agoraphobiairrational fear/anxiety while facing more than 2 specific situations(eg open/closed spaces, lines, crowds, public transport)
symptoms present over a period of >=6months
¥panic attack symptoms such as dyspnea, chest tightness, palpitations, dizziness, diaphoresis and feeling of impending doom psychiatryAmboss level4 May 8, 2020, 11:42 PM HirotoShishido
nonbenzodiazepine hypnotics
medication,
difference from benzodiazepinethese ZZZs put you to sleep
Zolpidem, Zaleplon, esZopiclone
the difference between maternal blues and MDD with peripartum onsetmaternal blues→resolves within ☆14days
postpartum depression→ onset is typically ☆4-6weeks (and symptom can be up to 1 year) psychiatryUWorld Oct 17, 2019, 6:39 AM HirotoShishido
depression with atypical features☆mood reactivity, hypersomnia, leaden paralysis(heavy feeling in arms and legs)
most common subtype of depression
→CBT, SSRI are first line
MAO inhibitors are effective but not first line because of their risk profile psychiatryUWorld Feb 2, 2020, 1:54 AM HirotoShishido
pathophysiology of tardive dyskinesia(antipsychotic side effects)
repetitive involuntary movements
orofacial dyskinesia(e.g. ☆facial grimacing, tongue movements, lip smacking and puckering)
caused by long-term (months to years)blockade of dopamine receptors in the nitrostriatal dopamine pathway, causing ☆receptor upregulation
(dystonia, akathisia, and parkinsonism tend to resolve after discontinuation of the offending agent, but TD usually continue despite discontinuation of medication) psychiatrypharmacologyUWorld SIM2 Mar 30, 2020, 9:22 AM HirotoShishido
hypnagogic or hypnopompic hallucination
cataplexy(loss of all muscle tone)
↓orexin(hypocretin) in lateral hypothalamus
>=1 of the following
cataplexy(brief loss of muscle tone precipitated by strong emotion)
☆low CSF levels of hypocretin-1
shortened REM sleep latency psychiatryUWorld Sep 10, 2019, 9:38 AM HirotoShishido
diagnosis of selective mutismonset before age 5
lasting ≥ 1 month involving refraining from speech in certain situations despite speaking in other, usually more comfortable situations
other psychiatric disorder whose diagnostic criteria requires at least 1 month duration
→ separation anxiety disorder, ☆panic disorder, schizophreniform disorder(<6months), delusional disorder psychiatry Jul 7, 2020, 8:23 AM HirotoShishido
inhibitory effects of tricyclic antidepressants(TCAs)・NE and 5-HT neurotransmitter reuptake
・☆cardiac sodium channels (arrythmias, conduction defects)
・H(histamine)1 receptors (sedation)
・peripheral alpha-1 adrenergic receptors (orthostatic hypotension)
・central& peripheral muscarinic acetylcholine receptors
(☆urinary retension, constipation) psychiatrypharmacologyUWorld Jun 7, 2020, 5:00 AM HirotoShishido
the difference between
conduct disorder, antisocial personality disorder, and oppositinal defiant disorderconduct diorder→ presents with behaviors that represent pervasive violations of the rights of others and/or of societal norms before the age of 18
antisocial personality disorder→ the diagnosis of conduct disorder in patients ★>18 years old
oppositinal difiant disorder→ disobedience towards authority figures in the absence of serious violation of societal norms psychiatryUWorld step2CK Nov 4, 2019, 12:02 AM HirotoShishido
how long does anxiety last in the patient with generalized anxiety disorder(GAD)
other characteristicsmore than 6 months(=schizophrenia)
within 3 months of an identifiable psychological stressor→ adjustment disorder psychiatryUWorld Nov 3, 2019, 3:49 AM HirotoShishido
the most common psychological disorder complicated with multiple sclerosis★Depression has been found in up to two-thirds of patients with MS and is the most common psychiatric complication. Depression can occur at any time and is likely caused by a combination of factors, including inflammatory changes in the brain, immune system changes, and psychological reactions to neurological deficits and the challenges of living with MS. neurologypsychiatryUWorld step2CK Sep 22, 2020, 10:49 AM HirotoShishido
treatment of rhabdomyolysis and crush syndrome☆IV fluid administration
Monitor fluid output and electrolyte levels
Correct electrolyte imbalances as necessary (see treatment of hypocalcemia and hyperkalemia)
In the case of renal failure: consider hemodialysis pharmacologypsychiatry国試 Jan 7, 2021, 2:18 AM HirotoShishido
typical antipsychotics adverse effectshyperprolactinemia
neuroleptic malignant syndrome
EPS(extrapyramidal symptoms)
→→ADAPT
hours to days①Acute Dystonia(muscle spasm→☆torticollis(neck muscle spasm,oculogyric crisis) ←benztropin(antimuscarinic), ★diphenhydramine
days to months②akathisia(restlessness)
←★β-blockers
③parkinsonism(bradykinesia)←benztropin, amantadine
months to years④tardive dyskinesia (orofacial chorea) ←valbenazine psychiatrypharmacologyUWorld step2CK Jun 12, 2019, 4:08 AM HirotoShishido
the reason why TCA toxicity is treated with bicarbonateto overcome the sodium channel-blocking activity of TCAs, but not for accelerating drug elimination. pharmacologypsychiatryUWorld step2CK Jun 26, 2020, 7:55 AM HirotoShishido
the disease whose symptoms are similar to PTSD but lasts between 3 days to 1 month(PTSD is HHARD→ Hypervigilance/increased startle response (eg, when nearby door slams), Hyperarousal, Avoidance of associated stimuli, Re experiencing of the event, ditress (eg, (★)feeling overwhelmed))
acute distress disorder
Life-threatening medical events, such as ★acute MI, may be experienced as traumatic and result in PTSD in some patients. psychiatryUWorld step2CK Dec 7, 2019, 3:06 AM HirotoShishido
management of Tourette syndrome・Behavioral therapy (habit reversal training)
・Antidopaminergic agents
Tetrabenazine（Nitoman®）(dopamine depleter= ★Vesicular monoamine transporter type 2 (VMAT2) inhibitors→日本ではコレアジン®→ハンチントンのみ適応)
Antipsychotics (receptor blockers)
(second generations are preferred(eg ★risperidone, aripiprazole(abilify®))
