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MAYO > CHAPTER 6 PSYCH2 > Flashcards

CHAPTER 6 PSYCH2 Flashcards

1
Q

less severe than major depressive disorder,
insidious onset, chronic course, and no loss of social or
occupational function

A

Dysthymic Disorder

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2
Q

DSM IV for Dysthymia

A 
“ACHE2S”
A—appetite (increased/decreased)
C—concentration down
H—hopelessness
E—energy down
E—esteem of self down
2—2 years (more days down than not)
S—sleep (increased/decreased)
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3
Q

___________= major depressive disorder +

dysthymia

A

“Double depression”

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4
Q

In Manic episode:

At least three (four if mood is only irritable) of the following

A 
D—distractibility
I—insomnia, decreased need for sleep
G—grandiosity, inflated self-esteem
F—flight of ideas
A—activities or goals increased or displays
psychomotor agitation
S—pressured speech
T—thoughtlessness, seeks pleasure without
considering consequences
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5
Q

Treatments for acute mania

FDA-approved:

A

lithium, divalproex, chlorpromazine,
haloperidol, aripiprazole, olanzapine,
quetiapine, risperidone, ziprasidone, and ECT

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6
Q

In mixed episode

a. Criteria met for manic episode and major depressive
episode except duration is at least _______
b. Causes impairment in functioning, psychotic features
exist, or hospitalization is required to ensure safety of
patient or others
c. Not due to ______

A

1 week

substance use

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7
Q

Hypomanic episode: overview of DSM-IV-TR criteria
a. At least ______ days of persistently elevated, expansive, or irritable mood
b. At least three (four if mood is only irritable) of the following:
____________
c. Change in functioning uncharacteristic of person’s usual
behavior
d. Changes are observable by others

e. Not severe enough to cause impaired functioning, no
psychotic features exist, and no hospitalization is
required to ensure safety of the patient or others

f. Not due to substance use

A

4

grandiosity or inflated self-esteem, decreased
need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased goal-directed activity, risky behaviors

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8
Q

a. Only one manic episode (see manic criteria above) and
no past major depressive episode
b. Not part of schizoaffective disorder, not superimposed
on schizophrenia, schizophreniform disorder, delusional
disorder, or psychotic disorder not otherwise specified

A

Bipolar I disorder, single manic episode

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9
Q

a. Bipolar I disorder: lifetime prevalence is ___________%, M=F
1) Early onset is associated with more ______ issues
2) Peak manic episodes occur in summer

A

1.0

psychotic

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10
Q

b. Bipolar II disorder: lifetime prevalence is___%

c. Cyclothymic disorder: lifetime prevalence is___%

A
  1. 5

0. 7

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11
Q

a. History of at least one major depressive episode
b. History of at least one hypomanic episode
c. No history of manic episode or mixed episode
d. Not better accounted for by one of the psychotic
disorders
e. Causes marked impairment

A

Bipolar II Disorder (recurrent major depressive

episode with hypomanic episodes)

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12
Q

GAD

a. At least ________months of excessive anxiety or worry about life
circumstances
b. Difficult for patient to control worry
c. At least three of the following: ______
d. Anxiety that does not satisfy criteria for another____
e. Causes marked impairment
f. Not due to substance use or general medical condition

A

6

restlessness, easily
fatigued, poor concentration, irritability, muscle tension,
sleep disturbance

Axis I disorder

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13
Q

Course of GAD: chronic with fluctuating severity, 33% develop ______

A

panic disorder

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14
Q

___________: unresolved unconscious

conflicts or separation from important objects

A

Psychoanalytic theory of anxiety:

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15
Q

__________: learned response from

exposure to situations that induce anxiety

A

Psychosocial theory of anxiety

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16
Q

Medications that induce GAD:

A

theophylline, caffeine, pseudoephedrine,

thyroxine

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17
Q

GAD tx:

a. Antidepressants:______
b. Benzodiazepines, buspirone, β-blockers

A

SSRIs, TCAs, mixed-mechanism

antidepressants

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18
Q

a. Intense fear or discomfort
b. At least four of the following: pounding heart, sweating,
trembling, shortness of breath, feelings of choking, chest
pain, nausea, dizziness, derealization, loss of control, fear
of dying, paresthesias, chills or hot flashes

