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psychiatry > CK 1 > Flashcards

CK 1 Flashcards

1
Q

Classical conditioning - definition in association with Pavolov’s experiment

A

Learning in which a natural response (salivation) is elicited by conditioned, or learned, stimulus (bell) that previously was presented in conjunction with unconditioned stimulus (food)

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2
Q

Operant conditioning - definition

A

Learning in which a particular action is elicited because it produces a punishment or reward
(voluntary response)

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3
Q

Operant conditioning - types

A
  1. positive reinforcement
  2. Negative reinforcement
  3. Punishment
  4. Extinction
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4
Q

Operant conditioning - positive reinforcement - definition and example

A

desired reward produces action (mouse presses button to get food)

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5
Q

Operant conditioning - negative reinforcement - definition + example

A

Target behaviour (response) is followed by removal of aversive stimulus (mouse presses button to turn off continuous loud noise)

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6
Q

Operant conditioning - punishment - definition

A

repeated application of aversive stimulus (positive punishment) or removal of desired reward (negative punishment) to extinguishes unwanted behaviour

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7
Q

Operant conditioning - extinction - definition

A

Discontinuation of reinforcement (positive or negative) eventually eliminates behaviour –> can occur in operant or classical conditioning

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8
Q

Transference - definition / example

A

patient projects feelings about formative or other important persons onto physician (psychiatrist is seen as parent)

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9
Q

countertransference - definition / example

A

doctor projects feelings about formative or other important persons onto patient (patient reminds physician of younger sibling)

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10
Q

immature defences - acting out definition / example

A

expressing unacceptable feelings and thoughts through actions (tantrums)

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11
Q

immature defences - denial definition / example

A

avoiding the awareness of some painful reality

ex. a patientw with ca plans a full time work despite being warned of significant fatique during chemo

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12
Q

immature defences - Displacement definition / example

A

transferring avoided ideas and feeling to a neutral person or object (vs projection)
ex. Mother yells at her child, because her husband yeled at her

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13
Q

immature defences - Dissociation definition / example

A

Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
ex. a victim of sexual abuse suddenly appears numb and detached when is exposed to her abuser

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14
Q

immature defences - fixation / example

A

partially remaining at a more childish level of development (vs regression)
adults fixating on video games

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15
Q

immature defences - identification

A

modelling behaviour after another person who is more powerful (though not necessarily admired)
ex. abused child identifies with an abuser

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16
Q

immature defences - isolation (of affected) definition / example

A

separating feelings from ideas and events

ex. describing murder in graphic detail with no emotional response

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17
Q

immature defences - passive aggression / example

A

Expressing negativity and performing below what is excepted as an indirect show of opposition
ex. disgruntled employee is repeatedly late to work

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18
Q

immature defences - projection / example

A

Attributing an unacceptable internal impulse to an external source (vs displacement)
ex. a man who wants another woman thinks his wife is cheating on him

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19
Q

immature defences - rationalization / example

A

proclaiming logical reasons for action actually performed for other reasons, usually to avoid self-blame
ex. After getting fired, claiming that the job was not important

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20
Q

immature defences - Reaction formation / example

A

Replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite (vs sublimation)
ex. a patient with libidinous thoughts enters a monastery

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21
Q

immature defences - regression / example

A

turning back the maturational clock and going back to earlier modes of dealing with the world (vs fixation)
- seen in children under stress such as illness, punishment, or birth of a new sibling (eg. bedwetting, in a previou toilet-trained child hospitalized)

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22
Q

immature defences - repression / example

A

involuntarily withholding an idea or feeling from conscious awareness (vs suppression)
ex. a 20-years-old does not remember going to counseling during his parents’ divorce 10 years earlier

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23
Q

immature defences - slitting / commonly seen in / example

A

Believing that people are either all good or all bad at differences times due to intolerance of ambiguity. Commonly seen in borderline personality disorder

  • borderline personality disorder
  • a patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly
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24
Q

ego mature defences - types?

