Psychotherapy: SAS/Review

Serotonin Syndrome

• Altered Mental Status

• Which drugs increase serum Lithium levels?

  • NSAIDs

  • Diuretics
    

    • Thiazides, spironalactone, triamterene

  What factors might precipitate delerium?

  I-WATCH-DEATH

  The slides specifically highlight factors in bold

  What is the difference between schizoaffective disorder and schizophrenia?

  • Schizoaffective disorder:
    

    • Mood symptoms regardless...

  Which area/circuit of the brain is impaired in Alzheimer’s Disease?

  Limbic Network

  Abnormal eye movements (nystagmus) are characteristic of which drug intoxication?

  Phencyclidine (PCP)

  Which antidepressants are contraindicated in patinets with current or history of anorexia nervosa or bulimia nervosa?

  Bupropion

  Is this neurotransmitter associated with wakefullness or sleep?

  Where is it secreted?

  Serotonin

  Wakefullness

  Raphe nuclei (pons)

  Which antipsychotics are most likely to have side effects of involuntary facial movements, restlessness, and dystonia?

  High-potency first-generation antipsychotics

  • Haloperidol

  • Fluphenazine

  • Trifluoperazine

  Hoover’s sign provides evidence for which disorder?

  Functional Neurological Disorder (aka conversion disorder)

  Is this neurotransmitter associated with wakefullness or sleep?

  Where is it secreted?

  Orexin

  Wakefulness

  Lateral hypothalamus

  Is this neurotransmitter associated with wakefullness or sleep?

  Where is it secreted?

  Histamine

  Wakefulness

  Tuberomamillary nucleus (hypothalamus)

  What differentiates Bipolar I from Bipolar II?

  • Bipolar I
    

    • At least 1 manic episode lasting 1+ weeks

  • Bioplar II
    

    • Hypomania
      

  Rapid withdrawal of what hormone can trigger migraine?

  Estrogen

  • Rapid withdrawal occurs during the following times:
    

    • Perimenopause

    • Post-partum

    • <...

  What is the most consistent but non-specific neuroimaging finding in schizophrenia?

  Enlarged ventricles

  • Almost always found in patients with schizophrenia

  • Not specific for schizophrenia

  Which seizure medications are prefered in women of childbearing age?

  Lamotrigine, levetiracetam

  Sometimes carbamazepine

  Avo...

  What is the most effective treatment for insomnia?

  Cognitive behavioral therapy

  Focuses on:

  • Sleep...

  What is the difference between schizotypal and schizoid personality disorders?

  • Schizoid

    • Socially withdrawn

    • Desire to be left alone

    • Limited emotional expression

    <...

  Which area/circuit of the brain is impaired in semantic aphasia/dementia?

  Central pathway of vision (temporal lobe)

  A set of sidely scattered but orchestrated crerebral areas that are activated by a specific task observed on neuroimaging is a…

  1. State network

  2. Attention network

  3. Channel network

  4. Default mode network

  c. Channel network

  Schizophrenia is a [developmental/degenerative] disorder

  What is the brain pathology?

  Schizophrenia is a developmental disorder

  Results from abnormal neuronal migration during development

  What are the classic features of MDD, melancholic subtype?

  • Anhedonia and/or lack of reactivity

  • Early morning awakening

  • Significant anorexia or weight loss

  • <...

  Which antipsychotic may cause neutropenia?

  Clozapine

  • Atypical anti-psychotic

  • Blocks serotonin and norepinephrine

  • Used as a 3rd line agent

    <...

  What kind of seizure is associated wtih tongue biting?

  Generalized tonic/clonic seizure

  What time period constitutes persistent depressive disorder?

  2+ years of depressed mood for most of the day, more days than not

  Which area/circuit of the brain is impaired in Lewy Body Dementia?

  Dorsal Pathway of Vision (parietal lobe)

  What syndrome is associated with thamine deficiency?

  Which population is at particular risk?

  Wernicke-Korsakoff Syndrome

  People with alcohol-use disorder

  • Wernicke

    • Ataxia, abnormal eye movmement

  Automatisms and aura of a funny taste in one's mouth before a seizure are characteristic of which kind of epilepsy?

  Temporal lobe epilepsy

  Automatism = fumbling with clothing/button, cannot stop

  Which type of reinforcement schedule has the fastest extinction?

