Exam 3 - Week 8/9 Flashcards
1
Q
retrograde amnesia
A
inability to recall the past (before a CNS insult)
2
Q
anterograde amnesia
A
cannot form new memories after a CNS insult
3
Q
korsakoff syndrome
A
late and irreversible manifestation of Wernickes that involves severe anterograde and retrograde amnesia with confabulation
4
Q
Wernicke’s ssx
A
opthalmoplegia (lateral rectus muscle, nystagmus), confusion, ataxia
5
Q
what is an illusion
A
distortion of real external stimuli
6
Q
order in which orientation is lost
A
time, place, person
7
Q
delirium tx if necessary for safety
A
haldol
8
Q
attention in dementia
A
mostly preserved until late stages
9
Q
what is depersonalization
A
feeling of unreality, detachment from, or unfamiliarity with one’s self
10
Q
what is derealization
A
uncreality, detachment from, or unfamiliarity with the world including individuals, objects, surroundings
11
Q
how to differentiate derealization from psychosis
A
PT’s sense of reality remains intact
12
Q
what is dissociative amnesia
A
inability to recall important person information, associated with trauma
13
Q
what is dissociative fugue
A
sudden travel away from home with inability to recall some or all of one’s past
14
Q
what is dissociative identity disorder
A
2 or more distinct identities and recurrent episdes of amnesia, associated with sexual abuse
15
Q
what is somatic symptom disorder
A
one or more somatic symptoms that are distressing or result in disruption of daily life. Excessive thoughts/behaviors related to the somatic ssx and associated health concerns manifesting as disproportional and persistent thoughts about seriousness, persistently high level of anxiety, excessive time/energy devoted to health concern
16
Q
conversion disorder aka
A
functional neurologic symptom disorder
17
Q
ways conversion disorder can manifest
A
weakness, paralysis, abnormal movement, swallowing/speech symptoms, seizures, sensory loss, special sensory ssx
18
Q
what is illness anxiety disorder
A
preoccupation with having or acquiring a serious illness that is disproportionate with symptoms and leads to excessive health-related behaviors or maladaptive avoidance of medical care
19
Q
what is perigrination
A
traveling/wandering after exhausting a healthcare system to find a less wary clinical care location
20
Q
what is factitious disorder
A
falsification of ssx or induction of injury or disease without obvious secondary gain
21
Q
what is malingering
A
intentional production of false ssx motivated by external incentives
22
Q
which psychiatric disorder has the highest mortality rate
A
anorexia
23
Q
anorexia is associated with
A
history of high achievement, perfectionism, trauma, family stressors
24
Q
medical sequelae of anorexia
A
electrolyte deficiencies, osteoporosis, bone marrow suppression, bradycardia, orthostatic hypotension
25
examples of bulimia purging behaviors
self-induced vomiting, laxatives, diuretics, excessive exercise, fasting
26
frequency of binge eating/purging to meet criteria for bulimia
once a week for 3 months
27
medical sequelae of bulimia
electrolyte deficiencies, swelling of parotid glands, erosion of dental enamel, Russell's sign
28
what is Russell's sign
scars/trauma to fingers/knucles from repetitively hitting teeth while inducing vomiting
29
body dysmorphic disorder criteria
preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others, associated with repetitive behaviors
30
difference between bulimia and binge eating/purging type of anorexia
if they have a significantly low body weight, it's considered anorexia
31
low calorie intake for how many days can lead to refeeding syndrome
10
32
what is refeeding syndrome
cellular dysfunction and inadequate oxygen delivery with associated organ dysfunction due to depletion of electrolytes and minerals during the increased metabolism of the first 4-5 days of refeeding
33
how to prevent refeeding syndrome
administer electrolytes and refeed gradually
