (3)
barbiturates
phenobarbital, secobarbital
Flumazenil (benzo competitive antag) - reverse CNS depression
tx for benzo overdose/toxicity
1. NRT
2. Varenicline/chantix
3. Buproprion/Zyban/Wellbutrin (^DA, suicide concerns)
tx for nicotine use disorder (3)
1. benzos
2. antipsychotics
3. reduce environ stimuli
4. restraints if needed
tx for PCP intox (4)
Naloxone (opioid recept antag, reverse resp & CNS depression)
tx for opiod OD
1. abstinence
2. Naltrexone
3. Replacement therapy via Methadone (full agonist) or Buprenorphine (partial agonist)
tx for opiod addiction (3)
1. Cortex, MGN, ^basolateral/central amygdala
2. ventromedial prefrontal cortex/ant cingulate
3. hippocampus
What areas fire to amygdala in:
1. Fear conditioning
2. Extinction
3. Contextual fear learning
James-Lange Theory
What theory?
stimulus > bodily response > emotion
Cannon-Bard Theory
"Can Be same time"
What theory?
stimulus > bodily resp + emotion same time
Schachter-Singer Theory
stimulus > bodily resp + cognitive appraisal/labelling > emotion
Kluver-Bucy Syndrome
Lesion to amygdala, hippo, temp lobe > docility, loss of fear, hyperoral, hyperphagia, hypersexual, psychic blindness, memory impairment, seizures
cortex, corticospinal, corticobulbar lesion
Cheyne stroke pattern, waxing & waning
Pontine lesion
Apneustic breathing (prolonged inspiration/expiration)
Medulla lesion (lower pons/upper medulla), bilateral medulla would cause resp arrest
Ataxic breathing (random large & small breaths w/prolonged apnea - BAD prognosis)
Awake
desynchronized (low volt high freq), alpha & some beta, ARAS system (monoaminergic & cholinergic)
REM
beta, nightmares, rapid eye mvmt, inhibits other musc tone, dreaming, paradoxical sleep - awake brain in sleeping body
NREM: N1 sleep
theta "The 1" transitional, hypogogic hallucinations (upon falling asleep)
NREM: N2
spindles, k complexes
NREM: N3 slow wave SWS
delta, burst mode, sleep terrors, sleep walking, restorative, dull absent sensation
Locked in syndrome
blockage/ischemia to basilar a pons > tetra/quadriplegia, CN3 & 4 intact comm by blink, conscious brain (midbrain intact)
E - eye opening (4)
M - motor resp (6)
V - verbal resp (5)
score = 3 to 15
<8 = coma
Glasgow coma scale & scoring
lesion in midbrain breathing
hyperventilation lesion
constricted/smaller but respond to light
diencephalon lesion: what happens to pupils
one eye dilated (unilateral fixed), both damaged = no vert mvmt, no adduction (can abduct)
CN3 uncal herniation: pupils, eye mvmt
midposition pupils, only eye near cold water turns toward cold water (other stays midpos), direction head turns (L/R) is the eye that stays middle & other eye turns opposite to head turn
Midbrain lesion: pupils, cold water in ear, doll head
large, unreactive
pretectal pineal tumor pupils
pinpoint BILATERALLY, slight resp 2 light > dolls: eyes roll counter to head mvmt > cold: eye turn toward cold
pons lesion: pupils, dolls head, cool water
Panic Disorder
PA >1 mon + fear/avoid
Agoraphobia
>2 situations avoided bc fear of escape
GAD generalized anxiety do
anxious about lots >6 mos
selective mutism
refuse to speak even though physically able, >1 month
somatic symptom do
physical sx + excessively worry its more serious
illness anxiety do
no/mild sx + worry they have serious illness
conversion disorder
neuro motor/sensory issue + normal neuro testing (pseudosymptom)
Factitious do/munchausen (self/another)
fake/induce sx bc like sick role
Malingering (self/by proxy)
fake/induce for external reward
PTSD
stressor + >1 mon + 1 sx from each cat (IANR): Intrusion, Avoidance, Neg altered cog/mood, altered arousal/Reactivity
Acute stress disorder
stressor + numerous PTSD sx + duration 3 days-1 mon
Adjustment disorder
stressor + onset w/in few months, resolve few mos after stressor termination
localized memory loss
total loss of memory during time period
selective memory loss
remember bits & pieces only during time period
generalized memory loss