A

Panic attack:

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19
Q

a. Anxiety in settings in which escape may be difficult or
help is not available
b. Those settings/situations are avoided

A

Agoraphobia

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20
Q

a. Recurrent panic attacks
b. At least 1 month of concern about having additional
attacks, worry about implications of another attack,
change in behavior related to attacks
c. Absence of agoraphobia (panic disorder without agoraphobia)
or presence of agoraphobia (panic disorder with
agoraphobia)
d. Not due to substance use or general medical condition
e. Not better accounted for by another Axis I condition

A

Panic disorder

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21
Q

Course of Panic DO

a. Usually considered chronic and ______, ______in
intensity
b. ______ of patients recover fully
c. ______ of patients have occasional symptoms but usually do well

A

lifelong, fluctuating

30%

50%

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22
Q

T or F

Females develop agoraphobia more often than males

A

T

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23
Q

Etiology and pathophysiology of Panic do

Carbon dioxide hypersensitivity: _____

A

“false suffocation

alarm”

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24
Q

_________: exaggerated fear of social

situations

A

Social anxiety disorder

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25
Q

a. Patient avoids social interactions
b. Patient is hypersensitive to criticism
c. Patient has low self-esteem, poor social skills, poor eye
contact

A

Social Phobia

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26
Q

Course of Social Phobia

a. Develops _________, _______
b. Waxes and wanes in intensity, complete remission is rare

A

slowly, is chronic, no precipitating stressor

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27
Q

Phobic disorders tend to ________; those with specific
phobias tend to have relatives with specific phobias and
not socials and vice versa

A

“breed true”

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28
Q

Tx of phobic do

a.________: first line of treatment
b. MAOIs, mixed-mechanism antidepressants,
benzodiazepines
c. _________ can help about 30 minutes before performance or test situation
d. Most effective treatment: ____ and _____

A

SSRIs

Propranolol

cognitive-behavioral therapy + medications

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29
Q

excessive, repetitive counting, checking,

cleaning; behaviors are ego dystonic

A

Obsessive-Compulsive Disorder

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30
Q

1) Recurrent or persistent thoughts, impulses, or images
felt to be intrusive or inappropriate and that cause
anxiety or distress
2) Not simply excessive “real-life” worries
3) Attempts are made to ignore and suppress or
neutralize
4) Patient recognizes these are products of his or her own
mind

A

Obsessions (thoughts)

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31
Q

1) Repetitive behaviors: counting, checking, praying,
repeating
2) Behaviors aimed at preventing or reducing stress or
preventing a perceived dreaded event from taking
place

A

Compulsions (behaviors)

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32
Q

In pts with OCD

a. Usually both _____ and ____ are present in
80% of patients
b. Consumes a great deal of time
c. ______

A

obsessions and compulsions

Ego-dystonic

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33
Q

In pts with OCD

Prognosis is worse if ______, ______, ____hospitalization is required because of severity of symptoms

A

yielding to compulsions, childhood

onset, obsessions and compulsions are bizarre,

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34
Q

Differential diagnosis for OCD:

A

schizophrenia, obsessivecompulsive

personality disorder

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35
Q

Behavioral theory: obsessive-compulsive disorder is

learned behavior ______

A

(classical conditioning)

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36
Q

In OCD

Psychoanalytic theory: OCD is caused by unconscious
conflicts (defensive, punitive) and show regression to ____

overactive superego leading to defense mechanisms such as ______, _______, ______

A

anal phase of development;

“undoing,” “reaction formation,”
and “displacement

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37
Q

OCD

Neurobiologic theory: occurs more often in patients
with _____, _______, ________

A

head trauma, epilepsy, Sydenham’s chorea,

Huntington’s disease

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38
Q

OCD is

associated with decreased size of ____

A

caudate nuclei

bilaterally

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39
Q

OCD is associated with

a. Increased blood flow to _____, _____ and _____

A

frontal lobes, basal ganglia, and cingulate cortex

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40
Q

Key feature is catastrophic traumatic event leading to
hyperarousal, withdrawal, flashbacks, survivor’s guilt,
numbing

