First Aid: Psychiatry - Sheet1 Flashcards
1
Q
Stanford-Binet
A
calculates IQ as mental age/chronological age x 100; mean = 100, SD = 15
2
Q
IQ < 70
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one of the criteria for diagnosis of mental retardation
3
Q
IQ < 40
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severe mental retardation; IQ < 20 = profound MR
4
Q
habituation
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type of simple learning; repeated stimulation -> decreased response
5
Q
sensitization
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type of simple learning; repeated stimulation -> increased response
6
Q
operant conditioning
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learning in which a particular action is elicited b/c it produces a reward
7
Q
operant conditioning: positive reinforcement
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desired reward produces action (mouse presses button to get food)
8
Q
operant conditioning: negative reinforcement
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removal of aversive stimulus elicits behavior (mouse presses button to avoid shock)
9
Q
operant conditioning: punishment
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application of aversive stimulus extinguishes unwanted behavior
10
Q
operant conditioning: extinction
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discontinuation of reinforcement eliminates behavior
11
Q
reinforcement schedules: variable ratio
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reward received after random number of repsonses; slowly extinguished; ex. slot machine
12
Q
transference
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patient projects feelings about formative or other important persons onto physician (eg psychiatrist = parent)
13
Q
countertransference
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doctor projects feelings about formative or other important persons onto patient
14
Q
Id
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primal urges, food, sex, aggression; instinct; entirely subconscious
15
Q
ego
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mediator between primal urges + behavior accepted in reality
16
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superego
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moral values, conscience; can lead to self-blame + attacks on ego
17
Q
social learning: shaping
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behavior achieved following reward of closer + closer approximations of desired behavior
18
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social learning: modeling
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behavior acquired by watching others + assimilating actions into one’s own repertoire
19
Q
ego defenses
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unconscious mental processes the ego uses to resolve conflict + prevent feelings of anxiety + depression
20
Q
ego defense: acting out
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unacceptable feelings + thoughts are expressed through actions; tantrums
21
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ego defense: dissociation
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temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress; ex. extreme forms can result in dissociative identity disorder (multiple personality disorder)
22
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ego defense: denial
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avoidance of awareness of some painful reality; ex. a common reaction in newly diagnosed AIDS + cancer patients
23
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ego defense: displacement
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process whereby avoided ideas + feelings are transferred to some neutral person or object (vs. projection); ex. mother places balame on child b/c she is angry at her husband
24
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ego defense: fixation
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partially remaining at a more childish level of development (vs. regression); ex. men fixating on sports games
25
ego defense: identification
modeling behavior after another person who is more powerful (though not necessarily admired); ex. abused child identifies himself/herself as an abuser
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ego defense: isolation of affect
separation of feelings from ideas + events; ex. describing murder in graphic detail w/ no emotional response
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ego defense: projection
an unacceptable internal impulse is attributed to an external source; ex. a man hwo wants another woman thinks his wife is cheating on him
