Psych USMLE
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| criteria for generalized anxiety d/o | anxiety on most days for 6mos + 3 of: restlessness, diff concentrating, irritabil, mscl tension, sleeping problems
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| acute tx generalized anxiety | benzos (clonazepam or diazepam (Valium))
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| long term Rx tx generalized anxiety (3) | SSRI (1st line), venlafaxine (Effexor, serotonin-NE RI), buspirone
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| gender predilection for OCD | affects m&f equally (unlike generalized anxiety, panic d/o
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| tx for OCD | clomipramine (TCA) or SSRI [+ cognitive behavioral therapy +/- desensitization]
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| onset OCD | usu adolescence or early adult
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| key differences OCD v OCPD | OCD is an Axis I d/o that is ego-dystonic (the behaviors bother them); OCPD is a personality Axis II where it doesn't bother them [ego syntonic]
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| key features of panic attack | lasts <25min and incl 4 of: CP, palpitations, sweating, chills or hot flashes, tachypnea/SOB, choking, nausea, dizziness, trembling, depersonalization, fear of dying or going crazy
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| for panic d/o need an episode + xx. What specify | at least 1mo worrying abt having another and changing their behavior to avoid. Must specify if w agorophobia (30-50%)
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| define agoraphobia | fear of being alone in public places
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| which SSRIs are esp good for OCD | paroxetine and setraline
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| immed relief for OCD with what | benzos, ie clonazepam
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| what are SE of SSRIs | N, GI upset, sex dysfxn, agitation, tremor
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| what are the 1st line uses of SSRIs | generalized anxiety, OCD, PTSD
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| what's a key SE of buspirone? Advantages? | sz w chronic use; no tolerance, dependence of withdrawal
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| which Rx most likely to cause SSRI wdrawal sympt? | paroxetine and setraline (short acting); fluoxetine can stop cold turkey
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| what are 2 commonly used benzos in psych and their SE, drawbacks | clonazepam and diazepam (Valium); decrsd sleep, risk of abuse/tolerance/depedence
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| how does bupropion work | inhibits reuptake of NE and Dopa
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| what are names of serotonin-NE reuptake inhibitors | venlafaxine (Effexor) and duloxetine (Cymbalta)
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| when are b blockers used in psych? Which? Which be careful for? | PTSD, performance anxiety (phobia); propanolol (non specific); asthma (bronchoconstrict)
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| what Rx can help w social phobia | low dose SSRI
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| for how long must sympt occur for PTSD | for >1mo
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| what's a perfect score on MMSE? What indicates cognitive dysfxn | 30; <25
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| 2 MC forms of dementia | Alzheimers (50%), multi-infarct
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| what's pseudodementia | depression
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| dx of dementia | amnesia [memory impairment] + 1 of: aphasia, apraxia, agnosia [4 A 's of dementia]
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| list some causes of dementia | DEMENTIAS=Degen,Endo=thyr, parathyr, Metabol=EtOH, B12, glu, hepatic/renal, Wilson, Exogen=Lead, CO, Rx; Neoplasia; Trauma=subdural; Infxs=mening/enceph, syph, HIV, Prion, Lym; Affect=pseudodementia, Alz; Stroke/Structure vasculit, nml pressure hydroceph
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| name 7 infxs causes of dementia | syph, HIV, prion, Lyme, mening, enceph, sepsis
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| w/u for dementia | CBC, lytes, TFTs, VDRL/RPR, B12, folate, brain CT or MRI
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| key feature nml pressure hydroceph | dementia, ataxia, urinary incontinence, dilated ventricles
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| tx dementia; what avoid | cholinesterase inhib (tacrine, donepezil, galantamine); avoid benzos
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| Alzheimers more common in males or females | females
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| pathol dx Alz | diffuse atrophy w flattened sulci, senile plaques w amyloid, neurofib tangles from Tau proteins (also nml aging and Downs)
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| tx Alz | NMDA antagonists (memantine), cholinesterase inhib (tacrine--but hepatic dysfxn), donepezil, galantamine)
