-
Where is the Presinilin 2 gene?
Chromosome 1
-
Inheritance pattern of Amyloid Precursor Protein mutations
Autosomal dominant
-
Inheritance pattern of Presinilin 1 mutations
Autosomal dominant
-
Inheritance pattern of Presinilin 2 mutations
Autosomal dominant
-
What percentage of Alzheimer's cases are believed to be due to mutations in Amyloid Precursor Protein, Presinilin 1 or 2?
5%
-
What medications are FDA approved for Social Anxiety Disorder? (2)
- 1. Sertraline
- 2. Paroxetine
-
Efficacy of TCAs in Social Anxiety Disorder
Not helpful
-
What class of antidepressants is used for depression following an MI?
SSRIs
-
Effect of Bupropion on BP
Can cause HTN
-
Effect of trazodone on BP
Due to α-adrenergic blockade, can cause orthostatic hypotension
-
Neurotransmitter that chiefly mediates the behavioral effects of cocaine
Dopamine
-
What sleep disorder of childhood is more common in boys?
Sleep terror disorder
-
What are the Antihistaminic Effects of TCAs? (2)
- 1. Sedation
- 2. Weight gain
-
What is the most important cardiovascular effect of TCAs?
Prolong cardiac conduction, which can exacerbate a heart block
-
What type of study is Imaging Genetics a form of?
Association Study
-
What is an Association Study?
Determines whether a gene occurs more often than chance in affected individuals when compared to unaffected individuals
-
What is Imaging Genetics?
Uses neuroimaging to compare brain structure in those who have a genetic variation to controls
-
Characteristics predicting a better prognosis in Schizophrenia (5)
- 1. Late age of onset
- 2. Good premorbid functioning
- 3. Longer remission periods
- 4. Being married
- 5. Good initial response to medication
-
Best predictor of good prognosis in Schizophrenia
Good initial response to medication
-
Initial class of medication used for emotional disregulation in Borderline Personality Disorder
SSRIs
-
Theory behind Structural/Strategic/Systematic Therapy
- Structural imbalances cause problems in family dynamics
- Symptoms of family issues are actually communications used to control relationships when other strategies can not be used
-
Findings that are more common in elderly patients with late-life onset of depression (3)
- 1. Chronic medical illness
- 2. Dementia
- 3. Poor treatment response
-
Medication FDA approved to treat MDD in pediatric patients
Fluoxetine
-
How long does Haldol Decanoate take to reach steady state?
3-6 months
-
Response to a trauma that predicts higher likelihood of developing PTSD
High anxiety in response to the trauma
-
Locus of control that is more likely to lead to PTSD after a trauma
External
-
Best model of treatment for dual diagnosis patients
Integrated treatment, in which the same physicians treat mental health and substance abuse, rather than separate teams
-
Medication with which Ginko Biloba is very unsafe
Warfarin; can cause intracranial bleeding or hematomas
-
"Atypical Features" in Depression (6)
- 1. Mood reactivity
- 2. Sensitivity to rejection
- 3. Increased sleep
- 4. Increased appetite
- 5. Fatigue
- 6. Phobic symptoms
-
Presentations of Depression with Melancholic Features (2)
- 1. Loss of pleasure in almost all activities
- 2. Loss of pleasure in previously enjoyed activities plus early waking, weight loss, guilt, psychomotor agitation or retardation, and depression worse in the morning
-
Antipsychotic with the greatest effect on Q-T interval
Thioridazine
-
What is Acamprosate FDA approved for?
Maintenance of abstinance from alcohol
-
Features of a patient appropriate for brief psychodynamic psychotherapy (5)
- 1. Focal conflict
- 2. Able to think in feeling terms
- 3. Motivated
- 4. At least one meaningful relationship
- 5. Good response to a trial interpretation
-
Effect of gender on neuroleptic dosing
Serum levels are higher in women than men
-
Effect of gender on dystonia due to neuroleptics
Women have more dystonia on equivalent doses
-
Effect of gender on sedation due to neuroleptics
Equal in men and women
-
Side effects of MDMA (3)
- 1. Nausea
- 2. Restlessness
- 3. Teeth grinding
-
Daily dose of caffeine at which withdrawal is seen
100mg/day
-
Caffeine withdrawal symptoms (3)
- 1. Headache
- 2. Fatigue
- 3. Nausea/vomiting
-
Course of caffeine withdrawal symptoms
- Begin within 12 hours
- Peak at 24-48 hours
- Last up to 1 week
-
Races that are often ultrarapid 2D6 metabolizers (2)
- 1. Middle Eastern
- 2. North African
-
Approach to giving neuroleptics to ultrarapid 2D6 metabolizers
Along with the neuroleptic, give paroxetine to inhibit 2D6
-
Effect of coadministration of Carbamazepine or Oxcarbazepine with OCPs
Induce metabolism of estrogen, leading to ineffective OCPs
-
Effect of coadministration of OCPs and Lamotrigine
Lower lamotrigine levels by about 50%
-
What distinguishes a Degenerative Dementia from a Non-Degenerative Dementia?
