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Psychiatry > Pathology > Flashcards

Pathology Flashcards

1
Q

Psych genetics

A

Combination of genetics and environmental influences

Genes seem to play a big role with schizophrenia and bipolar disorder

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2
Q

Infant deprivation effects

A

Weak
Wordless
Wanting
Wary

Be sure to distinguish failure to thrive causes: can be deprivation, malnutrition, malabsorption, or glycogen storage disease

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3
Q

Child abuse- physical

A

Fractures- spiral; in different stages of healing
Subdural hematomas and retinal hemorrhages
Lack of eye contact
Often mother (biological)

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4
Q

Child abuse- sexual

A

genital, anal, oral trauma; STIs, UTIs

Usually male perpetrator
Peak incidence in 9-12 year olds

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5
Q

Child neglect

A

Failure to provide kid with adequate food, shelter, supervision, education, affection

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6
Q

Vulnerable child syndrome

A

Parents think kid is extremely susceptible to injury
Often as a result of a serious or life-threatening event
Signs: missed school or overuse of medical services

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7
Q

ADHD

A

Onset before 12
Limited attention span and poor impulse control

Often continues into adulthood (50%)- tx with methylphenidate +/- CBT

Other treatments: atomoxetine, guanfacine, clonidine

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8
Q

Autism spectrum disorder

A

Poor social interactions, repetitive/ ritualized behaviors, restricted interests

May be assoc. with intellectual disability, savants (unusual abilities), more common in boys

Assoc with increased head/ brain size and tuberous sclerosis

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9
Q

Rett syndrome

A

X-linked dominant disorder (seen almost exclusively in girls- boys die)

Regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and HAND WRINGING

Think of this when you see a GIRL with HAND-WRINGING

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10
Q

Conduct disorder

A

Repetitive and pervasive behavior –> violates social norms (stealing, destruction of property)

Often progresses to antisocial disorder (dx at 18)

Tx: CBT

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11
Q

Oppositional defiant disorder

A

Enduring pattern of hostile and defiant behavior in the ABSENCE of serious violations of social norms

Kid saying no all the time

Oppositional defiant disorder –> Conduct disorder –> Antisocial

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12
Q

Separation anxiety disorder

A

7-9 years
Overwhelming fear of separation from home or loss of family figure
Factitious complaints/ Avoids going to school
Tx: family therapy, play therapy, CBT

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13
Q

Tourette syndrome

A

Onset before age 18
Sudden, rapid, recurrent, non-rhythmic motor and vocal tics that persist for > 1yr (Motor&raquo_space; Vocal)
Assoc with OCD and ADHD

Tx: psychoeducation, CBT
High potency anti-psychotics (fluphenazine, pimozide), tetrabenazine, guanfacine, and clonidine

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14
Q

NT changes- Alzheimers

A

Decreased ACh

Increased glutamate

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15
Q

Anxiety

A

Decreased GABA and 5-HT

increased NE

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16
Q

Depression

A

Decreased NE, 5HT, and dopamine

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17
Q

Huntington

A

Decreased GABA, ACh

Increased dopamine

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18
Q

Parkinson

A

Decreased dopamine

Increased ACh

Opposite (essentially) of Huntington (HT also affects GABA)

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19
Q

Schizophrenia

A

Increased dopamine (just like HT)

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20
Q

Orientation

A

Ability for a person to know who he or she is

General order of loss: 1. time, 2. place, 3. person

Causes of loss: alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, infection, nutritional deficiencies

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21
Q

Amnesia

A

Retrograde- can’t remember what happened BEFORE a CNS injury
Anterograde- can’t make new memories (AFTER a CNS injury)
Korsakoff- confabulations, anterograde amnesia, personality change, and memory loss (permanent)

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22
Q

Dissociative amnesia

A

Can’t recall important PERSONAL information after a severe trauma

Kind of sounds like repression??

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23
Q

Dissociative identity disorder

A

AKA multiple personality disoder

2 or more distinct identities or personality states (more common in women)

Associated with hx of sexual abuse, PTSD, depression, substance abuse, borderline personality, somatoform conditions

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24
Q

Depersonalization/ derealization disorder

A

Detachment or estrangement from body, through, perceptions, and actions (DEPERSONALIZATION)

Or from one’s environment (DEREALIZATION)

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25
Q

Delirium

A

REVERSIBLE (hrs to days)

“waxing and waning”– remember what else is?? Follicular B cell lymphoma

Either ways, waxing and waning level of consciousness with acute onset

Disorganized thinking, hallucinations (visual), illusions

Generally secondary to other illness (CNS disease, infection, trauma, substance abuse/withdrawal, metabolic and electrolyte disturbances, hemorrhage, fecal retention)

