CK 1 Flashcards
Classical conditioning - definition in association with Pavolov’s experiment
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)
Operant conditioning - definition
Learning in which a particular action is elicited because it produces a punishment or reward
(voluntary response)
Operant conditioning - types
- positive reinforcement
- Negative reinforcement
- Punishment
- Extinction
Operant conditioning - positive reinforcement - definition and example
desired reward produces action (mouse presses button to get food)
Operant conditioning - negative reinforcement - definition + example
Target behaviour (response) is followed by removal of aversive stimulus (mouse presses button to turn off continuous loud noise)
Operant conditioning - punishment - definition
repeated application of aversive stimulus (positive punishment) or removal of desired reward (negative punishment) to extinguishes unwanted behaviour
Operant conditioning - extinction - definition
Discontinuation of reinforcement (positive or negative) eventually eliminates behaviour –> can occur in operant or classical conditioning
Transference - definition / example
patient projects feelings about formative or other important persons onto physician (psychiatrist is seen as parent)
countertransference - definition / example
doctor projects feelings about formative or other important persons onto patient (patient reminds physician of younger sibling)
immature defences - acting out definition / example
expressing unacceptable feelings and thoughts through actions (tantrums)
immature defences - denial definition / example
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
immature defences - Displacement definition / example
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
immature defences - Dissociation definition / example
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
immature defences - fixation / example
partially remaining at a more childish level of development (vs regression)
adults fixating on video games
immature defences - identification
modelling behaviour after another person who is more powerful (though not necessarily admired)
ex. abused child identifies with an abuser
immature defences - isolation (of affected) definition / example
separating feelings from ideas and events
ex. describing murder in graphic detail with no emotional response
immature defences - passive aggression / example
Expressing negativity and performing below what is excepted as an indirect show of opposition
ex. disgruntled employee is repeatedly late to work
immature defences - projection / example
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
immature defences - rationalization / example
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
immature defences - Reaction formation / example
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
immature defences - regression / example
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)
immature defences - repression / example
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
immature defences - slitting / commonly seen in / example
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
ego mature defences - types?
- Altruism
- Humor
- Sublimation
- Suppression
mature defences - altruism / example
alleviating negative feelings via unsolicited generosity
- ex. Mafia boss large donation to charity
mature defences - Humor / example
appreciating the amusing nature of an anxiety-provoking or adverse situation
ex. nervous medical student jokes about boards
mature defences - sublimation / example
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
mature defences - Suppression / example
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
ego defences - vs? (one vs other)
- fixation vs regression
- Displacement vs projection
- Reaction formation vs sublimation
- Repression vs suppression
Idealization - description / example
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
Intellctualization - description / example
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
loss of orientation - order of loss
- time
- place
- person
Korsakoff syndrome
Amnesia (anterograde>retrograde) caused by vitamin B1 deficiency and associated destruction of mamillary bodies. (late neuropsychiatric complication of Wernicke encephalopathy)
depersonailization / derealization disorder
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)
disassociate identity disorder
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
Delirium - definition
“Waxing and waning” level of consciousness with acute onset –> rapid decreasing in attention span and level of arousal
Delirium - treatment
- identifying and addressing underling conditions
- Haloperidol may be used as needed
- avoid benzo in older
Dementia - reversible or irreversible
both –> usually irreversible
Dementia - first step of diagnosis
screen for depression and measure TSH, B12, levels
Delirium vs Dementia according to EEG
Delirium –> abnormal
Dementia –> usually normal
Delirium vs Dementia according to reversibility
Delirium –> reversible
Dementia –> both (usually irreversible)
Psychosis - definition
A distorted perception of reality characterized by
- delusions
- hallucinations
- disorganized thinking
Delusions - definition and example
and types
Unique, false beliefs despite the facts (eg. thinking aliens are communicating with you)
types: 1. persecutory 2. referential 3. grandiose 4. erotomanic 5. somatic
disorganized thoughts - definition
speech may be incoherent (world salad), tangential, or derailed
Hallucination types
- Visual 2. Auditory 3. Olfactory
- Gustatory 5. Gustatory 6. Hypnagogic
- Hypnopompic 8. tactile
visual hallucination - characteristics
More commonly a feature of medicall illness (eg. drug intoxication) than psychiatric illness
auditory hallucination - characteristics
more commonly a feature of psychiatric illness (eg. schizophrenia) than medical disorders
oflactory hallucination - characteristics
often occur as an aura of psychomotor epilepsy and in brain tumors
oflactory hallucination - often occurs as
gustatory hallucination - characteristics
- an aura of psychomotor epilepsy and in brain tumors
- rare but seen in epilpsy
tactile hallucination - characteristics
- 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”)
hypnagogic vs hypnopompic hallucination - characteristics
hypnagogic: Occurs while going to sleep
hypnopompic: Occurs while waking from sleep
- both in narcolepsy
Schizophrenia - definition
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
Schizophrenia - epidemiology/sex etc
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)
Schizophrenia - labs
- high dopaminergic activity
- decreased dendritic branching
- ventriculomegaly on brain image
Schizophrenia - histology / brain image
- decreased dendritic branching
- ventriculomegaly on brain image
Schizophrenia - diagnosis
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)
- Delusions
- Hallucinations (often auditory
- Disorganized speech (loose associations)
- Disorganized or catatonic behaviour
- Negative symptoms - flat affect, avolition, anhedonia, asociality, alogia
catatonic behaviour?
Behavior characterized by muscular tightness or rigidity and lack of response to the environment
disorders similar to schizophrenia (only the names)
- Brief psychotic disorder
- Schizophreniform disorder
- Schizoaffective disorder
disorders similar to schizophrenia - Brief psychotic disorder - characteristics
at least 1 positive symptom lasting for less than 1 month
- stress related
Brief psychotic - Schizophreniform disorder - characteristics
symptoms of schizophrenia, but 1-6 months
Brief psychotic - Schizoaffective disorder - characteristics
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
disorders similar to schizophrenia - duration
- Brief psychotic disorder –> less than a month
- Schizophreniform disorder –> 1-6 moths
- Schizoaffective disorder –> more than 2 weeks (plus periods of concurrent major mood episode with schizophrenic syptoms)
Delusional disorder
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
Mood disorder may includes
- major depressive disorder
- bipolar disorder
- dysthymic disorder
- cyclothymic
Manic episode?
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
Manic episode - diagnosis
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
Bipolar I defined by
presence of at least one manic episode with or without a hypomanic or depressive episode
Bipolar II defined by
presence of a hypomanic and a depressive episode
Cyclothymic disorder?
dysthymia and hypomania
Milder form of bipolar disorder lasting at least 2 years, fluctuating between mild depressive and hypomanic symptoms
Major depressive episodes are characterised by
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
Depression - sleep
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)
dysthymia (persistent depressive disorder)?
depression, often milder, lasting at least 2 years (with no more than 2 months without depressive symptoms
Atypical depression - manifestations
Differs from classical depression. Characterised by
- mood reactivity –> being able to experience improved mood in response to positive events, albeit briefly)
- “reversed” vegetative symptoms (hypersomnia, hyperphagia)
- leaden paralysis (heavy feeling in arms and legs)
- long-standing interpersonal rejection sensitivity
