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Unit 3 > Behavioral > Flashcards

Behavioral Flashcards

1
Q

What ages characterizes an infant?

A

0-18 months

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2
Q

Defining characteristics of an infant? (markers for development)

A

Their reflexes

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3
Q

Infant reflexes

A
  1. Rooting reflex - A newborn infant will turn its head toward anything that strokes its cheek or mouth, searching for the object by moving its head in steadily decreasing arcs until the object is found.
  2. Palmar Grasp reflex - grip any object put in palm
  3. Moro reflex - limbs extend when child is startled
  4. Babinksi reflex - dorsiflexion of toes when the sole of foot is stroked
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4
Q

Rooting reflex

A

The rooting reflex assists in the act of breastfeeding. A newborn infant will turn its head toward anything that strokes its cheek or mouth, searching for the object by moving its head in steadily decreasing arcs until the object is found.

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5
Q

Palmar Grasp reflex

A

When an object is placed in the infant’s hand and strokes their palm, the fingers will close and they will grasp it with a palmar grasp.

Appears as early as 16 weeks and persists until 5 or 6 months of age.

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6
Q

Moro reflex

A

The Moro reflex is an infantile reflex normally present in all infants/newborns up to 4 or 5 months of age as a response to a sudden loss of support, when the infant feels as if it is falling. It involves three distinct components:

  • spreading out the arms (abduction)
  • unspreading the arms (adduction)
  • crying (usually)

In summary: limbs extend when child is startled

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7
Q

Babinski reflex

A

Dorsiflexion of toes when the sole of foot is stroked

Dissappears as early as 1 year, but can take 2 years to go away.

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8
Q

One of the first tasks facing an infant (most important social relationship in its life)

A

Attachment to the parent or the primary caregiver

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9
Q

Stranger anxiety

A

After a child formed a strong attachment to his mother, he typically begins to show anxiety when handled by anyone other than the mother.

Whereas the child at 5 months was tolerant of being picked up by a stranger, the same child at 9 months will not tolerate this familarity.

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10
Q

Object permanence

A

During the first months of life, objects and people that leave the child’s LOS cease to exist for him.

Toward the end of the first year, children begin to understand that such objects continue to exist even if out of view –> sometimes results in separation anxiety (realization that mother is still there, but can no longer see)

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11
Q

Normal autistic phase

A

Occurs in the first postnatal month when children are in a state of self-involvement and alck of interest in others that in older children, signifies psychopathology.

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12
Q

What is the major task of the first year of life?

A

To form an attachment to the mother or the primary caregiver

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13
Q

Toddler (age group)

A

18 months to 3 years

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14
Q

Terrible twos

A

a period in a child’s early social development (typically around the age of two years) that is associated with defiant or unruly behavior.

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15
Q

Social interaction of toddlers

A

Toddlers like to be in the company of other children but do NOT yet play with others in a cooperative fashion.

Rather, play at this age takes the form of parallel play, that is playing next to but not reciprocally with other children.

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16
Q

Parallel play

A

Toddlers (18 months to 3 years) like to be in the company of other children but do NOT yet play with others in a cooperative fashion.

Rather, play at this age takes the form of parallel play, that is playing next to but not reciprocally with other children.

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17
Q

Toddler - milestones

A
  1. Parallel play with other children
  2. Terrible twos (defiance/negativity, but an understanding of language)
  3. Bladder control (beginning of bladder control and will be completely by 3 years in a majority and 4-5years in some others)
  4. Autonomy
  5. gender identity (understand if male/female)
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18
Q

At what age do children begin to gain bladder control?

A

They start to gain this at the end of their toddler years ~2 years. Control will be complete by typically 3rd year or sometimes go as late as 4 or 5 years

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19
Q

Preschool child (age group)

A

3-6 years

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20
Q

Preschool - milestones

A
  1. sibling rivalry
  2. regression
  3. between 2-4 years, vocabulary increases dramatically
  4. active fantasy life (imaginary life), but also understands they are not real
  5. cooperative play at 4 years
  6. strong fear of bodily injury (not a good time for elective surgeries)
  7. curiosity about bodies – playing doctor
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21
Q

Sibling rivalry

A

The birth of a sibling often occurs around age of 3 years in US, threatens the important primary relationship and may lead to jealousy or sibling rivalry

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22
Q

Regression

A

A consequence of sibling rivlary or any other life stressor such as changing residence.

The child may demand to have his bottle back or begin to wet the bed again etc… This reaction is temporary

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23
Q

Anxiety physical manifestations

A

Sympathetic NS - diaphoresis, mydriasis, tachycardia, tremor

GI/GU - diarrhea, increased urinary frequency

hyperventilation –> dizziness and syncope, parasthesia

Numbness and tingling in the extremiities and around the mouth

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24
Q

Anxiety psychological manifestations

A

restlessness, irritability, trouble concentrating, worry

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25
Q

Diagnosis of Anxiety (3)

A
  1. Be persistent (generally >6 months)
    • shorter periods for children
  2. Interfere with normal functioning (work, job, marriage, etc…)
  3. Cause significant stress
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26
Q

Generalized Anxiety Disorder (GAD) - DSM-V

A
  1. Excessive anxiety/worry, occurring more days than nor for ≥ 6 months,
  2. Difficult to control worry
  3. associated with ≥ 3 of the following symptoms
    • restlessness
    • easily fatigued
    • difficulty concentration
    • irritability
    • muscle tension
    • sleep disturbance
  4. causes significant impairment
  5. No other explanation for symptoms (physical, chemical, or mental)
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27
Q

Cognitive behavioral therapy (CBT)

A

The front line treatment for a lot of anxiety disorders. Most evidence based mode of treatment

Use of congitive (thinking) and mental techniques as a mode of therapy to basically essentially remove the mind from a current state. Examples:

  • statistical mental analysis
  • guided imagery

Behavioral techniques

  • deep breathing
  • mediatation
  • self-hypnosis
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28
Q

Cognitive behavioral therapy (CBT) - examples

A

Cognitive

  • statistical mental analysis
  • guided imagery

Behavioral techniques

  • deep breathing
  • mediatation
  • self-hypnosis
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29
Q

Generalized Anxiety Disorder (GAD) - front line treatment medication

A

SSRIs and some SNRIs

Increases in SR or NE or both downregulates or desensitizes receptors

SSRI - Citalopram/Paroxetine

SNRI - venlafaxine / Duloxetine

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30
Q

SSRI/SNRI mechanism of treatment for GAD

A

Increases 5HT and NE or both which downregulates/desensitizes receptors

Put so much 5HT/NE into the patient’s system that when they do have an anxiety attack, their brain doesn’t really see it as much due to the desensitization

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31
Q

Medications for GAD

A
  1. Antidepressants - SSRIs/SNRIs front line treatment
    • SSRI - esCitalopram, Paroxetine
    • SNRIs - Venlafaxine, Duloxetine
    • Increases 5HT/NE to downregulate/desensitize receptors
      • Weight gain and sexual side effects
  2. Buspirone (5HT1a receptor agonist)
    • initially lowers 5HT activity as these auto receptors (5HT1a are autoreceptors that downregulate 5HT activity). However overtime, the stimulate of these receptors causes their degradation and ultimately increase 5HT output.
      • less sexual and weight gain side effects than SSRI/SNRIs
    • ONLY FDA approved for GAD, nothing else
  3. Benzodiazepines (GABA-A receptor modulator – allows more Cl- channels to open)
    • 2nd line due to risk of addiction, falls, apnea
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32
Q

What drug is ONLY FDA approved for generalized anxiety disorder (GAD)?