Neuron destruction is due to the dementing illness, not a systemic condition or insult
-
Medication that can cause a false positive for PCP on a drug screen
Dextromethorphan
-
Medication that can cause a false positive for marijuana on a drug screen
Ibuprofen
-
Food (other than poppy seeds) that can cause a false positive for opiates on a drug screen
Tonic water
-
Medication that can cause a false positive for amphetamines on a drug screen
Phenylephrine (decongestant)
-
Personality disorder with highest heritability
Antisocial Personality Disorder
-
Personality disorders that have strong heritability (2)
- 1. Antisocial
- 2. Borderline
-
Medications that lower Lamotrigine levels by about half (3)
- 1. Carbamazepine
- 2. Phenytoin
- 3. Phenobarbital
-
Effect of coadministration of Lamotrigine and Phenytoin
Lowers lamotrigine levels by half
-
Effect of coadministration of Lamotrigine and Phenobarbital
Lowers lamotrigine levels by half
-
What is the only anxiety disorder that Buspar has been show to have efficacy in?
Generalized Anxiety Disorder
-
Basic pattern of inheritance of an X-Linked illness
Mother-to-son
-
Contraindications to disulfiram treatment (5)
- 1. Hepatic dysfunction
- 2. Renal failure
- 3. Cardiac disease
- 4. Pregnancy
- 5. Peripheral neuropathy
-
Symptom more often seen in at first presentation of psychotic patients who are male
Cognitive deficit
-
Symptom more often seen in at first presentation of psychotic patients who are female
Depression
-
Psychiatric medication that can cause acute secondary angle-closure glaucoma
Tomiramate, typically early in treatment
-
What medications are most helpful in Bulemia? (2)
- 1. Fluoxetine
- 2. Imipramine
-
What is the only medicatino FDA approved for Bulemia?
Fluoxetine
-
What is the American Academy of Pediatrics statement on lithium during breast-feeding?
Lithium is "associated with significant side effects in some nursing infants; use with caution"
-
How high are concentrations of lithium in breast milk?
40% of maternal serum concentrations
-
How high is the lithium level of a breast-fed baby whose mother takes lithium?
40% of the mother's serum concentration
-
What is the history of lithium toxicity in breast-fed infants whose mothers took lithium?
Only one convincing case has occurred, and it was associated with an infection
-
Psychiatric symptoms of Interferon-α
- Depression, fatigue, cognitive impairment, SI
- Psychosis
-
Rate of sexual side effects with Clomipramine
High!
-
Effect of a patient making the choice of which substance abuse program they will enter
No significant effect on treatment outcome
-
Two antipsychotics that are most likely to cause weight gain
- 1. Clozapine (most common)
- 2. Olanzapine (second most common)
-
Most effective treatment for Bulemia
CBT
-
What substance dependence is Bromocriptine used for (with mixed results)?
Cocaine dependence
-
Most important factor in suitability for Short-Term Psychodynamic Psychotherapy
Patient and therapist can agree on a defined focus of treatment
-
Is informed consent of a custodial parent required to release health information to the noncustodial parent?
Yes!
-
What is ventricular enlargement in Schizophrenia most closely associated with?
Prominent negative symptoms
-
Definition of a Personality Disorder
Enduring pattern of experience and behavior that deviates markedly from the expectations of the individual's culture
-
Effect of Twelve Step programs on smoking
No efficacy in smoking cessation
-
What is Brief Advice Intervention for smoking?
- One benefit is identified and discussed for less than 10 minutes
- Increases rate of cessation by 5-10%
-
What type of group of people are most likely to have Shared Psychotic Disorder?
Couples
-
Gender breakdown in Shared Psychotic Disorder
Women > Men
-
What form of mental retardation is most associated with Anxiety Disorders?
Fragile X
-
What form of psychotherapy formally gives permission to be in the "sick role"?
Interpersonal Psychotherapy
-
How are feelings framed in Interpersonal Psycotherapy
In terms of a medical illness
-
Treatment of choice for impulsivity/disinhibition in Borderline Personality Disorder
SSRIs
-
What class of medications is best for agitation in a geriatric patient with Parkinson Disease?
