3/27&28 psych Flashcards
cofactor for glutamate & GABA transaminase?
B6
fexofenadine
-what is it?
2nd gen. H1 blocker
2nd get H1 blockers
- suffix?
- exception?
- adine
- cetirizine
cetirizine
-what is it?
2nd get H1 blocker
-zertec
promethazine
-what is it?
1st gen H1 blocker
Buspirone
-pros?
Does not cause sedation, addiction, or tolerance.
DOPA
-short for what?
dihydroxyphenylalanine
rate-limiting step in catecholamine synth
tyrosine hydroxylase
-tyrosine => DOPA
reserpine
- mech:
- use:
-inhibits dopamine entry into pre-synaptic vesicles,
effectively causing a chemical sympathectomy.
-reduces BP & HR.
Ciliary muscle under what control?
Mostly muscarinic control.
-slight beta-2 control.
Opioids depress respiration by reducing responsiveness of central respiratory centers to ____
CO2
Highest risk age-group for suicide:
45-64
reuptake of Ca back into SR
-ATP dep?
yes, its ATP dependent. (ryanodine receptors).
- this is crucial part of malignant hyperthermia, burning all that ATP generates heat!
- high temp will induce muscle damage.
malignant hyperthermia
-how is the muscle damaged?
- low ATP & high temp from burning so much ATP damages muscle cells.
- you burn a lot of ATP trying to put that Ca back into the SR w/ryanodine receptors.
trigeminal neuralgia
-Tx:
carbamazepine
reduction of portal venous pressure to prevent variceal bleed
propranolol
Most feared side effect of carbamazepine
agranulocytosis
If a 3 year old doesn’t play cooperatively w/other, is that a social development delay?
No. At 3 yo children are expected to play in parallel w/other kids, not cooperatively.
phenelzine
-what is it?
MAO inhibitor
Depressed pt who has hypertensive crisis after a wine/cheese party.
MAO-inhibitor / tyramine crisis.
Classic conditioning v Operant conditioning
-which one is dealing w/involuntary responses & which w/voluntary?
classic = involuntary (ie. salivating). operant = voluntary (ie. behavior training).
Operant conditioning:
-what is “extinction”?
- Discontinuation of reinforcement (positive or negative) eventually eliminates behavior.
- ie. a child who climbs under his desk, a response which has been reinforced by attention, is subsequently ignored until the attention-seeking behavior no longer occurs.
Transference
-define:
Patient projects feelings about formative or other important persons onto physician (e.g., psychiatrist is seen as parent).
Countertransference
-define:
-Doctor projects feelings about formative or other important persons onto patient (e.g., patient reminds physician of younger sibling).
Dissociation
- mature or immature ego defense?
- define:
-immature
-Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress.
-Extreme forms can result in dissociative identity
disorder (multiple personality disorder).
Denial
-mature or immature ego defense?
immature
Ego defenses
-conscious or unconscious?
unconscious
Displacement
- mature or immature ego defense?
- define:
- example:
-immature
-transfer of an impulse toward a safer & less
distressful object.
-husband yelling at his dog after argument w/wife.
Fixation
- mature or immature ego defense?
- define:
- example:
-immature
-Partially remaining at a more childish level of
development (vs. regression).
-Men fixating on sports games.
Identification
-mature or immature ego defense?
immature
Isolation
- mature or immature ego defense?
- define:
- example:
- immature
- Separating feelings from ideas and events.
- Describing murder in graphic detail with no emotional response.
Fantasy
-mature or immature ego defense?
immature
Projection
- mature or immature ego defense?
- define:
- example:
-immature
-projecting your “unacceptable” feelings onto someone
else.
-A man who wants another woman thinks his wife is cheating on him.
Rationalization
-mature or immature ego defense?
immature
Regression
- mature or immature ego defense?
- example:
-immature
-bedwetting in a previously toilet-trained child
when hospitalized
Repression
- mature or immature ego defense?
- voluntary or involuntary?
immature
-involuntary
Splitting
- mature or immature ego defense?
- commonly seen in which disorder?
- immature
- Commonly seen in borderline personality disorder.
Altruism
-mature or immature ego defense?
mature
Humor
-mature or immature ego defense?
mature
Sublimation
- mature or immature ego defense?
