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M&M Week 3 LOs
Terms in this set (52)
Which diagnose trumps the other: bulemia nervosa or anorexia nervosa?
anorexia nervosa trumps bulemia nervosa
What is the time criteria for bulemia nervosa?
1x/week for 3 months
What are the types of long-term memory?
Delcarative= able to recall things from the past
Nondeclarative= independent of consciousness-->knowing how to automatically tie a shoe or drive
What is the benefit of the Alzheimer drugs/cognitive enhancers?
delay cognitive decline by 6-12 months but if notice not working then no use to keep on and stop or try switching classes
What are the functional regions of the brainstem? (ventral to dorsal) and know what runs in them.
Basis: Basilar Region-->descending somatomotor axons (corticobulbar-to CN AND corticospinal tracts-to ventral horn)
Telecephalon: ascending tracts (sensory axons) (spinothalamic, spinocerebellar, medial lemniscus-dorsal column tracts &
that surround nuclei
Tectum: only in midbrain that has the superior & inferior colliculi that involve vision & auditory
What is the organization of the tegementum?
medial: somatomotor-->brachiomotor-->visceromotor-->general viscerosensory-->special viscerosensory-->general somatosensory-->special somatosensory
What are the functions of the integration centers of the briansteam?
-arousal, wakefullness, consciousness-->stroke if something bad
-autonomic function-->respiration, BP, heart rate
Which cranial nerves come off parts of the brain stem?
midbrain= III (oculomotor), IV (trochlear)
Pons= V (trigeminal), VI (abducens), VII (facial), VIII (vestibulocochlear)
Medulla= IX (glossopharyngeal), X (vagus), XII (hypoglassal)
NOTE: for each type of modality of axon in each CN (somatosensory or visceromotor-ex) there is an associated nucleus in the brainstem
and usually CN nuclei are associated with the
If someone is having an issue with wake, consciousness or could have been damage from stroke which integration center and location in the brainstem is it?
midbrain and rostral pons
If someone is having trouble with gazing or the horizontal and vertical eye movements which integration center and location in the brainstem is it?
midbrain and rostral pons
If sonemone is having autonomic regulation with BP, heart rate or respirations which integration center and location in the brainstem is it?
caudal pons in the medulla
If soneone is haveing trouble with pain modulation which integration center and location in the brainstem is it?
periaquaductal gray in the midbrain
Know brainstem lesions if they are longitudional or latitude
Which do you typically see go first in a person with AD? intermediate activiteis of daily living (IADLs) or ADLs?
IADLs-->able to manage finances, coordiation of medical appointments etc.
What is a risk factor for AD that occurs in midlife that if you can correct can help with the progression of AD??
What is the pathophys for AD?
amyloid plaques that can result in microglial activaiton-->inflammation??
plaques can also result in neurofibrillary tangles
Know what and the symptoms for the other causes of dementia:
-Lewy body disease
Vascular dementia: from cerebrovascular disease (HTN, BP) that results in a stepwise decline, you get a vascular insult and then get decline and then another insult and decline
Lewy Body disease: visuospatial more affected and can get parkinsonism, hallucinations, and fluctuationg symptoms
Frontotemporal dementia: mutation in TDP-43 which leads to lobar degeneration of frontal or anterior temporal lobes. Will see disinhibition (acting strangely), apathy (sit around and not do much), and non-fluent aphasia)
If someone comes in with hallucinations of small animals running around and has tremors, what type of dementia should you think about?
-Lewy body disease
If someone comes in with disinhibition (acting strangly or inappropriate) and has non-fluent aphasia, what type of dementia should you think about?
Difference between dementia and delirium
Delirium: more acute onset and usually due to toxic, metabolic, or infectious etiology, waxes and wanes
Dementia: chronic, progressive and usually due to Alzheimers dieseae, vascular dementia, Lewy Body disease, frontotemporal dementia, or combionation, NO disease modifying treatments
What are the 5 components of a PTSD diagnosis?
-need to have a traumatic life event
-elevated adrelaline system (seem jumpy or on high alter)
-result in avoidance
-fear conditioning or feelings can get reactivated
-Impaired mood or cognition: impaired memory, irrational guilt, shortened future ("oh I won't live past 30"), numb, despersonalization
need to be longer than 1 month for PTSD or else could be acute stress disorder
What is the gold standard treatment for PTSD?
block alpha 1 adrenergic receptor-->Prazosin!
or TCAs or other antipsychiotcs also work
same with Propranolol
What are the harmful vs. helpful treatments for PTSD?