A
  • Buspirone (5HT1a receptor agonist)
  • Mechanism: initially lowers 5HT activity as these auto receptors (5HT1a are autoreceptors that downregulate 5HT activity). However overtime, the stimulate of these receptors causes their degradation and ultimately increase 5HT output.
    • less sexual and weight gain side effects than SSRI/SNRIs
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33
Q

How are ß-blockers used for anxiety?

A

Only performance anxiety. Not used to treat generalized anxiety

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34
Q

Panic disorder (DSM V Diagnostic criteria)

A
  1. An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected with ≥ 4 of the following:
    • palpitations, pounding heart, or accelerated HR
    • sweating
    • shaking/trembling
    • sensation of SOB or smothering
    • choking feeling
    • chest pain/discomfort
    • nausea
    • dissiness, lightheadedness or fainting
    • chills or heat
    • parasthesias
    • derealization
    • fear of losing control
    • fear of dying
  2. Recurrent panic attacks
  3. ≥ 1 attack followed by ≥ 1 month of ≥ 1 of the following
    1. concern about additional panic attacks or consequences
    2. significant maladaptive change in behavior related to attacks (typically phobic avoidance –agoraphobia)
  4. No other explanations for symptoms (physical, chemical, mental)
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35
Q

Panic attack

A

An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected with ≥ 4 of the following:

  • palpitations, pounding heart, or accelerated HR
  • sweating
  • shaking/trembling
  • sensation of SOB or smothering
  • choking feeling
  • chest pain/discomfort
  • nausea
  • dissiness, lightheadedness or fainting
  • chills or heat
  • parasthesias
  • derealization
  • fear of losing control
  • fear of dying
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36
Q

agoraphobia

A

Fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line or being in a crowd.

Highly associated with panic disorders/attacks but may be caused by other things

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37
Q

Panic disorder prognosis

A

Chronic and recurring

increased risk of depression and suicide

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38
Q

Panic disorder occurence/prevalence

A

1.5-3.5% prevalencein general population

Females > males

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39
Q

Panic disorder treatment

A

Therapy

  • Cognitive behavioral therapy
    • Systemic desensitization(step by step progression to doing the thing you fear the most) or flooding (immerse the person in the environment they fear the most and basically overflood their senses and eventually fine)
  • Psychodynamic therapy

Medication

  • emergency treatment: fast-acting benzodiazepines (alprazolam)
  • Long term 1st line: SSRI/SNRI
  • Intermediate or long acting benzos (not 1st line. 2nd due to addiction potential)

Combination treatment

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40
Q

Systemic desensitization or flooding

A
  • Systemic desensitization - step by step progression to doing the thing you fear the most
  • Flooding - immersion of the person in the environment they fear the most and basically overflood their senses and eventually fine

A type of cognitive behavioral treatment. (used in panic disorders, although not common)

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41
Q

Performance anxiety

A

A type of social anxiety. Technically called “social anxiety - performance type”

ONLY associated with performances and the anxiety that develops in any relationship to performances.

fear is restricted to public speaking or performing and does not generalize to other social aspects of life

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42
Q

Phobia (specific phobia)

A

Diagnostic criteria (DSM-V)

  • ≥ 6 months
  • causes significant impairment
  • marked fear/anxiety about a specific object/situation
  • object/situation almost always provokes fear/anxiety
  • actively avoids object/situation
  • fear/anxiety out of proportion to actual danger
  • no other explanation for symptoms

Types of specific phobias:

  • couirophobia - fear of clowns
  • ophidiophobia - fear of snakes
  • aerophobia - fear of airplanes
  • iatrophobia - fear of going to the doctor
  • etc…
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43
Q

Social anxiety disorder

A

Also referred to as Social phobia (same diagnostic criteria as specific phobia but for socialization purposes)

  • ≥ 6 months
  • causes significant impairment
  • marked fear/anxiety about a specific object/situation
  • object/situation almost always provokes fear/anxiety
  • actively avoids object/situation
  • fear/anxiety out of proportion to actual danger
  • no other explanation for symptoms

Performance only - fear is restricted to public speaking or performing and does not generalize to other social aspects of life

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44
Q

Specific phobia - treatment

A

Therapy (1st line): flooding, systemic desensitization (CBT)

Medication: sedatives such as benzos (especially if it is a one time thing/exposure)

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45
Q

social anxiety disorder (social phobia) - treatment

A

Therapy: CBT, assertiveness, training, group therapy

Medication

  • SSRI/SNRI (1st line): paroxetine / venlafaxine
  • MAOI: Phenetzine, tranylcypromine
  • ß blockers (propranolol) - 1st line for performance only
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46
Q

Obsessive Compulsive Disorder (OCD) – DSM-V Definition

A

Criterion A: The presence of obsessions and compulsions

Criterion B: These obsessions and compulsions must be either

  1. Time consuming (>1hr/day) or
  2. Cause clinically significant distress

{Either 1 or 2 from Criterion B}

  1. Are not substance-induced
  2. Not better explained as symptoms of another mental or medical disorder
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47
Q

What is an ‘obsession’?

A

Recurrent/persistent thoughts, urges, and/or images

Intrusive & unwanted

  • sometimes called ego dystonic (means person recognizes it is wrong and doesn’t want to do it)
  • cause the person anxiety/distress

Patient treis to ignore/supress these intrusive thoughts OR they try to neutralize them with a thought or action

  • this is an undoing ego defense mechanism
  • a compulsion to do something to reduce the anxiety/distress
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48
Q

What is an ‘compulsion’?

A

Repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that must be strictly adhered to.

  • A compulsion typically undoes or reduces anxiety (typically an obession)
  • stopping the compulsion often dramatically increases anxiety
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49
Q

ego-dystonic

A

of or relating to aspects of one’s behavior or attitudes viewed as inconsistent with one’s fundamental beliefs and personality (contrasted with ego-syntonic )

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50
Q

Ego-syntonic

A

a term referring to behaviors, values, and feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s ideal self-image.