loss of entire memory leading up to & including event
MDD
>1 MDE + no mania/hypomania
(MDE = 2+ wks of >5 sx, 1 must be depressed/anhedonia)
persistent depressive disorder
chronic dep 2+ yrs w/out euthymia
PDD w/persistent MDE
prolonged MDE
PDD w/pure dysthymic syndrome
prolonged dysthymia (no MDE)
PDD w/intermittent MDEs
dysthymic periods & MDEs
Disruptive mood dysregulation do
outburts 3x/wk, angry baseline mood, mostly children 6-10yrs, must be <18yrs
Bipolar I
mania epi, >1 week, impaired fcn (manic epi = elevated/irritable, ^E + 3 sx) - 80% MZ twins
Bipolar II
1 MDE + 1 hypomanic epi (>4 days, no impaired fcn)
Cyclothymic disorder
fluctuating hypomanic & dysthymic >2yrs (never extremes)
Insomnia
initiate/maintain sleep >3mos
Narcolepsy
irresistible sleep same day several x/wk, >3mos, + cataplexy/hypocretin orexin def/PSG abnormal
Non-REM sleep arousal disorder NRSAD
either sleep walking/somnambulism OR sleep terrors > content amnesia SWS
periodic limb movements
unaware of limb mvmt in sleep
anorexia: binge/purge (vomit, lax, diuret), restricting (diet, exercise, fasting)
BMI <18.5 or 5th percentile, fear of wt gain, body image disturb (may have lanugo, hypercholesterol, amenorrhea, hypotension, anemia etc)
bulimia nervosa
recurrent binge eating + compensatory behavior + >1x/wk for >3mos
binge eating disorder
binge >1x/wk for >3mos + guilty/disgusted + no comp behaviors
gender dysphoria
incongruence of assigned gender causes distress/impairment + >6 sx + >6 mos
dyspareunia
genital px during intercourse
vaginismus
involuntary vaginal contraction
exhibitionism "exhibit genitals"
arousal from exposing genitals
voyeurism
arousal from observing unsuspecting person in sexual, >18yrs
frotteurism
arousal from touching/rubbing against non-consenting
sexual sadism "want to make them sad"
arousal from CAUSING px
sexual masochism "receiving makes you mad"
arousal from RECEIVING px
pedophilia
perpetrator >16 yrs & at least 5 yrs older than child (child usually under 13 yrs)
schizophrenia
active phase >1 mon (>2 sx 1 must be core: delusion, hallucination or disorg speech) + 1 sx persists >6mos
schizophreniform
>1 mos active phase, <6 mos
brief psychotic disorder
>1 core sx, <1 mon
delusional disorder
delusion >1 mon (no other sx or impairment) > persecutory, gradiose, erotomanic, jealous, somatic types > bizarre/non
schizoaffective do "active concurrent epi"
1. active phase w/mood epi
2. active phase >2wks w/out mood sxs
3. mood sx present for majority
schizoid personality do
wants to "avoid" relations & be alone
schizotypal personality do
type of schizophrenia, magical thinking, odd appearance, a little off
histrionic PD
historically provocative, center of attn, use phys appearance for attn, shallow rapid shift emotions
borderline PD
instability relations/self image, intense uncontrolled anger
antisocial PD
>18yrs + lack remorse, deceitful, psycho/sociopath + must have had conduct disorder before age 15
avoidant PD
"Avoid rejection" desire relations but reluctant to engage
oppositional defiant disorder
childhood, irritable defiant to authority, NO violations
conduct disorder
serious violations of rights + >18yrs + >3 sx in cat: aggressive conduct, property destruction, deceit/theft, violate rules
intermittent explosive disorder
normal baseline + disprop outbursts
kleptomania
tension before + stealing UNNEEDED objects + relief/pleasure after (no other motive)
pyromania
fascinated w/fire + tension before + setting fires + pleasure/relief after (no other motive)
Broca's aphasia
nonfluent > norm comprehension > no repetition
inf frontal cortex damage, motor aphasia, dysarthria, stutter, effortful, agrammatical, telegraphic, cue, hemiplegia, apraxia
NORMAL: comprehension
Wernickes aphasia
fluent > no comp > no repetition
post sup temp gyrus, sensory aphasia, no comprehension, writing/speaking ok but doenst make sense, paraphasic, hemaniopia
NORM: fluent, loquacious
Gerstmann Syndrome
