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 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 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 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 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 HirotoShishido
how long does anxiety last in the patient with generalized anxiety disorder(GAD)
other characteristicsmore than 6 months(=schizophrenia)
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 HirotoShishido
State trait anxiety inventoryinventory based on a 4-point Likert scale and consists of 40 questions on a ☆self-report basis. The STAI measures two types of anxiety – state anxiety, or anxiety about an event, and trait anxiety, or anxiety level as a personal characteristic.
自記式（被験者が記入）
●☆Minnesota（ミネソタ）多面人格検査（MMPI）
●矢田部-Guilford性格テスト（Y-Gテスト）
●文章完成テスト
●☆Beck（ベック）のうつ病自己評価尺度
Beck Depression Inventory (BDI)
●気分プロフィール検査（POMS）
Profile of Mood States
●状態特性不安検査（STAI） psychiatry国試過去3年 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 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 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 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 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®))