A

PTSD

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41
Q

In PTSD

Exposure to traumatic event—must have both of the
following:
1) Experienced or confronted with actual or threatened
death or injury to self or others
2) Response involved intense _______

A

fear, helplessness, horror

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42
Q

In PTSD

Traumatic event is reexperienced in at least one of the
following:
1) Recurrent and intrusive ______
2) Recurrent and distressing ________
3) Acting or feeling as if event were recurring
4) Intense ______ at exposure to triggers or
cues related to the event
5) ________ on exposure to triggers or cues
symbolizing the event

A

recollections of the event

dreams of the event

psychologic distress

Physiologic reactivity

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43
Q

Common findings in PTSD:

A 
“psychogenic amnesia,”
 “psychic numbing,” 
depressive symptoms, 
impulsivity, aggression,
isolation, “survivor’s guilt,” 
marital strain, social and
occupational difficulties
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44
Q

Tx for PTSD

a. Antidepressants: _____ (first line), TCAs, trazodone,
MAOIs
b. Anxiolytics: ____ and ______
c. Mood stabilizers and antipsychotics
d. Psychotherapy:_____ and _____
stress inoculation therapy, desensitization, group
therapy, family therapy, marital therapy

A

SSRIs

benzodiazepines, buspirone

cognitive-behavioral therapy, insight-oriented,

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45
Q

In acute stress disorder

During or after experiencing traumatic event, must have
at least 3 of the following:

A

1) Feelings of numbing, detachment, absence of emotional
response
2) Decreased awareness of surroundings
3) Derealization
4) Depersonalization
5) Dissociative amnesia (unable to recall important
aspect of the trauma)

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46
Q

In acute stress disorder,

Duration: at least ______

Must occur within _______

A

2 days and less than 4 weeks

4 weeks after the traumatic event

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47
Q

SUBSTANCE-RELATED DISORDERS

  1. Maladaptive pattern of substance use
  2. Leading to marked ______ and ______
  3. At least one of the following during a _____

a. Recurrent use leading to failure to fulfill obligations at
home, work, school
b. Recurrent use in hazardous situations (e.g., driving,
operating machinery)
c. Recurrent substance-related legal problems
d. Continued use even when causing recurrent social or
interpersonal problems

  1. Symptoms have not met criteria for ______
A

distress and impairment

12-month period:

dependence

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48
Q

1) Need for increased amounts to achieve intoxication or
needed effects
2) Diminished effect with same amount of substance

A

Tolerance

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49
Q

Symptoms of withdrawal for that substance

Need for same or similar substance to relieve
symptoms of withdrawal

A

Withdrawal

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50
Q

during 12 months, at least 1 of following:
Failure at social obligations due to drug use
Legal problems due to drug use
Use even in hazardous situations
Use despite having social problems

A

Abuse

51
Q

during 12 months, at least 3 of following:

Tolerance, increased amounts needed
Withdrawal
Need to use more
Cannot cut down or control use
Much time spent obtaining the drug
Social activities relinquished as direct result of
drug use
Persistence of use despite being aware of harmful
effects
A

Dependence

52
Q

_____________ = 2 or less drinks/day for men
younger than 65 (≤1 drink/day for nonpregnant women
and anyone >65 years

A

“Moderate drinking”

53
Q

________ = state of an alcoholic who is uncomfortable

when not drinking

A

“Dry drunk”

54
Q

If you can smell alcohol on the person’s breath, the likely

level is greater than _______

A

0.125%

55
Q

_______ = state of an alcoholic who is uncomfortable

when not drinking (grandiose, impatience, overacting

A

“Dry drunk”

56
Q

CAGE questions

Two of four answered positively: _____ indicative
of alcohol dependence

Four of four answered positively: ______ indicative of
alcohol dependence

A

70%-80%

100%

57
Q

Withdrawal symptoms

1) Often starts with _____
2) Anxiety, agitation, aggressiveness
3) Hallucination (most often____), delusions
4) Hypertension, respiratory depression, seizures,
delirium tremens
5) Death if symptoms are severe
6) Symptoms can be reduced or cleared by alcohol or
cross-tolerant agents (________)

