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Subject 1 > First Aid: Psychiatry - Sheet1 > Flashcards

First Aid: Psychiatry - Sheet1 Flashcards

1
Q

Stanford-Binet

A

calculates IQ as mental age/chronological age x 100; mean = 100, SD = 15

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2
Q

IQ < 70

A

one of the criteria for diagnosis of mental retardation

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3
Q

IQ < 40

A

severe mental retardation; IQ < 20 = profound MR

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4
Q

habituation

A

type of simple learning; repeated stimulation -> decreased response

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5
Q

sensitization

A

type of simple learning; repeated stimulation -> increased response

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6
Q

operant conditioning

A

learning in which a particular action is elicited b/c it produces a reward

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7
Q

operant conditioning: positive reinforcement

A

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

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8
Q

operant conditioning: negative reinforcement

A

removal of aversive stimulus elicits behavior (mouse presses button to avoid shock)

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9
Q

operant conditioning: punishment

A

application of aversive stimulus extinguishes unwanted behavior

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10
Q

operant conditioning: extinction

A

discontinuation of reinforcement eliminates behavior

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11
Q

reinforcement schedules: variable ratio

A

reward received after random number of repsonses; slowly extinguished; ex. slot machine

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12
Q

transference

A

patient projects feelings about formative or other important persons onto physician (eg psychiatrist = parent)

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13
Q

countertransference

A

doctor projects feelings about formative or other important persons onto patient

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14
Q

Id

A

primal urges, food, sex, aggression; instinct; entirely subconscious

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15
Q

ego

A

mediator between primal urges + behavior accepted in reality

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16
Q

superego

A

moral values, conscience; can lead to self-blame + attacks on ego

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17
Q

social learning: shaping

A

behavior achieved following reward of closer + closer approximations of desired behavior

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18
Q

social learning: modeling

A

behavior acquired by watching others + assimilating actions into one’s own repertoire

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19
Q

ego defenses

A

unconscious mental processes the ego uses to resolve conflict + prevent feelings of anxiety + depression

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20
Q

ego defense: acting out

A

unacceptable feelings + thoughts are expressed through actions; tantrums

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21
Q

ego defense: dissociation

A

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)

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22
Q

ego defense: denial

A

avoidance of awareness of some painful reality; ex. a common reaction in newly diagnosed AIDS + cancer patients

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23
Q

ego defense: displacement

A

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

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24
Q

ego defense: fixation

A

partially remaining at a more childish level of development (vs. regression); ex. men fixating on sports games

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25
Q

ego defense: identification

A

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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26
Q

ego defense: isolation of affect

A

separation of feelings from ideas + events; ex. describing murder in graphic detail w/ no emotional response

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27
Q

ego defense: projection

A

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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28
Q

ego defense: rationalization

A

proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame

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29
Q

ego defense: reaction formation

A

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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30
Q

ego defense: regression

A

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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31
Q

ego defense: repression

A

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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32
Q

ego defense: splitting

A

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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33
Q

ego defense: sublimation

A

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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34
Q

ego defense: suppression

A

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

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35
Q

long-term deprivation of affection in infants

A

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

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36
Q

anaclitic depression (hospitalism)

A

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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37
Q

child physical abuse: evidence

A

healed fractures on x-ray, cig burns, subdural hematomas, multiple bruises, retinal hemorrhage or detachment

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38
Q

child sexual abuse: evidence

A

genital/anal trauma, STDs, UTIs

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39
Q

attention-deficit hyperactivity disorder (ADHD)

A

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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40
Q

attention-deficit hyperactivity disorder (ADHD): treatment

A

methylphenidate (Ritalin), amphetamines (Dexedrine), atomoxetine (nonstimulant SNRI)

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41
Q

conduct disorder

A

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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42
Q

oppositional defiant disorder

A

enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms

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43
Q

Tourette’s syndrome

A

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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44
Q

Tourette’s syndrome: treatment

A

antipsychotics (eg haloperidol)

