PP Psychiatry Flashcards
0
Q
How is mejor depression diagnosed?
A
Need 5 " SIG E CAPS" >2 weeks - Sleep disturbances: wake in am - loss of Interest (anhedonia) - Guilt - Energy loss - Concentration loss - Appetite loss - Psychomotor agitation - Suicide: hopelessness Usually lasting 6-12 month
1
Q
What is Autism?
A
Repetitive behavior
Lac of verbal skills and social interaction
Great focus on objects than on people
Below-normal intelligence
2
Q
What is Asperger’s?
A
Milder form of autism Good communication Impaired relationships No mental retardation Normal intelligence
3
Q
What is Rett’s?
A
Only in girls Regression Decrease head growth Lose motor skills Normal until 5month ( symptoms apparent around 1-4 y/o)
4
Q
What is childhood disintegrative disorder?
A
Kids stop walking/ talking after 2 years of apparently normal development
Onset 3-4 years
More common in boys
5
Q
What is the selective mutism?
A
Kids talk some time
6
Q
What is Separation Anxiety Disorder?
A
Kids scream when Mom leaves
Common onset at 7-9 years
7
Q
What is Conduct Disorder?
A
Before age 18 Aggressive Disregard for rule No sense of guilt Harm animals Illegal activity " bite"
8
Q
What is Oppositional Defiant Disorder?
A
Defiant toward authority figures.
Noncompliant
9
Q
What is Attention Deficit Heyperactivity Disorder?
Tx?
A
Onset before age 12
Normal intelligence
Overactivity
Difficulty in school
A/w decrease frontal lobe vol/ metabolism.
Tx : Methylphenidate, dextroamphethamine, atomoxetine
10
Q
What is Dysthymia?
A
Milder form of depression lasting at least 2 years
11
Q
What is cyclothymia?
A
Dysthymia w/ hypomania
Milder form of Bipolar disorder lasting at least 2 years
12
Q
What is Bipolar I?
A
> 1 manic episode with or without Psychotic features
13
Q
What is Bipolar II?
A
Hypomanic episode + MDD
14
Q
What is Neologism?
A
New word
15
Q
What is delusion?
A
False belief
16
Q
What is illusion?
A
Misinterprets stimulus
17
Q
What is Cataplexy?
A
Los of all muscle tone following strong emotional stimulus
* A/w Narcolepsy
18
Q
What is paranoid personality disorder?
A
Suspicious about everything, use projection
19
Q
What is Schizotypal personality disorder?
A
” Magical thinking”
Bizarre behavior
20
Q
What is schizoid personality disorder?
A
“Recluse”
Don’t want to fit in
Distant
21
Q
What is Antisocial personality disorder?
A
>18 year Lie Steal Cheat Destroy property Impulsive w/o remorse Illegally activity
22
Q
What is Histrionic personality disorder?
A
Theatrical
Sexually provocative, Attention seeking, concern with appearance.
23
Q
What is Borderline personality disorder?
A
Unstable mood and interpersonal relationships.
Self-mutilation, impulsivity , sense of emptiness
Splitting (love/hate) mechanisms of defense
24
What is Narcissistic personality disorder?
Grandiosity
| No empathy
25
What is Dependant personality disorder?
Clingy
Submissive
Low self confidence
Regression
26
What is Obsessive-Compulsive personality disorder?
Perfectionist
Doesn't show feeling
Detail-oriented
Uses isolation
27
What is Avoidant personality disorder?
Socially withdraw
| Afraid of rejection but wants to fit in
28
What is Kleptomania?
Steal for the fun of it
29
What is Pyromania?
Starts fires
30
What is Trichotillomania?
Pull out their hair
31
What is Lewy body dementia?
Stiff, visual hallucinations
32
What is Normal Pressure Hydrocephalus?
TrIAD = Incontinence, Ataxia " magnetic gait", Dementia
33
What is Korsakoff psychosis?
Alcoholic Thiamine deficiency
34
What is vascular " multi-infarct" dementia?
