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Year 5 Psych > Other Psych > Flashcards

Other Psych Flashcards

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1
Q

Hypothyroidism’s psychiatric effects

A

Dementia
Depression
Anxiety
Acute agitation (“myxoedema madness”)

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2
Q

Hyperthyroidism’s effect on mood

A

Anxiety, depression, apathy

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3
Q

Psych effects hypercortisolemia

A

Depression or mania

“Steroid psychosis”

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4
Q

Psych effects of hypocortisolemia (Addison’s)

A

Depression, apathy

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5
Q

Pysch effects of pheochromocytoma

A

Episodic anxiety

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6
Q

Psych effects of hyperparathyroidism

A

Depression
Apathy
Memory deficits
Psychotic symptoms

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7
Q

Psych effects of B12 deficiency

A 
Subacute combined degeneration of spinal cord'Slowing of mental processes
Confusion
Memory problems
Intellectual impairment
Paranoid delusions
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8
Q

Psych complications MS

A

Depression (>50%), stress-related
Suicidal ideation
Increased incidence BPAD
Transient psychoses and elation, related to disease progress
Early cognitive impairment and late progressive dementia

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9
Q

Psych complications SLE

A

Transient fluctuating psych disturbances, esp acute confusional states
Depressive psychoses less frequently
Steroid tx may further psych complications

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10
Q

Psych complications-Wilson’s

A

May be presenting feature in >50%
Affective and behavioral changes most commonly
Cognitive changes

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11
Q

Psych complications Acute Intermittent Porphyria

A

Delirium (50%)
Depression
Emotional lability
Schizophrenia-like psychoses (esp paranoid)

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12
Q

Simmond’s disease

A

Hypopituitarism causing depression, irritability, impaired memory

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13
Q

PMS

A

Physical and behavioral sxs that recur in 2nd half menstrual cycle and first few days menses. Sxs must be severe enough to impair social and occupational functioning

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14
Q

PMDD

A

Prominent presence of 1 or more marked affective syndromes (depression, anxiety, affective lability, anger, irritability). Related to menses

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15
Q

Menopause-psych complications

A

Increased anxiety and depression–experience itself, not hormones, OR hormones exacerbating pre-existing mood disorders

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16
Q

Ix-PMS

A

Prospective charting daily sxs for at least two menstrual cycles essential to confirm.
Rule out migraine, chronic fatigue, gynae conditions

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17
Q

Tx-PMS

A

Fluoxetine, starting in luteal phase

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18
Q

Pseudocyesis

A

Woman firmly believes herslef to be pregnant and develops objective pregnancy signs in absence pregnancy

Somatoform disorder, variant depression.
Presents as complication of post-partum depression or psychosis with amenorrhea.
Rule out ectopic, corpus luteal cyst, placenta previa, pituitary/pelvic tumor

Psych tx: supportive or insight-oriented psychotherapy

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19
Q

Postnatal depression

A

Signif depressive episode, within 6/12 postpartum.

RFs: personal or FHx depression, old age, single mother, poor relationship with own mother, ambivalence toward or unwanted pregnancy, poor support, signif other stressors, previous postpartum psychosis

Edinburgh Postnatal Depression Scale
Bio: antidepressants
Psychosocial: psychoeducation, CBT, support (health visitors, social workers)

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20
Q

Postpartum psychosis

A

Acute psychotic episode, peak at 2/52 postpartum
RF: personal/FHx major psych disorder, lack support, single parent, previous PPP

Lability of sxs, insomnia, perplexity, bewilderment, disorientation, thoughts suicide/infanticide

Bio: ECT, mood stabilizers (carbamazepine), early use antidepressants. Antipsychotics

ADMIT.

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21
Q

Sexual dysfunction

A

Persistent impairment normal patterns of sexual interest/response.