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ego defense: rationalization
proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame
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ego defense: reaction formation
proccess whereby a warded off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite; ex. a patient w/ libidinous thoughts enters a monastery
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ego defense: regression
turning back the maturational clock + going back to earlier modes of dealing w/ the world; ex. seen in children under stress (eg bedwetting) + in patients on dialysis (eg crying)
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ego defense: repression
involuntary withholding of an idea or feeling from conscious awareness; ex. not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconscious
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ego defense: splitting
belief that people are either all good or all bad at different times due to intolerance of ambiguity; seen in borderline personality disorder
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ego defense: sublimation
process whereby one replaces an unacceptable wish w/ a course of action that is similar to the wish but does not conflict with one's value system; ex. actress uses experience of abuse to enhance her acting
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ego defense: suppression
voluntary withholding of an idea or feeling from conscious awareness (vs. repression); ex. choosing not to think about the USMLE until the week of the exam
35
long-term deprivation of affection in infants
decreased muscle tone, poor language skills, poor socialization skills, lack of basic trust, anaclitic depression, weight loss, physical illness; severe deprivation can result in death; deprivation for > 6 mos can lead to irreversible changes
36
anaclitic depression (hospitalism)
depression in an infant attributable to continued separation from caregiver; infant becomes withdrawn + unresponsive; reversible, but prolonged separation can result in failure to thrive or other developmental disturbances (eg delayed speech)
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child physical abuse: evidence
healed fractures on x-ray, cig burns, subdural hematomas, multiple bruises, retinal hemorrhage or detachment
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child sexual abuse: evidence
genital/anal trauma, STDs, UTIs
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attention-deficit hyperactivity disorder (ADHD)
limited attention span + poor impulse control; onset before age 7; hyperactivity, motor impairment, emotional lability; normal intelligence but often coexists w/ difficulties in school; may continue into adulthood in as many as 50% of individuals; associated w/ decreased frontal lobe volumes
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attention-deficit hyperactivity disorder (ADHD): treatment
methylphenidate (Ritalin), amphetamines (Dexedrine), atomoxetine (nonstimulant SNRI)
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conduct disorder
repetitive + pervasive behavior violating social norms (physical aggression, destruction of property, theft); after 18 yr age, diagnosed as antisocial personality disorder
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oppositional defiant disorder
enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
43
Tourette's syndrome
sudden, rapid, recurrent, nonrhythmic, stereotypes motor movements or vocalizations (tics) that persist > 1 yr; lifetime prevalence of 0.1-1.0% in general population; coprolalia (obscene speech) in 20% patients; associated w/ OCD/ onset at < 18 yr age
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Tourette's syndrome: treatment
antipsychotics (eg haloperidol)
45
separation anxiety disorder
overwhelming fear of separation from home or loss of attachment figure; may lead to factitious physical complaints to avoid going to school; common onset at 7-9 yrs of age
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pervasive developmental disorders
difficulties w/ language + failure to acquire, or early loss of, social skills
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autistic disorder
severe language impairment + poor social interactions; greater focus on objects than on people; characterized by repetitive behavior + usually below-normal intelligence; rarely unusual abilities (savants); more common in boys
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autistic disorder: treatment
behavioral+ supportive therapy to improve communication + social skills
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Asperger's disorder