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51
Q

OCD prevalence

A

Men & women equally affected

Lifetime prevalence: 2-3%

50-70% have onset after a stressful event

Mean onset: Men = 19 years / Women = 22 years

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52
Q

OCD prognosis

A

Long, but variable course

20-30% have significant improvement

40-50% have moderate improvement

20-40% remain ill or worsen

Likely the hardest anxiety to treat

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53
Q

OCD - treatment

A

Psychotherapy

  • CBT: as effective as pharmacotherapy, with longer-lasting effecting
    • Exposure and response prevention (ERP) - basically step by step controlled exposure to withhold the compulsion, a desensitization protocol
  • ACT: Acceptance and commitment Therapy for obsessions - putting the image in their head of their compulsion. So a controlled method of basically desensitization to the obsession.
  • Supportive Psychotherapy? Dynamic Psychotherapy

Pharmacotherapy (best results when + psychotherapy)

  • 1st line: SSRIs, higher-dosage and duration than MDD (major depressive disorder)
  • 2nd line: clomipramine (a TCA, approved for OCD)
  • 3rd line: antipsychotics, other antidepressants
  • Benzodiapeine sedatives do not work.
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54
Q

Exposure and response prevention (ERP)

A

a step by step controlled exposure to withhold the compulsion, a desensitization protocol. Used in the treatment for OCD

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55
Q

ACT: Acceptance and commitment Therapy

A

putting the image in their head of their obsession. If it is fear of the death of her family, keep talking to her about the death of her family and conjure images of it in her head until the point that the idea is desensitized.

Basically desensitization to the point where the patient no longer cares or just accepts it for what it is and does not have any more compulsions for that obsession

Used in treatment for OCD

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56
Q

First drug approved for OCD

A

Clomipramine - a tricyclic antidepressant (TCA) - selective serotonin reuptake inhibitor (200x stronger affinity than for NE)

Also has antagonistic properties at the histamine H1 receptor, muscarinic ACh receptors and α1 adrenergic receptor

  • difference between SSRIs and TCAs is the anti-cholinergic properties –> dry mouth, blurred vision, tachycardia, constipation
  • very hard for patients to stay on these drugs due to side effects
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57
Q

What is most common thing that could cause PTSD?

A

Death of a loved one

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58
Q

What is the most likely thing to caused PTSD?

A

Assault

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59
Q

What are the greatest variables associated with PTSD?

A
  1. Proximity
  2. Harm by another human
  3. severity
  4. repetition
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60
Q

PTSD (DMS-V Definition)

A

Criterion A

Exposure to actual or threatened traumatic event:

  • death
  • serious injury
  • sexual violence
  1. Symptoms must be present for > 1 month
  2. Symptoms must cause significant distress/impairment
  3. Symptoms must not be the result of a substance or other medical condition

Criterion B

≥ 1 “Intrusion Symptom” associated with event

  • Reliving of events
  • distressing memories of the event
  • distressing dream/nightmares related ot the event
  • dissocative reaction during which the patient feels and/or acts as if events are recurring (flashbacks)

Criterion C

Avoidance of stimuli associated with tramuatic event

  • avoid memories/thoughts/feelings about or associated with event
  • avoid external reminders (people/places/situations) that may arouse such memories, thoughts or feelings
  • avoid interpersonal connectivity - estrangement, lack of commitment, unwilling to settle down, reclusiveness

Criterion D

Negative changes in cognition and mood associated with event (≥ 2 of the following)

  • inability to remember an important part of the event, due to dissociative amnesia or repression
  • presistent, exaggerated beliefs/expectations of oneslef, others, or the world (ie paranoid stance)
  • distortion of thoughts/memories of the event, causing the individual to blame themselves/others
  • persistently negative emotional state
  • decreased interest in participating in daily activities
  • feeling of detachment from others
  • inability to experience positive emotions

Criterion E

alterations in arousal/reactivity (≥ 2 of the following)

  • irritable behavior/angry outbursts, expressed as verbal or physical aggression towards other people/objects
  • reckless/self-destructive behavior
  • hypervigilance
  • exaggerated startle response
  • problems with concentration
  • sleep disturbances
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61
Q

Modes of exposure in PTSD

A

Exposure of death, serious injury, or sexual violence must have occured in one of the following ways

  1. Directly experiencing event(s)
  2. Witnessing event(s) as occured to others
  3. Learning that a family member/friend experience such an event
  4. Directly experiencing repeated/extreme exposure to horrific details of an event
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62
Q

Acute Stress Disorder (ASD)

A

Basically early PTSD

Key is the timeframe. PTSD

Only difference: Criteria B-D must persist for 3days - 1 month after exposure (vs >1 month for PTSD)

Earlier treatment can decrease the risk of full PTSD onset

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63
Q

PTSD & ASD - summary/short version

A

Must be exposed to life-threatening or potentially fatal situation

5 categories of symptoms must be present

  1. Re-experiencing the event (dreams, flashbacks, etc…)
  2. Avoidance (of thoughts, feelings, memories, people, etc…)
  3. Dissociative symptoms (Dissociative amnesia, time slowing, etc…)
  4. Negative mood
  5. Changes in arousal (Hyper-arousal, hypervigilance, sleep changes, decreased concentration, etc…)

ASD: Symptoms present 3 days to 1 month after exposure

PTSD: Symptoms present >1 month after exposure

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64
Q

PTSD & ASD occurence/prevalence

A

Lifetime prevalence

  • PTSD - 8%
  • ASD - 5-15%

Women > men

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65
Q

PTSD & ASD - treatment

A

Psychotherapy:

  • Initial support, grounding, validation of feelings
  • Relive event vs seal over and move on (as in other disorders)

Pharmacotherapy

  • 1st line: SSRIs
  • 2nd line: TCAs (Amitryptyline & Imipramine), atypical antipsychotics
  • 3rd: MAOi, trazodone, anticonvulsants, clonidine, propanolol

Prazosin (α1 inhibitor) for nightmares

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66
Q

Dyssomnia

A
  • sleep disorder characterized by problems in timing, quality, or amount of sleep
    examples: insomnia, sleep apnea, narcolepsy
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67
Q

Parasomnia

A
  • sleep disorder characterized by abnormalities in physiology or behavior associated with sleep
    examples: Bruxism, nightmare disorder, sleep terror disorder, sleepwalking disorder
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68
Q

Insomnia (DSM-V diagnosis)

A
  1. Complaint of dissatisfaction with sleep quantity or quality associated with at least one of the following symptoms
    • difficulty initating sleep
    • difficulty maintaining sleep
    • early-morning awakening with inability to return to sleep
  2. Sleep disturbance causes distress or impairment in social, occupation, educational, academic, behavioral, or other important areas of functioning
  3. Disturbance occurs at least 3 nights/week and for >3 months
  4. Not attributable to other substances or disorders
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69
Q

Excitatory neurotransmitters in excess at night in insomnia

A
  • —Norepinephrine from the locus ceruleus (keeps you awake, alert via frontal lobe stimulation)
  • —Serotonin from the raphe nucleus (pushes you into lighter sleep)
  • —Dopamine from the ventral tegmental area
  • —Histamine from the tuberomammillary nucleus
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70
Q

—Inhibitory neurotransmitter deficiency at night in insomnia

A
  • —Loss GABA tone
  • —Loss of melatonergic tone
  • —Loss of adenosinergic tone
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71
Q

Delusional disorder

A

Patients have a crystallized, often single delusion

They do not have hallucinations or thought disorder like schizophrenia

They often have normal lives

delusions cannot be substance induced or due to another disease

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72
Q

Capgras delusion

A

imposter delusion

Delusion where pt feels like someone has been replaced by an imposter

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73
Q

Fregoli delusion

A

Delusion belief that different people are in fact a single person who changes appearance or is in disguise.