Sudden unset
Uneven progression of deficit
" stair-step" decline
35
What is Huntington's?
In caudate/putamen
Triplet repeat disorder
Choreiform movement
36
What is Creutzfeldt-Jacob?
Prion included
Die within 1 year
Post cornea transplant
37
What is Pick's disease?
Frontal lobe atrophy
| Disinhibition
38
What is Alzheimer's ?
Decrease ACh in nucleus basales of Meynert
Bad ApoE
Amyloid plaques
Tangles bodies
39
What is Parkinson's?
```
In substantial nigra
Bradykinesia
Pill-rolling tremor
Shuffling gait
Lewy bodies
Decrease dopamine
Increase serotonin and ACh
```
40
What is Somatization?
Think they have a different illness all the time (at least 4 organ system)
41
What is Hypochondriasis?
Think they have the same illness all the time
42
What is Body Dismorphic disorder?
Imagined physical defect
43
What is pain disorder?
Prolonged pain not explained by physical causes
44
What is Malingering?
*Secondary gain
Fake illness for monetary gain
Avoids medical treatment
45
What is Factitious?
*Sick role
Fake illness to get attention
Seeks medical treatment
46
What is Munchausen syndrome by proxy?
Need to be the caregiver
| Mom fakes child's illness to get attention
47
What is Amnesia?
Can't recall important facts
48
What is Dossociative fugue?
Travel to new places with inability to recall the past
| Usually due to trauma
49
What is Multiple Personality disorder?
Is a Dissociative identity disorder
Have 5-10 alters
Usually associated w/ incest
50
What is Depersonalization disorder?
"Out of body" experiences
| Deja vu
51
What is Sublimation?
Replace an unacceptable wish with an action that is similar to the wish but doesn’t conflict with once values.
52
What is Displacement?
Transferring avoided feeling or ideas to a person or object.
53
What is Transference?
Patient views doctor as parent
| * patient projects feeling onto physician
54
What is Acting out?
Unacceptable feelings and thoughts are expressed through actions
Ex: "Tantrums"
55
What is Regression?
- Immature behavior
| - go back to previous stages
56
What is Rationalization?
"Justifying behavior to avoid difficult truth "
- logical reasons
- Make excuses for all situation to avoid self-blame
57
What is Intellectualization?
Act like a "know-it-all" to avoid feeling emotion
58
What is Isolation of Affect?
Is an immature defenses of the Ego
| Isolate feeling to keep on functioning
59
What is Suppression?
Choosing to block memory
60
What is Repression?
Involuntarily block of memory
61
What is reaction formation?
Replace a bad idea or feeling by focusing on the opposite.
| -Unconsciously act opposite to how you feel ( tears of a clown)
62
What is Sadism?
Gives pain
63
What is Masochism?
Receives pain
64
What is Exhibitionism?
Exposure to other
65
What is Voyeurism?
Watching other people without their permission
66
What is Frotteurism?
Rub penis against fully clothed women
67
What is Transsexual?
Gender identity crisis " man trapped in a woman's body"
68
What is Fetish?
Objects (vibrators, dildos, shoes)
69
What is Pedophile?
Children ( watching child pornography)
70
What is Necrophile?
Corpses
71
What is a Beastophile?
Animals
72
Can you die during EtOH withdrawal?
Yes
73
Can you die during Opiod withdrawal?
No; just very painful
74
What is Dissociation?
- drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress
75
What is Denial?
- avoidance of awareness of some painful reality
76
What is Fixation?
- remaining at a more childish level of development
77
What is projection?
an unacceptable internal impulse is attributed to an external source
78
What is Splitting?
- belief that people are either all good or all bad
| - commonly seen in Borderline personality disorder
79
What is Altruism?
- compensation
| - alleviated the gilt with an unsolicited generosity toward others
80
Which are the childhood and early-onset disorder?
```
ADHD
Conduct disorder
Oppositional defiant disorder
Tourette's syndrome
Separation anxiety disorder
```
81
What is Tourette's syndrome?