A

tremulousness

visual

benzodiazepines, barbiturates

58
Q

Possible positive effects of alcohol use (red wine thought
to be best)
1) One or two drinks per day: may lower risk of
_______ and ________
(possibly by reducing platelet “stickiness”) and can
increase level of high-density lipoproteins (“good
cholesterol”)

A

myocardial infarction or cerebrovascular accident

59
Q

Most alcoholic patients have promising prognosis: after

treatment,______ of patients have 1 year of abstinence depending on their pretreatment level of functioning

A

45% to 65%

60
Q

1) Close relatives of alcohol-dependent persons have _______ higher risk of developing alcohol dependence

A

3× to 4×

61
Q

Sons of severely alcoholic fathers have up to ______

chance of becoming alcohol-dependent in their lifetime

A

90%

62
Q

90% of alcohol is metabolized by oxidation in the
_______10% is excreted unchanged in the urine, sweat,
air

A

liver,

63
Q

_________ breaks down alcohol to
acetaldehyde, then ________ breaks
down acetaldehyde to acetic acid

A

Alcohol dehydrogenase

aldehyde dehydrogenase

64
Q

________ blocks aldehyde dehydrogenase,

thus build up of toxic acetaldehyde

A

Disulfiram (Antabuse)

65
Q

Disulfiram (Antabuse), _________ (ReVia, decreases

craving for alcohol

A

naltrexone

66
Q

Common psychotic symptom of MAP use is __________________(sensation
of crawling bugs, which may lead to excessive
scratching until the skin is severely excoriated)

A

formication

67
Q

Methylphenidate: route is_____ followed by ______

or ________

A

crushed, snorting, intravenous injection

68
Q

_______ marked withdrawal symptoms following a

high-dose use (“speed-run”), including depression, suicidal thoughts, intense cravings, anxiety, irritability

A

“Crash”:

69
Q

“Speed balling”: injecting combination of____ and ___

A

heroin and

cocaine

70
Q

Short-acting drug: rapid and powerful effects on CNS

1) Instant feelings of well-being, confidence, euphoria
2) Increased levels of _____ and _____ in brain

A

dopamine and NE

71
Q

Metabolite of cocaine _____ can be found in a urine
drug screen 1 to 3 days after a single dose or 7 to 12 days
after frequent use of high doses

A

(benzoylecgonine)

72
Q

Physiologic changes of hallucinogens:

A

hypertension, tachycardia,
pupillary dilation, sweating, tremors, blurry vision,
incoordination

73
Q

effects of hallucinogens

A

Can cause increased levels of glucose, cortisol, ACTH,

prolactin

74
Q

____ is much more potent than other hallucinogens

A

LSD

75
Q

_______ makes giving up nicotine so difficult

A

Craving:

76
Q

Smoking increases metabolism of many prescription
medications; smoking cessation can lead to worrisome
____________

A

increases in blood levels of those medications

77
Q

_________ dependence is the most prevalent substancerelated disorder

A

Nicotine

78
Q

Mx of nicotine abuse

A

a. Nicotine patches, sprays, inhalers
b. Clonidine
c. Bupropion (Zyban

79
Q

Personality disorder:

  1. Cluster A __________(paranoid, schizoid,
    schizotypal)
  2. Cluster B________ (antisocial,
    borderline, histrionic, narcissistic)
  3. Cluster C _________ (avoidant, dependent,
    obsessive-compulsive)
A

“odd or eccentric”

“dramatic, emotional, erratic”

“fearful, anxious”

80
Q

Patients with______ are heavy users of the health care

system

A

BPD

81
Q

In Personality DO,

Enduring pattern of inner experience and behavior that
deviates markedly from the expectations of the person’s
culture; this pattern is manifested in two (or more) of
the following areas:
a. __________(i.e., ways of perceiving and interpreting self,
other people, events)
b. __________ (i.e., range, intensity, lability, and appropriateness
of emotional response)
c. _________
d. _________