- Any atypical other than Risperdal, because:
- Atypical neuroleptics are best for geriatric patients
- Risperdal has too many EPS to give to Parkinson Disease patients
-
Predictors of good response to Lithium (6)
- 1. Euphoric mania
- 2. Full remission between episodes
- 3. No psychotic features
- 4. Course of episodes is Mania→
- Depression→Euthymia
- 5. Few lifetime episodes
- 6. No comorbidity
-
Transmission of Huntington's Disease
Autosomal Dominant
-
Psychiatric issues of Fetal Alcohol Syndrome (2)
- 1. High rate of intellectual impairment
- 2. High rate of Disruptive Behavior Disorder
-
Effect of in utero marijuana exposure
Mild impairment of attention and impulsivity
-
Effect of in utero cocaine exposure
Hypoxia causing small size for gestational age and small head circumference
-
Effect of in utero opiate exposure
- Low birth weight and head circumference
- No differences found in early childhood
-
Effect of in utero nicotine exposure
- Growth retardation
- Increased rate of ADHD
-
Difference in pharmacokinetics in children
Children have more efficient renal elimination than adults
-
What stage of sleep does Sleep Terror Disorder occur in?
3 or 4 (deep NREM sleep)
-
Symptoms necessary for diagnosis of Neuroleptic Malignant Syndrome (2)
- 1. Rigidity
- 2. Elevated temperature
-
Cardiac changes in NMS (2)
- 1. Tachycardia
- 2. Elevated or labile BP
-
Neurologic changes in NMS (3)
- 1. Tremor
- 2. Altered consciousness
- 3. Mutism
-
Laboratory changes in NMS (2)
- 1. Leukocytosis
- 2. Elevated CK (or other evidence of muscle injury)
-
Cause of Borderline Personality Syndrome, according to DBT
Dysfunction of emotion regulation
-
Criteria to diagnose a personality disorder in an individual under age 18 (2)
- 1. Symptoms for at least 1 year
- 2. Unlikely to be due to an axis 1 disorder or a particular developmental stage
-
Treatment of choice for mild PTSD
Psychotherapy without medications
-
How long must mood symptoms persist after achieving sobriety to warrant treatment?
2 weeks
-
What is a Linkage Analysis?
- Examines whether two genetic loci are co-inherited more often than by chance
- Type of gene mapping study
-
What is a Segregation Analysis?
Evaluation of what type of inheritance pattern an illness has
-
What type of trauma is most likely to cause PTSD?
Assault, including sexual assault
-
Effect of anorexia on amylase levels
Elevated
-
Most common side effect of cholinesterase inhibitors
Nausea
-
FDA indications for Clonazepam (2)
- 1. Seizure disorders
- 2. Panic Disorder
-
First-line treatment for Atypical Depression
SSRIs
-
Most effective class of medications in Atypical Depression
- MAOIs
- Not used first-line because of side effects
-
Least effective class of antidepressants in Atypical Depression
TCAs
-
Genetic condition causing "Guevodoces"
5-α Reductase Deficiency
-
Utility of Haloperidol in BPAD
Used as an adjunct to a mood stabilizer to treat psychotic symptoms, not mania
-
Most effective medication for Rapid Cycling
Valproic Acid
-
How long until initial effects are seen with neuroleptics?
2-4 weeks
-
How long for full response to neuroleptics?
6 months or longer
-
What is a Boundary Crossing?
- Minor break in the therapeutic frame that occurs in isolation and does not cause harm
- Discussed in therapy, leading to further exploration of transference
-
What is a Boundary Violation
- Exploitative break in the therapeutic frame
- Often not discussable in therapy
-
Effect of Escitalopram on p450
No clinically meaningful effects
-
What p450 enzyme is Atorvastatin a substrate for?
3A4
-
What p450 enzyme is Metoprolol a substrate for?
2D6
-
Mechanism of Methylphenidate
- Promotes release of dopamine
- Prevents dopamine reuptake
-
Most common cause of late-life psychosis
Alzheimer's Dementia
-
Age after which most cases of nocturnal enuresis will remit
7
-
Distinction between Ataque de Nervios and a Panic Attack
Ataque de Nervios is associated with a specific event and there is no acute fear
-
What is Pimozide? What does it uniquely (for its class) treat?
Neuroleptic approved for treatment of Tourette's Disorder
-
Goals of CBT in a rape victim (2)
- 1. Destigmitization
- 2. Desensitization
-
What is a Cultural Formulation?