```
Onset before age 18
Tics that persist for > 1 year
A/w OCD and ADHD
Treatment:
- fluphenazine
- pimozide
- tetrabenazine
- clonidine
- haloperidol
```
82
Types of amnesias?
- Retrograde: before the event
- Anterograde: after the event ( new memory)
- Korsakoff's : anterograde, caused by thiamine defi., destruction of mammillary bodies, associated with confabulation
- Dissociative: inhability to recall personal information after trauma or stress
83
What is a Psychotic disorder?
Distorted perception of reality
| Characterized bay delusion, hallucination and/or disorganized thinking
84
Which are the sings of psychosis?
Hallucinations
Delusions
Disorganized speech
85
What is Schizophrenia?
```
Mental disorder with periods of psychosis
Impaired functioning
Symptom last > 6 month
Increase dopamine
Have positive and negative symptoms
```
86
Brief psychotic disorder ?
< 1 month, stress related
87
What is Schizophreniform disorder ?
Same as schizophrenia but the time is different 1-6 month
88
What is Schizoaffective disorder?
Needs to present at least 2 weeks of psychotic symptoms with a stable mood and an episode of major depression, manic or mixed
89
What is a Delusional disorder?
Fixed, persitent, nonbizarre belief system lasting > 1 month
Functioning is not impaired
90
What is an Hypomanic episode?
Like a Manic episode, except mood disturbance is not severe enough to cause impairment
91
What is Atypical depression?
Subtype of depression that is characterized by:
- Hyperphagia
- Hypersomnia
- Mood reactivity
- Rejection hypersensitivity
92
What is Post-traumatic stress disorder?
Disturbance last > 1 month
| My involve nightmares or flashback
93
What is Acute-stress disorder?
Disturbance present between 2 days and 1 month
94
What is Generalized anxiety disorder?
Pattern of uncontrollable anxiety for at least 6 month
95
What is Conversion?
Sudden loss of sensory or motor Function, following an acute stressor
96
Time corse of schizophrenia?
< 1 month : brief psychotic disorder
1-6 month: Schizophreniform
> 6 month : schizophrenia
97
What is anorexia nervosa?
```
Excessive dieting
Intense fear of gainin weight
Body image distortion
Amenorrhea
Increase exercise
```
98
What is Bulimia nervosa?
Binge eating
Self induce vomiting or use of laxatives, diuretics or emetics
Associated with: parotitis, enamel erosion, electrolyte disturbance, alkalosis
Treated with: Fluoxetine
99
Which are the Depressants drugs?
- Alcohol
- Opioids ( morphine, heroine, methadone)
- Barbiturates
- Benzodiazepines
100
Which are the Stimulants drugs?
Amphetamines
Cocaine
Caffeine
Nicotine
101
Which are the Hallucinogens drugs?
PCP
LSD
Marijuana
102
How are classify the Antipsychotics?
```
Typical ( traditional neuroleptics)
- low potency
- high potency
* block Dopamine D2 receptor { increase cAMP}
Atypicals
```
103
Which are the low potency Antipsychotics?
Chlorpromazine
| Thioridazine
104
Which are the High potency Antipsychotics?
```
Haloperidol
Fluphenazine
Loxapine
Thiothixene
Trifluoperazine
```
105
Which are the Atypicals Antipsychotics?
```
Olanzapine
Quetiapine
Risperidona
Aripiprazole
Clozapine ( causes agranulositosis)
```
106
Buspirone?
Stimulates 5-HT1A receptors
| Use for Generalized anxiety disorder
107
Which are the types of Antidepresants?
SSRIs: inhibits re-uptake of Serotonin
SNRIs: inhibits re-uptake of Norepinephrine and Serotonin
TCA: inhibits re-uptake of Norepinephrine and Serotonin
MAOI: inhibits enzyme that metabolize and inactivates Norepinephrine
108
Which are the SSRIs?
Fluoxetine
Paroxetine
Sertraline
Citalopram
109
Which are the SNRIs?
Venlafaxine
| Duloxetine
110
Which are the TCA?
