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10. Psychology Flashcards

1
Q

Child Abuse

3 type/Example

A
  • Physical abuse - Ciggarette burn, healed fx in x-ray, bruise
    • Retinal hemorrhage MC finding
  • Child nelgect - Malnutrition, poor hygiene and failure to thrive
  • Sexual abuse - gental/anal trauma, STD
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2
Q

Domestic violence

Patient/MC case/Tx

A
  • Patient: MC women
  • MC case: Women try to report abuse or leave relationship
  • Tx: Keep them safe (escape plan)
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3
Q

Elder abuse

4 Risk factors

A
  • Caregive - substance, mental illness
  • Environment - lack of famlity support, shared living
  • Elder - advanced age
  • instiutional - poor working condition, low wage
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4
Q

GAD

Sx/Dx/Tx

A
  • Sx: excessive worry more than 6month
  • Dx: GAD7 (hx of caffeine or substance check)
  • Tx: SSRI (Paroxetine) + CBT
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5
Q

Panic attack/disorder

Attack vs disorder define/Agoraphobia/Sx/Tx

A
  • Attack - brief attack
  • Disease - recurrence (at least 2 or more)
    • May occur with Agoraphobia - anxiety being in place
  • Sx: Sudden chest pain, palpitation (sounds like heartattck)
  • Tx: CBT + SSRI
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6
Q

Phobia

Sx/Tx

A
  • Sx: specific stress event (flying, blood, needle)
  • Tx: Exposure therapy
    • Short term - benzo
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7
Q

Bipolar I

Risk factor/Sx/Tx

A
  • Risk factor: familty hx
  • Sx: Dig fast - (distraction, impulsive, grandiosity, flight of idea, activity, sleep problem, talkativeness) Mania at least 1 week
  • Tx: lithium
    • benzo for short term
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8
Q

Bipolar II

Sx/Dx/Tx

A
  • Sx: irritable mood but not harmful to other
  • Dx: hypomania 4 days of sx
  • Tx: Lithium (1st)
    • Cognitive therapy
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9
Q

MDD (major depressive disorder)

Sx/Dx/Lab/Tx

A
  • Sx: feeling worthless, insomnia, Sx more than 2 weeks
  • Dx: PHQ 2 (>3) -> PHQ 9 (>10) -> Tx
  • Lab: TSH (hypo), anemia, vit D check to rule out
  • Tx
    • Psychotheraphy (cognitive)
    • SSRI, SNRI (1st), Bupropion (2nd), requires 3-6 weeks to see benefit
      • SSRI, SNRI failed -> add bupropion -> Failed then refer out psych
    • ECT (Electroconvulsive therapy)
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10
Q

Pesistent depressive disorder

Dx/Tx

A
  • Dx: more than 2 year long MDD but able to function
  • Tx: Psychotherapy (1st), SSRI
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11
Q

PDD (premenstrual dysphoric disorder)

Sx/Tx

A
  • Sx: agner irritability before mense
  • Tx: SSRI + OCP
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12
Q

Suicidal behavior

Risk/Method/Tx

A
  • Risk
    • Previous attempt (strongest)
    • Female attempt higher, but male complete higher
    • Elder white men is highest suicidal in US
    • Marriage and children is protective from suicidal
  • Method
    • gun (very high)
    • haning, posion
  • Tx: Safety first, counselling later
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13
Q

Conduct vs oppositional defiant disorder

Dx/Tx

A
  • Conduct - agressive toward property, people, animal
  • Oppositional defiant disorder - angry easy, refuse obey rule
  • Dx
    • Conduct - 12 month + sx
    • Oppositional defiant disorder - 6 month + sx
  • Tx: Psychotherapy
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14
Q

Dissociative disorder

4 type list

A
  • Dissociative disorders - loss of self
  • Dissociative amnesia - loss memory of traumatic event
  • Dissociative Fugue - loss identity & travel to a new location
  • Dissociative identity - two or more personality
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15
Q

Anorexia vs Bulimia

Sx/PE/Tx

A
  • Anorexia nervosa
    • Sx: not eating due to distorted body perception, Amenorrhea
    • PE: Bradycardia, hypotension
    • Dx: BMI 17.5 less than
    • Lab: hypoK
    • Tx: Olanzepine
      • Hospitalization if less than 75% body weight
  • Bulimia
    • Sx: Binge eating
    • PE: Russell sign (calluses on the dorsum of the hand), teeth pitting enamel erosion
    • Lab: HypoK, HypoMg
    • Tx: CBT(1st) + Fluoxetine
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16
Q

Binge eating disorder

Define/Dx/Tx

A
  • Define: Eating more than normal person
  • Dx: Once a week for 3 month
  • Tx: Psychotherapy, SSRI
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17
Q

