4。精神科

35 flashcards · Other · by Wanying Koh

1. schizophrenia positive & negative symptoms define caused by what pathway 的 hyper-/hypoactivity?

   positive: s/s absent in normal people but present in schizophrenics // caused by mesolimbic dopamine p/w hyperactivity negative: s/s present in normal people but absent in schizophrenics // caused by mesocortical dopamine p/w hypoactivity

2. Depression s/s

3. 發生率 // M:F schizophrenia depression bipolar I panic disorder OCD generalized anxiety

   schizophrenia - 1% // 1:1 depression - 15% // 1:2 bipolar I - 1% // 1:1 (same as schizo) panic disorder - 1.5-5% // 1:2-3 OCD - 2-3% // 1:1 (年輕人 M > F) generalized anxiety - 5% // 1:2

4. neurotransmitter relationship: panic disorder OCD anxiety suicide

   panic disorder: NE, serotonin, GABA OCD: serotonin dysregulation anxiety: serotonin suicide: low serotonin, 5-HIAA, noradrenergic system

5. illness anxiety disorder vs. somatic symptom disorder age group 主要 difference

   elderly vs. 20s-30s 沒有身體s/s vs. 有身體 s/s (usually pain)

6. conversion disorder F: occurs at which side more commonly M: associated w what antisocial disorder

   F: left side M: antisocial disorder

7. tx of alcohol withdrawal

   benzodiazepines B blocker, clonidine - prevent SNS hyperactivity thiamine vit B1 補充 electrolytes replacement (會 hypoK, Mg)

8. withdrawal s/s peak hour, and 持續多久 amphetamine opioids

   amphetamine - peak in 2-4d, resolve by 1wk opioids - peak in 2-3d, resolve by 7-10d

9. which gender more: Alzheimers vascular dementia

   F > M M

10. ADHD associated NT associated brain area

    dopamine, NE dysfunction frontal lobe -- metabolism and bloodflow decreased

11. tourette's disorder motor or vocal tics 先出現

    motor > verbal 7 y/o > 11 y/o

12. ADHD tx using what prior to use need to check what parameters

    stimulants e.g. methyphenidate height , HR, BP due to AE affecting growth development, appetite, heart function

13. delirium RF

    dementia old age multiple comorbidities high-risk medication opioids long-acting BZD anti-cholinergics haloperidol - 首選藥物 for delirium

14. schizophrenia - suicide rates

    10-13%

15. acute stress disorder vs PTSD

    acute stress disorder: s/s for 3days - 1month PTSD: s/s for >1mo PTSD etiology: hypothalamic-pituitary-adrenal (HPA) axis 失調

16. conversion disorder tx

    anti-anxiolytics - lorazepam 行為治療 病逝感導向心理治療 Cluster B histrionic personality disorder

17. alcohol withdrawal tx 可以用 phenobarbital？

    benzodiazepines - diazepam, lorazepam B-blocker - clonidine ---- dec SNS thiamine (vit B1) supplement correct electrolyte imbalance - MgSO4 ---- low Mg, 也會low K IV fluids ---- phenobarbital - used for intractable alcohol withdrawal when BZD cannot control s/s

18. amphetamine induced psychotic disorder closest to what

    paranoid schizophrenia visual hallucinations common

19. akathisia 靜坐不安 tx

    propranolol

20. norepinephrine w age IQ BBB transport cerebral perfusion and bloodflow

    plasma conc of norepinephrine INCREASES CNS 內 conc DECREASES IQ no change BBB transport increases - BBB 出現漏洞, proteins enter brain cerebral perfusion and bloodflow decreases

21. PET scan in depression pt manic pt

    depression: ant brain 代謝下降 at dominant/left brain，代謝上升 at deep limbic system (part of the brain involved in our behavioural and emotional responses) manic: ant brain 代謝上升 / 活性上升 at dominant/left brain,

22. alcoholic blackout ST / LT memory impariment still able to function e.g. driving, chatting?

    無法形成 new long term memory yes, engages in behaviors like walking or talking but doesn’t remember doing so, fully conscious, remember events that happened before their BAC reached very high levels (.14%)

23. autism spectrum disorder tx

    drug POOR prognosis 症狀治療 non-drug cognitive-behavioral therapy (for orientation, 驚醒度, concentration) - dOES NOT target core symptoms sensory integration therapy speech therapy

24. BZD 五大作用

    抗焦慮 抗抽筋 CNS骨骼肌鬆懈 安眠 anterograde amnesia - for surgery

25. 可以透過建議，暗示或藥物e.g. lorazepam 緩解，就不是conversion disorder

    false - 還是有可能是 conversion disorder should have a proper clinical diagnosis to r/o conversion

26. conduct disorder age

    >18yo if hasnt fulfilled criteria for antisocial disorder, can still be considered conduct disorder

27. bulimia or anorexia 比較高 incidence

    bulimia more - 1-2% anorexia - 0.4-0.9%

28. suitable for IM meds haloperidol droperidol lorazepam diazepam

    all except diazepam BZDs - only lorazepam, midazolam IM. 其他不行

29. tx for alzheimers

    donepezil is a cholinesterase inhibitor CNS selective - so lesser GI AE other tx for alzheimers - NMDA-R antagonist e.g. memantine

30. aripiprazole approved by FDA for use in what disorders other than bipolar

    MDD ASD atypical antipsychotic Dopamine-serotonin stabilizer 用於: schizophrenia, bipolar, MDD, ASD 的輔助

31. opioids withdrawal s/s presentation timing

    6-8hr 出現 7-10d 改善 NT: opioid, cathecholamine, gamma-butyric acid system

32. short-acting BZD or long-acting addiction higher

    short acting higher addiction - 容易 tolerance

33. light therapy for depression may cause mania?

    may have mania risk - rare

34. lewy's body dementia core features

    fluctuating cognition visual hallucination parkinsonism

35. smoking withdrawal s/s presentation timing

    2h 出現 peaks at 1-2 days can last for weeks to months