```
Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine
Doxepin
Amoxapine
```
111
Which are the MAO?
Tranycypromine
Phenelzine
Isocarboxazid
Selegiline
112
Which are the Atypical Antidepressants?
Buspiron
Mirtazapine:
Maprotiline:
Trazodone:
113
Lithium is use for?
Mood stabilizer for Bipolar disorder
| Blocks relapse and acute manic event
114
What is akathisia?
restlessness
| inability to sit still
115
Which are the diagnostic criteria for a Manic episode?
```
"DIG FAST"
Disutractibility
Irresponsibility
Grandiosity
Flight of ideas
Increase Activity/ Agitation
Sleep
Talkativeness
```
116
What is a Manic episode?
Period of abnormally and persistently elevated, expansive or irritable mood
Lasting at least 1 week
117
Generalized anxiety disorder?
Chronic multiple worries, anxiety, tension.
118
Mention the Key clinical features for acute drug intoxication?
1. PCP
2. LSD
3. Cocaine
4. Methanphetamine
5. Marijuana (Canabis)
6. Heroine
1. Nystagmus, violent behavior
2. Visual hallucinations
3. CP, seizures, Mydriadis ( dilated pupil )
3. Choreiform movement, tooth decay
4. Conjunctival injection ( red eyes), increase appetite
6. Depressed mental status, Miosis ( constricted pupil), respiratory depression
119
What is adjustment disorder?
Involves emotional or behavioral symptoms developing within 3 months of an indentifiable stressor.
120
Which are the 2 types of Breath-holding spell?
* They are benign
* Characterized by brief period of apnea and skin color change
* Common in children age 6mo - 2y
1. Cyanotic type:
-crying & BH follow by apnea and loss of consciousness.
-brief with rapid return to baseline.
2. Pallid type:
-trigger by minor trauma
-fleeting loss of consciousness follow by BH, pallor & diaforesis
-less than 1 min with subsequent confusion and sleepiness for a
few min
121
Nightmare disorder vs. Sleep terror disorder?
- Nightmare: recurrent awakening from REM sleep, full alertness, dream recall, can be consoled.
- Terror: non-REM arousal, incomplete awakening, cannot recall dream, unresponsiveness to confort
122
Delayed vs. Advanced sleep phase syndrome?
*circadian rhythm disorder characterized by the inability of:
- Delayed: fall asleep at normal bedtime ( results in sleep-onset insomnia & daytime sleepiness)
- Advanced:stay awake in the evening, past 7 ( result in social functioning & early morning insomnia)
123
Catatonia
A syndrome seen in severe psychiatric &a medical illness.
* Characterized by: immobility, mutism and posturing.
- A Lorazepam challenge test can confirm the Dx
- Tx: Benzodiazepine, ECT for pt that don't improve.
124
Dissociative identity disorder
Discontinuity in identity and loss of personal agency with fragmentation into >2 distinct personality state
125
New onset of severe GI symptoms, confusion, ataxia and tremors.
Lithium toxicity
- use of Lithium in combination of : Thiazides, ACE-inhibitors, Tetracyclines, Metronidazole
126
Prevalent comorbid conditions that complicate the management and quality of life in pt with Tourette sy.
ADHD
| OCD
127
Neuroleptic Malignant syndrome signs/symptoms?
```
Muscle rigidity
Fever > 40C (104F)
Confusion
Autonomic instability
Increased CK
Leukocytosis
```
*Serotonin syn: tremor, hyperreflexia, myoclonus, Fever but not as high, nausea and vomiting.
128
Dissociative Amnesia
Inability to recal important personal info; usually of a traumatic or stressful nature
* Not exploded by another disorder
129
Precontemplation?
Not yet acknowledged that there is a problem
130
Atypical depression is characterized by?
```
Mood reactivity ( feeling better in response to positive events)
Laden paralysis (extremities feel heavy)
Rejection sensitivity ( overly sensitive to criticism)
Increase sleep and appetite
```
131
Acute stress disorder Vs. Post-traumatic stress disorder
ASD: more than 3days but less than a month
PTSD: persistence of symptoms for more than a month
132
4hour Acute dystonia Tx?