- Review of a patient's cultural background and the role of cultural context in their illness
- Also includes the role that the clinician's cultural differences will have on the relationship, so the psychiatrist must know his/her own culture!
-
Physical illness with the best-studied association with suicide
Seizure disorders, especially temporal lobe epilepsy
-
What is Numbing in trauma?
- Decrease in overall responsiveness
- Mechanism for avoiding stimuli that may be associated with the trauma
-
What is the Appreciation Standard?
- Whether the patient can apply facts to his/her medical condition
- Cam be impaired by a delusional belief only if it directly causes the patient to fail to apply relevant facts to his/her own case
-
Effect of grapefruit juice on Buspar levels
Increase four-fold
-
Effect of pharmacologic management of ADHD on substance use disorder
SIgnificantly decreased risk of substance abuse, even if amphetamines were given
-
What is Selective Mutism?
- Refusal to speak in school and to adults outside the home
- Remain interested in surroundings
-
What condition are children with Selective Mutism likely to develop in adulthood?
Social Anxiety Disorder
-
Treatment with greatest efficacy in permanently eliminating nocturnal enuresis
Behavioral Interventions (eg bell and pad)
-
Effect of TCAs on nocturnal enuresis
Have short-term efficacy, but are not effective as a long-term management
-
Effect of Desmopressin on nocturnal enuresis
Has short-term efficacy, but is not effective as a long-term management
-
Diagnosis after short-duration psychosis after a trauma
Brief Psychotic Disorder
-
Psychiatric medication associated with PCOS
Valproate
-
What was controlled for in the Epidemiologic Catchment Area study?
Socioeconomic status
-
Duration of washout after taking an irreversible MAOI
2 weeks
-
Effect of coadministering Metoprolol and Fluoxetine
- Fluoxetine inhibits 2D6, raising metoprolol levels
- Causes orthostatic hypotension
-
Illness more likely to be diagnosed in African Americans than Caucasians
Schizophrenia
-
Psychiatric illnesses underdiagnosed in African Americans
Mood Disorders
-
Excretion of Gabapentin
Renal
-
Duration of continuation treatment after a first episode of nonpsychotic depression
4-9 months
-
Can a divorce or loss of a loved one cause PTSD?
No! The trauma must be life-threatening or of similar intensity
-
Percentage of people with Dysthymia who are eventually diagnosed with MDD
70-80%
-
First approach if sexual dysfunction occurs with an SSRI but mood improvement is good
Lower the dose to see if the sexual dysfunction will remit without loss of efficacy
-
What do the criteria for substance abuse involve?
- Use despite consequences
- Not tolerance of physical dependence!
-
Presentation of depression in women as compared to men (5)
- 1. Earlier onset
- 2. Longer duration of illness
- 3. Lower rates of drug use
- 4. Higher rates of anxiety
- 5. More suicide attempts
-
What does Basic Genetic Epidemiology look for?
Degree of heritability
-
What does Advanced Genetic Epidemiology look for?
Nature and mechanism of genetic risk factors
-
What does Gene Finding look for?
Location and identity of susceptibility genes
-
What does Molecular Genetics investigate?
Biological pathways from DNA to disorder
-
Are positive psychotic symptoms present in Paranoid Personality Disorder?
No!
-
Effect of Frontotemporal Dementia on visuospatial skills
Preserved in early stages
-
Type of anomia that is common in Frontotemporal Dementia
Semantic Anomia (meaning of words is forgotten)
-
Psychiatric illness with greatest genetic contribution
Schizophrenia
-
Focus of Supportive Dynamic Psychotherapy
Problem Solving
-
Most effective behavior therapy technique for OCD
Exposure and response prevention
-
What is the cognitive error Personalization?
Linking internal occurrences to oneself
-
What is the cognitive error Arbitrary Inference?
Coming to a conclusion without adequate supporting evidence or despite contradictory evidence
-
Why do Narcissistic Personality Disorder patients not tolerate feeling better?
This would imply that the therapist has helped them
-
What is shared among a Cultural Group?
Values, beliefs, history, and customs
-
What is shared among an Ethnic Group?
Identity, ancestry, and history
-
What etiologies of catatonia are best-treated with ECT?
All etiologies!
-
What techniques are combined in Relapse Prevention?
Skill Training with Cognitive Therapy
-
Most common sexual disorder in men
Premature ejaculation
-
Defense mechanism most likely used by a highly-educated patient
Rationalization
-
Symptoms that do not accompany medical illness in older patients and suggest depression (3)
- 1. Suicidal ideation
- 2. Guilt
- 3. Decreased self-esteem
-
What percent of monozygotic twin pairs are concordant for Schizophrenia?