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74
Q

Vampirism

A

Delusion that one is a vampire

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75
Q

Lycanthropy

A

the delusion that one is a werewolf

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76
Q

Folie a Deux

A

syndrome in which symptosm of a delusion is transmitted to another

Foli imposee - likely has the delusion

Folie simultanee - incorporates delusion into his/her life

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77
Q

Cotard’s delusion

A

a rare mental illness, in which an afflicted person holds the delusion that they are dead, either figuratively or literally.

Typically occurs with another disease, but can occur by itself.

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78
Q

Krokodil (desomorphine)

A

Heroin-like drug that rots flesh and bone

Drug is injected into a user’s tissue can turn the skin scaly and green like a crocodile.

Festering sores, abscesses and blood poisoning are often seen among users.

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79
Q

Morgellons

A

aka delusional parasitosis

patient believes they are infested, can see and often see or feel parasites in or on them

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80
Q

delusional parasitosis

A

aka morgellons

patient believes they are infested, can see and often see or feel parasites in or on them

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81
Q

Erotomania

A

type of delusion in which the affected person believes that another person, usually a stranger, high-status or famous person, is in love with him or her

Ilness often occurs during psychosis, especially in patients with schizophrenia, delusional disorder or bipolar mania

treatment

  • these are psychotic conditions w/ the assumption that there is too much mesolimbic dopamine activity similar to schizophrenia
  • antipsychotics are sometimes effective, but often times not
  • psychotherapy may help patients cope, lower anxiety or agitation
  • be non-judgemental, nonincredulous, nonchallenging, empathic, facilitate communication
82
Q

Erotomania - treatment

A
  • these are psychotic conditions w/ the assumption that there is too much mesolimbic dopamine activity similar to schizophrenia
  • antipsychotics are sometimes effective, but often times not
  • psychotherapy may help patients cope, lower anxiety or agitation
  • be non-judgemental, nonincredulous, nonchallenging, empathic, facilitate communication
83
Q

Why do antihistamines cause weight gain?

A

Anything that blocks H1 receptors blocks the satiety center in the brain causing one to continue eating as if they are never full

84
Q

What drugs are associated with weight gain?

A

block H1 – blocks satiety center

anti-muscarinics (ACh)

block 5HT2c – causes fat cells to grow bigger

block D2 receptor – increases in prolactin is associated with weight gain

85
Q

Weight loss management drugs

A
  1. Amphetamines - decreases appetite
  2. Orlistat - lipase inhibitor
  3. Topiramate/Phentermine combo - improved carb metabolism, less gluconeogenesis, appetite suppressant
  4. Naltrexone/bupropion combo - dampens reward of eating, appetite suppressant
  5. Lorcaserin - blocks 5H2C receptors to increase metabolism, lessen tendency to store fat, improve leptin sensitivity?
86
Q

Amphetamines - weight loss mechanism

A

decreases appetite

87
Q

Orlistat

A

lipase inhibitor (fat inhibitor)

Coats your gut and essentially prevents the absorption of fat. You poop it out. Feces very oily and will definitely feel accidents when eating high fat diets

88
Q

Topiramate/Phentermine combo

A

Epilepsy medicine

improved carb metabolism, less gluconeogenesis, appetite suppressant

89
Q

Naltrexone/bupropion combo

A

Naltrexone - NE reuptake inhibitor. NE goes up –> curves appetite

Dampens reward of eating, appetite suppressant

90
Q

Lorcaserin

A

stimulate 5H2C receptors to increase metabolism, lessen tendency to store fat, improve leptin sensitivity?

91
Q

Anorexia Nervosa - diagnosis

A

DSM-V

  • Restriction of energy intake requirements –> low body weight
  • fear of gaining weight
  • body image disturbance (dysmorphism)

DSM-IV: includes the above 3 and:

  • refusal to maintain 85% typical weight
  • Missed menstrual cycles x3 (removed as it does not apply to men)

Severity is based off BMI

92
Q

Personality profile of aneroxics

A

More rigid, controlling and inflexible

high achieving (type A personalities)

obsessive compulsive

perfectionists

93
Q

anorexia - medical issues

A
  • weight loss
  • hypothermia
  • edema - not enough protein to keep water in your blood so it flows into tissues
  • bradycardia, hypotension, syncope
  • amenorrhea
  • electrolyte imbalance, low K+
  • ST, T, QT cardiac changes
  • Lanugo hair (fine white hair)
  • osteoporosis
  • delayed gastric emptying
  • metabolic acidosis
  • organ failure
94
Q

anorexia treatment

A

mostly behavioral management

95
Q

Bulimia Nervosa

A
  • Recurrent binge eating
  • eating an atypically large amount in discrete period of time disproportionate to typical eating
  • purging vs non-purging types
  • no anorexia present
  • loss of control
  • compensatory behaviors necessary for diagnosis. behaviors such as vomiting, laxative use, enemas, diuretics, exercise
  • binges 1X/wk for 3 months
96
Q

bulimia diagnosis

A
  • purging vs non-purging types w/ no anorexia present
  • compensatory behaviors necessary for diagnosis, such as vomiting, laxative use, enemas, diuretics, exercise
  • binges 1X/wk for 3 months
97
Q

bulimia - personality profile

A

erratic

emotional

chaotic

outgoing, angry, impulsive traits

98
Q

bulimia - cause

A

believe to be low serotonin

99
Q

bulimia - medical issues

A
  • poor dentition, enamel loss, cavities – typically associated with excess vomiting
  • abraided knuckles (Russell’s Sign) - from the afflicted’s knuckles making contact with the incisor teeth during the act of inducing the gag reflex at the back of the throat with their finger(s).
  • Normal/overweight
  • sexually active
  • lab changes
    • low PO4, low Mg
    • high amylase
  • salivary enlargement
  • esophagitis/tears
100
Q

Russell’s Sign - associated with bulimia

A

defined as calluses on the knuckles or back of the hand due to repeated self-induced vomiting over long periods of time (ie abraided knuckles)

The condition generally arises from the afflicted’s knuckles making contact with the incisor teeth during the act of inducing the gag reflex at the back of the throat with their finger(s).