Human Sexuality Questions

  1. like to show genital
  2. female with low sex drive
  3. sexual arousal with nonliving object like doll, or nongenital part
  4. male with low level of sexual activity
  5. sexual acts with children
  6. sexual arousal by beaten, humiliated
  7. like to observing undressing or nake
  8. All sex related Tx?
A
  1. exhibitionistic disorder
  2. female sexual interest and arousal disorder
  3. fetishistic
  4. Male hypoactive sexual desire disorder
  5. Pedophillic
  6. Masochaism
  7. Voyeuristic
  8. Psychotherapy, SSRI
18
Q

OCD (obsessive-compulsive disorder)

Define/4 major sx/Dx/Tx

A
  • Define: Obsession (thought), Compulsion (behavior)
  • 4 major Sx
    • keep cleaning
    • doubt (forget turn off iron)
    • perfectionist
    • keep thinking over and over
  • Dx: Yale-brown obsessive compulsive scale
  • Tx: SSRI + CBT
19
Q

BDD (body dysmorphic disorder)

Define/Tx

A
  • Define: obsession of body image
  • Tx: SSRI + CBT
20
Q

Stress disorder

  1. difficult to throw away things
  2. pull out one’s own hair
  3. compulsive picking of the skin
A
  1. Hoarding disorder
  2. Trichotillomania (hair pulling)
  3. Excoriation (skin-picking)
21
Q

ADHD

Sx/Dx/Tx/Stimulant vs nonstimulant (MOA, med list)

A
  • Sx
    • unable to sit still
    • failed close attention to detail
    • talk excessively
    • can’t wait for turn
  • Dx: 12y>, 6 month 6 sx
  • Tx: behavior therapy + Stimulant or nonstimulant
    • Stimulant MOA (methylphenadate, amphetamine) - block dopamin/Norepi reuptake
    • Nonstimulant MOA (Atomoxetine) - block dopamin
22
Q

Autism

Define/Sx/Tx

A
  • Define: socialization, language, and cognition delay
  • Sx
    • avoid eye contact
    • No communication with other
    • repetitive movement
  • Tx: Refer to specialist, speech and language therapist
    • For mood risperidone (2nd antipsychotic)
23
Q

Personality disorder Cluster A

Name the Dz, Sx and Tx

A
  1. Schizotypal
    • Sx: Believes superstition, bizarre fantasies (Magical thinking)
    • Tx: Psychotherapy
  2. Schizoid
    • Sx: loner, doesn’t care praises or criticism
    • Tx: Psychotherapy
  3. Paranoid
    • Sx: Can’t trust
    • Tx: Psychotherapy
24
Q

Personality disorder Cluster B

Name the Dz, Sx and Tx

A
  1. Antisocial
    • Sx: No anxiety of crime, doesn’t care of another person and very impulsive
    • Tx: Psychotherapy
  2. Boarderline
    • Sx: self harm behavior, unstable relationship, drug seeking
    • Tx: Psychotherapy (dialectic behavioral therapy)
  3. Histrionic
    • Sx: sexually attention, want to be center of attention
    • Tx: Psychotherapy
  4. Narcissistic
    • Sx: lack of empathy, self importance and superiority
    • Tx: Psychotherapy
25
Q

Personality disorder Cluster C

Name the Dz, Sx and Tx

A
  1. Avoidant
    • Sx: Social withdrawal (timid, shy, lack of confidence)
    • Tx: Psychotherapy
  2. Dependant
    • Sx: asking for assurance, can’t make decision
    • Tx: Psychotherapy
  3. OCD
    • Sx: contamination, perfectionist, doubt, keep thinking over and over
    • Tx: Psychotherapy
26
Q

Schizophernia

4 cause/Risk factor/Dx/Tx

A
  • Types
    • Less than 1 month - brief psychotic disorder
    • 6 month> - schizophreniform
    • 6 month< - schizophrenia
    • Schizophernia + mood problem - schizoeffective disorder
  • Risk: Strong Family hx
  • Dx
    • Positive sx (hallucination, delusion) - too much dopamin
    • Negative sx (flat emotion effect) dopamin not working
      • must have 2 or more sx with include 1 postivie
  • Tx: antipsychotic 2nd gen ROQ (Risperidone, olanzapine, quetiapine)
27
Q

Narcolepsy

Cause/Sx/Dx/Tx

A
  • Cause: hypcretin deficiency
  • Sx (triad)
    • daytime sleepiness
    • hallucination (just before sleep)
    • cataplexy (loss of muscle tone)
  • Dx: polysomnography
  • Tx: Stimulant
28
Q