Harm: debriefing, benzos, dissocation
Help: glucocorticoids, sleep deprivation, trauma specialized psychotherapy
How can you distinguish ADHD or OCD vs. a developmental disorder?
developmental disorders are typically diagnosed by age 3-4 because it will show developmental delays
What are some of the restrictive and repetitive behaviors that can be seen in developmental disorders such as autism?
stimming: hand flapping in periphery, rocking back and forth but NOT hand wringing (that is seen in Rett syndrome)
What is the one restrictive and repetitive behavior that is commonly mistaken for a feature of autism?
hand wringing-->seen in Rett syndrome
What are some of the social reciprocity features you might see in a child with a development psychiatric disorder such as autism?
-avoid eye contact
-lack of facial expression
-lack of shared enjoyment (if walk into room with people laughing, normal response to start laughing too?)
-pointing to shared interests
What are some of the common co-morbid conditions associated with developmental disordres such as autism?
also: ADHD, OCD, social anxiety, depression
If someone comes in and is having very distressing thoughts about symptoms they have, but they don't actually have anything wrong with them. What psychiatric condition is this?
somatic symptom disorder
What is the difference between hypochondriasis and a somatic disorder?
Hypochondriasis: believe symptoms are from a specific illness vs. somatic disorders you believe your symtpoms are from an unknown illness
What is the precursor to dopamine and what else can dopamine turn into?
What are the dopamine pathways?
where do they originate from and where do they go to?
mesocoritcal and mesolimbic originate form the ventral tegmentum
-nigrostriatal pathway: start at substantia nigra go to putamen, thalamus, dorsal striatum
-mesocortical: go to the cerebrum
-mesolimbic: go to nucleus accumbens
-tuberoinfundibular: go from pituitary into hypothalmaus
What is the pathophys of positive symptoms in schizophrenia?
What about negative symtpoms?
which one is associated with too much vs. too little dopamine?
positive= overactive mesolimbic pathway (ventral tegmentum-->nucleaus accumbens)
negative= mesocorticoal pathway and get when there is
Describe how the nigrostriatial pathway is affected when you treat someone with schizophrenia with anti-dopaminergic agents (anti-psychiotics)?
too little (low) dopamine in the nigrostriatal pathway (which normally is involved with movememnts) can lead to Parkinson's or parkinson-like symptoms (tremor, shuffling gait)
the meds used to treat schizophrenia lower dopamine levels so this is why you can get parkinsonian sytmpoms as a side effect
If someone comes in and has oculogyric crisis (eyes stuck looking in a certain direction) what antipsychiotic med the on?
what do you treat akathisia (side effect of 2nd generation antipsychiotics)?
What are some distinctions between NREM and REM sleep?
NREM: has increased parasympathetic activity (decreased BP and heart rate), decreased EMG muscle activity
REM sleep: increased sympathetic activity, paralysis of skeletal muscle, dreaming, rapid eye movement
when do you have more slow wave sleep (SWA) vs. REM in the early or later parts of the night?
more SWA in the begining and then more REM later on in night
What are the NREM and REM parasomnias?
NREM & Wake= sleep walking, sleep terrors-->don't remember and typically grow out of
REM & Wake= RBM (rem sleep behavorial diorders), nighmares
If someone has a decrease in their sleep paralysis and starts acting out their dreams what might they have?
RBD-->rem sleep behaviorial disorder
people usually able to recall the dream and their eyes are closed
a REM/Wake disorder
what is the age group most commonly associated with RBD and then what are they possibly at increased risk for?
older men and increased chance of parkinson's?
who do you usually see NREM and REM parasomnias in?
NREM= childhood and spontaneously resolves
REM= older adults and associated with parkinsons
what are the cardinal symptoms of narcolepsy?
-Excessive daytime sleepiness
-Sleep paralysis (wake up frozen)
-Hypnagogic/hypopomic imagery (seeing person)
-Cataplexy (lots of laughter)
-Automatic behaviors/disrupted sleep (do things & not rembmer
If you see someone who has daytime sleepiness and then lots of almost uncontrolled laughter what should you think of?
what is the pathophysiology of narcolepsy (type I)?
loss of hypocretin/orexin containing neurons-->an autoimmune reaction
which of the sleep disorders has sleep paralysis and laughter?
What does the sleep study look like for someone with narcolepsy?
fall asleep very fast (<8 minutes) and then have decent amount of REM cycles?
What are the clinical features of restless leg syndrome?
U=urge to move legs
R=relief with movement
G=gets worse with rest
-can run in family and response to dopaminergic therapy
What is thought to be the pathophysiology of restless leg syndrome?
dysfunction of iron metabolism in the CSF (low ferrotin)
Or could be secondary due to: anemia (iron def), pregnancy, renal faillure, medication induced
cicardian rhythem low at begining of day and then peaks at 7pm and then drops-->what makes you sleepy
What do you need to check to see for someone who has chronic insomnia?
What is the biologicla etilogy of insomnia?
What is the treatment for insomina?
-check to see if any medications they are on can cause insomnia
-biological etiology= CNS hyperarousal ("brain always on")
, CBT, benzo agonist drugs, melatonin
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