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psychiatry shlav alef > chapter 32-end > Flashcards

chapter 32-end Flashcards

1
Q

robert butler- middle adulthood (40-65)

A

aging
taking stock of accomplishment and setting goals for future.
reassessing commitments to family, work, and marriage.
dealig with parental illness and death
attending to all developmental tasks withou losing capacity to experiene pleasure

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2
Q

george valliant- factors correlating with emotional well being in middle adulthood

A

physical health
psychosocial adjustment during college years
stable parental home
close sibling relationship durng college years
capacity to work during chilhood

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3
Q

climacterium

A

during middle adulthd- decreased biological and hysiological functioning-womes menopause (40-55),
male’s hormones stay constant at 40-50, and then begin to decline, a derease in healthy sperm and seminal flid

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4
Q

Paul Bhannan- types of separation at divorce

A 
psychic divorce- recovery takes 2 years
legal divoce- 75%(W) and 80%(M) marry within 3 years
economic divorce
community divorce
coparental divorce
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5
Q

life expectancy

A

M= 77.4, F= 82.2

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6
Q

predictors for longevity

A

heriditary- 50% of fathers to people over 80 also lived past 80
other predictors- regular checkup, minimal caffeine and alcohol, work gratification and perceived sense of self as being useful, eating healthy, exercise

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7
Q

changes in causes of death -CVA, MI

A

60% decline in mortality fromm CVA, 30% in coronary

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8
Q

leading causes of death among older people

A

heart disease, cancer, stroke

also accidents are prevalent- e.g. falls- most commonly resulting from hypotension or arrythimia

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9
Q

M:F ratio with age(per 100 females)

A

55-64: 92
65-74- 83
75-84- 67
85< - 46

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10
Q

alcohol , salt, statins and longevity

A

1 oz =30 ml of alcohol a day reduce HDL and correlate with longevity
salt less than 3 gr- reduce hypertension
statins reduce CV disease in diet and exercise resistant hyperlipidemia

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11
Q

aging changes- neurons

A

degenaeration mainly in superior temoral ,precentral and inferior temporal gyri.
no loss in brainstem nuclei

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12
Q

aging- cellular changes

A

increased collagen and elastin
altered receptor sites and sensitivity
deacreased anabolism and catabolism of cellular transmitter substances

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13
Q

immune changes in aging

A

increased autoimmune,
leukocytes unchanged but reduced T lymphocytes and their response
increased ESR

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14
Q

usculoskeletal changes in aging

A

2 inch loss of height from second to 7th decade
slongation of nose and ears
deepening of thoracic cage
risk of hip fractue at age 90- 10-25%

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15
Q

weight changes - aging

A

men gain till 60, then lose

women gain till 70, then lose

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16
Q

crainal sutures closure- aging

A

parietomastoid suture does not attain complete closure until age 80

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17
Q

grey hair- aging

A

by age 50, 50% of people are 50% grey/

caused b loss of melanin

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18
Q

vision- aging

A

thickening and yellowing of optic lens
reduced peripheral visio and accomodation (presbyopia)
decreased light-dark adaptation
reduced acuity of all senses

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19
Q

hearing loss- aging

A 
high frequency hearing loss (presbyacusis):
age 60- 25%
65- 30%
75- 50%
by age 80- 65%
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20
Q

neuropsychiatric- aging

A

slowed learning new material, but still complete learning
IQ stable till 80
verbal ability maintained
decreased psychomotor speed

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21
Q

memory- aging

A

difficult to shift attention
encoding and simple recall diminish
recognition remains intact

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22
Q

neurotransmitters -aging

A

decreased NE and increased MAO and serotonin

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23
Q

brain changes - aging

A

17% decrease of brain weight by 80
wide sulci, smaller convolutions, gyral atrophy
enlarged ventricle
increased transport in BBB
decreased cerebral blood flow and oxygenation

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24
Q

cardiovascular- aging

A

increased in size and weight- lipofuscin
decreased valvulaar elasticity
cardiac output maintained in absence of coronary heart disease