Can be caused by anticholinergics in the elderly

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26
Q

Dementia

A

DeMEMtia is characterized by MEMory loss; usually IRREVERSIBLE

Decrease in intellectual function WITHOUT affecting consciousness

Memory deficits, apraxia, aphasia, agnosia, loss of abstract thought, behavioral/ personality changes, impaired judgment

**NOTE: In the elderly, depression and hypothyroidism (which causes decreased energy/ depression) can present like dementia; therefore check TSH levels, B12 levels, and screen for depression before diagnosing them with dementia

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27
Q

Psychosis

A

Distorted perception of reality –> characterized by hallucinations (auditory), and disorganized thinking

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28
Q

Delusions

A

Unique false beliefs that persist despite the facts (thinking aliens are communicated with you)

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29
Q

Disorganized thought

A

Speech may be incoherent, tangential, or derailed

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30
Q

Hallucinations

A

Perceptions in the absence of external stimuli

Visual- assoc. with MEDICAL illness
Auditory- assoc. with psych illness (SCHIZOPHRENIA)
Olfactory- can be seen with temporal lobe epilepsy and brain tumors
Gustatory- rare, seen in epilepsy
Tactile- seen with alcohol WITHDRAWAL and stimulant USE (cocaine crawlies)
HypnaGOgic- while GOing to sleep (seen in narcolepsy)
HypnoPOMPic- when waking from sleep (also seen in narcolepsy)

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31
Q

Schizophrenia

A

S&S > 6 MONTHS
Chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning

  1. Delusions
  2. Hallucinations (auditory)
  3. Disorganized speech
  4. Disorganized behavior
  5. Negative symptoms (affective flattening, avolution (lack of motivation), anhedonia- can’t feel pleasure, asociality, alogia- lack of speech)

Can be precipitated by cannabis use; ventriculomegaly seen in brain imaging

Tx: ATYPICAL antipsychotics (e.g. risperidone)

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32
Q

Brief psychotic disorder

A

If schizophrenic symptoms last for <1mo

Assoc with stress

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33
Q

Schizophreniform disorder

A

If lasting 1-6 months

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34
Q

Schizoaffective disorder

A

If > 2 weeks of hallucinations or delusions, but NO MOOD DISORDER (depression or mania)

35
Q

Delusional disorder

A

False beliefs lasting >1month
Can be shared by individuals in close relationship

Ex: Man is convinced that his wife is cheating on him (involves one person –> not pervasive like paranoid personality disorder)

36
Q

Mood disorder

A

Abnormal range of moods or internal emotional states and loss of control over them

Episodic psychotic features may be present

37
Q

Manic episode

A

Lasts AT LEAST 1 week

DIGFAST
Distractibility
Irritability
Grandiosity
Flight of ideas
Agitation
Sleep is less
Talkativeness
38
Q

Hypomanic

A

Similar to manic, but LESS THAN 4 days

39
Q

Bipolar

A

Bipolar I- at least one manic episode +/- depressive/hypomania
Bipolar II- hypomanic + depressive episode

Think that Type II has TWO types of moods

Tx: mood stabilizers (lithium, valproic acid, carbamazepine), ATYPICAL antipsychotics

40
Q

Major depressive disorder

A

Lasts 6-12 months

SIGECAPS + depressed mood
Sleep disturbance
Interest is lost (anhedonia)
Guilt/ worthlessness
Energy loss and fatigue
Concentration probs
Appetite/ weight changes
Psychomotor retardation or agitation
Suicidal ideation

Episodes: at least 5/9 symptoms for 2 or more weeks

Tx: 1st line- CBT and SSRIs
SNRIs, mirtazapine (alpha2 blocker), buproprion (increases NE and dopamine)

41
Q

Persistant depressive disorder (dythymia)

A

milder depression, lasts > 2years

42
Q

Depression (with atypical features)

A 
Mood reactivity (+ mood --> but brief)
Hypersomnia, hyperphagia
Leaden paralysis (heaviness in arms and legs)
Interpersonal rejection sensitivity
Tx: CBT and SSRIs
43
Q

Postpartum mood disturbances

A

Onset within 4 wks of delivery

“Blues”: resolves within 10 DAYS
Depression: More than 10 days –> SIGECAPS
Psychosis: delusions, hallucinations, and thoughts of harming the baby or self –> Tx: hospitalization, atypical antipsychotic, ECT