A

Cognition

Affectivity

Interpersonal functioning

Impulse control

82
Q

Characterized by suspiciousness, distrust; interprets

actions of others as threatening or “out to get them

A

Cluster A—paranoid personality disorder

83
Q

DSM criteria for personality DO

a. Enduring, pervasive distrust and _____
b. Interprets intentions of others as harmful or exploitive
c. At least four of the following:

d. Not part of schizophrenia, psychotic mood disorder, or
general medical condition

A

suspiciousness

1.suspects others are deceiving or exploiting,
2. preoccupied with doubts regarding loyalty
or trustworthiness of others,
3. finds it difficult to confide in others,
4. reads hidden meanings into words or situations,
unforgiving and bears grudges,
5. quickly reacts angrily if perceives character has been attacked,
6. unjustified suspicions regarding fidelity of significant other

84
Q

In Personality DO

increased prevalence among those with relatives
having ______ and ________disorder,
_______ type

A

chronic schizophrenia

delusional

paranoid

85
Q

Characterized by social detachment and limited emotional reactivity

A

Cluster A—schizoid personality disorder

86
Q

DSM IV for schizoid personality DO

a. Enduring, pervasive \_\_\_\_\_\_\_ or isolation and
limited \_\_\_\_\_\_\_
b. At least four of the following: 
1.
2.
3.
4.
5.
6. 
7. 
c. Not a part of schizophrenia, psychotic mood disorder, or
general medical condition
A

social detachment

emotional reactivity

  1. no desire for close relationships,
  2. participates in solitary activities,
  3. minimal interest in sexual activity with others,
  4. very few activities bring pleasure,
  5. has very few close confidants,
  6. indifferent to opinions of others,
  7. limited emotional range
87
Q

schizoid personality DO

increased prevalence among relatives of
______ or those with ______personality
disorder

A

schizophrenics

schizotypal

88
Q

Characterized by discomfort with close relationships,
cognitive and/or perceptual distortions, and eccentric
behaviors and beliefs

A

Cluster A—schizotypal personality disorder

89
Q

Cluster A—schizotypal personality disorder

Challenge for providers is to prevent pushing too hard,
which can lead to

A

increased anxiety or paranoia, and to

build trust and minimize anxiety

90
Q

Cluster A—schizotypal personality disorder
Social skills training can be helpful, but group ____
can be threatening to them

A

psychotherapies

91
Q

Characterized by pervasive disregard for and violation

of the rights of others

A

Cluster B—antisocial personality disorder

92
Q

Cluster B—antisocial personality disorder

a. Enduring and pervasive pattern of disregard for others,
violation of the rights of others and occurring since age________
b. At least three of the following:

others

c. Must be at least 18 years old
d. Previous history of conduct disorder before age 15
e. Not part of schizophrenia or a manic episode

A

15

unlawfulness, deceitfulness, impulsivity or failure to plan ahead, repeated physical assaults and irritability, reckless disregard for self or others, irresponsibility, indifferent to or rationalizes hurting

93
Q

Key feature is instability of mood, but these patients
are also characterized by pervasive instability of affect,
identity, marked impulsivity, chaotic interpersonal relationships, self-injurious behaviors, failed marriages, lost jobs, “black and white” thinking, “splitting” (one care
provider valued and the other one is devalued, often
causing strife among the providers)

A

Cluster B—borderline personality disorder

94
Q

Prevalence: _______ of general population, ____ among persons seen in outpatient mental health clinics, about ______ among psychiatric inpatients, 30% to 60% of clinical
populations with personality disorders

A

2%

10%

20%

95
Q

IN borderline personality DO,

Increased prevalence among those with early ______________ (sexual abuse, neglect, hostility, parental loss)

A

traumatic

experiences

96
Q

Has become a standard treatment for borderline personality DO

A

Dialectical behavioral therapy (DBT)

97
Q

Dialectical behavioral therapy (DBT) is also used in management of recurrent ____ and ____