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25
Q

GI- aging

A

risk for atrophic gastritis, hiatal hernia, diverticulosis

diminished saliva flow, constipation, reduced gi absorption

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26
Q

endrocrine changes- aging

A

reduced androgens and estrogen
increased LHm FSH inpostmenopause
T4, TSH normal, decreased T3
glucose tolerance test results decrease

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27
Q

respiratory functions- aging

A

decreased VC , cough reflex and bronchial ciliary action

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28
Q

stable personality traits

A

agreableness ,conscientiousness, openness to experience, neuroticism, extroversion,
A CONE
may increase agreeblenss and decreased extroversion(first letter, last letter)

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29
Q

aging- erik erikson

A

integrity(sastisfaction of past life) vs despair

contenment comes with getting beyond narcissism and into intimacy and generativity

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30
Q

George Vaillant - correlates of emotional health at 65

A

having close brothers and sister during college and developing traits of pragmatism and dependabilityin young adulthood predict well being
deression between 21-59 -emotional problems
early traumatic experiences did not crrelate with oor adaptation

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31
Q

top 10 chronic conditions in 65+

A 
arthritis
hypertension
hearing loss
heart disease
cataract
orthopedic deformities and problems
chronic sinusitis
diabetes
visual loss
varicose veins
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32
Q

depression in the elderly

A

less depression and dysthymia than youner

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33
Q

suicide rate in the elderly

A

high- 40/100,000

women perceived as mentally adn men as physically ill

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34
Q

alzheimer heredity

A

autosomal dominant in 10-30%

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35
Q

among the elderly who consider suicide- what is the most common reason

A

loneliness

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36
Q

mental morbidity among patients who commit suicide

A

75% had depression and/or alcohol

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37
Q

methodist episcopelian

A

tests broca aphasia

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38
Q

cant demnstrate use of simle objects(key, match ets)

A

ideomotor apraxia

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39
Q

test wernickes aphasia

A

naming objects

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40
Q

visuospatial functioning in the elderly

A

some decline

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41
Q

loss of abstract thinking

A

ma be an early sign of dementia

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42
Q

immediate retention and recall

A

6 digits forwards, 5-6 digits backwards in normal people

but can be impaired also in anxiety

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43
Q

effects of age and education on MMSE

A

can affect results (pg 1344)

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44
Q

effects of depression on psychomotor performance

A

impaired visuospatial and timed motor performance

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45
Q

tests for visuospatial functions

A

Bender Gestalt test

Halstead-Reitan Battery(covers entire spectrum of information processing and cognition)

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46
Q

most common psychiatric disorders in the elderly

A

depression, cognitive disability,alchol, phobia,

DeCAP

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47
Q

prevalence of dementia

A

5% above 65 -severe dementia, 15%- mild dementia

20% above 80 have severe dementai

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48
Q

delusions and hallucinations in dementias

A

75% of patients

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49
Q

treatable dementias

A

10-15%

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50
Q

subcortical dementias

A

NPH, wilson, huntington, parkinson, casculat

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51
Q

characteristics of subcortical dementia

A

movement dis,gait apraxia, psychomotor retardation, akinetic mutism, apathy

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52
Q

characteristics of cortical dementias

A

aphasia, agnosia, apraxia

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53
Q

prion disease- mutation

A

prion protein gene- PRNP- can be inherited, acquired, sporadic

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54
Q

types of prion diseases

A

autosomal dominant: CJB, gertsmann- straussler- scheinker, fatal familial insomnia
kuru- cannibalism and implantations(cornea, GH, gonadotropin)
CJD- 85% sporadic. 1/milion/year, mean age of onset- 65

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55
Q

depression among the elderly

A

15%

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56
Q

risk factors for depression in the elderly

A

not age!

widow, chronic illness.