101
Q

bulimia - treatment medications

A

SSRIs are approved

103
Q

PICA

A

persistent eating of nonutritive substances x 1 months

not developmentally or culturally appropriate

not medical or from intellectual disability or autism

104
Q

Rumination

A

repeated regurgitation and re-chewing of food

no weight gain

not medical or from intellectual disability or autism

often before 6 years

105
Q

Avoidant/restrictive food intake disorder

A
  • Failure to meet diet/energy needs
  • weight loss, nutritional deficiency, supplementation needed, psychosocial distress

essentially doesn’t meet full anorexia criteria

106
Q

Binge eating disorder

A
  • Binges
  • do NOT need the compensatory behavior
  • Lack of congrol
  • ego dystonic
  • 1x/wk for 3 months
  • No purges or compensations
  • Newest FDA approved treatment is stimulate called lisdexafetamine (a prodrug in the amphetamine class)

basically a milder version of bulimia

107
Q

milder version of anorexia

A

avoidant/restriction food intake disorder

108
Q

milder form of bulimia and why?

A

binge eating disorder

only difference is there isn’t a requirement for the compensatory behavior

109
Q

Age associated cognitive changes

A
  • difficulty retrieving words and names
  • slower processing speed
  • difficulty sustaining attention when faced with competing environmental stimuli
  • learning something new takes a bigger effort
  • no functional impairment
110
Q

Mild cognitive impairment (MCI)

A

basically people who have some problems with memory but are otherwise functioning perfectly normally.

  • NO loss of functional capacity (this is how you distinguish from AD or other types)

Not demented.

111
Q

Amnestic MCI (mild cognitive impairment)

A

Memory loss not meeting the criteria for dementia

Progresses to AD (alzheimer disease) at rate of 10-15% vs 1-3% incidence in general population

may be the earliest phase of AD

112
Q

Genes associated with early-onset AD

A

X #1 - abnormal presenilin 2

X #14 - abnormal presenilin 1

X #21 - abnormal amyloid precursor protein

113
Q

Genes associated with late-onset AD

A

Chromosome 19 - apolipoprotein E4 gene implicated

114
Q

late-onset AD

A

most common form

develops after age 60

combination of factors likely responsible

Chromosome 19 - apolipoprotein E4 gene implicated

115
Q

most common cause of dementia

A

alzheimer disease

116
Q

Cerebral atrophy associated with Alzheimer Disease

A

atrophy will occur in the frontal, temporal and parietal lobes.

occipital lobe spared for unknown reason.

117
Q

What makes Alzheimer disease unique?

A

ONLY disease that is both a beta amyloidopathy and a tauopathy

  • extracellular deposits of beta-amyloid peptide (Aß) associated with dystrophic neurites
  • Filamentous intracellular inclusions of tau proteins called neurofibrillary tangles (NFTs) and neuropil threats (NTs)
118
Q

Most atrophied part of brain in Alzheimer

A

Atrophy in parietal, temporal and frontal lobes with occipital lobe sparring.

Atrophy of the hippocampus most pronounced over any other part.

119
Q

How do neurofilament tangles arise and why are they dangerous? (tau)

A

NFTs arise due to hyperphosphoyrlation of tau, a microtubule-associated protein.

They are dangerous because they conform the neuron structure and are insoluble. When the neuron dies due to aggregation of the tau protein, the body cannot clear it (insoluble)

120
Q

Alzheimer Disease

121
Q

Depression vs dementia

A

Depression in old people can often lead to AD.

The symptoms of depression and dementia often overlap

  • Patients with primary depression
    • demonstrate less motivation during cognitive testing
    • express cognitive complaints that exceed measured deficits
    • maintain language and motor skills
  • People with dementia on the other hand will:
    • try very hard to do well
    • positive review of systems
122
Q

Frontotemporal Dementia

A

Also known as Pick’s Disease

Characterized by emotional blunting resulting in decline in social interpersonal conduct –> worldwind of inappropriateness.

  • Insidious onset, gradual progression
  • early impairment in regulation of personal conduct with loss of insight
  • early decline in social interpersonal conduct
  • early emotional blunting
  • characterized by behavioral abnormalities
  • memory loss and dementia occurs later
123
Q

Pick’s Disease

A

Also known as frontotemporal dementia

Characterized by emotional blunting resulting in decline in social interpersonal conduct –> worldwind of inappropriateness.

  • Insidious onset, gradual progression
  • early impairment in regulation of personal conduct with loss of insight
  • early decline in social interpersonal conduct
  • early emotional blunting
  • characterized by behavioral abnormalities
  • memory loss and dementia occurs later
124
Q

Frontotemporal dementia - treatment

A

No role for cholinesterase inhibitors

Careful use of atypical antipsychotics (quetiapine, risperdol etc..)

Divalproex for behavior control

SSRIs for irritability, depression, impulsive behaviors.

125
Q

Congo red

A

stains amyloid fibrils (assoicated with Alzheimer Disease)

126
Q

Alzheimer disease - treatment categories

A

Cholinergic therapy (rivastigmine, donepezil, galantamine)

NMDA receptor antagonists (memantine)

Investigational agents

Treatment of neuropsychiatric symptoms in AD patients

127
Q

Why do anticholinesterase’s work? (for AD)

A

There is a degeneration of the basal nucleus of Meynert (aka nucleus basalis) in AD that is normally responsible for ACh production –> ACh deficiency.

This contributes to memory deficits that characterize this disorder

128
Q

Side effect of AChE inhibitors

A

Typically associated with GI –> N&V

Sleep disturbance also associated

129
Q

Donepezil

A

Mech: inhibits AChE

Metabolims: Cyt P450

Therapeutics: all stages of Alzheimer Disease (only drug approved for all stages)

SE: N&V, sleep disturbance

130
Q

Rivastigmine

A

Mech: Inhibits AChE and BuChE

Metabolism: hydrolysis by cholinesterases

Therapeutics: only drug in transdermal-patch form. Used in treatment for AD.

SE: N&V, sleep disturbance

131
Q

Galantamine

A

Mech: inhibits AChE and allosteric modulator of nicotinic receptors

Metabolism: Cyp450

Therapeutics: Alzheimer disease. Not used as commonly as donepezil and rivastgimine

SE: N&V, sleep disturbance

132
Q

Memantine - what does it do and why does it work?