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| what NT are abnl in Alz | Ach and NE are decrsd
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| if looks like Alz, but personality/behavioral changes present early think of…; pathol | Picks/Frontotemporal dementia; atrophy of frontotemproal, Pick bodies (intraneural inclusion bodies), no Tx
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| mechanism of Huntington (incl genetics) | AD trinucleotide repeat on Chrom 4 affecting BG (loss of GABA in striatum); caudate atrophy
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| young person w choreiform d/o, think | Wilsons
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| mechanism of Parkinsons | loss of pigmented cells/neurons in substantia nigra giving Dopa to BG
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| pathology of Parkinsons | Lewy bodies (hyaline intracytoplasmic inclusion bodies)
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| which NT are altered in Parkinsons | low Dopa, high Ach
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| clinical characteristics of Parkinsons | bradykinesia, cogwheel rigidity, resting pill rolling tremor, masklike facies, shuffling gait, dysarthria, postural instability, micrografia
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| tx of Parkinsons(5) | 1) carbidopa-levodopa; 2) dopa agonist (bromocriptone, pergolide, pramipexole), 3) amantadine (unkn mech, transient help); 4) amitryptyline (helps as anti-chol w tremors and anti-depress; 5) MAOI (selegeline)
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| how does selegeline help Parkinsons, what type of Rx | MAOI inhibits Dopa breakdown
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| what dopa agonists are used in Parkinsons | pramipexole (MC), bromocriptone, pergolide
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| how does carbidopa work | inhibits dpadecarboxylase preventing levodopa from becoming dopa before reaches brain
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| SE of carbidopa-levodopa | dyskinesias after 5-7y, so may use dopa agonist for a while, also N/V, anorexia, HTN, hallucincations
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| name some Rx that can cause Parkinsonian sympt | neuroleptic (haloperidol, chlorpromazine), metoclopramide (gastro Rx), reserpine (anti HTN and anti-psych)
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| EEG may help differentiate which dementia | CJD, see periodic spikes and waves [Alz just see generalized background slowing]
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| what unique clinical features help differentiate CJD | myoclonus, cortical blindness
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| if Parkinsonian like gait, dementia but also urinary incontinence think | nml pressure hydroceph
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| key difference delirium v dementia | waxing/waning, impaired attn, psych, altered sleep-wake and sun downing
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| what Rx can help delirium | low dose quetiapine (Seroquel) or haloperidol for agitation and psychotic sympt
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| name components SIGECAPS | Sleep, interest, guilt (worthlessness, inapprop guilt), energy, concentration, appetite, psychomotor agitation or retardation, suicidal
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| dx criteria for major depressive episode | depressed mood or loss of interest or pleasure + 5 SIGECAPs for 2wks
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| name some subtypes of depression | postpartum, psychotic features, atypical (wgt gain, sleep more), seasonal, dbl depression (on top of dysthmia)
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| describe nml bereavement | shouldn't have severe impairment and should resolve within 1yr
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| define dysthmia | milder, chronic depression w depressed mood most of the time >2yr, no mania/hypomania or psychosis. Tx resistant
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| what Rx can cause depression | steroids, thyroid, anti-HTN, OCP, Parkinson Rx
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| name 4 atypical anti-depressants | bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), trazodone
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| key adv/disadv bupropion | decrsd sz threshold, NOT for bulimics, NO SEX SE
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| uses for atypical anti-depress | depression, anxiety, chronic pain
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| CVS SE of venlafaxine | diastolic HTN
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| SE of trazodone | hi sedate, priapism
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| how do TCAs work | prevent reuptake of NE, 5HT, block alpha adrenergic and muscarinic (causing anti-chol SE)
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| name 5 TCAs | nortriptyline, amitriptyline, imipramine, clomipramine, desipramine