milder form of autism; all-absorbing interests, repetitive behavior, problems w/ social relationships; children are of normal intelligence + lack verbal or cognitive deficits; no language impairments
50
Rett's disorder
X linked disorder almost always in girls (males die in utero or shortly after birth); symptoms starting at ages 1-4, followed by regression characterized by loss of development, mental retardation, loss of verbal abilities, ataxia, stereotyped hand-wringing
51
childhood disintegrative disorder
marked regression in mulitple areas of functioning after at least 2 yrs of apparently normal development; significant loss of expressive or receptive language skills, social skills, or adaptive behavior, bowel or bladder control, play, or motor skills; common onset between 3 + 4 yrs of age; more common in boys
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anxiety: NT changes
increased NE, decreased GABA, serotonin (5-HT)
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depression: NT changes
decreased NE, serotonin (5-HT), dopamine
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Alzheimer's dementia: NT changes
decreased Ach
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Huntington's disease: NT changes
decreased GABA, ACh
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schizophrenia: NT changes
increased dopamine
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Parkinson's disease: NT changes
decreased dopamine, increased serotonin, ACh
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orientation
patient's ability to know who he is, what date + time it is, what his or her present circumstances are; order of loss: 1st - time; 2nd - place; last - person
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common causes of loss of orientation
alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional deficiencies
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retrograde amnesia
inability to remember things that occurred before a CNS insult
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anterograde amnesia
inability to remember things that occurred after a CNS insult (no new memory)
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Korsakoff's amnesia
classic anterograde amnesia caused by thiamine deficiency; leads to bilateral destruction of mammillary bodies; may also lead to some retrograde amnesia; seen in alcoholics + associated w/ confabulations
63
dissociative amnesia
inability to recall important personal info usually subsequent to severe trauma or stress
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delirium
waxing + waning level of consciousness w/ acute onset; rapid decrease in attention span + level of arousal; acute changes in mental status, disorganized thinking, hallucinations (often visual), illusions, misperceptions, distrubance in sleep-wake cycle, cognitive dysfunction
65
delirium: etiology
usually 2ndary to other illness (eg CNS disease, infection, trauma, substance abuse/withdrawal); most common psych illness on medical + surgical floors; abnormal EEG; check for drugs w/ anticholinergic effects; often reversible
66
dementia
gradual decrease in cognition w/ no change in level of consciousness; memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgment; patient is alert; no psychotic symptoms; increased incidence w/ age; more often gradual onset; normal EEG
67
dementia: etiology
caused by Alzheimer's, vascular thrombosis/hemorrhage (may have acute/subacute onset), HIV, Pick's disease, substance abuse, CJD; in elderly patients, depression may present like dementia (pseudodementia)
68
hallucinations
perceptions in the absence of external stimuli (eg seeing light that is not actually present)
69
illusions
misinterpretations of actual external stimuli (eg seeing a light + thinking htat it's the sun)
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delusions
false beliefs not shared w/ other members of culture that are firmly miaintained in spite of obvious proof to the contrary
71
loose associations
disorders in the form of thought (the way ideas are tied together)
72
visual hallucinations
common in delirium
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auditory hallucinations
common in schizophrenia
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olfactory hallucination
often occurs as an aura of psychomotor epilepsy + in brain tumors
75
gustatory hallucination
rare
76
tactile hallucinations
common in alcohol withdrawal (eg formicaiton - sensation of ants crawling on skin); also in cocaine abusers (cocaine bugs)
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hypnagogic hallucinations
occurs while going to sleep
78
hypnopompic hallucination
occurs while waking from sleep
79
schizophrenia