A

Mechanism: NMDA receptor antagonist

SE: dizziness, confusion, headache, constipation

Metabolism: mostly excreted unchanged in urine

Therapeutics: Alzheimer disease

  • in AD, there is abnormal (increased) NMDAR activity. Excessive activity –> excitotoxicity –> neuronal damage/death
  • This drug aims to reduce that excessive activity. Side effects are associated with downregulation activity
133
Q

Lewy bodies

A

fibriller deposits of a presynaptic terminal protein call α-synuclein (Lewy body)

Most commonly found in

  • Parkinson’s Disease
  • Dementia with Lewy Bodies

Oversimplification:

  1. if disease happened first in cortex –> dementia w/ lewy bodies
  2. if disease happened first in substantia nigra –> Parkinson
134
Q

Parkinson Disease

A

1-2% of people over 65

Most cases sporadic

Cardinal symptoms

  • resting tremor
  • difficulty initiating movement (akinesia)
  • slowed movement (bradykinesia)
  • rigidity
  • shuffling gait
  • postural instability
  • dementia occurs in some cases

Dopaminergic deficit

Response to L-Dopa therapy

135
Q

Parkinson Disease - cardinal symptoms

A

resting tremor

  • difficulty initiating movement (akinesia)
  • slowed movement (bradykinesia)
  • rigidity
  • shuffling gait
  • postural instability
  • dementia occurs in some cases
136
Q

What is required histologically to diagnose Parkingson Disease?

A

Lewy bodies in substantia nigra

137
Q

What is the disease diagnosis if, histologically, there are lewy bodies in substantia nigra?

A

Parkingson disease

138
Q

What is the disease diagnosis if the following is found on histology?

  • Pallor of the substantia nigra
  • No presence of lewy bodies
A

Progressive supranuclear palsy or

Cortical basilar degeneration

MUST have Lewy bodies to diagnose Parkinson

139
Q

Neuropathology of Parkinson Disease

A

Gross: pallor of the substantia nigra

Microscopic:

  • degeneration and loss of the pigmented, dopaminergic neurons of the substantia nigra pars compacta and other pigmented neurosn of the brainstem such as locus ceruleus
  • Neurons contain eosinophilic inclusions called Lewy Bodies
  • Other nuceli such as the cholinergic nucleus basalis of Meynert are also affected
  • Striatum, thalamus and other cortical regions are functionally affected due to the loss of dopaminergic input
140
Q

Dementia with Lewy Bodies (DLB)

A

Sporadic, primarily late-onset

Memory frequently less affected compared to AD

Frontal and subcortical features – deficits in attention and alertness are prominent

pronounced fluctuations and variations in symptoms

Neuropsychiatric symptoms – vivid visual hallucinations, delusions

Motors symptoms of PD are variably present

141
Q

Neuropathology of (DLB)

A

Gross: Nigral pallor. Cortical atrophy is less severe than in AD. Atrophy of limbic areas is often significant.

Microscopic:

1) “Cortical”-type Lewy bodies (LBs) in frontal, temporal, and insular cortex, and in limbic areas (amygdala, cingulate gyrus – the first places where LBs form in this disease).
2) Nigral LBs.
3) LNs (lewy neurites), especially in hippocampus and striatum.
4) DLB patients usually have plaques and tangles, and a dual diagnosis of DLB and AD applies in most cases.

142
Q

First place that Lewy bodies form in Dementia w/ Lewy Bodies

A

amygdala, and cingulate gyrus

143
Q

Does the brain atrophy in DLB like it does with AD?

A

No. Barely any cortical atrophy. Biggest prominence is the pallor that develops in the substantia nigra.

144
Q

Lewy Body Dementia - clinical features

A

žShort term memory loss, gradual onset

žVisual hallucinations - more so than any of the other diseases

žCognitive fluctuations

žREM sleep disorder is common - will pantomime (act out) their dreams

žFrequent falls

žAutonomic dysfunction

145
Q

Lewy Body - treatment

A
  • žCholinesterase inhibitors may provide symptomatic support
  • žTrial of carbidopa/levodopa for severe movement symptoms
  • žAVOID antipsychotic drugs due to increased sensitivity
    • enhance any Parkinson symptoms
  • žREM Sleep Disorder: Clonazepam
146
Q

Lewy Body vs. Parkinson’s Dementia

A

žLewy Body Dementia

  • Onset of dementia within 12 months of parkinsonism

žParkinson’s disease and dementia

  • Onset of dementia more than 12 months after the diagnosis of PD
147
Q

Activities of Daily Living

A

If you can’t do ADLs - you pretty much die… acronym DEATH

D - Dressing

E - eating

A - ambulating

T - toileting

H - hygiene

148
Q

Instrumental Activities of Daily Living

A

If you can’t do iADLs, you don’t die but you get “SHAFT”ed

S - Shopping

H - housekeeping

A - Accounting

F - Food preparation

T - Transportation

149
Q

Psychosexual stages of development - oral phase

A

Birth - 1.5 years

Sucking and dependent

Adult “oral” traits: enjoy food, chew gum, smoke, drink

  • passive, dependent
150
Q

Psychosexual stages of development - anal phase

A
  • Libidoà Anal: 1 ½ - 3 years
    • Crawling, exploring
    • “No!”
    • Potty training
      • (holding on, letting go)
    • terrible twos (paradise lost!)
151
Q

Psychosexual stages of development - phallic phase

A

Between 3 to 5/6 years

This is the period when children are curious about their sexual difference

close to parent of the opposite sex

  • Oedipal complex in boys
  • electra complex in girls
152
Q

Psychosexual stages of development - latency phase

A

between 6 years and adolescent. Not much happens.

Girls scouts and boy scouts

153
Q

Psychosexual stages of development - genital phase

A

Adolescent to adult and onwards

This is the phase where children acquire and develop for capacity for true intimacy

154
Q

Id - structural model of the mind

A

This refers to the “child” within someone or the childish characteristics

155
Q

structural model of the mind (Id, Ego, Superego)

A

Id = child

Ego = adult (growing, evolving and has to do with “I”)

Superego = parent (rules, morales, values – develops based on input from authorities)

156
Q

Ego defense mechanisms

A

Occurs when ego is under stress.

“can’t deal with this” –> anxiety –> ego defense mechanisms

Purpose: to decrease distress; make reality better

Level I - Psychotic mechanisms

Level II - Immature mechanisms

Level III - Neurotic defenses

Level IV - Mature mechanisms

157
Q

Defense Mechanisms - “Psychotic Mechanisms”

A
  1. Delusional projection - frank delusions about external reality, usually of a presecutory type
  2. Psychotic denial - denial of external reality
  3. distortion - grossly reshaping external reality to suit inner needs

Common in “healthy” individuals before age 5

Common in adult dreams and fantasy

  • For the user – these mechanisms alter reality
  • To the beholder, they appear “crazy”
158
Q

Delusional Projection

A

Frank delusions about external reality, usually of a presecutory type

Class: Psychotic Defense Mechanisms

Common in “healthy” individuals before age 5

Common in adult dreams and fantasy

  • For the user – these mechanisms alter reality
  • To the beholder, they appear “crazy”
159
Q