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45
Q

separation anxiety disorder

A

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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46
Q

pervasive developmental disorders

A

difficulties w/ language + failure to acquire, or early loss of, social skills

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47
Q

autistic disorder

A

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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48
Q

autistic disorder: treatment

A

behavioral+ supportive therapy to improve communication + social skills

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49
Q

Asperger’s disorder

A

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

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50
Q

Rett’s disorder

A

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

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51
Q

childhood disintegrative disorder

A

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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52
Q

anxiety: NT changes

A

increased NE, decreased GABA, serotonin (5-HT)

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53
Q

depression: NT changes

A

decreased NE, serotonin (5-HT), dopamine

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54
Q

Alzheimer’s dementia: NT changes

A

decreased Ach

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55
Q

Huntington’s disease: NT changes

A

decreased GABA, ACh

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56
Q

schizophrenia: NT changes

A

increased dopamine

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57
Q

Parkinson’s disease: NT changes

A

decreased dopamine, increased serotonin, ACh

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58
Q

orientation

A

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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59
Q

common causes of loss of orientation

A

alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional deficiencies

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60
Q

retrograde amnesia

A

inability to remember things that occurred before a CNS insult

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61
Q

anterograde amnesia

A

inability to remember things that occurred after a CNS insult (no new memory)

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62
Q

Korsakoff’s amnesia

A

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

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63
Q

dissociative amnesia

A

inability to recall important personal info usually subsequent to severe trauma or stress

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64
Q

delirium

A

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

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65
Q

delirium: etiology

A

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

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66
Q

dementia

A

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

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67
Q

dementia: etiology

A

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)

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68
Q

hallucinations

A

perceptions in the absence of external stimuli (eg seeing light that is not actually present)

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69
Q

illusions

A

misinterpretations of actual external stimuli (eg seeing a light + thinking htat it’s the sun)

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70
Q

delusions

A

false beliefs not shared w/ other members of culture that are firmly miaintained in spite of obvious proof to the contrary

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71
Q

loose associations

A

disorders in the form of thought (the way ideas are tied together)

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72
Q

visual hallucinations

A

common in delirium

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73
Q

auditory hallucinations

A

common in schizophrenia

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74
Q

olfactory hallucination

A

often occurs as an aura of psychomotor epilepsy + in brain tumors

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75
Q

gustatory hallucination

A

rare

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76
Q

tactile hallucinations

A

common in alcohol withdrawal (eg formicaiton - sensation of ants crawling on skin); also in cocaine abusers (cocaine bugs)

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77
Q

hypnagogic hallucinations

A

occurs while going to sleep

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78
Q

hypnopompic hallucination

A

occurs while waking from sleep

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79
Q

schizophrenia

A

chronic mental disorder w/ periods of psychosis, disturbed behavior + thought, + decline in functioning that lasts > 6 mos

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80
Q

schizophrenia: etiology

A

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

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81
Q

schizophrenia: epi

A

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
Q

schizophrenia: diagnosis

A

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
Q

schizophrenia: 5 subtypes

A

paranoid (delusions), disorganized (w/ regard to speech, behavior, affect), catatonic (automatisms), undifferentiated (elements of all types), residual

84
Q

schizophrenia: brief psychotic disorder

A

< 1 mo; usually stress related

85
Q

schizophrenia: schizophreniform disorder

A

1-6 mos

86
Q

schizophrenia: schizoaffective disorder

A

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
Q

delusional disorder

A

fixed, persistent, non-bizarre belief system lasting > 1 mo; functioning otherwise not impaired; often self-limited

88
Q

delusional disorder: shared psychotic disorder

A

aka folie a deux; development of delusions in a person in a close relationship w/ someone w/ delusional disorder; often resolves upon separation

89
Q

dissociative identity disorder

A

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
Q

depersonalization disorder

A

persistent feelings of detachment or estrangment from one’s own body, a social situation, or the env

