general Flashcards by Bree Smouse

delirium
ophthalmoplegia
ataxia

Wernicke encephalopathy (EtOH, thiamine deficiency)

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CAGE

Cut down on drinking?
Annoyed by someone criticizing drinking?
Guilty about drinking?
Eye opener?
yes to 2 or more

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stages of EtOH withdrawal symptoms

jitteriness, tremulousness (6-8 hrs)
psychosis, perceptual symptoms (8-12 hrs)
sz (12-24 hrs)
delirium tremens (24-72 hrs)
- can be fatal

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Ddx for EtOH withdrawal

pheo
thyroid storm
inappropriate use of beta-agonist inhalers or sympathomimetics

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anxiety
sweating
intolerance of loud noises or light
muscle twitching

bento withdrawal (later sz)
- can be life threatening

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anxiety
irritability
hypersomnolence
fatigue

cocaine withdrawal

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reduced regional brain volume
enlarged cerebral ventricles
altered dopamine function

schizophrenia

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schizophrenia vs. schizoaffective vs. schizophreniform

schizophrenia > 6 mo, schizophreniform

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schizophrenia age of onset

early 20s for men, late 20s for women

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negative symptoms of schizophrenia

flattened affect (little emotion), allege (lack of words), asociality 
- absence of normal social/mental functions

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positive symptoms of schizophrenia

hallucinations, delusions, bizarre behavior

- addition of unusual thoughts, perceptions, behaviors

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schizophrenia subtypes

paranoid, catatonic, disorganized, undifferentiated, residual

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hyperthermia (fever)
mm. rigidity
autonomic instability

neuroleptic malignant syndrome

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how long does an untreated major depressive episode last?

6-12 months

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pressured speech
racing thoughts/flight of ideas
easy distractibility, etc.

mania

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difference between bipolar I and II

I has mania, II has hypomania

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oscillation between hypomania and dysthymia

cyclothymic disorder

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specific phobia dx

duration of > 6 mo
insight into excessiveness of fear
impairs everyday activities/relationships

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social phobia criteria (social anxiety disorder)

fear, insight, avoidance, impairment
greater than > 6 mo
not related to medical condition if applicable (i.e.: psoriasis but fear of voice cracking)

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restlessness, pacing, jitteriness in pt with new medication

akathisia (side effect of antipsychotic)

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defense mechanism for paranoid personality disorder

projection

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schizoid personality disorder defense mechanism

fantasy

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borderline personality disorder defense mechanism

splitting; acting out

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histrionic personality disorder defense mechanism

dissociation

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ocd personality disorder defense mechanism

isolation

emotionally detached, aloof loner difficulty expressing/experiencing emotion * do not desire relationships

schizoid personality disorder

odd thoughts, affect, perception, beliefs few relationships +/- paranoia

schizotypal personality disorder

clusters A,B,C personality disorders

A: weird (paranoia, schizoid, schizotypal) (accusatory, aloof, awkward) B: wild (antisocial, borderline, histrionic, narcissisitic) C: worried (avoidant, dependent, OCD) (cowardly, compulsive, clingy)

``` disregard for rules/laws of society explotative lie frequently impulsive, aggressive no remorse ```

antisocial personality disorder

reversible causes of dementia

NPH, B12 deficiency, hypothyroid, neurosyphilis, HIV

time course

``` delusional disorder: > 1 mo manic episode: > 1 wk or psychotic symptoms or hospitalization cyclothymic disorder: > 2 yrs MDD: > 2 wk dysthymia: > 2 yrs adult, > 1 yr kids GAD: > 6 mo ```