chronic mental disorder w/ periods of psychosis, disturbed behavior + thought, + decline in functioning that lasts > 6 mos
80
schizophrenia: etiology
assciated w/ increased dopaminergic activity, decreased dendritic branching; marijuana use is risk factor for schizophrenia in teens; genetic factors > environmental; lifetime prevalence: males = females, blacks = whites
81
schizophrenia: epi
presents earlier in men (late teens to early 20s vs late 20s to early 30s in women); patients are at increased risk of suicide
82
schizophrenia: diagnosis
2 or more of the following (1-4 are positive symptoms): 1) delusions 2) hallucinations - often auditory 3) disorganized speech (loose associations) 4) disorganized or catatonic behavior 5) negative symptoms - flat affect, social withdrawal, lack of motivation, lack of speech or thought
83
schizophrenia: 5 subtypes
paranoid (delusions), disorganized (w/ regard to speech, behavior, affect), catatonic (automatisms), undifferentiated (elements of all types), residual
84
schizophrenia: brief psychotic disorder
< 1 mo; usually stress related
85
schizophrenia: schizophreniform disorder
1-6 mos
86
schizophrenia: schizoaffective disorder
at least 2 wks of stable mood w/ psychotic symptoms, plus a major depressive, manic, or mixed (both) episode; 2 subtypes: bipolar or depressive
87
delusional disorder
fixed, persistent, non-bizarre belief system lasting > 1 mo; functioning otherwise not impaired; often self-limited
88
delusional disorder: shared psychotic disorder
aka folie a deux; development of delusions in a person in a close relationship w/ someone w/ delusional disorder; often resolves upon separation
89
dissociative identity disorder
formerly known as mulitple personality disorder; presence of 2 or more distinct identities or personality states; more common in women; associated w/ history of sex abuse
90
depersonalization disorder
persistent feelings of detachment or estrangment from one's own body, a social situation, or the env
91
dissociative fugue
abrupt change in geographic location w/ inability to recall past, confusion about personal identity, or assumption of a new identity; associated w/ traumatic circumstances (eg natural disasters, wartime, trauma); leads to distress or impairment; not the result of substance abuse or genreal medical conditions
92
manic episode
distinct period of abnormally + persistently elevated, expansive, or irritable mood lasting at least 1 wk; often distrubing to patient
93
manic episode: diagnosis
3 or more of the following are present during mood disturbance: 1) distractibility 2) irresponsibility - seeks pleasure w/o regard to consequences (hedonistic) 3) grandiosity - inflated self esteem 4) flight of ideas - racing thoughts 5) increase in goal directed activity/psychomotor agitation 6) decreased need for sleep 7) talkativeness or pressured speech; maniacs DIG FAST
94
hypomanic episode
like manic episode but mood distrubance is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitlaizaiton; no psychotic features
95
bipolar disorder
presence of at least 1 manic (bipolar I) or hypomanic (bipolar II) episode; depressive symptoms always occur eventually; patient's mood + functioning usually return to normal between episodes; use of antidepressants can lead to increased mania; high suicide risk
96
bipolar disorder: treatment
mood stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics
97
cyclothymic disorder
dysthymia + hypothymia; milder form of bipolar disorder lasting at least 2 yrs
98
major depressive episode
self-limited disorder, w/ each episode usually 6-12 mos; at least 5 of the following 9 symptoms for 2 or more weeks (symptoms must include patient reported depressed mood or anhedonia): 1) sleep disturbance 2) loss of interest (anhedonia) 3) guilt or feelings of worthlessness 4) loss of energy 5) loss of concentration 6) appetite/weight changes 7) psychomotor retardation or agitation 8) suicidal ideations 9) depressed mood; SIGECAPS
99
major depressive disorder, recurrent
requires 2 or more major depressive episodes w/ a symptom free interval of 2 mos
100
dysthymia
milder form of depression lasting at least 2 yrs
101
seasonal affective disorder
associated w/ winter season; improves in response to full-spectrum light exposure
102
lifetime prevalence of major depressive episode
5-12% male, 10-25% female
103
atypical depression
hypersomnia, overeating, mood reactivity (ability to experience improved mood in response to positive events vs. persistent sadness); associated w/ weight gain + sensitivity to rejection; most common subtype of depressoin
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treatment of atypical depression
MAO inhibitors, SSRIs
105
maternal (postpartum) blues
50-85% incidence rate; depressed affect, tearfulness, fatigue; resolves within 10 days
106