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| SE of TCA | lethal OD from cardiac arrhythmias [toxicity 3 Cs: convulsion, coma, cardiac arrhyth], sex SE. Anti chol: dry mouth, constipation, urinary retention, sedation
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| uses for TCAs | depression, anxiety, chronic pain, migraine, enuresis (imipramine), clomipramine (OCD)
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| name 2 MAOI and their uses | phenelzine, tranylcypromine; depression esp atypical
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| SE MAOI | HTN crises if taken w high tyramine (cheese, red wine, smoked meats); can't give w SSRI (serotonin syndrome), or meperidine (Demerol, an opioid). Sex SE, orthostatic hypotension, wgt gain
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| elderly depressed what Rx start? | SSRI [TCA anti chol and sedating, MAOI have hypotension]
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| components neuroeleptic syn; tx | FALTER=F, autonomic instability (BP), leukocytosis, tremor, elevated CPK, rigidity; also myoglobulinuria and elevated LFTs; give dantrolene or bromocriptine
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| what are NT levels in anxiety? Depression? | Anxiety=high NE, low GABA and 5HT; depression=low NE and 5HT
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| features of serotonin syndrome | abd pain, diarrhea, hi BP and HR, sweating, hyperthermia, myoclonus, AMS, sz
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| elderly w pyschotic sympt, what start | low dose haloperidol (bc least anti-Chol)
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| which anti-psych Rx work best for negative sympt | atypical/2nd gen (ie ripseridone, olanzapine (zyprexa), clozapine
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| which anti-psych have most extra pyramidal SE? least? | haloperidol most, chlorpromazine (low potency) least
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| 4 MC extrapyramidal SE and tx | 1) acute dystonias 1st hrs/days; antichol (benztropine), anti His (benadryl); 2) akthisis, restlessness in 1st days; b blocker benzo or antichol; 3) dyskinesias/Parkinson in 1mos; 4) tardive dyskensia, decr dose, antichol, switch to clozapine)
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| when clozapine used in psych | only for treatment resistant, severe tardive dyskinesia, PD w psych
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| SE clozapine | agranulocytosis, must monitor CBCq wk
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| tx Tourettes | typical anti psych, ie haloperidol, pimozidine or clonidine
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| SE typical anti psych | EPS, hyperprolactin, antichol, sz, hypotension, sedation, QT prolong, neuroleptic syn
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| unique SE of thioridazine | retinal pigment
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| name 4 atypical anti-psych | clozapine, risperidone, quetiapine (Seroquel), olanzapine (Zyprexa)
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| SE of atypical anti-psych | fewer EPS, wgt gain, DMII, somnolence/sedation, QT prolong
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| use of Li | 1st line mood stabilizer, acute mania, bipolar
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| SE Li | DI, thirst, polyuria, tremor, wgt gain, hypothyr, N, diarrhea, sz, teratogen, nephrotoxic longterm
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| Li levels incrs w what OTC | NSAIDs
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| signs Li toxicity | ataxia, dysarthria, delirium
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| SE carbamzepine | N, skin rash and Stevens-Johnson, AV block, NTD, aplastic anemia **CBC biweekly
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| name 4 mood stabilizers | Li, carbamazepine, valproic, lamotrigine (last 3 are also anti-convulsant)
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| SE of valproic acid | GI (N/V), tremor, sedation, alopecia, wgt gain, NTD; rarely: pancreatitis, decrsd plts, agranulocytosis, fatal hepatotoxicity
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| gender predilection for bipolar | equal m, f
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| dx of manic episode | 1 wk of persistently elevated or irritated mood + 3 DIGFAST
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| components DIGFAST | distractibility, insomnia, grandiosity, flight of ideas or racing thgts, activities/agitation, sexual indiscretion or pleasurable activities, talkative/pressured speech
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| differentiate bw bipolar I, II, cyclothmic | 1=at least 1 manic or mixed episode, 2=at least 1 major depressive episode and 1 hypomanic; cyclothmic=chronic and less severe w episodes of hypomania and mod depression >2yrs
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| tx of mania | anti psych and mood stabilizer
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| name personality disorder clusters | A weird : paranoid, schizoid, schizotypal, B wild : borderlines, histrionic, narcissitic, antisocial, C worried, wimpy OCPD, avoidant, dependent