  Which types have the slowest extinction?

  Fastest extinction = continuous (also has fastest learning)

  Slowest extinction = variable interval or variable ratio

  (Fixed interval an...

  Which antipsychotics are likely to cause abnormal lactation?

  • Low-potency first-generation

    • Chlorpromazine

    • Thioridazine

  • Second-generation - lower ri...

  List the parts of the Papez circuit, in order

  • Entorhinal cortex (anterior part of the parahippocampal gyrus)

    • Via perforant (through dentate) or alvear pathways to the…

      ...

  What kind of medication is cyclobenzaprine?

  Muscle relaxant

  Which sleep disorder is associated with low orexin levels in the CSF?

  Describe 3 associated symptoms

  Narcolepsy

  • Cataplexy

    • Knees buckle in response to emotion

  • Vivid dreams

  • Sleep par...

  Which area/circuit of the brain is impaired in frontal type dementia?

  Frontal cortex

  What kind of defense mechanism:

  A perosn is angry at their psysician for cancelling their appointment. Next time they see their physician, they compliment the physician on their shirt

  Reaction formation

  | (Doing the opposite of what you feel)

  Which class of antidepressants is most likely to have cardiac effects?

  What are the effects?

  TCAs

  Long QT -> Torsades (potentially fatal arrhythmia)

  • Amitriptyline

  • Nortriptilyine

  • Desipraim...

  How is lithium metabolized?

  Excreted unchanged by the kidney

  (No hepatic metabolism)

  Which cognitive domain will be affected first in Alzheimer's Disease?

  Memory

  | (Limbic system)

  What are the indications for haloperidol in a patient with delerium?

  • Psychosis

  • Hallucinations

  • Agitation

  But remember, the focus of the treatment should always be ...

  What further testing is indicated when a child presents with signs and symptoms of autism spectrum disorder?

  • Genetic testing

  • Lead levels (if reasonable environmental risk)

  • EEG<...

  How are abscence seizures differentiated from focal seiziures without loss of consciousness?

  No post-ictal period (confusion) after abscence seizure

  According to Robins and Guze (1970), what 5 steps can help achieve diagnostic validity for psychiatric disorders?

  1. Clinical description

  2. Delimitation from other disorders

  3. Follow-up study (including treatment response)

  Which kind of reinforcement schedule results in the fastest conditioning?

  Fixed schedules - type of partial reinforcement

  (Continuous reinforcement has the fastest learning)

  What are the classic features of MDD, atypical subtype?

  • Mood reactivity

  • Significant weight gain

  • Hypersomnia

  • Leaden paralysis

  Is this neurotransmitter associated with wakefullness or sleep?

  Where is it secreted?

  Norepinephrine

  Wakefulness

  Locus ceruleus (pons)

  Which medication can be used to augment the effects of SSRIs and is known for reducing the risk of suicide?

  Lithium

  Is this neurotransmitter associated with wakefullness or sleep?

  Where is it secreted?

  GABA

  Sleep

  Ventrolateral peroptic nucleus (VLPO)

  What is a "homeopathic" treatment?