91
Q

dissociative fugue

A

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
Q

manic episode

A

distinct period of abnormally + persistently elevated, expansive, or irritable mood lasting at least 1 wk; often distrubing to patient

93
Q

manic episode: diagnosis

A

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
Q

hypomanic episode

A

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
Q

bipolar disorder

A

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
Q

bipolar disorder: treatment

A

mood stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics

97
Q

cyclothymic disorder

A

dysthymia + hypothymia; milder form of bipolar disorder lasting at least 2 yrs

98
Q

major depressive episode

A

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
Q

major depressive disorder, recurrent

A

requires 2 or more major depressive episodes w/ a symptom free interval of 2 mos

100
Q

dysthymia

A

milder form of depression lasting at least 2 yrs

101
Q

seasonal affective disorder

A

associated w/ winter season; improves in response to full-spectrum light exposure

102
Q

lifetime prevalence of major depressive episode

A

5-12% male, 10-25% female

103
Q

atypical depression

A

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

104
Q

treatment of atypical depression

A

MAO inhibitors, SSRIs

105
Q

maternal (postpartum) blues

A

50-85% incidence rate; depressed affect, tearfulness, fatigue; resolves within 10 days

106
Q

maternal (postpartum) treatment

A

supportive; follow-up to assess for possible postpartum depression

107
Q

postpartum depression

A

10-15% incidence; depressed affect, anxiety, poor concentration; lasts 2 wks to 2 mos

108
Q

postpartum depression: treatment

A

antidepressants, psychotherapy

109
Q

postpartum psychosis

A

0.1-0.2% incidence; delusions, confusion, unusual behavior, possible homicidal/suicidal ideations or attempts; lasts days to 4-6 wks

110
Q

postpartum psychosis: treatment

A

antipsychotics, antidepressants, possible inpatient hospitalization

111
Q

electroconvulsive therapy (ECT)

A

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
Q

risk factors for suice completion

A

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
Q

panic disorder

A

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
Q

panic disorder: treatment

A

cognitive behavioral therapy (CBT), SSRIs, TCAs, benzodiazepines

115
Q

social phobia: treatment

A

SSRIs

116
Q

OCD

A

ego dystonic: behavior inconsistent w/ one’s own beliefs + attitudes (vs. obsessive compulsive personality disorder); associated w/ Tourette’s disorder

117
Q

OCD: treatment

A

SSRIs, clomipramine

118
Q

post-traumatic stress disorder: duration

A

disturbance lasts > 1 mo; w/ onset of sympotms beginning anytime after event + causes significant distress and/or impaired functioning

119
Q

PTSD: treatment

A

psychotherapy, SSRIs

120
Q

acute stress disorder: duration

A

between 2 days - 1 mo

121
Q

generalized anxiety disorder

A

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
Q

generalized anxiety disorder: treatment

A

benzos, buspirone, SSRIs

123
Q

adjustment disorder

A

emotional symptoms (anxiety, depression) -> impairment following an identifiable psychosocial stressor (eg divorce, illness) + lasting < 6 mos (> 6 mos in presence of chronic stressor)

124
Q

malingering

A

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
Q

factitious disorder

A

patient consciously creates physical and/or psychological symptoms in order to assume sick role + get medical attention (primary gain)

126
Q

Munchausen’s syndrome

A

chronic factitious disorder w/ predominantly physical signs + symptoms; history of mulitple hosipital admissions + willingness to receive invasive procedures

127
Q

Munchausen’s syndrome by proxy

A

when illness in child is caused by caregiver; motivaiton is to asume sick role by proxy; form of child abuse

128
Q

somatoform disorders

A

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
Q

somatization disorder

A

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
Q

conversion

A

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
Q

hypochondriasis

A

type of somatoform disorder; preoccupation w/ + fear of having a serious illness despite medical evaluation + reassurance

132
Q

body dysmorphic disorder

A

type of somatoform disorder; preoccupation w/ minor or imagined defect in appearance -> emotional distress or impaired functioning; often seek cosmetic surgery