maternal (postpartum) treatment
supportive; follow-up to assess for possible postpartum depression
107
postpartum depression
10-15% incidence; depressed affect, anxiety, poor concentration; lasts 2 wks to 2 mos
108
postpartum depression: treatment
antidepressants, psychotherapy
109
postpartum psychosis
0.1-0.2% incidence; delusions, confusion, unusual behavior, possible homicidal/suicidal ideations or attempts; lasts days to 4-6 wks
110
postpartum psychosis: treatment
antipsychotics, antidepressants, possible inpatient hospitalization
111
electroconvulsive therapy (ECT)
treatment option for major depressive disorder if other treatments fail; -> painless seizure in anesthetized patient; major adverse reactions: disoreintation + temporary anterograde/retrograde amnesia usually resolving in 6 mos
112
risk factors for suice completion
sex (male), age (teenager or elderly), depression, previous attempt, ethanol or drug use, loss of rational thinking, sickness (medial illness, 3 or more prescription medications), organized plan, no spouse (divorced, widowed, or single, esp if childless), social support lacking; SAD PERSONS
113
panic disorder
presence of recurrent periods of intense fear + discomfort peaking in 10 min w/ at least 4 of the folllowing: palpitations, paresthesias, abdominal distress, nausea, intense fear of dying or losing control, light headedness, chest pain, chills, choking, disconnectedness, sweating, shaking, shortness of breath; strong genetic component
114
panic disorder: treatment
cognitive behavioral therapy (CBT), SSRIs, TCAs, benzodiazepines
115
social phobia: treatment
SSRIs
116
OCD
ego dystonic: behavior inconsistent w/ one's own beliefs + attitudes (vs. obsessive compulsive personality disorder); associated w/ Tourette's disorder
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OCD: treatment
SSRIs, clomipramine
118
post-traumatic stress disorder: duration
disturbance lasts > 1 mo; w/ onset of sympotms beginning anytime after event + causes significant distress and/or impaired functioning
119
PTSD: treatment
psychotherapy, SSRIs
120
acute stress disorder: duration
between 2 days - 1 mo
121
generalized anxiety disorder
pattern of uncontrollable anxiety for at least 6 mos that is unrelated to specific person, situation, or event; sleep disturbance, fatigue, GI disturbance, difficulty concentrating
122
generalized anxiety disorder: treatment
benzos, buspirone, SSRIs
123
adjustment disorder
emotional symptoms (anxiety, depression) -> impairment following an identifiable psychosocial stressor (eg divorce, illness) + lasting < 6 mos (> 6 mos in presence of chronic stressor)
124
malingering
patient consciously fakes or claims to have disorder in order to attain specific 2ndary gain (eg avoid work); avoids treatment by medical personnel; compalints cease after gain (vs factitious disorder)
125
factitious disorder
patient consciously creates physical and/or psychological symptoms in order to assume sick role + get medical attention (primary gain)
126
Munchausen's syndrome
chronic factitious disorder w/ predominantly physical signs + symptoms; history of mulitple hosipital admissions + willingness to receive invasive procedures
127
Munchausen's syndrome by proxy
when illness in child is caused by caregiver; motivaiton is to asume sick role by proxy; form of child abuse
128
somatoform disorders
characterized by physical symptoms w/ no identifiable physical cause; both illness production + motivation are unconcious drives; not intentionally proudced or feigned; more common in women
129
somatization disorder
type of somatoform disorder; variety of complaints in mulitple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over period of yrs
130
conversion
type of somatoform disorder; sudden loss of sensory or motor function (eg paralysis, blindness, mutism), often following acute stressor; patient is aware but indifferent toward symptoms (la belle indifference); more comon in adolescents + young adults
131
hypochondriasis
type of somatoform disorder; preoccupation w/ + fear of having a serious illness despite medical evaluation + reassurance
132
body dysmorphic disorder
type of somatoform disorder; preoccupation w/ minor or imagined defect in appearance -> emotional distress or impaired functioning; often seek cosmetic surgery
133
pain disorder
type of somatoform disorder; prolonged pain w/ no physical findings; pain is focus of presentaiton + psychological factors play role in severity, exacerbation, or maintenance of pain
134
personality disorder
inflexible, maladaptive, rigidly pervasive pattern of behavior -> subjective distress and/or impaired functioning; person is usually not aware of problem; presents by early adulthood
135
cluster A personality disorders