- define:
- example:
- mature
- Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system (vs. rxn formation).
- Teenager’s aggression toward his father is redirected to perform well in sports.
Reaction formation
- mature or immature ego defense?
- define:
- example:
-immature
-a person does the opposite of what he/she desires.
Usually a short-term immature response that eventually
breaks down. You feel bad about this desire.
-a former smoker vigorously enforcing a smoking ban.
Suppression
-mature or immature ego defense?
mature
mature ego defenses
-mnemonic:
Mature adults wear a SASH:
-Sublimation, Altruism, Suppression, Humor.
Anaclitic depression
- what is it?
- what is it a result of?
- infant withdrawn/unresponsive.
- result of infant deprivation.
Infant deprivation
- after how long are changes irreversible?
- what can severe deprivation result in?
> 6 mo
-Severe deprivation can result in infant death.
Sexual abuse of child
- peak age range?
- abuser?
- 9-12
- Known to victim, usually male
Physical abuse of child
- peak age range?
- abuser?
< 3 yo
-Usually biological mother
ADHD
- onset before age __
- intelligence level?
- associated w/what physical brain abnormality?
- 12
- normal intelligence but commonly coexists w/difficulties in school.
- Associated with frontal lobe volume/metabolism.
atomoxetine
- what is it?
- whats it used for?
- NE reuptake inhibitor.
- ADHD
Conduct disorder
- age range?
- will most likely progress to what?
- < 18yo
- After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder.
Oppositional defiant disorder
-define:
Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms.
Tourette syndrome
- onset of age:
- how long must it last for a Dx?
- Tx:
- < 18 yo
- > 1 year
- antipsychotics and behavioral therapy.
Separation anxiety disorder
- common age of onset?
- Tx:
- 7-9 yrs
- SSRIs and relaxation techniques/behavioral interventions.
Pervasive developmental disorders
- define:
- name 2 of them:
- Delays in the development of socialization and communication skills.
- Autism spectrum disorder, Rette disorder.
Do autistic children get separation anxiety?
-no separation anxiety b/c there was no attachment
in the first place.
Rett disorder
- inheritance pattern:
- seen in which pt population:
- X-linked recessive
- Seen in GIRLS bc boys w/disease die in utero.
Rett disorder
-Sxs:
-loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing.
Anxiety: NT levels
- NE:
- 5-HT:
- GABA:
- inc. NE
- dec. GABA
- dec. 5-HT
Huntingtons disease: NT levels
- GABA:
- ACh:
- dopamine:
- dec. GABA
- dec. ACh
- inc. dopamine
Parkinson disease: NT levels
- dopamine:
- ACh:
- 5-HT:
- dec. dopamine
- inc. ACh
- inc. serotonin
Parkinsons disease
-serotonin level?
-inc. serotonin
Schizophrenia
-which NT level is off the most?
inc. dopamine
Orientation
-what 3 things do they check and in which order are they lost?
Order of loss:
1st—time
2nd—place
last—person.
Dissociative amnesia
-what is it?
Inability to recall important personal information, usually subsequent to severe trauma or stress.
-May be accompanied by dissociative fugue.
Dissociative fugue
Abrupt travel or wandering during a period of
dissociative amnesia, associated with traumatic circumstances.
Cognitive disorder
- define:
- what two syndromes does are encompassed?
- Significant change in cognition: memory, attention, language, judgment.
- Includes delirium and dementia.
“Waxing and waning” level of consciousness
with acute onset.
-delirium or dementia?
Delirium
Delirium vs Dementia
- onset:
- consciousness:
- course:
- Delirium = acute = impaired consciousness = fluctuating
- Dementia = gradual (months to years) = intact consciousness = progressive
Delirium vs Dementia
-reversible?
Delirium = reversible Dementia = irreversible
Delirium
-check drugs for which type of effect?
-anticholinergic effects.
Delirium
- hallucinations?
- if so what type?
hallucinations = often visual.
Delirium
- normal or abnormal EEG?
- Tx:
- Abnormal EEG.
- Optimize brain condition (O2, hydration, pain, etc.) & antipsychotics (mainly haloperidol).
Normal Pressure Hydrocephalus
-is the dementia reversible?
-yes, reversible.
Hypothyroidism
-is the dementia reversible?
-yes, reversible.