Bio causes: drugs/EtOH, med side effects, pain/discomfort, feeling tired, recent childbirth

Psych causes: relationship problems, performance anxiety, excessive monitoring self-arousal, guilt, fear preg or STIs, lack knowledge, previous rape or childhood abuse

Social: fear interruption, partner (attractiveness), disinterest, criticism, sexual inexperience, sexually incompatible

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22
Q

Sexual aversion

A

Strong negative feelings, fear, anxiety due to prospect of sexual interaction, of sufficient intensity to lead to active avoidance of sexual activity

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23
Q

Excessive sexual desire

A

Nymphomania in women, satyriasis in men.
Can be secondary to mood disorder (mania), in early dementia, associated with LD, secondary to brain injury, drug side effect

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24
Q

Erectile failure

A

Inability to develop/maintain erection.
RF: moral/religious views on sex, previous negative experiences, performance anxiety, EtOH/drugs, stress/fatigue

Physical causes: older, gradual onset, no erections, lost RFs (smoking, DM, obesity, HTN, EtOH etc)
Psych causes: younger, sudden onset, erections present at morning, on masturbation

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25
Q

Conduct disorder

A

One or more of following:

  • Aggression/cruelty to people/animals
  • Destruction property
  • Deceitfulness
  • Theft
  • Fire-setting
  • Truancy
  • Running away from home
  • Severe provocative or disobedient behavior
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26
Q

Oppositional defiant disorder

A

Enduring pattern negative, hostile, defiant behavior
No serious violation societal norms or rights of others
May occur in one situation only

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27
Q

Tx conduct disorder and oppositional defiant disorder

A 
Functional family therapy
Behavioral management aggression
Parent training (positive parenting program, incredible years program)
Remedial teaching
Alternative peer group activities
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28
Q

Separation anxiety disorder

A

Increased and inappropriate anxiety around separation from attachment figures or home

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29
Q

School refusal

A

Not a dx
May have somatization
Peak ages 5-6 (separation anxiety) and 10-11 (school transition), adolescents (low self-esteem, depression)

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30
Q

Most common emotional disorder in childhood

A

Generalized anxiety

Somatization common
Temperament and parental overprotection may predispose

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31
Q

Pervasive development disorder

A

Severe impairments social interactions and communication skills. Restricted stereotyped interests and behaviors
Includes autism, asperger’s, rett’s, childhood disintegrative disorder

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32
Q

Autism

A

Abn reciprocal social interaction, communication, language impairment.
Repetitive repertoire of interests and activities

RFs: Downs, Fragile X, obstetric complications, toxic agents, pre or post-natal infection (rubella), neuro disorders (e.g. tuberous sclerosis)

Three characteristic features within first three years life:

  1. Impairment in social interaction (poor use non-verbal behaviors)
  2. Impairment in communication
  3. Restricted stereotyped interests and behaviors
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33
Q

Asperger’s

A

Similar to autism but no signif abnormalities in language acquisition or cognitive development/intelligence

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34
Q

Childhood disintegrative disorder (heller’s syndrome)

A

M>F
2 years normal development followed by loss previously acquired skills before age 10.
Assoc with autism-like impairment of social interaction and repetitive stereotyped interests and mannerisms

After deterioration, may resemble autism

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35
Q

Tx-autism

A

Antipsychotics for stereotypies
SSRIs for compulsive and self-harming behavior
Behavioral interventions: behavioral modification, social skills training, CBT
Social therapies include educational and vocational interventions

36
Q

Rett’s syndrome

A

Almost all are women
Initially normal development then motor deterioration and severe LD from 6/12
Progressive and destructive encephalopathy and stereotyped hand movements (midline hand-wringing)

MECP2 gene on X chromo implicated

37
Q

ADHD/Hyperkinetic disorder: RFs and sxs

A

80% genetically inherited. Increased risk with low birth weight, maternal substance use in pregnancy, head injury, metabolic disorders, prolonged emotional deprivation.

Three core sxs:

  • Inattention
  • Hyperactivity
  • Impulsiveness
38
Q

Ix-ADHD

A 
Interview family and child
Observe child in more than one setting
Collateral information (SCHOOL REPORT)
Conner's rating scale
Screen for comorbidities
Neuro exam
39
Q

Tx-ADHD

A

Methylphenidate (Ritalin)
Atomoxetine

Psychoeducation

Behavioral interventions
School interventions

40
Q

Elective mutism

A

Selectivity in vocal communication depending on social circumstances

Small percentage have speech/articulation problem
Psycho-social: psych stress, social anxiety, oppositional behavior

41
Q

Tic disorders

A

Sudden, repetitive, non-rhythmic movements or vocalizations
Involuntary but can be suppressed for brief periods
More prominent during times stress

Simple motor tics, e.g. blinking, neck jerking
Simple vocal tics, e.g. grunting, coughing
Complex motor tics, e.g. jumping
Complex vocal tics, e.g. senseless repetition of words

42
Q

Gilles de la Tourette’s syndrome

A

Multiple motor and one or more vocal tics
At least one year
Causes distress and impaired function
Usu develops by age 7