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57
Q

recurrence in late onset depression

A

commn

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58
Q

common features in geriatric depression

A

melancholic features, somatic, hypochondriasis, sleep problems- early awakening and multiple awakenings. low self esteem, self accusations (especially about sex and sinfullness), paranoid and suiciadal ideation

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59
Q

pseudodemntia among depressive elderly

depression among dementia patients

A

15% pseudodementia among depressives

25-50% depression among dementia patients

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60
Q

schizophrenia in the elderly

A

among early onset schizohprenics- 20% show no active symptoms by age 65. the rest- varying impairments.
30% of all schizophrenics are residual- need chronic care.
late onset- usually paranoid type, more woman.

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61
Q

delusional disorder in the elderly

A

age of onset- usually 40-55. most comon-perseutory

in one study of 65 yo and older- 4% had persecutory ideation

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62
Q

paraphrenia

A

lateonset delusional disorder, typically persecutory. not associated with dementia

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63
Q

prevalence of anxiety among the elderly

A

5.5% in 1 month.
4-8% most common-phobia.
panic- 1%
rect more severly to PTSD

64
Q

percentage of chronic disorders among persons over 60

A

80%(usually arthritis and CV disease)

65
Q

alcohol dependence in nursing homes

A

20%

66
Q

percentage of alcohol and substance dis of emotional problems among the elderly

A

10%

67
Q

OTC among the elderly

A

35%-70%, and 30% use laxatives. rule out when examining symptomotoligy

68
Q

the single most importat factor associated with increased prevalence of sleep diso

A

advanced age

69
Q

most common sleep dis. among the elderly

A

dyssmonias, especially: primary insomnia, nocturnal myoclonus, restless leg syndrome, sleep apnea.

70
Q

parasomnias that almost exclusively iccur among the elderly

A

REM sleep behavior disorder

71
Q

effects of alcohol on sleep

A

fragmantation, early awakening, aggrevate apnea

72
Q

sleep changes in people over 65

A

REM: redistribution throughout the night: more REM period, but shorter and less total REM sleep
NREM: decreased delta amplitude, lower stage 3 and 4, higher 1 and 2
low amplitude of circadian rhythm, 12 hour sleep propensity ryth, shorter cycles. ,

73
Q

suicide among the elderly

A

the highest than any population. rate for white men over 65- time 5 than general population,
1/3 report loneliness as a reason for considering suicide
10 of those with suicidal ideation report financial problems, poor mecial health, depression for reason.

74
Q

suicide victims vs suicide attempts

A

60% of those who commit suicide- men.
75% of those who attempt- woman
among those who succeed- usually guns or hanging
among attemters- 70% -drug OD, 20%- cut,

75
Q

precipitants for suicide

A

most common preciitants are physical illness and loss.
most who commited suicide had a mental dis, especially depression
more of them are widowed, and few re single/divorced/separated(as opposed to younger adults)

76
Q

most common suicide precipitants among oung adults

A

problems with employment, finances and family relationships

77
Q

do the elderly communicate about their suicidal ideation

A

most ofsuicide victims communicate their thought with family or friends before commiting the act

78
Q

elder abuse

A

10%

79
Q

study of psychotherapy in an old age home

A

less urinary incontinence, improved gait, greater mental alertness, improved memory, better hearing

80
Q

Bernice Neugarten major conflict of old age

A

giving up position of authority , evaluating achievements. reconciliation with others. resolution of grief over the death of others and approaching death

81
Q

Daniel levinson

A

between 50-55 transition with developmental crisism person feels incapable of changins intolerable life structure
“late adult transition”- ages 60-65, narcissists and those too invested with body appearenceare liable to become more reoccupied with death.
creative mental activity is a normal substitute for reduced physical activity

82
Q

second and third individuation

A

second individuation- when adolescents leave their parents

third- continues through adulthood

83
Q

cavin colarusso and robert nemiroff

A

adult developmental process same as child, but child develops psychic structure, and adult continues evolution of existing structure.

