Exam 2 Flashcards
What are examples of immature defenses?
Acting Out Externalization Fantasy Idealization Omnipotent Control Passive Aggressive Projection Projective Identification Somatization
What are examples of neurotic defenses?
Displacement Dissociation Hypochondriasis Intellectualization Isolation Rationalization Reaction Formation Regression Repression/Blocking Undoing
What are examples of mature/high order defenses?
Altruism Anticipation Humor Identification Introjection Sublimation Suppresion
Define displacement
discharging pent up feelings usually of hostility on object less dangerous than the one that initially aroused the emotion
Define rationalization
justifying ones failures with socially acceptable reasons instead of the real reasons
Define reaction formation
transforming anxiety producing thoughts into their opposites in consciousness
Define regression
returnign to more primitive levels of behavior
Define denial
refusing to admit that something unpleasant is happening or that a taboo emotion is being experienced
Define personality
Combination of stable, habitual patterns of behavior that are characteristic of a person and that develop over the first two decades of life and then change little
What is a personality trait vs. personality state?
Personality patterns are considered traits because they
are longstanding and consistent while personality state behavior refers to behaviors that come and go, such as a mood state
What is temperament?
Infants and children manifest patterns of behavioral style (e.g., shy, fussy, calm, easy, etc.) that form the core of adolescent and adult personality.
What is the path to personality and temperament?
genes, environment and stessors
When does non-shared environment play less of a role and neural development is substantially complete?
once past age 20-25
What are defense mechanisms of depression?
introjection
What are defense mechanisms of psychosis/paranoia?
projection
What are defense mechanisms of obsessive-compulsive?
undoing
What are defense mechanisms of antisocial PD?
omnipotent control
What are defense mechanisms of borderline personality d/o?
splitting and projective identification, acting out, dissociation
What are defense mechanisms of shizotypal PD?
fantasy
What are defense mechanisms of histronic PD?
hypochondriasis, somatization, regression
What are defense mechanisms of narcissistic PD?
omnipotent control, denial, externalization
What are defense mechanisms of dependent PD?
idealization
What is the 6th most disabling illness?
BPD
What percentage of mood disorders does BPD account for?
25%
What is the most expensive behavioral health care diagnosis?
BPD
What is average age of onset of first episode for BPD?
18 yo (most 1st episodes are <25 yo)
What is typically the first BPD episode in females?
depressive
What is typically the first BPD episode in males?
manic
What is suicide risk for BPD patients?
15x general pop
accounts for 25% all completed suicides
What is risk of divorce in BPD patients?
2-3x general pop
What is the etiology of BPD?
exact cause unk, benetic, biochem, socio environmental factors
What biochemical process plays a role in BPD?
neuroendocrine-hypothalamus-Pituitary adrenal axis and excess cortical secretion
hypothyroidism
define bipolar I
episodes of full blown mania and major depression (may also have hypomania)
define bipolar II
episodes of hypomania and major depression but not full blown mania
define paranoid personality disorder
pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent
define schizoid personality disorder
pattern of detachment from social relationships and a restricted range of emotional expression
define schizotypal personality disorder
pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior
Define antisocial personality disorder
pattern of disregard for, and violation of, the rights of others
Define borderline personality disorder
pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity
define histrionic personality
pattern of excessive emotionality and attention seeking
define narcissistic personality disorder
pattern of grandiosity, need for admiration, and lack of empathy
define avoidant personality disorder
pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
define dependent personality disorder
pattern of submissive and clinging behavior related to an excessive need to be taken care of
What are common causes for substance or medication induced BPD?
cocaine
corticosteroids
stimulants
What is BPD often misdiagnosed as?
MDD because pts underreport elevated mood (and its also less common than depressed mood)
What is the ratio of depressed mood:elevated?
3: 1 in BP I
37: 1 BP II
Ddx for BPD
unipolar MDD schizoaffective d/o schizophrenia ADHD Borderline PD substance abuse
What are comorbitidies of BPD?
substance use d.o, anxiety d/o, personality d/o, ADHD
What is rapid cycling?
4 or more episodes in a year
What is precontemplation stage?
no intention of changing within the next 6 mo (uneducated on risks, tried and failed)
What is contemplation stage?
intent to take action within 6 mo (know pros and cons, can last long time)
What is preparation stage?
ready to take action in the next month
What is the action stage?
has made the change
What is the maintenance stage?
behavior is changed
What is the termination stage?
may reach a point where
\there is no change of relapse for some behaviors (not true for all)
What are the 5 Rs for “don’t want to quit”?
relevance- encourage pt to quit risks- ID potential negative consequences rewards- benefits of stopping roadblocks- barriers in quitting repetition- repeat every visit
What are the 5 A’s for “want to quit”?
Ask- if they use
Advise- to quit
Assess- willingness to quit (within 30 d)
Assist- (STAR) set quit date, tell fam, anticipate challenges, remove products
Arrange-
What are normal BMI values?