34
what is pica
persistent eating of nonfood substances for at least 1 month
35
bulimia tx
CBT, nutritional support, SSRIs
36
binge eating disorder tx
CBT, mindfulness, SSRIs, topiramate, lisdexamfetamine
37
body dysmorphic disorder tx
SSRIs, CBT
38
what is la belle indifference
Pt shows lack of concern about ssx in conversion disorder
39
lab abnormalities in bulimia
hypokalemia, hypomagnesemia, increased amylase, metabolic alkalosis
40
which area of the brain is involved in use and restraint of primitive behaviors
lateral orbitofrontal cortex
41
which area of the brain is associated with higher level, goal-directed, adaptive use of basic cognitive abilities
dorsolateral prefrontal cortex
42
location of problems leading to executive dysfunction
dorsolateral prefrontal cortex, subcortical structures, white matter connecting cortex to subcortex
43
what is social cognition
processing, recalling, and using info about self, others, and social context to explain and predict thoughts/behaviors/emotions of others
44
what is emotional understanding
understanding/predicting one's own and others' emotions
45
what is theory of mind
attribution of mental states to oneself and others and using this to explain/predict behaviors of others
46
what is motivation
intrinsic drive of the system to produce goal direction cognition, emotion, behavior
47
what conditions cause DLPFC circuit damage
ADHD, tourette's, OCD, schizophrenia spectrum, MDD, TBI, cerebrovascular disease, Picks, AD, parkinsons, MS
48
SUD cluster A
impaired control: taking more than intended, persistent desire to control use, craving, spending a lot of effort trying to obtain
49
SUD cluster B
social impairment: still using despite it causing major life problems
50
SUD cluster C
risky use: Using drug despite it being physically hazardous physically or psychologically
51
mild SUD how many ssx
2-3
52
SUD cluster D
pharmacological: tolerance and withdrawal
53
moderate SUD # of ssx
4-5
54
severe SUD #of ssx
6+
55
early SUD remission
3-12 months
56
sustained remission SUD
12+ months
57
stages of change in overcoming addition
pre-contemplation, contemplation, preparation/determination, action/willpower, maintenance, relapse
58
what is pre-contemplation
not planning to take any action in the next 6 months
59
what is contemplation
considering making a change in the next 6-12 months
60
what is preparation/determination
has made the decision to change within the next month +/-a plan of action
61
what is action/willpower stage
has taken steps and has made a change within the last 6 months
62
what is maintenance stage
working to prevent relapse. 6-months to 5+ years
63
low dose CNS depressant effects
mood elevation, decreased anxiety and behavior inhibition
64
high dose CNS depressant effects
sedation and respiratory depression
65
BAC 50-100 ssx
subjective high, anxiolysis, sedation
66
BAC 100-200 ssx
motor impairment, ataxia, slurred speech
67
BAC 200-300 ssx
emesis, stupor
68
BAC 300-400 ssx
coma
69
BAC >400 ssx
respiratory depression, death
70
binge drinking males/females
males: 5 drinks/occasion. Females: 4 drinks/occasion
71
cocaine and amphetamines MOA
enhance release and reuptake of norepi and dopamine
72
which effects are shorter lived, cocaine or amphetamines
cocaine
73
cocaine/amphetamine use ssx
increased awareness and attention span, rapid elevation in mood, anorexia/weight loss
74
caffeine MOA
adenosine receptor antagonist enhancing excitatory transmission
75
nicotine MOA
nicotinic cholinergic agonist enhancing release of excitatory neurotransmitters
76
caffeine/nicotine use ssx
increased awareness/attention span, mild improvement in mood and decreased appetite
77
LSD MOA
agonist of some serotonin receptors and D2 receptors, enhancing the release of glutamate
78
LSD effects
intensifying thoughts/emotions/sensory perceptions, hallucinations, illusions, pupillary dilation, increased body temp/HR/BP, sweating, muscle weakness/tremors
