Behavioral/Ethics Flashcards
patients with schizophrenia have what NT change?
Increased dopamine
Dopamine hypothesis: hyperactive dopaminergic activity in the mesolimbic system leads to psychosis, and dec in mesocortical dopamine causes negative and cognitive sx.
patient with dilated pupils, tremors, inc HR and RR, lack coordination, hallucinations, and ideas of reference from TV are consistent with intoxication with what?
LSD (hallucinogen)
dry mouth, slowed reactions, inc appetite are common symptoms of ____ intoxication?
cannabis.
Nightmares are a common symptom accompanying withdrawal from what?
Amphetamines or alcohol
Hallucinations while falling asleep is a common symptom of what condition?
Narcolepsy
What is it called when we respond to people or situations in the present as if they were people or situations from our past experience?
Transference
Dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds are common signs of _____ withdrawal
heroin
Delusions, hallucinations, disorganized speech for at least 1 mo. Negative sx (flat affect, asociality, anhedonia). Continuous signs for >6mo
Schizophrenia
In what disorders do psychotic symptoms occur EXCLUSIVELY during major depressive or manic episode?
Major depressive disorder with psychotic features
Bipolar disorder
Acute onset of psychotic symptoms >=1 day but <1 mo with full return to premorbid level of functioning
Brief psychotic disorder
How is schizophreniform disorder different from schizophrenia?
> 1 mo and <6mo
Delusions or hallucinations can occur in the ABSENCE of mood symptoms for >=2 wk at some point
SchizoAFFECTIVE
Violent behavor, hallucinations, nystagmus, amnesia, and ataxia are signs of ____ intoxication
PCP - phencyclidine
Chest pain, agitation, euphoria, seizures, tachycardia, HTN are signs of ____ intoxication
Cocaine
Violent behavior, choreiform movements, tooth decay are signs of _____ intoxication
Methamphetamine
Differentiate chronic tic disorder from Tourretes
Chronic tic disorder: 1+ motor or verbal tics (but not both) for >= 1 year
Tourretes: BOTH vocal and motor tics
How does opioid intoxication present?
Miosis, depressed mental status, dec resp rate, dec bowel sounds
HYPOtension, BRADYcardia
Differentiate delusional disorder from paranoid personality disorder
Delusional: >=1 delusions in absence of other psych sx
Paranoid personality: persistent patterns of behavior pervasive across broad range of situations. Suspiciousness or distrust of many people.
Selection bias created by choosing hospitalized patients as the control group
Berkson’s bias
Tendency of study subjects to change behavior as a result of awareness they are being studied
Hawthorne effect
Researcher’s belief in the efficacy of treatment can potentially affect outcome
Pygmalion effect (eg case with “low IQ and high IQ students”)
Differentiate acute stress disorder from PTSD
Can present similarly - duration makes the difference
Acute stress = 3 days to 1mo after trauma
PTSD = >=1 mo
Inc appetite, hypersomnia, intense PSYCHOMOTOR RETARDATION, severe depression is a sign of ____ withdrawal
Cocaine/stimulants
Inc appetite, dysphoria, irritability, and anxiety is a sign of ___ withdrawal
nicotine
Differentiate bipolar I vs bipolar II
Bipolar I - manic episodes +/- depressive episodes
Bipolar II - hypomanic + >=1 depressive episode
Note: hypomanic - no psychosis and able to work without hosp.
Learning disorder vs ADHD?
Learning d/o difficulty with key academic skills (eg reading, writing, math) –> low performance.
ADHD - inattentive/hyperactive across at least 2 settings
College student with paranoid ideation tachy, HTN, hyperthermia, diaphoresis, mydriasis indicates what?
Substance-induced psychotic disorder
Note: brief psychotic disorder is similar, but less likely in college students. Substance abuse more likely
Deficits of voluntary motor and/or sensory function that are incompatible with any recognized neurological condition
Conversion disorder
Note: somatic symptom d/o is characterized by excessive and persistent health anxiety and preoccupation with multiple somatic symptoms.
Increased appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity are hallmarks of what?
Atypical depression
Tx with MAOI - eg phenelzine
Differentiate repression from suppression from rationalization
Repression - unacceptable thoughts or feelings are blocked from entering conscious awareness
Suppression - mature defense mech involving conscious choice not to dwell on a particular thought or feeling.
Rationalization - making excuses for unacceptable feelings or situations.
In the US, the majority of overdose deaths are caused by what?
opioids - prescription analgesics and heroin
Individuals with this personality disorder appear to comply or act appropriately, but actually behave negatively and passively resist. This personality disorder is a chronic condition, meaning that it lasts throughout life.
passive-aggressive personality disorder
Boy with daily headaches, confused, forgetful, clumsy, broad-based, ataxic gait is suspicious of what substance abuse?
inhaled glue - intentional inhalation of volatile
hydrocarbons, such as model glue, correction fluid, spray paint, and gasoline, to achieve
an altered mental state.
It is a common health problem in adolescence. “quick drunk” because it resembles alcoholic intoxication. Initially, euphoria develops; then, lightheadedness and
agitation. Disorientation, ataxia, and dizziness might develop with increasing intoxication. In extreme cases, generalized weakness, hallucinations, and nystagmus can occur. Abusers often show deterioration in school performance, disturbance of family relationships, and increased risk-taking behaviors. Encephalopathy is the major chronic morbidity following chronic inhalant abuse. Hydrocarbons are highly lipophilic and can
easily distribute to the brain.
If you are giving a patient bad news and before you can tell them they say “it’s bad news, isn’t it?”, what do you say?
Yes it is.
Patient with close friend who wants to stay after visiting hours when the unit policy is only family members are permitted to stay. What do you say?
“the two of you seem to have a very important relationship. Of course you may stay together”
What do you do if a patient’s family member wants to give a benign folk medicine instead of the treatment you are giving?
Negotiate rather than order
Treatment choices are the result of agreement, not commands by the physician.
Relationship and agreement support adherence.
Accept the health beliefs of the patients
Be accepting of benign folk medicine practice. Expect them. Dx need to be explained in the way patients can understand, even if not technically precise.
Offer to explain things to family members for the patients
What symptoms would be more likely to improve in a patient treated with clozapine rather than haloperidol?
Atypical antipsychotics (e.g. clozapine, quetiapine, etc) are more likely to improve NEGATIVE symptoms (affective flattening, anhedonia, avolition, aphasia) when compared to typical antipsychotics (e.g. haloperidol). They are no more effective at treating positive symptoms (hallucinations, delusions). Highly testable fact.*