Tx with antipsychs, alpha adrenergics if severe and impairing
Treat comorbid conditions (OCD, ADHD)
Psychoeducation
Awareness and relaxation training, habit reversal traning
School liaison

43
Q

Non-organic enuresis

A

Involuntary voiding of urine in children who have established bladder control according to devel age.
Primary: never established urinary continence
Secondary: continence achieved in past

44
Q

Causes non-organic enuresis

A

Genetics (75% have 1st degree relative with same problem)
Devel delay
Stress
Inadequate toilet training

45
Q

Tx-non-organic enuresis

A

Medication is last resort: desmopressin, imipramine
Psych: enuresis alarms, STAR CHART! for good behavior (e.g. using bathroom before bed), not outcomes
Social: parental education, educate about toilet training esp if primary

46
Q

Non-organic encoparesis

A

Deposition feces in inappropriate places in children who should have established consistent bowel control
Primary-when bowel control never been achieved
Secondary-after period normal bowel control

47
Q

Non-organic encoparesis: causes

A 
Devel delay
Coercive or punitive potty training
Emotional, physical, or sexual abuse
Disturbed parent-child relationship
Parental marital conflict
Other psych disturbance, e.g. autism
48
Q

Non-organic encoparesis: tx

A 
Medical management if appropriate e.g. laxatives
Change in diet if appropriate
Education child and family
STAR CHARTS
Sneaky Poo therapy
49
Q

Learning Disability-definition

A

Devel condition characterized by global impairment intelligence and signif difficulties in socially adaptive functioning

50
Q

impairment-definition

A

Loss or abnormality of psych, physiological, or anatomical structure or function

51
Q

Disability-definition

A

Restriction or lack (from impairment) of ability to perform an activity in manner and range considered normal

52
Q

handicap-definition

A

Disadvantage for given individual, resulting from impairment or disability that limits or prevents the fulfilment of role that is normal to that individual

53
Q

Mild learning disabilities

A

Language alright but delayed
Live independently
Struggle academically
Variable emotional/social immaturity

54
Q

Moderate learning disabilities

A

Speech delayed; deficits in speech and comprehension
Few have numeracy/literacy
Can do simple, supervised work
Reduced self-care and limited motor skills
Majority have identifiable organic cause

55
Q

Severe learning disabilities

A

Marked impairment motor fn
Little/no speech in childhood–may develop some later
24hr care

56
Q

Profound learning disabilities

A

Severely limited language, communication, self-care and mobility
Significant associated medical problems, higher level support
Organic etiology clear in most cases

57
Q

Down’s syndrome

A

Trisomy 21
Intell impairment, characteristic facies and habitus
Dx’d at birth but intell disability evident end 1st year life
Delayed milestones

Many associated physical problems

Psychiatric comorbidities common–depression, BPAD, Tourette’s, schizophrenia, autism, DEMENTIA–early onset

58
Q

Genetic conditions causing LD

A 
Prader-Wili
Angelman ("Happy Puppet syndrome")
Cri du chat
DiGeorge
Noonan's
Tuberous sclerosis
Neurofibromatosis
Sturge-Weber
PKU
Fragile XTurners
Trisomy X
Klinefleters
XYY male
Autism
59
Q

Non-genetic causes LD

A 
FAS
Iodine deficiency and congenital hypothyroidism
Toxins
infective agents (TORCH infections)
Hypoxic damage
CNS and skull devel abnormalities
60
Q

Biological causes dementia

A

Parenchymal degeneration
intracranial mass
Infection (vCJD, syph)
Endo-hypothyroid, hyperparathyroid, Cushings, addisons
Metabolic-uremia, hepatic encephalopathy, hypoglycemia, Mg derangement, electrolyte imbalance, B12 defic
Toxins-heavy metal, EtOH

61
Q

Sxs dementia

A

Short to long term memory impairment
Personality change: forgetful, social withdrawal, mood lability, disinhibition, silliness, reduced self-care, apathy, fatigue, deteriorating executive fn
Dysphagia, agnosia, apraxia
Anxiety and/or depression

62
Q

Ddx-depression

A 
Delirium
Depression (pseudodementia)
Amnestic disorders
LD
Psychosis
Normal aging
63
Q