133
Q

pain disorder

A

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
Q

personality disorder

A

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
Q

cluster A personality disorders

A

odd or eccentric; inability to develop meaningful social relationships; no psychosis; genetic association w/ shizophrenia

136
Q

paranoid personality disorder

A

pervasive distrust + suspiciousness; projection is major defense mechanism; cluster A personality disorder

137
Q

schizoid personality disorder

A

voluntary social withdrawal, limited emotional expression, content w/ social isolation (vs avoidant); cluster A personality idsorder

138
Q

schizotypal personality disorder

A

eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness; cluster A personality disorder

139
Q

cluster B personality idsorder

A

dramatic, emotional, or erratic; genetic association w/ mood disorders + substance abuse

140
Q

antisocial personality disorder

A

disregard for + violation of rights of others, criminality; males > females; ocnduct disorder if < 18 yrs; cluster b personality disorder

141
Q

borderline personality disorder

A

unstable mood + interpersonal relaitnships, impulsiveness, self-mutilation, boredom, sense of emptiness; females > males; splitting is major defense mechanism; cluster b personality disorder

142
Q

histrionic personality disorder

A

excessive emotionality + excitability, attention seeking, sexually provocative, overly concerned w/ appearnace; cluster b

143
Q

narcissistic personality disorder

A

grandiosity, sense of entitlement, lacks emapthy + requires excessive admiration; often demands the best + reacts to criticism w/ rage; cluster b

144
Q

cluster c personality disorders

A

anxious or fearful; genetic association w/ anxiety disordres

145
Q

avoidant personality disorder

A

hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy; desires relaitnships w/ others (vs. schizoid); cluster c personality disorder

146
Q

obsessive compulsive personality idsorder

A

preoccupation w/ order, perfectionism, control; ego syntonic behavior consistent w/ one’s own beliefs + attitudes (vs OCD); cluster c

147
Q

dependent personality disorder

A

submisive + clinging, excessive need to be taken care of, low self-confidence; cluster c

148
Q

keeping schizo straight

A

schizotypal (odd thinking, no auditory hallucinations) < schizophrenic (greater odd thinking, auditory hallucinations) < schizoaffective (schizophrenic psychotic symptoms + bipolar or depressive mood disorder)

149
Q

< 1 mo schizophrenia

A

brief psychotic disorder, usually stress related

150
Q

1-6 mo schizophrenia

A

schizophreniform disorder

151
Q

> 6 mo schizophrenia

A

schizophrenia

152
Q

anorexia nervosa

A

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
Q

bulimia nervosa

A

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
Q

transsexualism

A

desire to live as opposite sex, often through surgery or hormone treatment

155
Q

transvestism

A

paraphilia; wearing clothes (vest) of opposite sex (cross dressing)

156
Q

substance dependence

A

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
Q

substance abuse

A

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
Q

substance withdrawal

A

behavioral, physiologic, cognitive state caused by cessation or reduciton of heavy + prolonged substance use; signs + symptoms often opposite to those seen in intoxication

159
Q

stages of change in overcoming addiction

A

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
Q

depressants: intoxication signs

A

nonspecific: mood elevation, decreased anxiety, sedation, behavioral disinhibition, resp depression

161
Q

depressants: withdrawal signs

A

nonspecific: anxiety, tremor, seizures, insomnia

162
Q

alcohol: intoxicaiton signs

A

emotional lability, slurred speech, ataxia, coma, blackouts, serum gamma-glutamyltransferase (GGT) - sensitive indicator of alcohol use; lab AST value is twice ALT value

163
Q

serum gamma-glutamyltransferase (GGT)

A

sensitive indicator of alcohol use

164
Q

treatment of alcohol intoxication

A

naltrexone

165
Q

alcohol: withdrawal signs

A

mild withdrawal: similar to other depressants; severe withdrawal - DTs (delirium tremens)