84
Q

trailmaking part A

A

information processing speed; rapid graphomotor tracking

85
Q

WAIS digit symbol

A

information processing speed-rapid graphomotor tracking

86
Q

stroop A, B

A

information processing speed- rapid word reading and color naming

87
Q

finger tapping

A

motor dexterity:right and left finger dexterity

88
Q

boston naming test

A

word retrieval

89
Q

WAIS picture completion

A

visual perception

90
Q

WAIS block design

A

construction ability

91
Q

Rey-Osterieth Complex Figure

A

visuospatial- paper and pencil copy og complex design

92
Q

Beery developmental test of visual motor integration

A

paper and pencil copy of simple to complex designs

93
Q

logical memory subtest

A

immediate and delayed recall of visual designs

94
Q

Rey-Osterieth Complex Figure 3 minute delyed recall

A

delayed recall of complex design

95
Q

trailmaking part B

A

executive functions- rapid alterations between tasks

96
Q

stroop C

A

exectuive functions- inhibition of an overlearned response

97
Q

wisconsin card sorting test

A

executive functions- categorization and mental flexibility

98
Q

design fluency

A

executive functions- rapid generation of novel designs

99
Q

verbal fluency

A

executive functions- FAS and category- rapid word generation

100
Q

brain death evaluations

A

0-2 months- 48hr interval, two cofirmatory tests
2-12 months- 24 hr interval, one confirmatory test
1-18 yrs- 12 hr interval , confirmatory test- optional
above 18- optional ,confirmatory test- optional

101
Q

examples of brain death clinical criteria

A

absence of pupilary response to light, uils at midposition with respect to dilatation (4-6 mm)
absence of respiratory drive at paCO2 60 mm HG or higherm or 20 mm HG above normal baseline
coma
and more

102
Q

causes of death amng the young

A

half of 1-14, and 75% of late adolescence and early adlthood- from accidents, homicides and suicides

103
Q

preschool attitude to death

A

preoperational.
death is seen as a temporary absence, incomplete and reversible , like departure or sleep.
the main fear is seperation from care taker. - a fear that surfaces iin nightmaresm aggressive play, concern about death of others.
terminally ill preschoolers- may assume responsibility for their illness, as a unishment, and family seperation as rejection

104
Q

school age attitude to death

A

concrete operational. recognize death as a final reality, but think it happens to old people only
between ages 6-12- active phantasies of violence, aggression, often dominated by themes of death and killing.

105
Q

grief

A

צער

subjective feeling precipitated by the death of a loved one

106
Q

Mourning

A

אבל

the process by which grief is resolvedm a societal expression of post bereavemtn behavior

107
Q

bereavement

A

שכול

the state of being deprived of someone by death and refers to being in the state of mourning

108
Q

normal stages of response to loss

A

shock and denial- minutes-weeks- disbelief, numbness, protest, and then searching behaviors, yearning
acute anguish- weeks-months- somatic distress, withdrawal, preoccupation, anger, guilt
lost patterns of conduct- restless and agitated, aimless and amotivational, identification with the bereaved
resolution- months, years- returns to work, old rules, reexperience pleasure, seek companionships.

109
Q

most lasting manifestation of grief, especially after spisal death

A

loneliness

110
Q

grief process

A

length varies, usually 6 -12 months.

may have waves, can reemerge later with triggers

111
Q

anniversary reaction

A

reemergance of grief at date of death, or when the bereaved reaches the age of the deceased when he died.

112
Q

patterns of complicated bereavement

A

chronic, hypertrophic, delayed

113
Q

chrnoic grief

A

most common of complicated bereavement.
.bitterness, idealization
occurs when dependant/very close/ambivalent relationship and when social supports lacking, no friends to share surrow

114
Q

hypertrophc grief

A

usually after sudden death. bereavemt. reaction is intense, withdrawal. can disrupt family. frequently long term

115
Q

delayed grief

A

prolonged denial, anger and guilt may complicate it’s course

116
Q

traummatic grief

A

combined hypertrophic and chronic grief.
recurrent intense pangs of grief, persistent longing, intrusive images, avoidance and preoccupation with reminders of loss.
positiive memories often are blocked
a history of pschiatric illness is comon , as is a very close identity-defining relationship with the deceased.
(note- in DSM 5-it is s pecifier for complex bereavemtn regarding bereavement after violent death (e.g. suicie, homicie)

117
Q

mortality assocaited with bereavement

A

highest after bereavement, especially from IHD.
greatest effect on mortality- men under 65
.