Reversible causes dementia

A 
Hematomas
SOL
NPH
Endocrine causes
Vitamin deficiencies
64
Q

Ix-dementia

A

Bloods: FBC, LFT, U&Es, gluc, ESR, TSH, Ca, Mg, PO4, VDRL, HIV, B12, folate, CRP, blood culture,
LP, EEG, CXR, ECG, CT, MRI, SPECT
Let’s just do all the tests

Assess with MMSE, ACE-III
Assess functionality and social functioning

65
Q

Tx-dementia

A

Anticholinesterase inhibitors (tacrine, donepezil, rivastigmine)
Antioxidants (selegiline, Vit E)
Treat comorbidities

66
Q

Alzheimers: pathology and cause

A

MCC dementia (2/3)
Amyloid plaques in hippocampus, cortex, substantia nigra
Neurofibrillary tangles (phosphorylated tau)
Loss neurons and synapses

Causes:
genetics: APP, apoE4
Age

67
Q

Alzheimer’s-sxs

A

Four A’s: amnesia, aphasia, agnosia, apraxia
Early: failing memory, muddled efficiency with ADLs, spacial dysfn, wandering, irritability
Middle: intell and personality changes. Dysphasia, aphasia, apraxia, agnosia, impaired visospatial skills and executive fn
Late: fully dependent, physical deterioration, incontinecne, gait abnormalities, spasticity, seizures, tremor, weight loss, primitive reflects, EPS
Psych delusions and hallucinatins in a few
Depression comon

68
Q

Lewy body dementia

A

15-20% senile dementia
Progressive cognitive decline of sufficient magnitude to interfere with normal functions

Lewy bodies: eosinophilic neuronal inclusions with alpha-synuclein and ubiquitin in brainstem nuclei, BG, paralimbic structures

69
Q

Lewy body dementia-sxs

A

Fluctuating cognition with pronounced variations in attention and alertness
Recurrent visual hallucinations: well-formed and detailed
Spontaneous motor features parkinsonism

70
Q

Lewy body dementia-tx

A

Don’t give with antipsychs (at least at our level)–neuroleptic malignant syndrome risk

71
Q

Fronto-temporal dementia (Pick’s disease)

A

Early onset. Atrophy fronto-temporal regions

Associated with mutations in tua gene

72
Q

Fronto-temporal dementia: sxs

A

insidious onset and gradual progression, early decline in social/interpersonal conduct. Emotional blunting, loss insight

All sorts of other signs too long to list but are exactly what you imagine they are.

73
Q

vascular dementia

A 
Infarcts caused by thromboemboli or arteriosclerosis (causing HTN)
RFs are RFs for atherosclerosis
STEP-WISE decline.  May follow CVA.
More acute than Alzheimer's
Emotional and personality changes early.

Manage causative factors
Daily aspirin especially–delays progression

74
Q

Delusional misidentification syndrome

A

Delusional belief that someone you know has been replaced by an imposter who is their exact double
Delusions that strangers or ppl pt meets are pt’s persecutors in disguise

75
Q

Delusional parasitosis

A

Believe that insects are colonizing their bodies

76
Q

Folie a deux

A

Shared delusion, usu within family

77
Q

De Clerambault’s syndrome

A

Delusion that someone (usu man of higher status) is in love with her
Inappropriate advances. Can become angry and violent when rejected

78
Q

Cotard’s syndrome

A

Nihilistic delusion where pt thinks parts of body are rotting and they’ve stopped existing
Believe themselves to be dead/unable to die, therefore eternally alive

79
Q

Munchausens/Factitious disorder

A

Feigned illness

Can have munchausen’s by proxy

80
Q

Couvade syndrome

A

Experience symptoms resembling pregnancy in expectant fathers

81
Q

Ganser’s syndrome

A

Approximate, absurd, inconsistent answer to simple questions
Dissociative reaction against intolerable stress
Overrepresented in prison populations

82
Q

Idealization

A

Part of splitting

Another individual has more positive traits/qualities than actually possesses

83
Q

Sublimation

A

Transforms negative emotion into socially acceptable ones. E.g. art, sport

84
Q

Projective identification

A

Self-fulfilling prophecy

Projected emotions/feelings alter behavior

85
Q

Systemic therapy

A

Aka family therapy

Explores relationships between individuals (i.e. in systems).

86
Q

Dialectical behavior therapy

A

Intended for borderline

CBT + distress tolerance + mindfulness

87
Q

Arbitrary inference

A

Cognitive distortion where individual jumps to conclusion without evidence

Year 5 Psych (5 decks)

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