Neurosyphilis
-is the dementia reversible?
-yes, reversible.
B12 deficiency
-is the dementia reversible?
-yes, reversible.
Dementia
- normal or abnormal EEG?
- Tx:
- normal EEG.
- no Tx
Chronic substance abuse
-is the dementia reversible?
-No.
Creutzfeldt-Jakob disease
-is the dementia reversible?
-No.
Lewy body dementia
-is the dementia reversible?
-No.
Psychosis
- definition:
- characterized by:
- A distorted perception of reality.
- Delusions, hallucinations, &/or disorganized thinking.
Visual hallucinations
-More commonly a feature of what type of illness?
Medical illness (ie. drug intox).
Auditory hallucinations
-More commonly a feature of what type of illness?
Psychiatric illness (e.g., schizophrenia).
Tactile hallucinations
-Commonly seen in what?
- Common in alcohol withdrawal (e.g., formication—the sensation of bugs crawling on one’s skin).
- Also seen in cocaine abusers (“cocaine crawlies”).
HypnaGOgic hallucinations
-when do they occur?
Occurs while GOing to sleep.
HypnoPOMPic hallucinations
-when do they occur?
Occurs while waking from sleep (“POMPous upon awakening”).
Schizophrenia
- Sxs have to last for how long?
- chemical imbalance?
- inc or dec. dendritic branching?
> 6 mo.
- inc. dopamine
- dec. dendritic branching
Schizophrenia
-Dx req 2 of the following:
- Delusions
- Hallucinations—often auditory
- Disorganized speech (loose associations)
- Disorganized or catatonic behavior
- “Negative symptoms”—flat affect, social withdrawal, lack of motivation, lack of speech or thought
Schizophrenic Sxs for < 1 mo:
- defined as what?
- will pt fully recover?
- Brief psychotic disorder
- pt will return to full functionality.
Schizophrenic Sxs for 1-6 mo:
-defined as what?
Schizophreniform disorder
Schizoaffective disorder
- what needs to happen to Dx this?
- 2 subtypes:
-At least 2 weeks of stable mood w/psychotic symptoms, plus a major depressive, manic, or mixed (both) episode. -2 subtypes: bipolar or depressive.
Delusional disorder
- has to last how long?
- describe it:
> 1 mo
-typically have a persistent, over-riding delusion w/a specific theme. Behavior is not obviously bizarre.
Dissociative disorders
-what are they?
- conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception.
- People with dissociative disorders use dissociation, an immature defense mechanism, pathologically and involuntarily.
Dissociative identity disorder
-formerly known as?
-Multiple personality disorder
-
Mood disorders
- what are they?
- name some of them:
- Abnormal range of moods or internal emotional states and loss of control over them.
- major depressive disorder
- bipolar disorder
- dysthymic disorder
- cyclothymic disorder
Mood disorders
-can psychotic features be present?
Yes.
Schizophrenia
-when does it present: men & women?
- Presents earlier in men.
- men: late teens to early 20s
- women: late 20s to early 30s
Manic episode
-by definition, how long does it have to last?
At least 1 week.
Manic episode
- requires hospitalization or at least 3 of the following:
- mnemonic?
DIG FAST
- Distractibility
- Irresponsibility—seeks pleasure without regard to consequences (hedonistic).
- Grandiosity—inflated self-esteem
- Flight of ideas—racing thoughts
- Inc. in goal-directed Activity/psychomotor Agitation
- dec. need for Sleep
- Talkativeness or pressured speech
Hypomanic episode
- what is it?
- are there psychotic features?
- how long does it last?
- Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization.
- No psychotic features.
- Lasts at least 4 consecutive days.
Bipolar disorder
-Bipolar I =
-presence of at least 1 manic episode with or without a hypomanic or depressive episode.
Bipolar disorder
-Bipolar II
-defined by the presence of a hypomanic and a depressive episode.
Bipolar disorder
-is pts mood ever normal?
-Patient’s mood and functioning usually return to normal between episodes.
Should you use anti-depressants to treat bipolar pts?
No - it can lead to mania.
-you dont want to increase their dopamine!
Cyclothymic disorder
- what is it?
- how long does it have to last by definition?
-dysthymia and hypomania; milder form of bipolar disorder -Lasting at least 2 years.
dysthymia =
-mild but chronic depression.