Anticholinergics:
- Benztropine
- Diphenhydramine
* symptoms: muscles spasm, stiffness, oculogyric crisis
133
4 month Tardive dyskinesia?
```
Involuntary movement ( tongue,lips, face, extremities)
* Clozapine may help
```
134
Serotonin syndrome is characterized by a triad of?
1. Autonomic instability: hyperthermia, HTN, tachycardia
2. AMS
3. Neuromuscular hyperactivity ( hyperreflexia, miotonic)
135
Action/ willpower
Changing behavior
136
Pt experiencing MDD episode should be screen for?
Past MANIC episode to rule out Bipolar disorder
137
Contemplation
Acknowledging that there is a problem, but not yet ready or willing to make a change
138
Depressant drugs?
Alcohol
Opioids (morphine, heroin, methadone)
Barbiturates
Benzodiazepines
139
Delusions or hallucinations fro more than 2 weeks in the absence of MD episode or manic episode is?
Schizoaffective disorder
140
Symptoms of opioids intoxication?
* morphine, heroin, methadone
Euphoria
Respi & CNS depression
Pupillary constriction ( point pupil)
-Tx for overdose: Naloxone
141
Caine withdrawal is characterized by?
Acute depression accompanied by:
- Vivid dreams
- Hyperinsomnia
- Hyperphagia
- Fatigue
142
Dilate pupils, yawning, lacrimation
Heroin withdrawal
* in baby - look for sneezing, vomiting, diarrhea
143
Pupillary findings on intoxication with
1. Stimulants
2. Depressants
1. Stimulants- dilate
| 2. Depressant- constrict
144
Delirium is characterized by?
Acute
Fluctuating cognitive impairments
Ex. Poor attention, disorientation
145
Alcohol withdrawal syndrome 6-24hrs?
Mild
| -symp: anxiety, insomnia, Tremors, diaphoresis, palpitations, GI upset, oriented.
146
Alcohol withdrawal syndrome 12-48hrs?
- seizures
- hallucinations
- oriented
- normal VS
147
Alcohol withdrawal syndrome 48-96hrs?
Delirium tremors
| - confusion, agitation, fever, tachycardia, HTN, diaphoresis, hallucinations
148
Tx for Neuroleptic malignant syndrome?
- Dopaminergic agents: Bromocriptine, Amantadine
| - Muscle relaxant: Dantrolene
149
Most consistently replicated neuroimaging finding in schizophrenia?
Enlargement of the. Lateral cerebral ventricles
150
Specific phobia?
Excessive anxiety about specific object or situation.
151
Panic disorder?
Recurrent, unexpected panic attack’s
152
Neurotransmitter changes in Alzheimer disease?
Decrease ACh
| Increase glutamate
152
Neurotransmitter changes in Anxiety?
Increase NE
| Decrease GABA and 5-HT
152
Neurotransmitter changes in Depression?
Decrease: NE, dopamine and 5-HT
152
Neurotransmitter changes in Huntington disease?
Increase:dopamine
Decrease: GABA and ACh
152
Neurotransmitter changes in Parkinson disease?
Decrease dopamine
| Increase ACh
152
Sensation of bugs crawling
MC in alcohol withdrawals
| Also seen in cocaine abusers
152
Negative symptoms of schizophrenia?
Flat affects
Social withdrawals
Lack of motivation
Lack of speech or thought .
-Symptoms improve with antipsychotic
152
Maternal blues
Starts 2-3 days after delivery
Symptoms: depress affect, tearfulness and fatigue.
Tx supportive, FU for evaluation of PD
152
Postpartum depression (PD)
Starts after 4 weeks of delivery
Symptoms: depression, anxiety, poor concentration
Tx CTB AND SSRI 1 line
152
Common side effect of ECT?
Amnesias: retrograde and anterograde
152
Social anxiety disorder?
Social phobia
- anxiety restricted to social & performance situations.
- fear of scrutiny & embarrassment.