odd or eccentric; inability to develop meaningful social relationships; no psychosis; genetic association w/ shizophrenia
136
paranoid personality disorder
pervasive distrust + suspiciousness; projection is major defense mechanism; cluster A personality disorder
137
schizoid personality disorder
voluntary social withdrawal, limited emotional expression, content w/ social isolation (vs avoidant); cluster A personality idsorder
138
schizotypal personality disorder
eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness; cluster A personality disorder
139
cluster B personality idsorder
dramatic, emotional, or erratic; genetic association w/ mood disorders + substance abuse
140
antisocial personality disorder
disregard for + violation of rights of others, criminality; males > females; ocnduct disorder if < 18 yrs; cluster b personality disorder
141
borderline personality disorder
unstable mood + interpersonal relaitnships, impulsiveness, self-mutilation, boredom, sense of emptiness; females > males; splitting is major defense mechanism; cluster b personality disorder
142
histrionic personality disorder
excessive emotionality + excitability, attention seeking, sexually provocative, overly concerned w/ appearnace; cluster b
143
narcissistic personality disorder
grandiosity, sense of entitlement, lacks emapthy + requires excessive admiration; often demands the best + reacts to criticism w/ rage; cluster b
144
cluster c personality disorders
anxious or fearful; genetic association w/ anxiety disordres
145
avoidant personality disorder
hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy; desires relaitnships w/ others (vs. schizoid); cluster c personality disorder
146
obsessive compulsive personality idsorder
preoccupation w/ order, perfectionism, control; ego syntonic behavior consistent w/ one's own beliefs + attitudes (vs OCD); cluster c
147
dependent personality disorder
submisive + clinging, excessive need to be taken care of, low self-confidence; cluster c
148
keeping schizo straight
schizotypal (odd thinking, no auditory hallucinations) < schizophrenic (greater odd thinking, auditory hallucinations) < schizoaffective (schizophrenic psychotic symptoms + bipolar or depressive mood disorder)
149
< 1 mo schizophrenia
brief psychotic disorder, usually stress related
150
1-6 mo schizophrenia
schizophreniform disorder
151
> 6 mo schizophrenia
schizophrenia
152
anorexia nervosa
excessive dieting +/- purging; intense fear of gaining weight, body image distortion, increased exercise; body weight < 85% ideal body weight; decreased bone density; severe weight loss, metatarsal stress fractures, amenorrhea, anemia, electrolyte disturbances; adolescent girls; coexists w/ depressoin often
153
bulimia nervosa
binge eaitng +/- purging; followed by self-induced vomiting or use of laxatives, diuretics, or emetics; body weight often within normal range; parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting (Russel's sign)
154
transsexualism
desire to live as opposite sex, often through surgery or hormone treatment
155
transvestism
paraphilia; wearing clothes (vest) of opposite sex (cross dressing)
156
substance dependence
maladaptive pattern of substance use defined as 3 or more of following signs in 1 yr: 1) tolerance - need more to achieve same effect 2) withdrawal 3) substance taken in larger amts or over longer time than desired 4) persistent desire or unsuccessful attempts to cut down 5) significant energy spent obtaining, using, or recovering from substance 6) important social, occupational, or recreational activities reduced b/c of substance use 7) continued use in spite of knowing the problems that it causes
157
substance abuse
maladaptive pattern leading to clinically significnat impairment or distress: 1) recurrent use resulting in failure to fulfill major obligations at work, school, or home 2) recurrent use in physically hazardous situations 3) recurrent substance related legal problems 4) continued use in spite of persistent problems caused by use
158
substance withdrawal
behavioral, physiologic, cognitive state caused by cessation or reduciton of heavy + prolonged substance use; signs + symptoms often opposite to those seen in intoxication
159
stages of change in overcoming addiction
1) precontemplation - not yet acknowledging there is a problem 2) contemplation - acknowledging that there is a problem, but not yet ready or willing to make a change 3) preparation/determination - getting ready to change behavior 4) action/will power - changing behaviors 5) maintenance - maintaining the behavior change 6) - relapse - returning to old behaviors + abandoning new changes
160
depressants: intoxication signs
nonspecific: mood elevation, decreased anxiety, sedation, behavioral disinhibition, resp depression
161
depressants: withdrawal signs