A

suicidal

and parasuicidal behaviors

98
Q

Characterized by excitable, emotional, colorful, flamboyant
behavior and by inability to maintain long-lasting
relationships

A

histrionic personality disorder

99
Q

Characterized by high sense of self-importance and

uniqueness

A

Cluster B—narcissistic personality disorder

100
Q

Cluster B—narcissistic personality disorder

a. Enduring and pervasive pattern of ______need for
admiration, and lack of empathy
b. At least five of the following:

A

grandiosity,

grandiose sense of selfimportance;
preoccupied with fantasies of success, power,
brilliance, beauty, or love;
believes self to be special or unique;
needs excessive admiration; has high sense of
entitlement; takes advantage of others; lacks empathy;
envious of others; behaves arrogantly or haughtily

101
Q

Characterized by extreme sensitivity to rejection, shyness,

need for uncritical acceptance

A

Cluster C—avoidant personality disorder

102
Q

In pts with avoidant personality DO

a. Infants with_______ may be prone to this
disorder
b. _____ may predispose to this disorder

A

timid temperament

Disfigurement

103
Q

Characterized by excessive reliance on others for emotional support and decision-making

A

Cluster C—dependent personality disorder

104
Q

Cluster C—dependent personality disorder

Predisposing factors may be ______ or
_______

A

chronic physical illness

separation anxiety disorder

105
Q

Cluster C—dependent personality disorder

Challenge for the provider is to prevent reestablishment
of the ________ relationship that is seen in
patient’s other relationships

A

dominant-dependent

106
Q

Characterized by preoccupation with orderliness, perfectionism, control to point of inflexibility

A

Cluster C—obsessive-compulsive personality disorder

107
Q

Cluster C—obsessive-compulsive personality disorder

a. Predisposing factors may be linked to high central ___________

A

serotonergic

function

108
Q

Recommended therapies for obsessive-compulsive personality disorder:

A

psychodynamic psychotherapy,

cognitive-behavioral therapy

109
Q

Clinical uses Antidepressants : primary use is for

A 
depression, 
bipolar depression, 
panic disorder, agoraphobia,
 OCD, social phobia, 
generalized anxiety disorder, 
posttraumatic stress disorder, 
bulimia nervosa
110
Q

SSRIs inhibit _______ reuptake but

do not act on NE or dopamine

A

5HT

111
Q

thought to be safest SSRI in pregnancy, but potentially there may be increased risk of perinatal complications (with use during third trimester

A

fluoxetine

112
Q

mild 2D6 inhibitors

A

Citalopram (Celexa), Escitalopram (Lexapro)

113
Q

potent 2C19 inhibitor

A

Fluvoxamine (Luvox):

114
Q

potent 2D6 inhibitors

A

Fluoxetine (Prozac):Paroxetine (Paxil)

115
Q

dose-dependent 2D6

inhibitor

A

Sertraline (Zoloft)

116
Q

For anti-depressants

1) Transient dizziness and vertigo, lethargy, paresthesias
(paroxetine) , nausea, vivid dreams, irritability
2) Treat by tapering dose

A

Discontinuation syndrome

117
Q

1) May sometimes occur months or years after successful
treatment
2) Reduced motivation, apathy, poor initiation; may be
features of recurrent depression

A

Apathy syndrome

118
Q

Features of Serotonin syndrome

A

Altered mental status, agitation, fever, hypotension,

ataxia, hyperreflexia, myoclonus

119
Q

longest half-life and active metabolite
with longest half-life, side effects include
reduced appetite

A

Fluoxetine:

120
Q

best profile in

regard to sexual side effects

A

Fluoxetine and fluvoxamine

121
Q

________worst profile in regard to sexual side
effects, most potent blocker of dopamine
transporters, has active metabolite with short
half-life

A

Sertraline:

122
Q

___________ no active metabolites,
more likely to cause discontinuation syndrome
with abrupt withdrawal of drug

A

Fluvoxamine and paroxetine:

123
Q

______ most selective for 5HT

A

Citalopram:

124
Q

________most potent SSRI, side effects

include weight gain and somnolence

A

Paroxetine:

MAYO (4 decks)

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