Somatization disorder

5 type/sx/Tx

A
  • Somatic symptom disorder
    • Sx: True sx, but unable to find cause
    • Tx: continue appt with health care provider
  • Illness anxiety (hypocondriasis)
    • Sx: preoccupied illness
    • Tx: continue appt with health care provider
  • Conversion disorder
    • Sx: True Neuro sx but uable to find cause
    • Tx: Psychotherapy
  • Factitious (munch) disorder
    • Sx: go for invasive diagnosis, but no gaining
    • Tx: None
  • Malingering disorder
    • Sx: fake sx, gain something
    • Tx: None
29
Q

Opioid withdrawal/intoxication

Sx/Tx

A
  • Intoxication
    • Sx: Pupil constriction + breathing slow/difficult
    • Tx: Naloxone
  • Withdrawal
    • Sx: Pupil dilated + breathing fast + piloerection (goose bump)
    • Tx: Clonidine, buprenophine/Naloxone (suboxone)
      • Methadone tapering
30
Q

Alcohol intoxication/withdrawal/dependant

Sx/Tx

A
  • Intoxication
    • Sx: slurred speech
    • Tx: observe, (may need thiamine and Mg)
  • Withdrawal
    • Type
      • 1 day + tremor, palpitation - uncomplicated withdrawal
      • 1 day + tonic clonic siezure - withdrawal
      • 1-2 day + hallucination - alcoholic hallucination
      • 2-5 day + delirium + anormal vital sign - delirium tremens
    • Tx: IV benzo (zepam meds) + IV thiamine & Mg
  • Dependant
    • Screening - CAGE
      • Cut, Annoy, Guilty, Eye open
    • Tx: Disulfiram, Naltrexone
31
Q

Tabaco dependant

Sx/Tx

A
  • Sx: palpitation, tremor, restlessness
  • Tx: Counselling, CBT
    • Nicotine tapering - gum, transdermal
    • Bupropion
    • Varenicline (chantix)
32
Q

PTSD

Sx/Tx

A
  • Sx: Traumatic event (war, assult)
  • Tx: SSRI + CBT
    • trazodone for insomnia
33
Q

Adjustment disorder

Sx/Tx

A
  • Sx: depressed by losing job, divorce in 3 month
  • Tx: usually go away in 6month, psychotherapy
34
Q

Grief reaction

Vs MDD/Hx/Tx

A
  • Vs MDD: preserved self-esteem
  • Hx: lost love ones
  • Tx: Psychotherapy (Should no longer than 1 year)
35
Q

1st gen vs 2nd gen antipsychotic medication

Med list/MOA/IND/SE/Which one is better and why?

A
  • 1st gen med list: Haloperidol, Chlorpromazine (thorazine)
    • MoA: Dopamin block
    • IND: Schizophrenia
    • SE: EPS (DR,TD)/NMS
  • 2nd gen Med list: ROQC (resperidone, olanzapine, quetiapine)
    • MoA: Dopamin + Serotonin block
    • IND: Schizophrenia
    • SE
      • clozapine check CBC Q7d (agranulocytosis/myocarditis)
      • olanzapine - weight gain
  • Which one better and why?
    • Less EPS
36
Q

DR vs TD vs NMS

Sx/Tx/medication cause

A
  • DR
    • Sx: trismus, protrusion of tongue
    • Tx: Stop med + Diphenhydramine IV or add benztropine
  • TD
    • Sx: lip smacking, rolled tongue
    • Tx: Stop med
  • NMS
    • Sx: hyperthermia (overheat) + mental change
    • Tx: Stop med + cool blanket/Ice + bromocriptine
  • Medication cause: 1st gen (haloperidol, Chlopromazin
37
Q

Lithium

MoA/IND/SE/CI

A
  • MoA: Norepi, serotonin
  • IND: bipolar
  • SE
    • hypothyrodism
    • narrow theraputic (0.6-1.2) (keep check weekly)
    • Thristy and urination (should drink water)
  • CI: pregnancy (ebstain anomaly)
38
Q

SSRI vs SNRI

Med list/MoA/SE

A
  • SSRI Med list
    • Sertraline - night (clam down)
    • Citalopram, escitalopram
    • Paroxetine, fluoxetine - morning (active)
  • IND: MDD, PTSD
  • MoA: Serotonin
  • Benefit: Less SE
  • SE: sexual dysfunction
  • SNRI Med list
    • Venlafaxine, duloxetine
  • IND: Chronic pain, Hot flash
  • MoA: serotonin, norepi, dopamin
  • SE: HTN
39
Q

TCA

Med list/MoA/SE

A
  • TCA med list
    • Amitriptyline
  • MoA: serotonin, norepi
  • SE: if overdose anticholinergic effect (prolong QT, tachycardia)
40
Q

Bupropion

MoA/SE/Benefit/CI

A
  • MoA: Dopamin, norepi
  • SE: weight loss
  • Benefit: less sex dysfunction
  • CI: hx of seizure (lower threshold)
41
Q

Mirtazapine

SE/Benefit

A
  • SE: sedation
  • Benefit: fast action in 2-3 weeks

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