nonspecific: anxiety, tremor, seizures, insomnia
162
alcohol: intoxicaiton signs
emotional lability, slurred speech, ataxia, coma, blackouts, serum gamma-glutamyltransferase (GGT) - sensitive indicator of alcohol use; lab AST value is twice ALT value
163
serum gamma-glutamyltransferase (GGT)
sensitive indicator of alcohol use
164
treatment of alcohol intoxication
naltrexone
165
alcohol: withdrawal signs
mild withdrawal: similar to other depressants; severe withdrawal - DTs (delirium tremens)
166
treatment of delirium tremens
benzodiazepines
167
opioids (eg morphine, heroin, methadone): intoxicaiton signs
CNS depression, nausea + vomiting, constipation, pupillary ocnstriction (pinpoint pupils), seizures (overdose is life-threatening)
168
treatment of opioid intoxicaiton
naloxone, naltrexone
169
opioids: withdrawal signs
sweating, dilated pupils, piloerection (cold turkey), fever, rhinorrhea, nausea, stomach cramps, diarrhea (flulike sympotms); treatment is sympotmatic
170
barbiturates: intoxication signs
low safety margin, marked respiratory depression
171
treatment of barbiturate intoxication
sympotm management (assist resp, increase BP)
172
barbitruates: withdrawal signs
delirium, life threatening CV collapse
173
benzos: intoxicaiton signs
greater safety margin; ataxia, minor resp depression
174
treatment of benzo intoxication
flumazenil (competitive GABA antagonist)
175
stimulants: intoxication signs
nonspecific: mood elevation, psychomotor agitaiton, insomnia, cardiac arrhythmias, tachycardia, anxiety
176
stimulants: withdrawal signs
nonspecific: post-use crash, including depression, lethargy, weight gain, headache
177
amphetamines: intoxicaiton signs
impaired judgment, pupillary dilation, prolonged wakefulness + attention, delusions, hallucinations, fever
178
amphetamines: withdrawal signs
stomach cramps, hunger, hypersomnolence
179
cocaine: intoxication signs
impaired judgement, pupillary dilaiton, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death
180
treatment of cocaine intoxicaiton
benzos
181
cocaine: withdrawal signs
suicidality, hypersomnolence, malaise, severe psychological craving
182
caffeine: intoxication signs
restlessness, increased diuresis, muscle twitching
183
nicotine: intoxicaiton signs
restlessness
184
nicotine: withdrawal signs
irritability, anxiety, craving
185
treatment of nicotine withdrawal
nicotine patch, gum, or lozenges; bupropion/varenicline
186
PCP: intoxication
hallucinogen; belligerence, impulsiveness, fever, psychomotor agitation, vertical + horizontal nystagmus, tachycardia, homicidality, psychosis, delirium
187
PCP: withdrawal
depression, anxiety, irritability, restlessness, anergia, distrubances of thought + sleep
188
LSD: intoxication
hallucinogen; marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation
189
marijuana: intoxication
hallucinogen; euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, hallucinations
190
marijuana: withdrawal
irritability, depression, insomnia, nausea, anorexia; most symptoms peak in 48 hrs + last for 5-7 days; can be detected in urine up to 1 month after last use
191
heroin addiction
users at increased risk for hepatitis, abscesses, overdose, hemorrhoids, AIDS, + right-sided endocarditis; look for track marks (needle sticks in veins)
192
methadone
long-acting oral opiate; used for heroin detox or long-term maintenance
193
suboxone
used in heroin addiction; naloxone + buprenorphine (partial agonist); long acting w/ fewer withdrawal symptoms than methadone; naloxone is not active when taken orally, so withdrawal symptoms occur only if injected (lower abuse potential)
194
alcoholism
physiologic tolerance + dependence w/ symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs) when intake is interrupted
195
alcoholism: complications
alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy
196
Wernicke-Korsakoff syndrome
caused by thiamine deficiency; triad of confusion, ophthalmoplegia, ataxia (Wernicke's encephalopathy); may progress to irreversible memory loss, confabulation, personality change (Korsakoff's psychosis); alcoholism is a cuase
197
associated w/ periventricular hemorrhage/necrosis of mamillary bodies
alcoholism -> Wernicke-Korsakoff syndrome
198
Mallory-Weiss syndrome
longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting; often presents w/ hematemesis; associated w/ pain (vs. esophageal varices); alcoholism
199
treatment of alcoholism
disulfiram (to condition the patient to abstain from alcohol use), supportive care; alcoholics anonymous + other peer support groups are helpful in sustaining abstinence
200
delirium tremens (DTs)
life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink; symptoms in order of appearance: autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions), confusion