44
Q

Grief

A

Usually less than 6 months
Characterized by shock, denial, guilt, sadness, anxiety, yearning and somatic symptoms

May have hallucinations of the deceased person; duration varies widely

NO SUICIDAL IDEATION

45
Q

Pathologic grief

A

Generally after more than 6 months; persistent and can cause functional impairment

46
Q

Electroconvulsive therapy

A

Used for tx refractory depression (or deep with psychotic symptoms)
Produces grand mal seizure in patient
Can lead to disorientation, temporary headache, amnesia (that generally resolves in 6 months)

47
Q

Suicide completion risk (SADPERSONS)

A

SADPERSONS

Sex (male)
Age (young adult or elderly)
Depression
Previous attempt
Ethanol or drug use
Rational thinking loss (psychosis)
Sickness (medical illness)
Organized plan
No spouse or social support
Stated future intent

Most common method of success is firearms

48
Q

Anxiety disorder

A

Inappropriate experience of fear/worry and its physical manifestations

Interfere with daily functioning

Includes panic disorder, phobias, generalized anxiety disorder, and selective mutism

Tx: CBT, SSRIs, and SNRIs

49
Q

Panic disorder

A

Recurrent panic attacks

Requires 1 MONTH or more of:

  • Persistent concern of additional attacks
  • Worrying about the consequences of attack
  • Behavioral change related to attack

Periods of intense fear (peaking in 10 minutes, with at least 4 of the following)

Palpitations, paresthesias, dePersonalizations/ derealization
Abdominal distress
Nausea
Intense fear of dying, intense fear of losing control or going crazy, lIghtheadedness
Chest pain, chills, choking
Sweating, shaking, shortness of breath

Tx: CBTs, SSRIs, and venlafaxine (SNRI) –> same as anxiety disorder

50
Q

Specific phobia

A

Fear or anxiety about a specific object or situation

Social anxiety- fear of social situations (public speaking, public restrooms)
Agoraphobia- fear of open or enclosed places (e.g. public txportation, leaving home alone, lines, crowds)

Tx: Same as with panic disorder (CBT, SSRI, SNRI) + beta blocker or benzo for acute attacks (social) OR MAOIs for agoraphobia

51
Q

Generalized anxiety disorder

A

Anxiety for > 6 MONTHS

UNRELATED to a specific person, situation, or event
Same tx as anxiety disorder (CBT, SSRIs, SNRIs)

52
Q

Adjustment disorder

A

Anxiety about an identifiable psychosocial stressor lasting < 6 MONTHS (can be greater is the stressor is chronic)

Tx: CBTs, SSRIs

53
Q

OCD

A

Reccuring obsession that cause sever distress; relieved by partaking in the compulsion

Associated with Tourettes

Tx: CBT, SSRI and clomipramine (TCAD)

54
Q

Body dysmorphic disorder

A

Preoccupation with minor or imagined defect in appearance

Pts seek repeated cosmetic treatment

Tx: CBT

55
Q

PTSD

A

Disturbance last > 1 month after prior trauma

Tx: CBT, SSRIs, and venlafaxine (just like with panic disorder)

56
Q

Acute stress disorder

A

Similar symptoms as PTSD but lasts between 3 days and 1 month

Tx: CBT, pharm generally not needed

57
Q

Malingering

A

Patient fakes or exaggerates to get a secondary (external) gain (e.g. avoid work)

Complaints CEASE after gain, as opposed to factitious disorder

58
Q

Factitious disorder

A

Patient CONSCIOUSLY creates a physical/ psychological symptom in order get primary (internal gain)–> attention

HOWEVER these people do not have a variety of bodily complaints –> that is more characteristic of somatic symptom disorder

59
Q

Subclasses of factitious disorder

A

Imposed on self (Munchausen): chronic, physical signs and symptoms; multiple hospital admissions an willingness to undergo invasive procedures

imposed on another (Munchausen by proxy): illness in a child or elderly patient is caused or fabricated by caregiver –> THIS IS ELDER/CHILD abuse

60
Q

Somatic symptom and related disorders

A

Physical symptoms causing significant distress and impairment

Illness production and motivation are UNCONSCIOUS drives –> not intentionally produced or feigned

61
Q

Somatic symptom disorder

A

Variety of bodily complaints (pain, fatigue) –> lasts months to years

Associated with anxiety about symptoms

Tx: CBT and SSRIs

62
Q

Conversion (functional neurological symptom) disorder

A

Loss of sensory or motor function (paralysis, blindness, mutism) –> often following an acute stressor

63
Q

Illness anxiety disorder

A

Excessive preoccupation with acquiring or having a serious illness (despite medical evaluation)