A
  1. Altruism
  2. Humor
  3. Sublimation
  4. Suppression
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25
Q

mature defences - altruism / example

A

alleviating negative feelings via unsolicited generosity

- ex. Mafia boss large donation to charity

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26
Q

mature defences - Humor / example

A

appreciating the amusing nature of an anxiety-provoking or adverse situation
ex. nervous medical student jokes about boards

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27
Q

mature defences - sublimation / example

A

replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system (vs reaction formation)
ex.teenager’s aggression toward his father is redirected to perform well in sports

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28
Q

mature defences - Suppression / example

A

intentionally withholding an idea or feeling from conscious awareness (vs repression,) temporary
- ex. choosing to not worry about the big name until it is time to play

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29
Q

ego defences - vs? (one vs other)

A
  1. fixation vs regression
  2. Displacement vs projection
  3. Reaction formation vs sublimation
  4. Repression vs suppression
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30
Q

Idealization - description / example

A

Expressing extremely positive thoughts of self and others while ignoring negative thoughts
ex. a patient boasts about his physician and his accomplishments while ignoring any flaws

31
Q

Intellctualization - description / example

A

using facts and logic emotionally distance oneself from stressful situation
- ex. in a therapy session patient diagnosed with cancer focuses only on rates of survival

32
Q

loss of orientation - order of loss

A
  1. time
  2. place
  3. person
33
Q

Korsakoff syndrome

A

Amnesia (anterograde>retrograde) caused by vitamin B1 deficiency and associated destruction of mamillary bodies. (late neuropsychiatric complication of Wernicke encephalopathy)

34
Q

depersonailization / derealization disorder

A

patient feelings of detachment or estrangement from one’s own body, thoughts, perceptions and actions (depersonalization) or one’s environment (derealization)
- intact reality testing (vs psychosis)

35
Q

disassociate identity disorder

A

aka: multiple personality disorder
presence of 2 or more distintict identities or personality states. More common in women.
history of sexual abuse, PTSD, depression, substance abuse, borderline, somoatoform conditions
- may be accompanied by dissociative fugue (abrupt travel or wandering associated with traumatic circumstances

36
Q

Delirium - definition

A

“Waxing and waning” level of consciousness with acute onset –> rapid decreasing in attention span and level of arousal

37
Q

Delirium - treatment

A
  1. identifying and addressing underling conditions
  2. Haloperidol may be used as needed
    - avoid benzo in older
38
Q

Dementia - reversible or irreversible

A

both –> usually irreversible

39
Q

Dementia - first step of diagnosis

A

screen for depression and measure TSH, B12, levels

40
Q

Delirium vs Dementia according to EEG

A

Delirium –> abnormal

Dementia –> usually normal

41
Q

Delirium vs Dementia according to reversibility

A

Delirium –> reversible

Dementia –> both (usually irreversible)

42
Q

Psychosis - definition

A

A distorted perception of reality characterized by

  1. delusions
  2. hallucinations
  3. disorganized thinking
43
Q

Delusions - definition and example

and types

A

Unique, false beliefs despite the facts (eg. thinking aliens are communicating with you)
types: 1. persecutory 2. referential 3. grandiose 4. erotomanic 5. somatic

44
Q

disorganized thoughts - definition

A

speech may be incoherent (world salad), tangential, or derailed

45
Q

Hallucination types

A
  1. Visual 2. Auditory 3. Olfactory
  2. Gustatory 5. Gustatory 6. Hypnagogic
  3. Hypnopompic 8. tactile
46
Q

visual hallucination - characteristics

A

More commonly a feature of medicall illness (eg. drug intoxication) than psychiatric illness

47
Q

auditory hallucination - characteristics

A

more commonly a feature of psychiatric illness (eg. schizophrenia) than medical disorders

48
Q

oflactory hallucination - characteristics

A

often occur as an aura of psychomotor epilepsy and in brain tumors

49
Q

oflactory hallucination - often occurs as

gustatory hallucination - characteristics

A
  • an aura of psychomotor epilepsy and in brain tumors

- rare but seen in epilpsy

50
Q

tactile hallucination - characteristics

A
  • common in alcohol withdrawal (eg. formication - the sensation of bugs crawling on one’s skin) and stimulant use (cocaine, amphetamines)
  • also seen in cocaine abusers (“cocaine crawlies”)
51
Q

hypnagogic vs hypnopompic hallucination - characteristics

A

hypnagogic: Occurs while going to sleep
hypnopompic: Occurs while waking from sleep
- both in narcolepsy

52
Q

Schizophrenia - definition

A 
Chronic mental disorder with:
1. periods of psychosis
2. disturbed behavior and thought
3. decline in functioning lasting more than six months
LASTING MORE THAN 6 MONTHS
53
Q

Schizophrenia - epidemiology/sex etc

A

Lifetime prevalence is 1.5% (males = females, blacks = whites)
Present earlier in men (late teens to early 20s) vs late 20s to early 30s in women)