50-60%
-
What percent of dizygotic twin pairs are concordant for Schizophrenia
4-15%
-
Treatment modality most helpful for managing refusal to cooperate in ADHD
Behavior therapy, particularly parent training and classroom behavior modification
-
Cortical regions damaged by acute herpes encephalitis (3)
- 1. Medial
- 2. Temporal
- 3. Orbitofrontal
-
Most common residual deficit after herpes simplex encephalitis
Amnesia
-
Elimination half-life of Qaxepam
Long (>20 hours)
-
Elimination half-life of Chlordiazepoxide
Intermediate (6-20 hours), but with metabolites whose half-lives are long (>20 hours)
-
What category of PTSD symptom does Difficulty Recalling fall into?
Avoidance
-
Effect of lamotrigine on body weight
Weight-neutral
-
Effect of Divalproex on body weight
Causes weight gain
-
Most effective psychotherapeutic technique for trichotillomania
Habit Reversal
-
Condition most commonly comorbid with OCD
MDD (occurs in 2/3 of patients, 1/3 currently depressed)
-
Functional imaging findings in OCD (2)
- 1. Increased metabolism in the basal ganglia, especially the caudate
- 2. Smaller caudates bilaterally
-
Effect of l-dopa on sleep
Can cause vivid dreams and/or night terrors
-
How deliriogenic is l-dopa?
3% of those taking l-dopa for 2 or more years become delirious
-
Diagnostic criteria for a Mixed Episode
1 week in which criteria are met for both a depressive and a manic episode
-
Head size in autism
Growth does not decelerate or stagnate
-
Presentation of Disintegrative Disorder
After at least 2 years of unequivocably normal development, a child develops an autistic-like condition
-
Varieties of Circadian Rhythm Sleep Disorder (4)
- 1. Delayed sleep phase type
- 2. Jet lag type
- 3. Shift work type
- 4. Unspecified type
-
Early manifestation of Creutzfeldt-Jakob Disease
Myoclonus
-
What does the short form of the promoter for 5-HT Transporters predict?
Poor response to or intolerance of SSRIs in Caucasians
-
Main personality traits in Avoidant Personality Disorder
Timidity, speaking in a self-effacing manner
-
What does viewing culture as an Interpretive and Explanatory Tool allow for?
Describing nonpathologic behaviors in the context of the patient's culture
-
What does viewing culture as a Pathogenic and Pathoplastic Agent allow for?
Noting that some pathology is a result of cultural practices
-
What does viewing culture as a Diagnostic and Nosologic Factor allow for?
Framing of a disease as unique to a culture
-
What does viewing culture as a Management and Service Instrument allow for?
Giving cultural factors a role in how mental health services are delivered
-
What does viewing culture as a Therapeutic and Protective Element allow for?
Using culture to protect mental health
-
Criteria for Acute Stress Disorder (4)
- 1. Three dissociative symptoms
- 2. Hyperarousal symptoms
- 3. Lasts 2 days to 2 weeks
- 4. Occurs within 4 weeks of a trauma
-
Illness most often causing olfactory hallucinations
Partial complex seizures
-
Accomplishments required to successfully process a traumatic event (3)
- 1. Engage emotionally with the trauma
- 2. Organize and articulate the story in a sequenced, coherent fashion
- 3. Address and correct dysfunctional thoughts that occur after the trauma
-
Effect of age on metabolism of benzodiazepines by conjugation
None!
-
Effect of age on metabolism of benzodiazepines by oxidation
Metabolism is decreased with age
-
When can a patient not be given an advance notice of termination from a psychiatric practice?
If condition is severe and may be worsening
-
Race in which drug use is highest among girls
Native Americans
-
Races in which drug use is lowest among girls (2)
- 1. African Americans
- 2. Asian Americans
-
Duration of symptoms for Acute PTSD
Less than 3 months
-
Duration of symptoms for Chronic PTSD
3 months or more
-
Presentation of MDD that is more common among youths than adults
Irritable mood
-
If depressive symptoms are not treated 2 months after a loved one's death, how long are they often present?
Often still present a year later!
-
Psychiatric medication that can cause kidney stones
Topiramate
-
Effect of Aripiprazole on body weight
Weight neutral
-
Effect of Ziprasidone on QTc interval
Prolongs it significantly
-
Most common Extrapyramidal Side Effect
Akathesia
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