1
Q
What is the definition of Obesity?
A
- More than 20% over ideal weight
- BMI >30
2
Q
2 Genetic mutations associated w/ obesity
A
- Leptin receptor
- Melanocortin 4 receptor
3
Q
What drug class can cause weight gain?
A
Antipsychotics (D2 receptor, 5HT2c blockade –> increased prolactin)
4
Q
Amphetamine mechanism for obesity
A
Decrease appetite
5
Q
Orlistat mechanism:
A
Lipase inhibitor
6
Q
Topiramate/Phentermine combo mechanism:
A
Improves carb metabolism, less gluconeogenesis, appetite suppressant
7
Q
Naltrexone/Bupropion combo mechanism:
A
Dampens reward of eating, appetite suppressant
8
Q
Lorcaserin mechanism:
A
5HT2c receptor stimulator –> increase metabolism, lessen tendency to store fat, improve leptin sensitivity?
9
Q
Anorexia Nervosa DSM-5 Criteria
A
- Refusal to maintain 85% of typical weight
- Restricting energy intake
- Fear of gaining
- Body dysmorphism
- Restricting vs Binge/Purge type
- Severity based on BMI
10
Q
Age and Gender pattern in Anorexia:
A
- Start mid-teen to 20s
- Female > male (20:1)
11
Q
What is lanugo hair?
A
- Fine, white hair
- Seen with anorexia
12
Q
Bulimia Nervosa DSM-5 Criteria
A
- Recurrent binge eating = eating a lot in discrete period of time disproportionate to typical eating
- Purging vs. non-purging type
- 1x/week for 3+ months
- Compensatory behaviors necessary for diagnosis
13
Q
Age and Gender pattern in Bulimia:
A
- Later onset than anorexia
- Female > male (10:1)
14
Q
Bulimia characteristics compared to Anorexia:
A
- Greater prevalence
- More personality disorder
- More substance abuse
15
Q
What are physical symptoms of Bulimia?
A
- Poor dentition, enamel loss, cavities
- Abraided knuckles = Russell’s sign
- Salivary enlargement
16
Q
Name for milder versions of Anorexia and Bulimia
A
Mild anorexia = Avoidant/Restrictive Food Intake Disorder
Mild bulimia: Binge Eating Disorder
17
Q
Pharmacotherapy can be used for what eating disorder? What drug class is most commonly used?
A
- Bulimia Nervosa
- SSRIs
18
Q
What is Capgras Delusion?
A
Thinks someone has been replaced by an imposter
19
Q
What is Fregoli Delusion?
A
Thinks different people are a single person who changes apperance or is in disguise
20
Q
What is Vampirism?
A
Thinks that oneself is a vampire
21
Q
What is Lycanthropy?
A
Thinks that oneself is a werewolf
22
Q
Psychopathic Cannibalism is associated with what disorders?
A
- Antisocial personality
- Psychopathy
- Sociopathy
- with delusions…
23
Q
What is Shared Delusion Disorder?
Most common version?
A
-1st person has a psychotic symptom and passes it on to others who develop the symptoms (not necessarily psychotic)
24
Q
What is conversion disorder?
A
-Neurologic disorder induced by stress
25
What is Cotard's Delusion
Thinks that oneself is dead, does not exist, or is missing organs
26
What is Morgellons/Delusional Parasitosis?
Believes they are infested, and can see or feel parasites in or on them
27
What is Erotomanic Delusions?
Thinks another person, usually a stranger, is in love with him/her
28
What is the neurobiologic basis of Delusions?
Too much DA activity in Mesolimbic area like in Schizophrenia
29
Normal Age-associated cognitive changes
- Difficulty retreiving words and names
- Slower processing speed
- Difficulty sustaining attention
- More effort to learn
- No functional impairment
30
Mild Cognitive Impairment definition
- Memory complain corroborated by an informant
- Objective memory impairment for age and education
- Preserved general cognition
31
What is Amnestic MCI
- Memory loss not meeting criteria for dementia
- But 10-15% progression to AD
- Earliest phase of AD?
32
Chromosomes and Genes associated w/ Early-Onset AD
1--Presenilin 2
14--Presenilin 1
21--Amyloid Precursor Protein (APP)
33
Chromosome and gene associated w/ Late-Onset AD
19--ApoE4 gene
34
Neuropathologic findings of AD:
1. gross cerebral atrophy
2. B amyloid plaques
3. Amyloid angiopathy
4. Neurofibrillary tangles and neuropil threads
35
Enzymes that cause B-amyloid monomers
Beta-secretase and Gamma-secretase
36
What is normal and non-normal products of APP cleavage?
```
Normal = AB40
Non-normal = AB42
```
37
1st and 2nd Greatest risk factor for AD
1. age
| 2. APOE e4 allele
38
What stain do you use and what do you see in looking for B-amyloid?
- Congo Red stain
| - Apple-green birefringence
39
What happens to hyperphosphorylated tau?
- Dissociates from microtubules
- Assembles to form paired helical filaments (PHFs)
- PHFs bundle together to form NFTs
40
Important aspects of FTLD
- 2 most common =Tau and TDP
- Earlier onset than AD
- Gross observation = knife-edge
- Pick bodies (tau)
41
Pick's Disease Clinical Differentiation from AD
- Early social inappropriateness
- Emotional blunting
- Loss of insight
- Later memory loss
42
How do AChE Inhibitors work in AD?