  Like treating like

  Ex: using seizures in ECT to help treat patients with seizures

  View all 54 terms

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  Psychotherapy: SAS/Review

  Term	Definition
  Which opioids affect serotonin levels? Why is this important?	Tramadol, fentanyl Patients on serotoninergic agents should not take! Can lead to serotonin syndrome (altered mental status, autonomic dysfunction, neuromuscular abnormalities)
  What kind of defense mechanism: A perosn is angry at their phsysician for cancelling their appointment. They end up cleaning their entire department to avoid thinking about being angry	Sublimation Channeling anger, discomfort, unpleasant thoughts at productive activities
  Which cognitive domain will be affected first in Dementia with Lewy Bodies?	Attention/executive function, visuospatial reasoning Will also have Parkinsonism (Parietal lobe)
  Which side effect of first-generation antipsychotics is likely to present after decades of use?	Tardive dyskinesia Due to long term dopamine blockade chlorpromazine, fluphenazine, thioridazine, haloperidol
  Describe the general timeline of symptoms onset during alcohol withdrawal	6-48h: ANS hyperactivity 12-48h: Seizures 12-24h: Hallucinations 3-5+ days: Delirium Tremens
  Which cognitive domain will be affected first in Frontotemporal Dementia?	Personality changes, language deficits (Frontal lobe)
  What are the risks associated with MAO inhibitors?	Serotonin Syndrome Altered Mental Status Autonomic Dysfunction Neuromuscular abnormalities Hypertensive crisis Must avoid tyramine-rich foods Severe interaction with meperidine MAOi Hydrazine Tranylcypromine Rasagiline
  Which drugs increase serum Lithium levels?	NSAIDs Diuretics Thiazides, spironalactone, triamterene ACE inhibitors Ca2+ channel blockers Metronidazole Tetracycline
  What factors might precipitate delerium?	I-WATCH-DEATH The slides specifically highlight factors in bold Infection - pneumonia Withdrawal Acute metabolic Trauma CNS pathology Hypoxia/hypercarbia - hypoxia Deficiencies Endocrine Acute vascular Toxins - diphenhydramine Heavy metal
  What is the difference between schizoaffective disorder and schizophrenia?	Schizoaffective disorder: Mood symptoms regardless of whether psychotic symptoms are present or absent Schizophrenia: Mood symptoms only present when psychotic symptoms are present (Thank you @Nathan Shlobin!)
  Which area/circuit of the brain is impaired in Alzheimer’s Disease?	Limbic Network
  Abnormal eye movements (nystagmus) are characteristic of which drug intoxication?	Phencyclidine (PCP)
  Which antidepressants are contraindicated in patinets with current or history of anorexia nervosa or bulimia nervosa?	Bupropion
  Is this neurotransmitter associated with wakefullness or sleep? Where is it secreted? Serotonin	Wakefullness Raphe nuclei (pons)
  Which antipsychotics are most likely to have side effects of involuntary facial movements, restlessness, and dystonia?	High-potency first-generation antipsychotics Haloperidol Fluphenazine Trifluoperazine
  Hoover’s sign provides evidence for which disorder?	Functional Neurological Disorder (aka conversion disorder)
  Is this neurotransmitter associated with wakefullness or sleep? Where is it secreted? Orexin	Wakefulness Lateral hypothalamus
  Is this neurotransmitter associated with wakefullness or sleep? Where is it secreted? Histamine	Wakefulness Tuberomamillary nucleus (hypothalamus)
  What differentiates Bipolar I from Bipolar II?	Bipolar I At least 1 manic episode lasting 1+ weeks Bioplar II Hypomania Different from mania b/c does not cause marked impairment in social/occupational functioning, does not require hospitalization No manic episodes
  Rapid withdrawal of what hormone can trigger migraine?	Estrogen Rapid withdrawal occurs during the following times: Perimenopause Post-partum Perimenstruation
  What is the most consistent but non-specific neuroimaging finding in schizophrenia?	Enlarged ventricles Almost always found in patients with schizophrenia Not specific for schizophrenia
  Which seizure medications are prefered in women of childbearing age?	Lamotrigine, levetiracetam Sometimes carbamazepine Avoid valproate, topiramate!!
  What is the most effective treatment for insomnia?	Cognitive behavioral therapy Focuses on: Sleep hygeine Sleep restriction Bed is for sleeping and sex only! Wake up at the same time every day Stimulus control Don’t sleep until you’re tired If you can’t fall asleep in 20 min, get out of bed and read Avoid screens
  What is the difference between schizotypal and schizoid personality disorders?	Schizoid Socially withdrawn Desire to be left alone Limited emotional expression Schizotypal Also socially withdrawn Interpersonal awkwardness Magical thinking, eccentricity
  Which area/circuit of the brain is impaired in semantic aphasia/dementia?	Central pathway of vision (temporal lobe)
  A set of sidely scattered but orchestrated crerebral areas that are activated by a specific task observed on neuroimaging is a… State network Attention network Channel network Default mode network	c. Channel network