118
Q

risk for death among widows

A

cirhosis and suicide increase

119
Q

effect of bereavement on health behavior

A

increased alcohol consumption, smoking, use of OTC medications.

120
Q

mental effects of bereavement

A

MDD, suicide, alchohol, smoking and drugs, prolonged anxiety,panic and PTSD like symptoms

121
Q

biological effects of grief

A

impaired immune fuctions, decreased lymphocyte proliferation, impaired function of NK cells

122
Q

grief therapy

A

one on one , group or self help.

30% of widows and widowers report becoming isolated after loss- grief therapy most useful for them

123
Q

mourning in chldren

A

o-2 years: loss of sepach, diffuse distress
younger than 5- eating, aleeping and bowel and bladder dysfunction.
school aged- phobic, hypochondriac, withsrawan, pseudomature, reduced skill performance and peer relations
dolescents- behavioral problems, somatic symptoms, arratic mods, stoicis. boys- delinquent, girls- sexual
rates of depression in bereaved children and adolescents is as high as bereaved adults.

124
Q

bereavement vs MDD

A

in bereavement- no guilt/worthlessesssuicidality/psychomotor retardation.
dysphoria triggered by reminders of deceased
onset within 2 months, and duration up to 2 months, only mild and transient functional impairment, no family or personal history of MSS

125
Q

criterion A and B in persistent complex bereavement disorder

A

a. death of someone close
b. 1/4 for 12 months(adult( or 6 mnths(child):
1. persistent yearning .longing
2. intense surrow
3. preoccupation with the deceased
4. preoccupation with circumstances of the death

126
Q

criterion C persistent complex bereavement disorder

A

6/12 for 12 months (adults), 6 mos(child)
1. difficulty accepting death
2. disbelief/emotional numbness
3.difficulty with positive reminisicne
4.bitterness or anger
5. maladaptive appraisals about death(e.g. self blame)
excessive aviodance of remininding.
7. desire to die to join with the deceased
8, difficulty trusting others
9. feeling alone and detatched
10. life is meaningless,cannot function without him
11. confusion about role and identity
12.difficulty to pursue interests or plan future

127
Q

endicott substitution criteria for depression:

changes in appetite/weight

A

tearfullness, depressed appearance

128
Q

endicott substitution criteria for depression:

sleep disturbance

A

social withdrawal, decreased talkativeness

129
Q

endicott substitution criteria for depression: loss of energy

A

brooding, self pity, pessimism

130
Q

endicott substitution criteria for depression: memory and concentration deficits, indecisiveness

A

lack of reactivity

131
Q

symptoms of persistent vegetative states

A

no evidence of awareness
no responsse
no receptive or expressive language
return of sleep-wake cycles,arousal, smiling, frowning, yawning
preserved brainstem ot hypothalamic autonomic functions
bowel and bladder incontinence
variably preserved cranial nerve and spinal reflexes

132
Q

tarasoff 1 and 2

A

tarasoff 1- duty to warn in case a patient is dangerous

tarasoff 2- duty to protect in addition to warning

133
Q

indications for seclusion and restraint

A

prevent imminant harm
prevent siginificant diruption to treatment program or physical surroindings
assist in treatment as part of an ongoing behavior therapy
decrease sensory ovestimulation(for seclusion)
patient’s voluntary reasonable request

134
Q

contraindications for seclusion and restraint

A

unless under close supervivions: extremely unstable medical/mental condition
delirious ot demented who cnnot tolerate decreased stimulation
overly suicidal patientssevere drug reaction ot OD who require moitoring

135
Q

M’Naghten rule

A

unguilty if crime due to mental disorder

136
Q

Durham rule

A

an accused person is not criminally responsible if the act was a product of mental health