- AD = basal nucleus of Meynert degeneration --> ACh deficiency
- AChE Inhibitors prevent degeneration to slow progression of memory loss
43
Mechanism of Memantine in AD?
-Glutamate NMDA receptor blocker
44
Where do hypertensive disease infarcts most likely to affect?
Basal ganglia and internal capsule
45
What is a Lewy body?
Intracellular fibriller deposits of a-synuclein
46
2 Most common Lewy body syneuclienopathies:
1. Parkinson's
| 2. Dementia w/ Lewy bodies
47
Location where disease begins in Synucleinopathies:
Parkinson = substantia nigra
Lewy body Dementia = cortex
48
Dementia w/ visual hallucinations is pathognomonic for:
Dementia of Lewy Body
49
What drugs to avoid in Lewy Body Dementia? Why?
- Antipsychotics
| - Increased sensitivity
50
Scoring of MMSE:
Normal = 30-27
Mild = 20-27
Moderate=10-20
Severe =
51
What are the 5 ADLs?
```
Dressing
Eating
Ambulating
Toileting
Hygiene
```
52
What are 5 Instrumental ADLs?
```
Shopping
Housekeeping
Accounting
Food preparation
Transportation
```
53
What is psychic determinisim?
Everything (event/symptom) has meaning
54
What is in the Topographic model of the mind?
Consciousness = currently aware
Pre-conscious = easily recalled
[Repression barrier]
Unconscious = repressed thoughts and feelings
55
What are the psychosexual stages of development in order?
1. Oral - birth - 1.5
2. Anal - 1.5-3
3. Phallic - 3-5
4. Latency - 6-adolescence
5. Gential - adolescence-adult
56
What are 3 parts of the structural model of the mind?
1. Id - "child"
2. Ego and ego defense systems - "adult", purpose
3. Superego - "parent", conscience
57
When and how does superego start?
- At age 5
| - Start with being taught
58
What are Level 1 Ego Defense Mechanisms?
"Psychotic" -
1. Delusional projection
2. Psychotic denial
3. Distortion
59
What are Level 2 Ego Defense Mechanisms?
"Immature"
1. Projection
2. Somatization
3. Acting Out
4. Splitting
60
What are Level 3 Ego Defense Mechanisms?
"Neurotic"
1. Denial
2. Displacement
3. Dissociation
4. Identification
5. Intellectualization
- -Isolation of Affect
- -Rationalization
6. Reaction formation
- -Regression
- -Undoing
61
What are Level 4 Ego Defense Mechanisms?
"Mature"
1. Altruism
2. Sublimation
3. Anticipation
4. Suppression
5. Humor
62
What is the most common defense mechanism?
Denial
63
Stockholm syndrome is an example of what defense mechanism?
Identification
64
What is the concept of transference?
Transfer relationships (feelings) from past to current relationships
65
What defense mechanism is most commonly seen in Manics?
Distortion
66
Woman who sees everything as super awesome one day, and then all bad the next.
What defense mechanism? Associated w/ what personality disorder?
- Splitting
| - Borderline Personality Disorder
67
Your boss tells you that you did something wrong even though you didn't. You have horrible road rage on the drive home.
What defense mechanism?
Displacement
68
After a car accident that kills the driver, the surviving passenger is interviewed, but claims she remembers nothing.
What defense mechanism?
Dissocation
69
Difference between Isolation of Affect and Rationalization defense mechanisms
Isolation of affect is understanding without experiencing feelings, while rationalization is using reasonable accounts to explain away negative feelings
70
I say I love studying even though I don't
| What defense mechanism?
Reaction formation
71
Whenever JoeBob has an inclination to rob a bank, he instead plays GTA.
What defense mechanism?
Sublimation
72
Definition of Acute vs. Chronic pain
Acute = 6 months
73
Symptoms of Chronic regional Pain Syndrome
Limb is cold, red, muscle wasting, nail changes
74
What neurotransmitter is responsible for neuropathic pain?
Glutamate -- long term potentiation remembers inflammatory pain --> neuropathic pain
75
What kind of pain does anti-epileptics treat?
Neuropathic pain -- Na or Ca channel blocker, some are Glutamate blockers
76
What mechanism of antidepressants treats neuropathic pain?
NRI mechanism
77
What is the Hawthorne effect?
Improvement as a result of receiving attention
78
Behavioral therapy is based on what theory and what techniques?
- Learning theory
| - Classical and operant conditioning
79
What is Stimulus Generalization
Associating similar stimuli to the conditioned stimulus
80
Difference between punishment and negative reinforcement
Punishment = weakens behavior
Negative reinforcement = strengthens behavior
81
Age and gender distribution of Somatoform Disorders
- Higher incidence in women
| - Starts early adulthood
82
Somatization Disorder DSM-5 Criteria
- 4+ Pain issues
- Onset before 30
- Chronic symptoms, complete remission rare
- Unconscious, no secondary gain
83
Hypochondriasis requires symptoms to persist for ___
6 months
84
What antidepressant to use for smoking cessation? Mechanism?
Bupropion -- Block reuptake of NE and DA
85
What nicotine receptor agonist to give for smoking cessation?
Mechanism?
Varenicline -- partial agonist
MQW U3
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