54
Q

Schizophrenia - labs

A
  • high dopaminergic activity
  • decreased dendritic branching
  • ventriculomegaly on brain image
55
Q

Schizophrenia - histology / brain image

A
  • decreased dendritic branching

- ventriculomegaly on brain image

56
Q

Schizophrenia - diagnosis

A

Requires at least 2 of the following for at least 1 month, and at least 1 of these should include 1-3 (first 4 are positive symptoms)

  1. Delusions
  2. Hallucinations (often auditory
  3. Disorganized speech (loose associations)
  4. Disorganized or catatonic behaviour
  5. Negative symptoms - flat affect, avolition, anhedonia, asociality, alogia
57
Q

catatonic behaviour?

A

Behavior characterized by muscular tightness or rigidity and lack of response to the environment

58
Q

disorders similar to schizophrenia (only the names)

A
  1. Brief psychotic disorder
  2. Schizophreniform disorder
  3. Schizoaffective disorder
59
Q

disorders similar to schizophrenia - Brief psychotic disorder - characteristics

A

at least 1 positive symptom lasting for less than 1 month

- stress related

60
Q

Brief psychotic - Schizophreniform disorder - characteristics

A

symptoms of schizophrenia, but 1-6 months

61
Q

Brief psychotic - Schizoaffective disorder - characteristics

A

more than 2 weeks of hallucinations or delusions without major major mood episode (major depression or mania), plus periods of concurrent major mood episode with schizophrenic symptoms

62
Q

disorders similar to schizophrenia - duration

A
  1. Brief psychotic disorder –> less than a month
  2. Schizophreniform disorder –> 1-6 moths
  3. Schizoaffective disorder –> more than 2 weeks (plus periods of concurrent major mood episode with schizophrenic syptoms)
63
Q

Delusional disorder

A

Fixed, persistent, false belief system lasting more than a month. Functioning otherwise NOT impaired
- can be shared by individuals in close relationship (folie a deux)
- ex: a woman who genuinely believes she is married to a celebrity when in fact she is not
MORE THAN 1 MONTH

64
Q

Mood disorder may includes

A
  1. major depressive disorder
  2. bipolar disorder
  3. dysthymic disorder
  4. cyclothymic
65
Q

Manic episode?

A

distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently high activity or energy (often disturbing patients)
LASTING AT LEAST ONE WEEK

66
Q

Manic episode - diagnosis

A

Hospitalization or at least three of the following
(mnemonic DIG FAST)
Distractibility
Irresponsibility: seeks pleasure without regard to consequences (hedonistic)
Grandiosity: inflated self-esteem
Flight of ideas: racing thoughts (go very fast)
elevation in goal directed Activity/psychomotor Agitation
decreased need to Sleep
Talkativeness or pressured speech

67
Q

Bipolar I defined by

A

presence of at least one manic episode with or without a hypomanic or depressive episode

68
Q

Bipolar II defined by

A

presence of a hypomanic and a depressive episode

69
Q

Cyclothymic disorder?

A

dysthymia and hypomania

Milder form of bipolar disorder lasting at least 2 years, fluctuating between mild depressive and hypomanic symptoms

70
Q

Major depressive episodes are characterised by

A 
at least 5 of the following 9 symptoms for 2 or more weeks (symptoms must include patient-reported depressed or anhedonia)  
mnemonic: SIGECAPS 
Sleep disturbances 
Interest loss (anhedonia) 
Guilt or feeling worthlessness
Energy loss and fatigue 
Concentration problems
Appetite/weight changes
Psychomotor retardation or agitation 
Suicidal ideations 
Depressed mood
71
Q

Depression - sleep

A

Sleep disturbances in sleep stages: 1. decreased slow wave sleep
2. decreased REM latency 3. increased REM early in sleep cycle 4. increased total REM sleep 5. Repeated nightime awakening 6. Early-morning wakening (terminal insomnia)

72
Q

dysthymia (persistent depressive disorder)?

A

depression, often milder, lasting at least 2 years (with no more than 2 months without depressive symptoms

73
Q

Atypical depression - manifestations

A

Differs from classical depression. Characterised by

  1. mood reactivity –> being able to experience improved mood in response to positive events, albeit briefly)
  2. “reversed” vegetative symptoms (hypersomnia, hyperphagia)
  3. leaden paralysis (heavy feeling in arms and legs)
  4. long-standing interpersonal rejection sensitivity

psychiatry (6 decks)

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