Major depressive disorder
-how long do episodes have to be, minimally?
2 or more weeks.
Major depressive disorder
- have to have 2 of the 9 Sxs
- name the Sxs:
- mnemonic:
SIG E CAPS:
- Sleep disturbance
- loss of Interest (anhedonia)
- Guilt or feelings of worthlessness
- Energy loss and fatigue
- Concentration problems
- Appetite/weight changes
- Psychomotor retardation or agitation
- Suicidal ideations
Major depressive disorder: sleep changes
- slow wave sleep?
- REM latency
- total REM sleep
- nighttime awakening?
- dec. slow wave sleep
- dec. REM latency
- inc total REM sleep
- inc. nighttime awakenings
- early morning awakenings.
Major depressive disorder: sleep changes
-whats a good screening question?
Do they have early-morning awakenings.
Atypical depression
-difference from typical depression?
-mood reactivity
-“reversed” vegetative symptoms (weight gain).
-leaden paralysis (heavy feeling in arms and legs).
-
mood reactivity
- define
- what disorder do you see it in?
- being able to experience improved mood in response to positive events, albeit briefly.
- atypical depression.
Maternal (postpartum) “blues”
- how long after delivery does it begin?
- how long does it last?
- starts 2-3 days after delivery.
- usually resolves w/in 10 days.
Postpartum depression
- how long after delivery does it begin?
- how long does it last?
- starts within 4 weeks of delivery.
- lasts 2 weeks to a year or more.
Postpartum psychosis
- how long after delivery does it begin?
- how long does it last?
- starts within 4 weeks of delivery.
- lasts btwn 4-6 weeks.
If a pt complains about another doctor to you, what should you tell them?
I understand you’re upset, but I suggest you speak directly to Mr. Smith about your concerns.
- If the pt is uncomfortable doing so, the hospital has pt advocates who can address their concerns for them.
- If the pt has a problem with someone in your office staff, tell the pt you will speak to that individual.
Bupropion
-C/I in which pts? why?
- Can cause seizures in bulimic w/purging or anorexia w/purging.
- bupropion reduces seizure threshold.
- due to their electrolyte imbalances from purging.
melanosis coli
-what is it?
Blackened area on the colon as a result of laxative abuse.
Which drug can be used in anorexics who have depression w/o fear of them losing more weight?
Mirtazapine
nortriptyline
-what is it?
TCA
If baby will die w/o C section but coherent mother refuses C section & admissions note also states she doesn’t want C section - do you perform the C section to save the babies life?
No
-Even tho woman is pregnant, it does not limit the requirement of informed consent for a procedure.
Loss to follow-up
-what sort of bias is this?
Part of selection bias.
Sampling bias leads to a lack of ______ validity.
external
What age does babinsky reflex disappear?
12 months
At what age can baby climb stairs alone?
18 months
If a pt is calling w/anxiety about something - do you deal with it then or tell her to write down her questions and talk about it at appointment?
You deal with it then.
Does the good samaritan law protect you from legal action?
No
-you can get sued if the care provided was negligent and results in injury. Also if you didn’t use standard of care.
Which recreational drug can produce vertical & horizontal nystagmus?
PCP
TCA OD
-Tx:
sodium bicarb for CV tox.
PCP OD
-Tx:
benzos & anti-psychotics
PTSD
-Tx:
SSRI
-fluoxetine.
BMI =
BMI = (weight in kg)/ [(height in m)^2]
Late-look bias
-what is it?
- info gathered at inappropriate time
- sampling people w/milder form of disease bc those w/severe form have already died from it.
whats a type 2 error
Finding no difference when in fact there is one.
-False negative
false negative rate of a test
-alpha or beta?
beta
Normal grief
-how long does it last?
6-12 months
Simple hallucinations during grieving
-normal or pathological?
normal
-ie. hearing name called.
Electroconvulsive therapy
-whats it used for?
1)major depressive disorder refractory to other treatment. 2)pregnant women with major depressive disorder.
Is access to firearms a risk for suicide completion?
Yes
Anxiety disorder
-encompasses which 3 disorders?
Includes panic disorder, phobias, and generalized anxiety disorder.
Panic attack
-how long after it starts does it usually peak?
10 min
Panic disorder
-Dx requires what?