79
MDMA MOA
enhances release of serotonin and norepi (at higher doses)
80
MDMA effects
similar to LSD with increasing energy, empathy, pleasure, teeth grinding, sweating, increased HR
81
long term MDMA effects
memory problems, insomnia, paranoia
82
PCP MOA
NMDA receptor antagonist, D2 partial agonist and dopamine reuptake inhibitor
83
PCP effects
hallucinations, distorted sound, violent behavior, seizures, suicide, comas
84
marijuana effects
euphoria, increased appetite, altered perception of consciousness, anxiolysis, increased libido, increased HR, dry mouth, reddning of the eyes, facial flushing
85
ETOH intoxication tx
address electrolyte imbalances, administer glucose PRN, glutathione, thiamine. +/-intubation, hemodialysis if severe
86
why are barbiturates so dangerous
low therapeutic index, high potential for drug-drug interactions
87
barbiturate OD tx
no reversal agent; supportive care
88
benzo OD ssx
sedation, AMS, slurred speech, ataxia, rarely respiratory depression but usually not dangerous in the absence of other CNS depressants
89
benzo OD tx
flumazenil is reversal agent, generally not used bc it can induce withdrawal seizures
90
which opioids can cause seizures in OD
tramadol, meperidine
91
general ssx of stimulant intoxication
mood elevation, insomnia, decreased appetite, anxiety, psychomotor agitation, arrhythmia
92
ssx of cocaine OD
pupillary dilation, tactile hallucinations, paranoia, angina, sudden death
93
cocaine OD tx
benzos, labetalol
94
what is contraindicated in cocaine OD and why
pure beta blockers due to cardiac steal syndrome
95
amphetamine OD ssx
same is cocaine plus delusions, hallucinations, fever
96
amphetamine OD tx
benzos +/-antipsychotics
97
nicotine/caffeine OD ssx
agitation, insomnia, HTN, tachycardia, diarrhea
98
nicotine/caffeine OD tx
benzos
99
LSD OD ssx
visual hallucinations, illusions, depersonalization, derealization, mingling of senses, anxiety, depression, delusions, AMS
100
LSD OD tx
benzos, antipsychotics
101
MDMA OD ssx
HTN, tachycardia, hyperthermia, hyponatremia, serotonin syndrome
102
MDMA OD tx
benzos, NOT antipsychotics
103
PCP OD ssx
violence, analgesia, nystagmus, tachycardia, HTN, ataxia, seizures, psychosis
104
mild ETOH withdrawal ssx
HTN, tachycardia, anxiety, insomnia, tremors that diminish within a few days
105
severe ETOH withdrawal SSX first phase
agitation, dysphoria, confusion, hallucinations, arrhythmias, seizures
106
severe ETOH withdrawal second phase
DTs: delirium, agitation, tachycardia, HTN, autonomic instability, fever, diaphoresis
107
when do DTs begin
after 3-4 days
108
DTs prognosis
can last a week to 10 days, fatal in 20% from hyperthermia or arrhythmia
109
what score on CIWA-Ar scale indicates need for medication
10 or more
110
scale for alcohol withdrawal
CIWA-Ar
111
how to taper benzos
10% of dose per day for longer acting agents, 25% of dose per week for shorter acting agents
112
how to prevent seizures during benzo withdrawal
carbamazepine
113
when does heroin withdrawal begin
within 6-12 hours
114
opioid withdrawal ssx
anxiety, insomnia, anorexia, sweating, rhinorrhea, lacrimation, yawning, GI distress, myoclonus, bone pain
115
scale for opiate withdrawal
COWS
116
meds for opiate withdrawal
meds for diarrhea, trazodone, clonidine, methocarbamol for muscle aches
117
LSD withdrawal ssx
irritability, flashback episodes
118
MDMA withdrawal ssx
similar to amphetamines (depression, fatigue, appetite disturbance, anxiety, difficulty concentrating)
119
PCP withdrawal ssx
not exactly withdrawal but it may be released from lipid stores randomly and cause a sudden onset of severe violence
120
marijuana withdrawal ssx
irritability, anxiety, depression, insomnia, restlessness, decreased appetite
121
3 drugs approved for psychotherapy adjuncts in alcohol abuse disorder
naltrexone, acamprosate, disulfiram
122
treatments for tobacco use disorder