166
Q

treatment of delirium tremens

A

benzodiazepines

167
Q

opioids (eg morphine, heroin, methadone): intoxicaiton signs

A

CNS depression, nausea + vomiting, constipation, pupillary ocnstriction (pinpoint pupils), seizures (overdose is life-threatening)

168
Q

treatment of opioid intoxicaiton

A

naloxone, naltrexone

169
Q

opioids: withdrawal signs

A

sweating, dilated pupils, piloerection (cold turkey), fever, rhinorrhea, nausea, stomach cramps, diarrhea (flulike sympotms); treatment is sympotmatic

170
Q

barbiturates: intoxication signs

A

low safety margin, marked respiratory depression

171
Q

treatment of barbiturate intoxication

A

sympotm management (assist resp, increase BP)

172
Q

barbitruates: withdrawal signs

A

delirium, life threatening CV collapse

173
Q

benzos: intoxicaiton signs

A

greater safety margin; ataxia, minor resp depression

174
Q

treatment of benzo intoxication

A

flumazenil (competitive GABA antagonist)

175
Q

stimulants: intoxication signs

A

nonspecific: mood elevation, psychomotor agitaiton, insomnia, cardiac arrhythmias, tachycardia, anxiety

176
Q

stimulants: withdrawal signs

A

nonspecific: post-use crash, including depression, lethargy, weight gain, headache

177
Q

amphetamines: intoxicaiton signs

A

impaired judgment, pupillary dilation, prolonged wakefulness + attention, delusions, hallucinations, fever

178
Q

amphetamines: withdrawal signs

A

stomach cramps, hunger, hypersomnolence

179
Q

cocaine: intoxication signs

A

impaired judgement, pupillary dilaiton, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death

180
Q

treatment of cocaine intoxicaiton

A

benzos

181
Q

cocaine: withdrawal signs

A

suicidality, hypersomnolence, malaise, severe psychological craving

182
Q

caffeine: intoxication signs

A

restlessness, increased diuresis, muscle twitching

183
Q

nicotine: intoxicaiton signs

A

restlessness

184
Q

nicotine: withdrawal signs

A

irritability, anxiety, craving

185
Q

treatment of nicotine withdrawal

A

nicotine patch, gum, or lozenges; bupropion/varenicline

186
Q

PCP: intoxication

A

hallucinogen; belligerence, impulsiveness, fever, psychomotor agitation, vertical + horizontal nystagmus, tachycardia, homicidality, psychosis, delirium

187
Q

PCP: withdrawal

A

depression, anxiety, irritability, restlessness, anergia, distrubances of thought + sleep

188
Q

LSD: intoxication

A

hallucinogen; marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation

189
Q

marijuana: intoxication

A

hallucinogen; euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, hallucinations

190
Q

marijuana: withdrawal

A

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
Q

heroin addiction

A

users at increased risk for hepatitis, abscesses, overdose, hemorrhoids, AIDS, + right-sided endocarditis; look for track marks (needle sticks in veins)

192
Q

methadone

A

long-acting oral opiate; used for heroin detox or long-term maintenance

193
Q

suboxone

A

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
Q

alcoholism

A

physiologic tolerance + dependence w/ symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs) when intake is interrupted

195
Q

alcoholism: complications

A

alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy

196
Q

Wernicke-Korsakoff syndrome

A

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
Q

associated w/ periventricular hemorrhage/necrosis of mamillary bodies

A

alcoholism -> Wernicke-Korsakoff syndrome

198
Q

Mallory-Weiss syndrome

A

longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting; often presents w/ hematemesis; associated w/ pain (vs. esophageal varices); alcoholism

199
Q

treatment of alcoholism

A

disulfiram (to condition the patient to abstain from alcohol use), supportive care; alcoholics anonymous + other peer support groups are helpful in sustaining abstinence

200
Q

delirium tremens (DTs)

A

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

Subject 1 (1 decks)

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