137
Q

risk managemtn of recovered memories(pg 1390)

A

neutrality, do not suggest abuse
stay clinically focused
carefully document
closely monitor supervisory and collaborative therapy relationships
clarify nontreamten roles with family members
avoid hypnosis/amobarbitl unless indicated(with consultaion only)
dont take cases you cannot handle
obtain coonsultation
don’t suggest law suits
inform that more than brief therapy may be required
stop and refer if unconfortable

138
Q

leading cases of disability -adjusted life year

A

HIV (12.1), MDD (5.7)

139
Q

suicide - mental illness

A 
a systematic review shoew that 98% had mental dis.
35,8%- mood dis
22.4%- substance
11.6%- personality
10.6%- schziophrenia
140
Q

medications that can mimic dementia

A 
anticholinergic
antihypertensive
antipsychotic
steroids
digitalis
narcotics
NSAIDS
phenytoin
polypharmacy
sedative hypnotics
141
Q

mental situation that mimic dementia

A

anxiety
depression
maina
delusional (paranoid) disorders

142
Q

metabolic and endocrine disorders that may resemble dementia

A 
addisn
cushing
hepatic faiure
hypercarbia(COPD)
hyper/hyonatremia
hyer/hypothyroidism
hyperparathyroidism
hypoglycemia
renal failure
volue depletion
143
Q

conditions that resemble dementia

A

fecal impaction
hospitalizaion
impaired hearing/vision

144
Q

in WAIS R- what is and is not affected by age?

A

voacbulary and general knowledge may even improve with age (at least for first 7 decades)- chapter 54.2e in comprehensive text book
other test results- similarities ad digit symbol susbstitution- may change with age.

145
Q

depression in depression in neuropsychiatric evaluation

A

impaired psychomotor performance, especially visuospatial functioning and timed motor performance

146
Q

whcih part of WAIS-R is most sensitive indicator of brain damage?

A

performance more than verbal part.

147
Q

delirium/confusion among the terminally ill

A

90%. reversible in 50%. may repond to antipsychotics or pain relievers

148
Q

treatment of fatigue among terminally ill

A

stimulants

149
Q

treatment for nausea and vomiting among terminally ill

A

THC.
oral- dronabinol (Marinol), 1-2 mg every 8 hours.
marijuana cigaretes more effective

150
Q

depression or anxiety among terminally ill

A

use antianxiety/antidepressants. opoiods have strong antianxiety effect

151
Q

dyspnea or cough among terminally ill

A

treat with: opiiids, oxygen, bronchodilaters

152
Q

pשin for terminally ill

A

opiods are gold standard

153
Q

among those considering euthenasia- what are the most common end of life concerns?

A

loss of autonomy-85%
decreased ability to participate in enjoyable life activities- 77%
losing control of body functions- 63%

154
Q

4 elements of malpratice

A

4 Ds- duty, deviation, damage, direct causation:
1) a doctor -patient relationship existed that created a duty of care
2)a deviation from the standatd of care occured
3) patient was damaged
4) deviation directly caused the damage
giving advice on radio show- cannot be sued for malpractice

155
Q

באלו מקרים לא חייבים הסכמת הורי לבדיקה וטיול במי שלא מלאו לו 18 שנים?

A
  1. החלטות הקשורות להריון
  2. מחלות מין
  3. תלות בסמים ואלכוהול
  4. מחלות מדבקות
156
Q

policemant at the elbow law

A

criminal is not responsible if acted on an irresistible impulse- it could have been done even if the police were present.

157
Q

M’Nagthen rule

A

persons are not guilty if crime performed under a mental illness, such that they were unaware of the naturem quality and consequences of their acts or if they were incapable of realizing that their act was wrong
to sbsolve from punshment- a delusio used in evidence must be one that, if true, would be an adequate defense. if the delusinal idea does not justify the crime- they are held resposible, guilty and punishable.
knwon as the “right-wrong” test.

psychiatry shlav alef (22 decks)

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