when to use ECT

``` MDD refractory to meds pregnant women acutely suicidal depression c psychotic features catatonia ```

suffix for typical antipsychotics

haloperidol + "-azine"

suffix for TCA

"-iptyline" or "-ipramine"

medical conditions that can cause mania

Huntington's, Wilson's, CVA, cerebral neoplasm or trauma, encephalitis, MS, epilepsy, hyperthyroid, uremia, B12 deficiency

in adolescence, mania is often accompanied by....

psychotic features

child defiantly opposes wishes of others and breaks minor rules

oppositional defiant disorder

presentation of MDD in elderly

usual MDD S/S +/-: - transient cognitive impairments reversible c tx - poor effort during the interview - good insight into intellectual difficulties (vs. dementia)

medical conditions that present with anxiety

Graves, PE, hyperthyroid, Sjogren, some seizures

comorbidites with GAD

other anxiety disorders (panic, phobias) MDD or dysthymic disorder substance use disorders

depressed mood/hopelessness irritability insomnia racing thoughts

think bipolar mixed state

a few drugs that can cause manic-like behavior

corticosteroids levodopa stimulants (ie: cocaine)

olfactory, gustatory hallucinations (new onset)

consider psychosis caused by a general (non psychiatric) medical condition

timeline for acute stress disorder vs. PTSD

ASD: 4 weeks

timeline for postpartum blues

peaks within 3-5 days after delivery | resolves 7-14 days

biggest risk factor for postpartum depression

prior history of MDD (especially postpartum)

common co-morbid condition with postpartum psychosis

bipolar disorder

miosis, slurred speech, drowsiness

opioid intoxication

nystagmus, HTN, mm. rigidity

phencyclidine intoxication

conjunctival injection, increased appetite, dry mouth

cannabis intoxication

fatigue, increased appetite, vivid and unpleasant dreams

cocaine intoxication

autonomic hyperactivity, GI distress, mm. aches, yawning, goose flesh, sensitivity to touch and light

opioid withdrawal

Tarasoff court case

clinical providers have a duty to warn and protect potential victims if pt has threatened to harm them regardless of pt confidentiality

M'Naghten

a person is not responsible for a criminal act if they have a mental illness or mental retardation and do not understand the nature of the criminal act or do not realize that the criminal act is wrong

side effect profile: anticholinergic effects

atypical antipsychotics or TCAs

side effect profile: coarse tremor, confusion, ataxia, and diarrhea

lithium toxicity

atypical features of MDD with atypical features

2 of the following: increased appetite or weight gain, hypersomnia, leaden paralysis, and a long-standing pattern of extreme sensitivity to perceived interpersonal rejection

chronic pattern of behavior that includes excessive emotionality, superficiality despite a typical claim of having multiple intimate relationship, dramatic and provocative behavior, and inappropriate flirtation

histrionic personality disorder

This disorder involves a reversible memory impairment in which memories of personal experience cannot be retrieved in a verbal form

dissociative amnesia

amnesia for one’s identity coupled with sudden unexplained travel away from home

dissociative fugue

pt feels sad and hopeless when alone, lacks self-confidence, and has great difficulty making decisions

dependent personality disorder

physical complication of cocaine intoxication

chest pain from coronary vasospasm

hallmark of delirium

fluctuation in the level of consciousness

hallmark of delirium

fluctuation in the level of consciousness

inflexibility, emotionally constricted, stubborn, orderly, miserly, serious, over devoted to work but trouble making deadlines

obsessive-compulsive personality disorder

inflexibility, emotionally constricted, stubborn, orderly, miserly, serious, over devoted to work

obsessive-compulsive personality disorder

common comorbid psych disorder with antisocial personality disorder

substance abuse

dx of antisocial personality disorder

only made after age 18 | - but a conduct disorder with onset before 15 must be present

insomnia, paranoia, visual hallucinations in elderly pt with dementia

think Lewy body disease

difference between oppositional defiant disorder and conduct disorder and antisocial personality disorder

- ODD offenses do not typically cause significant harm to others like CD - APD diagnosed after 18yo

schizoaffective disorder

combo of depressed mood and psychosis that occur with and also without each other (vs. MDD with psychotic fx that always occur together) - types: depressed, bipolar

dx of ADHD

at least 6 mo begins before age 7 present in more than one setting (home, school, etc.)

hallmark of hypochondriasis

belief that pt has a serious medical disorder (vs. focus on symptoms like somatization disorder)

factitious disorder vs. malingering

both conscious (vs. somatization/pain) factitious - motivation is to assume sick role malingering - secondary gain motivation

sleep terror disorder vs. nightmares

in sleep terror disorder pt cannot recall dream and events occur in delta (vs. REM) sleep

dx tourette

presence of both motor and vocal tics > 1 year onset before 18 yo

dx criteria for mental retardation

- IQ