angular gyrus, L/R confusion, acalculia, agraphia, trouble putting meaning to representations, slight hemiparesis, hemianopsia
NORM: repetition
Conduction aphasia
fluent > norm comp > no repetition
arcuate fasciculus, impaired repetition, moderate impairment in most other things, slight hemiparesis, neglect R sided stimuli
global aphasia
nonfluent > no comprehension > no repetition
combination of broca + wernicke + conduction > impaired motor, comprehension & repetition, hemiplegia, hemiparesis
transcortical sensory aphasia
fluent > poor comp > good rep
occipito-temporal-parietal, similar to wernicke but CAN repeat, hemaniopia, hemisensory loss, alexia
transcortical motor aphasia
nonfluent > good comp > good rep
frontal watershed, similar to brocas but can repeat > dysarthric, agrammatical, hemiplegia, apraxia
sensory > perforant > entorhinal > dentate > mossy fibers > CA3 > fornix/schaffer > CA1 > subiculum > back to entorhinal
trisynaptic circuitry - synaptic plasticity
intellectual disability
deficits in intellectual fcn + adaptive fcn/ADL + begin before 18yrs
global developmental delay
<5 yrs + not met multiple milestones (cannot assess IQ)
specific learning disorder
>1 sx for >6mos + interferes w/ADL
language disorder
diff aquisition & use of lang, decr vocab + below expectations for age
speech-sound disorder
diff w/speech sound perceptions "wabbit" norm by 3-4yrs
child onset fluency disorder
dx by age 6, stuttering repetitions + anxiety/limited comm
social pragmatic comm disorder
diff using social cues (rarely made before 4-5 yrs old bc still learning cues)
autism spectrum disorder
deficits in social comm/interaction , social-emotional reciprocity, eye contact, prob w/play, RRBs rep patterns of behaviors, fixated interests, inflexible adherence to routine, hypo or hyper-reactivity to sensory stimuli (dx usually by age 2)
aspergers
Autism spectrum do w/out lang impairment & w/out intellectual impairment
ADHD
6+ sx >6mos
ADHD inattention sx
lack of attn to detail, may seem not to be listening, diff organizing tasks, lose things, forgetful, diff focusing, lack follow through, avoid tasks req sustained effort, easily distracted
ADHD hyperactivity & impulsivity sx
fidgets, squirms in seat, on the go motor, talk excess, blurt out/cant wait for turn, leave seat when not expected, run about inapprop, unable to remain quiet, interrupt, intrudes
delirium
acute confusional state, cloudy consciousness, decr awareness/alertness, decr attn + another cog disturbance > fluctuate throughout day, has specific cause
alzheimers
gradual onset steady progressive decline, memory encoding, cortical/hippo atrophy, ventriculomegaly, post parietal/temporal hypometab, beta amyloid plaque, neurofibrillary tangles
early stage AD
memory: rapid forgetting, anomia/word finding difficulties - can still tell you fcn
middle stage AD
further decline, visuospatial, agnosias (perceive but cant identify) - visual, prosopagnosia, auditory > mood/personality change, psychosis
late stage AD
severe deficits, very little fcn, global aphasia, motor dysfcn, die from opportunistic infections
vascular dementia
retrieval prob (cues help), infarcts cause stepwise progression, focal sx
frontotemporal dementia (pick's disease)
onset 40-50s, frontal sx disinhibited, personality, poor judgement, frontal lobe atrophy, lobar/chunk atrophy, pick's bodies
lewy body dementia
pseudodelirium, FLUCTUANT, visual halluc, mild parkinsonism, norm preceded by REM sleep beh do, lewy bodies in cortex, dementia develops w/in first 12 mos of motor signs
parkinsons disease dementia
50% get dementia, lewy bodies in midbrain, develops >12 mos after PD motor
prion dementia
RAPID RAPID progression over months & die w/in 2 yrs
Pseudodementia
dementia syndrome of depression, elderly, perform inconsistently across tests of same ability
benign senescent forgetfulness
cog decline w/NORMAL aging
Men = 4/day or 14/week
Women = 3/day or 7/week
max drinks for men & women per day & week
THIS SET IS OFTEN IN FOLDERS WITH...