nicotine replacement therapy, varenicline, bupropion
123
indirect biomarkers of chronic ETOH consumption
elevated GGT, elevated AST, MCV, carbohydrate-deficient transferrin
124
direct biomarker of ETOH use
fatty acid ETOH esters, peth, ethyl glucucronide, ethyl sulfide
125
naltrexone for ETOH use disorder MOA
mu receptor opioid antagonist that decreases craving and euphoria
126
acamprosate MOA
decreases cravings by affecting glutamate and GABA transmission
127
disulfiram MOA
acetaldehyde dehydrogenase inhibitor that induces N/V, HA, vasomotor ssx on consumption of ETOH
128
risk factors for developing lithium toxicity
renal insufficiency, volume depletion, elderly, use of thiazides/NSAIDs/ACE inhibitors
129
ssx of lithium toxicity
QT prolongation, diabetes insipidus, diarrhea, N/V, hyperreflexia, central ataxia, diffuse tremors that start fine and become coarse, seizures, syncope, hypothyroidism, hyperparathyroidism
130
lithium toxicity tx
isotonic hydration, dialysis
131
when does neuroleptic malignant syndrome occur
within 2 weeks of starting an antipsychotic, especially with concurrent lithium use
132
ssx of neuroleptic malignant syndrome
fever, autonomic instability, mental status change, involuntary movements, hyperreflexia, coma, death, diaphoresis, rigidity
133
lab abnormalities with neuroleptic malignant syndrome
elevated CK
134
neuroleptic malignant syndrome tx
stop offending med, supportive treatment in ICU: bromocriptine, amantadine, dantrolene, benzos
135
TCA OD ssx
cardiotoxicity (wide complex tachycardia), convulsions, coma. Also anticholinergic toxidrome, prolonged QT, AMS
136
TCA OD tx
activated charcoal if within 1 hour of ingestion and airway is stable, benzos, replace potassium, bicarb. Admit all symptomatic patients
137
narcolepsy age of onset
teens and 20s
138
narcolepsy cause
degradation of orexin neurons, associated with HLA
139
narcolepsy ssx
chronic, daytime sleepiness, cataplexy, hypnagogic hallucinations
140
what is cataplexy
sudden loss of tone in face, neck, knees triggered by strong emotions
141
test for narcolepsy
multiple sleep latency test
142
narcolepsy tx
modafinil, amphetamines, sodium oxybate
143
what is classical conditioning
linking stimuli to create a conditioned response
144
principles of operant conditioning
reinforcement, punishment, extinction
145
what is reinforcement
a consequence that is designed to increase the rate or probability of behavior - the best way to promote behavior
146
what is punishment
consequence designed to decrease the rate or probability of behavior. To be avoided whenever possible
147
what is extinction
when a response is no longer reinforced
148
what is habituation
decrease in response strength with repeated exposure to a particular stimulus
149
what is sensitization
increase in response strength with repeated exposure to a stimulus
150
what is transference
phenomenon when the person in therapy is influenced by the emotion of the therapist or an unconscious redirection from one person to another
151
what is countertransference
psychotherapists emotions are influenced by patient
152
what is splitting
selectively hyper elevating some and denying the worth of others
153
what are the primitive defense mechanisms
denial, regression, acting out, dissociation, projection, reaction formation
154
what are the less primitive defense mechanisms
repression, displacement, intellectualization, rationalization, undoing
155
what are the mature defense mechanisms
sublimation, compensation, assertiveness
156
what is isolation
creation of a gap between unpleasant thoughts/feelings
157
what is denial
refusal to accept reality because it is too painful
158
what is regression
reversion to an earlier stage of development in the face of something unacceptable
159
what is acting out
extreme behavior in order to express a thought/feeling as a form of pressure release
160
what is dissociation