- Dx reqs attack followed by 1 month (or more) of 1 (or more) of the following:
- persistent concern of additional attacks.
- worrying about consequences of the attack.
- behavioral change related to attacks.
Panic attack
- what acid/base disorder do you get?
- what will bicarb be?
- respiratory alkalosis due to hyperventilation.
- bicarb is normal bc its an acute attack.
Shortness of breath
- aka?
- does it cause a resp acidosis or alkalosis?
dyspnea
- resp alkalosis bc you’re breathing so fast.
- is this true? i dont know.
Social anxiety disorder
-Tx:
SSRI
Generalized anxiety disorder
-how long does it have to last to make the Dx?
> 6 months
Generalized anxiety disorder
-Tx:
SSRI, SNRI, buspirone.
Adjustment disorder
- branch of what disease?
- what is it?
- how long does it have to last to make the Dx?
- Generalized anxiety disorder
- emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor.
- < 6 months (> 6 months in presence of chronic stressor).
Obsessive-compulsive disorder
-associated w/what other disease?
-Associated with Tourette disorder.
Obsessive-compulsive disorder
-egodystonic or egosyntonic?
-egodystonic (vs. obsessive-compulsive personality disorder).
Pt. w/repeated plastic surgeries: may have what disease?
Body dysmorphic disorder
-preoccupation with minor or imagined defect in appearance, leading to significant emotional distress.
PTSD
-how long it last to make the Dx?
> 1 month
-leads to avoidance of stimuli.
PTSD
-Tx:
-psychotherapy, SSRIs.
What do you call PTSD that lasts btwn 3 days and 1 month?
Acute stress disorder
Malingering
-define
Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific 2° (external) gain (e.g., avoiding work, obtaining compensation).
Somatoform disorders
-is there a conscious attempt to deceive?
no
Factitious disorder
-is there a conscious attempt to deceive?
yes
Living will vs. durable power of attorney
-which supercedes?
Durable power of attorney supercedes
Does normal grief include suicidal thoughts?
No
Jehovah fitness child in emergency and needs blood. Parents refuse. Do you give him the blood?
Yes.
Bipolar I or II
-which has a manic episode?
Bipolar I has manic episode.
-bipolar I can be Dx after a single manic episode.
Non-random assignment to study groups
-what type of bias?
Selection bias.
Group of subjects is not representative of the population of interest
-what type of bias?
Sampling bias.
Premature delivery/labor: why would you want to stop labor?
So you can give penicillin & steroids to prevent group B strep & NRDS.
Prematurity
-limit of viability?
24 weeks.
tocolysis
-define
stopping labor.
-ie. terbutaline, ritodrine, magnesium sulfate.
tocolysis is attempted until how many weeks?
attempted for all babies < 34 weeks.
Stack six blocks, 2 word sentences, use utensils
-how old?
2 yo
Case control vs cohort
-make sure to pay attention to what?
Pay attention to wording of the question.
- If they wanna know what the risks of “developing” something is - that means prospective study which means cohort study.
- pay attention to tense of verbs.
Alcoholic withdrawal Tx:
-pt has cirrhosis
Out The Liver
Oxazepam, temazepam, lorazepam
*1st line = lorazepam.
Tuberous sclerosis
-associated w/which mental disability?
Autism.
Schizoid v avoidant
-which one desires relationships w/others?
avoidant
Hawthorne effect
- what is it?
- mnemonic?
- groups who know they’re being studied behave differently than they would otherwise
- being on the streets in Hawthorne knowing the cops are watching you. The criminals behave differently.
antisocial personality disorder
-associated w/which comorbidity?
substance abuse
Changes in elderly:
- more or less fat?
- more or less REM & slow wave sleep?
- more fat, less muscle.
- less REM & slow wave sleep.
Disorganized speech / loose connections - aka how kendall talks when he’s manic.
-part of what umbrella term?
Part of psychosis.
Can psychotic features be present in mood disorders (ie. bipolarism)?
-example?
Yes.
-Like Kendall. He has bipolar disorder but also psychotic features like loose association (disorganized speech). He may also have hallucinations & delusions - who knows.
Baby rolls over w/o assistance
-how old?
6 mo.
Schizo
-inc. dopamine in which pathway?
mesolimbic system