Psychotic denial

A

Class: Psychotic Defense Mechanisms

denial of external reality

Common in “healthy” individuals before age 5

Common in adult dreams and fantasy

  • For the user – these mechanisms alter reality
  • To the beholder, they appear “crazy”
160
Q

distortion

A

Class: Psychotic Defense Mechanisms

Grossly reshaping external reality to suit inner needs

Common in “healthy” individuals before age 5

Common in adult dreams and fantasy

  • For the user – these mechanisms alter reality
  • To the beholder, they appear “crazy”
161
Q

Defense Mechanisms - “Immature Mechanisms”

A
  1. Projection - attributing one’s own unacknowledged feelings to others
    • includes severe prejudice, rejections of intimacy through unwarranted suspicion, marked hypervigilance to external danger and injustice-collecting
    • behavior may be eccentric and abrasive but within the ‘letter of the law’.
    • assoicated with paranoid personality
  2. Somatization - turning an unacceptable impulse or feeling from bereavement, lonelinees, fear or anger into complaints of pain or somatic illness
    • ie ‘My chest hurts’ rather than ‘ please pay attention to me’ or ‘please care about me’
    • associated with hypochondriac, and psychosomatic disorders
  3. Acting out - direct expression of an unconscious wish or impulse in order to avoid being conscious of the affect that accompanies it
    • deliquent or impulsive act to avoid being aware of one’s feelings (ie of anger or sadness)
    • doing instead of think or feeling

Common in “healthy” individuals ages 3 to 15

Seen in personality disorders

  • For the user, alter distress due to the threat of interpersonal intimacy or its loss
  • For the beholder, they appear socially undesirable
162
Q

Projection

A

Projection - attributing one’s own unacknowledged feelings to others

  • includes severe prejudice, rejections of intimacy through unwarranted suspicion, marked hypervigilance to external danger and injustice-collecting
  • behavior may be eccentric and abrasive but within the ‘letter of the law’.
  • assoicated with paranoid personality

Class: Immature defense mechanisms

Common in “healthy” individuals ages 3 to 15

Seen in personality disorders

  • For the user, alter distress due to the threat of interpersonal intimacy or its loss
  • For the beholder, they appear socially undesirable
163
Q

Somatization

A

Class: Immature defense mechanisms

Somatization - turning an unacceptable impulse or feeling from bereavement, lonelinees, fear or anger into complaints of pain or somatic illness

  • ie ‘My chest hurts’ rather than ‘ please pay attention to me’ or ‘please care about me’
  • associated with hypochondriac, and psychosomatic disorders

Common in “healthy” individuals ages 3 to 15

Seen in personality disorders

  • For the user, alter distress due to the threat of interpersonal intimacy or its loss
  • For the beholder, they appear socially undesirable
164
Q

Acting Out

A

Class: Immature defense mechanisms

Acting out - direct expression of an unconscious wish or impulse in order to avoid being conscious of the affect that accompanies it

  • deliquent or impulsive act to avoid being aware of one’s feelings (ie of anger or sadness)
  • doing instead of think or feeling

Common in “healthy” individuals ages 3 to 15

Seen in personality disorders

  • For the user, alter distress due to the threat of interpersonal intimacy or its loss
  • For the beholder, they appear socially undesirable
165
Q

Defense Mechanisms - “Neurotic Mechanisms”

A
  1. Denial - unable to accept (therefore seems to ignore/be unaware of / denies) intolerable facts about relation
    • the commonest defense seen in medical practice
  2. Displacement - the redirection of feelings toward a relatively less cared for object than the person or stiutation arousing the feelings
    • If angry at your boss but unable to say anything, you replace her by a thing (kick a chair) or a stranger (road rage)
    • Most phobias, many hysterial conversion reactions and prejudice involve displacement
  3. Dissociation - temporary but drastic modification of one’s character or of one’s sense of personal identity to avoid emotional distress
    • acute reaction to trauma, multiple personality disorder
  4. Identification - unconscioous patterning of one’s behavior after a power, influential person
    • adopting the habits of a parent or coach
    • behaviors/parenting style “runs in families”
    • Stockholm syndrome ‘identification with the aggressor’
  5. Intellectualization - thinking about instinctual wishes in formal, affectively bland terms, and not acting on them. The idea is in consciousness, but the feeling is missing (ie rationalization, magical thinking)
  6. Reaction formation - behavior in a fashion diametrically opposed to an unacceptable instinctual response
    • overtly caring for someone else when one wishes to be cared for oneself
    • ‘hating’ someone or something one really likes; ‘loving’ a hated rival or unpleasant duty
  7. Regression - appearance of child-like behavior during periods of stress
  8. Undoing - Protecting against a negative past event by acceptable “corrective” behavior (ie superstitious rituals or formal atonement or confession)

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
166
Q

Denial

A

Denial - unable to accept (therefore seems to ignore/be unaware of / denies) intolerable facts about relation

the commonest defense seen in medical practice

Class: Neurotic Mechanisms

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
167
Q

Displacement

A

Class: Neurotic Mechanisms

Displacement - the redirection of feelings toward a relatively less cared for object than the person or stiutation arousing the feelings

  • If angry at your boss but unable to say anything, you replace her by a thing (kick a chair) or a stranger (road rage)
  • Seen in most phobias, many hysterial conversion reactions and prejudice involve displacement

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
168
Q

Dissociation

A

Class: Neurotic Mechanisms

Dissociation - temporary but drastic modification of one’s character or of one’s sense of personal identity to avoid emotional distress

  • acute reaction to trauma, multiple personality disorder

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
169
Q

Identification

A

Class: Neurotic Mechanisms

Identification - unconscioous patterning of one’s behavior after a power, influential person

  • adopting the habits of a parent or coach
  • behaviors/parenting style “runs in families”
  • Stockholm syndrome ‘identification with the aggressor’

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
170
Q

Stockholm syndrome

A

Psychological phenomenon where the hostage identifies with the aggressor.

Expression of sympathy and empathy and positive feelings toward their captors sometimes to the point of defending and identifying with the them

Associated with identification - a neurotic mechanism that is normally seen in healthy humans

171
Q

Intellectualization

A

Class: Neurotic Mechanisms

Intellectualization - thinking about instinctual wishes in formal, affectively bland terms, and not acting on them. The idea is in consciousness, but the feeling is missing (ie rationalization, magical thinking)

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
172
Q

Reaction formation

A

Class: Neurotic Mechanisms

Reaction formation - behavior in a fashion diametrically opposed to an unacceptable instinctual response

  • overtly caring for someone else when one wishes to be cared for oneself
  • ‘hating’ someone or something one really likes; ‘loving’ a hated rival or unpleasant duty

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
173
Q

Regression

A

Class: Neurotic Mechanisms

Regression - appearance of child-like behavior during periods of stress

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
174
Q

Undoing

A

Class: Neurotic Mechanisms

Undoing - Protecting against a negative past event by acceptable “corrective” behavior (ie superstitious rituals or formal atonement or confession)