when a person loses track of time/person, and instead finds another representation of their self in order to continue in the moment
161
what is projection
misattribution of a person's undesired thoughts, feelings, or impulses onto another
162
what is reaction formation
the converting of unwanted or dangerous thoughts/feelings into their opposites
163
what is repression
the unconscious blocking of unacceptable thoughts/feelings
164
what is displacement
taking something out on the wrong person
165
what is intellectualization
overemphasis on thinking when confronted with an unacceptable situation in order to place the thoughts into context
166
what is rationalization
offering a different explanation for one's perceptions or behaviors in the face of a changing reality
167
what is undoing
the attempt to take back an unconscious behavior or thought that is unacceptable
168
what is sublimation
channeling of unacceptable impulses/thoughts/emotions into more acceptable ones
169
what is compensation
counterbalancing perceived weakness by emphasizing strength in other areas
170
what is assertiveness
emphasis of a person's needs or thoughts in a manner that is respectful, direct and firm. Between passive and aggressive
171
what is assertiveness
emphasis of a person's needs or thoughts in a manner that is respectful, direct and firm. Between passive and aggressive
172
1-3 months milestones
lifts head when prone, social smile, coos/gurgles in response to attention
173
4-6 months milestones
turns over, sits unassisted, reaches for things, recognizes people , babbles
174
7-11 months milestones
crawls, pulls to stand, pincer grasp, stranger danger, peek-a-boo, imitates sounds and gestures, knows name
175
12-15 months milestones
walks unassisted, separation anxiety, first words, object permanence
176
18 months milestones
throws a ball, stacks 3 blocks, scribbles, rapprochement, says own name, 10+ words
177
2 y/o milestones
kicks a ball, balances on 1 foot, feeds self with spoon, tantrums, 2 word sentences, name body parts
178
3 y/o milestones
rides tricycle, partially dresses independently, gender identity, bowel/bladder control, complete sentences, colors
179
4 y/o milestones
catches ball, hops on 1 foot, dress independently, cooperative/imaginative play, tells stories
180
5 y/o milestones
catches ball with 2 hands, skips with alternating feet, copies squares, romantic feelings, concerned about physical injury
181
6 y/o milestones
ties shoelaces, rides bike, prints, moral development, starts to read, think logically
182
how does myelination progress
head to toe, paired with evolutionary need
183
when does social smile present
2 months
184
when does stranger danger peak
9 months
185
when does separation anxiety resolve
2 y/o
186
bonding vs attachment
bonding is mother's feelings toward infant. Attachment is the capacity to which the infant can trust primary caregiver
187
attachment styles from strongest to weakest
secure, anxious, disorganized, avoidant
188
age group most likely to suffer sexual abuse
8-13
189
most common form of abuse
neglect
190
first line drug for adhd
methylphenidate
191
methylphenidate MOA
blocks re-uptake of and increase release of norepi and dopamine
192
what is atomoxetine
selective norepi reuptake inhibitor for ADHD
193
alpha 2 agonists for ADHD
clonidine, guanfacine
194
first line tx for ADHD in <7 y/o
non-stimulants like alpha agonists first
195
extrapyramidal effects
acute dystonia, akathisia, bradykinesia, tardive dyskinesia
196
chlorpromazine unique side effect
corneal deposits
197
thioridazine unique side effect
retinal deposits resembling retinitis pigmentosa
198
risperidone unique side effect
hyperprolactinemia
199
clozapine unique side effect
agranulocytosis
200
high potency antipsychotics
haldol, trifluoperazine, fluphenazine
201
low potency antipsychotics
thioridazine, chlorpromazine
202
highest risk of extrapyramidal side effects
high potency typical antipsychotics