Hypochondriacs

64
Q

Pseudocyesis

A

False, non delusional belief of being pregnant

65
Q

Eating disorders- anorexia

A

Anorexia- excessive dieting or binging/purging with BMI < 18.5

Associated with decreased bone density, severe weight loss, stress fractures, and amenorrhea (due to loss of hypothalamic GnRH signal)

Tx: psychotherapy and nutritional rehabilitation (NOTE: SSRIs are not first line! -vs. Bulimia)

BEWARE of refeeding syndrome: increased insulin –> hypophosphatemia & hypokalemia –> cardiac complications

66
Q

Bulimia nervosa

A

NOT associated with low BMI

Binge eating with purging/fasting/laxatives occurring weekly for at least 3 months & overvaluation of body image

Associated with parotitis, enamel erosion, electrolyte disturbances, alkalois, dorsal hand calluses

Tx: psychotherapy, nutritional rehab, and antidepressants

67
Q

Binge eating disorder

A

Regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors)

Increased risk of diabetes

Tx: psychotherapy such as CBT, SSRIs

68
Q

Gender dysphoria

A

People not identifying with their gender

E.g. people who are transgender may have gender dysphoric disorder

69
Q

TransSEXualism

A

Desire to live as the opposite sex (often through surgery)

70
Q

TrasVESTism

A

Paraphilia, not gender dysphoria; wearing CLOTHES (e.g. VEST) of the opposite gender (cross-dressing)

71
Q

Sexual dysfunction

A

Sexual desire disorders
Sexual arousal disorders
Orgasmic disorders
Sexual pain disorders

DDx: drugs (antiHTN, anti depressants, neuroleptics), diseases (depression, diabetes, and STIs), and psychological (performance anxiety)

72
Q

Sleep terror syndrome

A

Terror with screaming in the middle of the night
Occurs during slow-wave/ deep (N3) sleep

Triggers: emotional stress, fever, lack of sleep

Usually self-limited

73
Q

Restless leg syndrome

A

Uncomfortable sensation in legs –> accompanied by urge to move them (worse at rest and falling asleep)

Tx: dopamine agonists (pramiprexole)

74
Q

Narcolepsy

A

Disordered regulation of sleep-wake cycle –> excessive daytime sleepiness, though they awaken feeling rested

Caused by decreased OREXIN (HYPOCRETIN) production in the lateral hypothalamus

Associated with:

  1. Hypnogogic/ hypnopompic hallucinations
  2. nocturnal and narcoleptic sleep episodes that start with REM sleep
  3. Cataplexy: loss of all muscle tone following strong emotional stimulus (e.g. laughter)

Strong genetic association

Tx: daytime stimulants (amphetamines, modafinil), nighttime (sodium oxybate- GHB)

75
Q

Substance use disorder

A

Two or more of the following signs
Tolerance
Withdrawal
Taken in larger amounts or over a larger time than desired
Persistant desire or unsuccessful attempts to cut down
Significant energy spent obtaining or using (or recovering)
Impacts other activities
Craving
Continued use despite physical/psych effects

76
Q

Stages of overcoming

A
  1. Precontemplation- no acknowledgment of prob
  2. Contemplation- acknowledges prob, but doesn’t want to do anything about it
  3. Preparation/ determination- getting ready to make a change
  4. Action/ willpower- changes behavior
  5. Maintenance- maintains changed behavior
  6. Relapse- goes back to old habits, abandons new changes
77
Q

Pica

A

Consistent consumption of non-food or non-staple food for > 1 month (e.g. ice, soil, flour, etc)

78
Q

Short acting vs. long acting benzos

A

Short: MOT- midazolam, oxazepam, and triazolam

Mid (6-24 hrs): ALT- alprazolam, lorazepam, and temazepam

Long: Diazepam, chlordiazepoxide, flurazepam

Use short/ mid acting ones to minimize undesirable daytime lethargy

79
Q

Benzos that are not metabolized in the liver

A

LOT- lorazepam, oxazepam, temazepam

80
Q

Lithium

A

Used for bipolar

SE: hypothyroidism (constipation, fatigue, etc.) and nephrogenic DI

81
Q

Valproate

A

Used to tx absence, tonic-clonic, and myoclonic seizures

SE: Hepatotoxicity, NTDs

82
Q

Carbamazepine

A

Used for trigeminal neuralgia

SE: agranulocytosis, SIADH, NTDs

83
Q

Lamotrigine

A

Used to tx depressive episodes and focal seizures

SE: rash, SJS

Psychiatry (4 decks)

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