18.5-24.9
What are sx of delirium?
reduced awareness, drowsy, lethargic, distractable, new memory impairment, hallucinations, delusions, sleep-wake reversal, sx wax and wane through the day
What neuro exam should you do for delirium?
sterngth testing, sensory testing, cranial nerve testing, visual fields, nuchal rigidity
What is the MC etiology of meningitis in elderly?
listeria
How long can a pt be involuntary held for if suicide risk and refuse?
72 hrs
What is a contract for safety?
make agreement that they’ll contact the office if they feel suicidal
What is the Tarasoff ruling?
health professional have a duty to protect intended victim by warning (not duty only to pt)
Define psychosis
disturbance in perception of reality, evidenced by hallucinations, delusions or thought disorganization
What are psychotic pts at high risk for?
agitation, agression, suicide, homicide
What pts are highest risk for violence in psychosis?
M>F
substance abusers x 30
antisocial PD x100
How often does a patient in restraints need to be checked on
every 15 min
When can an alcohol intoxicated pt go home?
when they know ehere they are and can walk safely or caly BAC
How quickly can alcoholics clear BAC?
25 mg/dl/hr
Why do pts have muscle aches, back pain and nausea and noth other sx?
pain fibers are unequally distributed (not on organs like spleen, kidney etc) but pain fibers are on muscles and joints
What is the significance of diffuse/poorly localized sx?
in CNS things far apart int he body lie close together-
generalized regulatory process “central sensitization”
Describe the somatosensory pain pathways
direct and relayed, bidirectional and shaped by experience
What is the pathway of sensory and somatosensory information?
info reaches amygdala and triggers rapid response via HPA while at the same time info is relayed via thalamus to cingulate cortex and prefrontal cortex which will apply memory and interpretation and then back regulates the thalamus
How do hormones affect somatic distress?
testosterone affects pain sensitivity and other emotional states
female reproductive organs may produce sx (endometriosis)
E2/P regulares monoamine neurotrans activity
What pain do males with somatic system disorder typically present with?
low back pain
What is malingering?
feigning illness for obvious gain
common in soldiers, prisoners, people involved in legal proceedings
associated with antisocial PD
What us somatic system d/o?
Physical distress that preoccupies person, care seeking dramatic self report
What is illness anxiety disorder?
Preoccupation with having or acquiring a serious illness
What is a factitious disorder?
Production of sx to receive medical attention
Can be induced by parents
What is Pseudocyesis?
false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy
What is Trichotillomania?
hair pulling disorder
What is excoriation?
skin picking disorder
What is YBOCS?
yale-brown obsessive compulsive scale
used to follow tx and assess progress, well validated
What is the pathophys oc OCD?
“hyperfrontality” corticothalamic striatal learning
What are subtypes of major and minor neurocog dz?
Alzheimer’s dz (MC) vascular disease Lewy bodies TBI HIV infection Prion disease Parkinson’s disease Huntington’s disease Substance/medication-induced Frontotemporal neurocognitive disorder another medical condition
What is the idea of the puberty light switch?
psychosocial effects of puberty play a role in hormones and genetic risk for eating disorder to develop
What are physiological findings associated with AN?
delayed gastric emptying
brain vol reduction in frontal, insular, cingulate and parietal cortices
What genes play a role in AN?
5HT transporter s and l
What are inhibitory signals for satiety?
leptin feedback/adipose signal
insulin FB
What are excitatory signals to stimulate eating?
Ghrelin-stomach
What is released as reward from eating?
dopamine, endogenous opioids, endocannabinoid
What are good prognostic factors of ED?
young age first episode short duration before treatment somewhat preserved body weight intact family absence of co-morbidity
What are poor prognostic factors of ED?
purging anorexia
chronicity >12 y
alcohol and drug use
psych comorbidities
What biological changes should you assess for in ED?
wt/ht ↓pulse/↓ BP ↓ temp EKG (arrhythmias) CBC CMP (met alkalosis, hypokalemia) Thyroid (nrml TSH ↓T3) UA Bone scan (↓density)
What are renal complications of ED?
↑BUN and ↑ CR due to dehydration and ↓ GFR
What are cardio complications of ED?
bradycardia, hypotension, QT prolongation
What are neuro complications of ED?
↑CSF, ↓grey and white matter, structural brain abnormalities
What is criteria for hospitalization of children and adolescents with ED?
<75% BMI acute weight loss severe bradycardia hypotension <90/45 orthostatic ↑in pulse or ↓ BP EKG abnor Hypothermia Electrolyte disturb Exercise >2d Uncontrolable binging/purging Acute food refusal
What is refeeding syndrome?
fluid and electrolyte imbalances as result of reintroducing nutrition
highest risk is 1st week (peak day 4)
What are signs of refeeding syndrome?
hyophosphatemia hypokalemia hypomagnesemia abnormal glucose metabolism vitamin deficiencies
What is bereavement?
experience after loss of loved one to death