  Schizophrenia is a [developmental/degenerative] disorder What is the brain pathology?	Schizophrenia is a developmental disorder Results from abnormal neuronal migration during development
  What are the classic features of MDD, melancholic subtype?	Anhedonia and/or lack of reactivity Early morning awakening Significant anorexia or weight loss Excessive or inappropriate guilt
  Which antipsychotic may cause neutropenia?	Clozapine Atypical anti-psychotic Blocks serotonin and norepinephrine Used as a 3rd line agent But must register in database Track any neutropenia resulting so it is not prescribed in the future
  What kind of seizure is associated wtih tongue biting?	Generalized tonic/clonic seizure
  What time period constitutes persistent depressive disorder?	2+ years of depressed mood for most of the day, more days than not
  Which area/circuit of the brain is impaired in Lewy Body Dementia?	Dorsal Pathway of Vision (parietal lobe)
  What syndrome is associated with thamine deficiency? Which population is at particular risk?	Wernicke-Korsakoff Syndrome People with alcohol-use disorder Wernicke Ataxia, abnormal eye movmement Korsakoff Amnesia, poor judgement, confabulation, spurious answers to questions
  Automatisms and aura of a funny taste in one's mouth before a seizure are characteristic of which kind of epilepsy?	Temporal lobe epilepsy Automatism = fumbling with clothing/button, cannot stop
  Which type of reinforcement schedule has the fastest extinction? Which types have the slowest extinction?	Fastest extinction = continuous (also has fastest learning) Slowest extinction = variable interval or variable ratio (Fixed interval and fixed ratio have the fastest conditioning)
  Which antipsychotics are likely to cause abnormal lactation?	Low-potency first-generation Chlorpromazine Thioridazine Second-generation - lower risk than FGA, but can still happen Quetiapine Olanzapine Risperidone Aripiprazole Ziprasodone Clozapine
  List the parts of the Papez circuit, in order	Entorhinal cortex (anterior part of the parahippocampal gyrus) Via perforant (through dentate) or alvear pathways to the… Hippocampus Fornix Mammillary bodies (hypothalamus) Via mammilothalamic tract to the… Anterior thalamic nuclei Via internal capsule to the… Cingulate Back to the parahippocampal gyrus
  What kind of medication is cyclobenzaprine?	Muscle relaxant
  Which sleep disorder is associated with low orexin levels in the CSF? Describe 3 associated symptoms	Narcolepsy Cataplexy Knees buckle in response to emotion Vivid dreams Sleep paralysis
  Which area/circuit of the brain is impaired in frontal type dementia?	Frontal cortex
  What kind of defense mechanism: A perosn is angry at their psysician for cancelling their appointment. Next time they see their physician, they compliment the physician on their shirt	Reaction formation | (Doing the opposite of what you feel)
  Which class of antidepressants is most likely to have cardiac effects? What are the effects?	TCAs Long QT -> Torsades (potentially fatal arrhythmia) Amitriptyline Nortriptilyine Desipraime Amoxapine Imipramine Clomipramine Doxepin
  How is lithium metabolized?	Excreted unchanged by the kidney (No hepatic metabolism)
  Which cognitive domain will be affected first in Alzheimer's Disease?	Memory | (Limbic system)
  What are the indications for haloperidol in a patient with delerium?	Psychosis Hallucinations Agitation But remember, the focus of the treatment should always be the underlying cause!!
  What further testing is indicated when a child presents with signs and symptoms of autism spectrum disorder?	Genetic testing Lead levels (if reasonable environmental risk) EEG Hearing and vision Wood's lamp (for Tuberous Sclerosis)
  How are abscence seizures differentiated from focal seiziures without loss of consciousness?	No post-ictal period (confusion) after abscence seizure
  According to Robins and Guze (1970), what 5 steps can help achieve diagnostic validity for psychiatric disorders?	Clinical description Delimitation from other disorders Follow-up study (including treatment response) Family study Laboratory studies
  Which kind of reinforcement schedule results in the fastest conditioning?	Fixed schedules - type of partial reinforcement (Continuous reinforcement has the fastest learning)
  What are the classic features of MDD, atypical subtype?	Mood reactivity Significant weight gain Hypersomnia Leaden paralysis
  Is this neurotransmitter associated with wakefullness or sleep? Where is it secreted? Norepinephrine	Wakefulness Locus ceruleus (pons)
  Which medication can be used to augment the effects of SSRIs and is known for reducing the risk of suicide?	Lithium
  Is this neurotransmitter associated with wakefullness or sleep? Where is it secreted? GABA	Sleep Ventrolateral peroptic nucleus (VLPO)
  What is a "homeopathic" treatment?	Like treating like Ex: using seizures in ECT to help treat patients with seizures