Common in “healthy” individuals ages 3-90

Seen in neurotic disorder and in acute stress

  • For the user, these alter private feelings or instinctual expression
  • For the beholder, they are quirks or “hang-ups”
175
Q

Defense mechanisms - Mature mechanisms

A
  1. Altruism - vicarious but constructive and instinctually gratifying service to others
  2. Sublimation - indirect or attenuated expression of instincts w/o either adverse consequences or marked loss of pleasure
    • expressing aggression through pleasurable games, sports and hobbies
    • romantic attentuation of instinctual expression during a real courtship
    • instincts are channeled rather than dammed or diverted. Successful artistic expression remains the classic example
    • feelings are acknowledged, modified, and directed toward a relatively significant person or goal so that modest instinctual satisfaction results
  3. Anticipation - realistic anticipation of or planning for future inner discomfort
    • includes goal-directed but overly careful planning or worrying (premature but realistic affective anticipation of death or surgery or separation)
  4. Suppression - the conscious or semiconscious decision to postpone paying attention to a conscious impulse or conflict
    • deliberately postponing but not avoiding. “I will think about it tomorrow”; and the next day one remembers to think about it
  5. Humor - overt expression of ideas and feelings without individual discomfort or immobilization and w/o unpleasant effect on others
    • like hope, humor permits one ot beat and yet to focus upon what is too terrible to be borne

Common in “healthy” individuals ages 12-90

  • For the user, they integrate reality, interpersonal realationships, and private feelings
  • For the beholder, they appear as convenient virtues
176
Q

Altruism

A

Class: Mature defense mechanisms

Altruism - vicarious but constructive and instinctually gratifying service to others

Common in “healthy” individuals ages 12-90

  • For the user, they integrate reality, interpersonal realationships, and private feelings
  • For the beholder, they appear as convenient virtues
177
Q

Sublimation

A

Class: Mature defense mechanisms

Sublimation - indirect or attenuated expression of instincts w/o either adverse consequences or marked loss of pleasure

  • expressing aggression through pleasurable games, sports and hobbies
  • romantic attentuation of instinctual expression during a real courtship
  • instincts are channeled rather than dammed or diverted. Successful artistic expression remains the classic example
  • feelings are acknowledged, modified, and directed toward a relatively significant person or goal so that modest instinctual satisfaction results

Common in “healthy” individuals ages 12-90

  • For the user, they integrate reality, interpersonal realationships, and private feelings
  • For the beholder, they appear as convenient virtues
178
Q

Anticipation

A

Class: Mature defense mechanisms

Anticipation - realistic anticipation of or planning for future inner discomfort

  • includes goal-directed but overly careful planning or worrying (premature but realistic affective anticipation of death or surgery or separation)

Common in “healthy” individuals ages 12-90

  • For the user, they integrate reality, interpersonal realationships, and private feelings
  • For the beholder, they appear as convenient virtues
179
Q

Suppression

A

Class: Mature defense mechanisms

Suppression - the conscious or semiconscious decision to postpone paying attention to a conscious impulse or conflict

  • deliberately postponing but not avoiding. “I will think about it tomorrow”; and the next day one remembers to think about it

Common in “healthy” individuals ages 12-90

  • For the user, they integrate reality, interpersonal realationships, and private feelings
  • For the beholder, they appear as convenient virtues
180
Q

Humor

A

Class: mature defense mechanisms

Humor - overt expression of ideas and feelings without individual discomfort or immobilization and w/o unpleasant effect on others

  • like hope, humor permits one ot beat and yet to focus upon what is too terrible to be borne

Common in “healthy” individuals ages 12-90

  • For the user, they integrate reality, interpersonal realationships, and private feelings
  • For the beholder, they appear as convenient virtues
181
Q

Transference

A

Patient’s unconscious “transfer” and replay of relationship with influential figures from the past. More likely w/ physicians.

Positive: unrealistic expectations

Negative: Mistrust, missed appointments, non-adherence, poor outcomes

182
Q

Countertransference

A

The MD’s transference to the patient - positive or negative.

183
Q

Acute vs chronic pain

A

Acute - 1 week or less

chronic - considered an autonmous disease. present for at least 6 months

184
Q

Inflammatory vs neuropathic pain

A

Inflammatory - typically refers to acute pain caused by the onset of trauma or inflammation which causes the release of prostaglandins that can mediate pain. Can be reduced with NSAIDs

Neuropathic pain - refers to chronic pain typically caused by miscellaneous nerve firings (or memory of pain potentiated via glutamate activation of NMDA receptors).

185
Q

Opiates vis Opioids

A

Opiates - derivates fo poppy plant: heroin, morphine

Opioids - any drugs that occupies opioid receptors: fentanyl, methadone

186
Q

NSAIDs - mechanism

A

Inhibit COX - enzyme that converts arachidonic acid to prostaglandins and thromboxane which provoke tissue inflammation

187
Q

NSAIDs - side effects

A

žProstaglandins protect the stomach lining from acid. COX-2 specific inhibitors; celecoxib and low dose meloxicam (7.5 mg/day) cause less gastric irritation

188
Q

Fever is mediated by what compound (associated with NSAIDs)

A

žFever is caused by prostaglandin E2. PGE2 signals hypothalamus to increase body’s thermal set point

189
Q

endorphin

A

endogenous morphine

190
Q

Treatment for neuropathic pain

A

anticovulsants

tricyclics

Opioids doesn’t really tone down the pain, but rather makes the patient less concernd about the pain

191
Q

Treatment for inflammatory pain

192
Q

Epilepsy

A

žEpilepsy is a condition where cortical neurons kindle and then fire in synchrony causing a neuromuscular seizure to occur.

žAll antiepileptic drugs (AEDs) function by lowering a neuron’s ability to fire by hyperpolarization

193
Q

Antiepileptics drugs - mechanism

A

žAll antiepileptic drugs (AEDs) function by lowering a neuron’s ability to fire by hyperpolarization.

They primarily dampen sodium and potassium influx. There are drugs targeted for chloride influx and also glutamate.

194
Q

Carbamazepine

A

Na+ channel blocker

Anti-epileptic

SE: aplastic anemia, requires blood levels, CYP3A4 inducer causing drug interactions

195
Q

lamotrigine

A

Na+ channel blocker

Anti-epileptic

SE: StevensJohnson Syndrome rash, No pain approvals

196
Q

topiramate

A

Na+ channel blocker

SE: Weight loss, acidosis, oligohydrosis, glaucoma

·For migraines

197
Q

Na+ channel blocker

A

carbamazepine

lamotrigine

topiramate

198
Q

Gabapentin

A

·Ca++ channel blockers

SE: Weight gain, sedation

·For Diabetic neuropathy

199
Q

Pregabalin

A

·Ca++ channel blockers

SE: Mild addiction, weight gain, sedation

·For Diabetic neuropathy, fibromyalgia

Unit 3 (5 decks)

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