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| describe 3 cluster A personality d/o | Paranoid-distrustful, see others as malevolent m>f; schizoid-loners don't want relationship, cold affect, m>f, schizotypal: odd bheaviors, perceptions incl cults
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| describe 4 cluster B personality d/o | borderline: unstable mood relationships, feel empty/alone, impulsive h/o suicide, f>m; histrionic: attn seeking, dramatic, f>m; narcissitic: self imptc, uses others, lack of empathy; antisocial=deceitful, reckless, no remorse m>f
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| describe 3 cluster C personality d/o | OCPD: perfectionism, inflexible, orderly m>f, avoidant: fear rejection so avoid social even though want relationships; dependent: f>m
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| gender predilection for schizo | m, f equal but m tend to do worse
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| subtypes schizo (5) | paranoid-best px, presents late; disorganized (speech, behavior), poor contact w reality, presents earlier and worse px; catatonic-rare, peculiar posturing; residual-mostly negative sympt; undifferentiated (mltpl character)
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| positive sympt schizo (5) | halluc, delusions, disorganized speech, bizarre behavior, thgt d/o
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| negative sympt schizo (5) | flat affect, decrsd emotional reactivity, poverty of speech, lack of purposeful action, anhedonia
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| dx of schizo | 2 or more present for 6mos causing dysfxn
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| define schizophreniform | if schizo <6mos
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| define schizoaffective d/o | schizophrenia + depression or bipolar
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| dx of ADHD | 6 or more sympt from ea inattn and hyperactivity categories in at least 2 settings for 6mo; some sympt must be present before 7yo
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| restrictions on antisocial dx | must be >18 and have had sympt of conduct d/o as child
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| tx ADHD | stimulants: 1)methylphenidate (Ritalin), dextramphetamine
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| SE ADHD meds | insomnia, irritability, anorexia, tic exacerbat, decrd grwth (nmlzes when stop)
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| differentiate Autism and Aspergers | Aspergers has no language or cognitive delay
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| other dzs autism assoc w | tuberous sclerosis and fragile X
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| characteristics autism | impaired social interact and commun <3yo, impaired spoken language; stereotyped speech and behavior (hand flapping); restricted interests
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| describe Retts | neurodegen dz of females; 5mos nml grwth then head grwth stops and lose milestones
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| dx of conduct d/o | violating basic rights of others or social norms for 1yr; can be aggressive or nonagressive. Most progress to conduct d/o
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| describe oppositional defiant d/o | defiant, disobedient toward authority for 6mo. Can progress to conduct d/o
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| describe features of narcolepsy | decrsd REM sleep lacency, cataplexy (sudden loss of motor tone), hallucinations as fall asleep (hynagogic) or waking up (hypnopompic), sleep paralysis
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| tx narcolepsy | scheduled naps, stimulants (amphetamines), SSRIs for cataplexy
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| tx for cataplexy | SSRIs
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| factitious v malingering | factitious the gain is the medical attn, malingering there's 2ry gain
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| name 5 somatization d/o and key feature v factitious | key: pt has no control over sympt; 1) somatization (mltpl complaints in mltpl organs); 2) conversion (motor or sensory s/p stressful event); 3) hypochondriasis-fear of having dz despite negative tests/reassurance; 4) body dysmorphic; 5) pain d/o
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| tx pain d/o | analgesics not helpful, TCAs and venlafaxine can help
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| define conversion d/o | motor/sensory complaint occurring close to stressful event; usu resolve spont, f>m
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| gender predilection for hypodchondriasis | m and f equal
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| more like to complete suicide if | male, older, depressed, prev attempt, substance/EtOH, chronic illness, no spouse/social support
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| how does disulfiram work for EtOH abuse | inhibits acetaldehyde dehydrogenase needed for breaking down EtOH; get flushed, tachycardic, hypotension, SOB, N/V, HA
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