Psy Guy Flashcards
{{BLANK}} is the only phobia w/ a paradoxical response of bradycardia, hypotension, and fainting
Blood-inj. phobia
SANS activation during blood injury. phobia creates a {{BLANK}} response/fainting
vasovagal
A social phobia is more likely to develop after?
Stressful or humiliating
Panic Dx must be present as a panic attack along w/ {{BLANK}} to be diagnosed
> 1 month of concern/effects from the attack
{{BLANK}} is the main cause of the S/Sx of panic disorder
Hypocapnia
A person w/ agoraphobia is scared to…
Be in public places (10% remission w/o Tx)
1 reason people use marijuana is
anxiety
1 reason people D/C marijuana is
anxiety
DOC for specific phobias
CBT (incl. exposure)
Flooding Tx is dangerous in phobia Tx why?
Can either work or make worse
EtOH works similarly to {{BLANK}} in the treatment (self) for SAD
BZDs
T/F: Current treatments are over 50% effective in the treatment of SAD (e.g., SSRI, SNRI, BZD, etc.)
True
T/F: SSRIs have not been shown to be more efficacious than placebo in the Tx of panic dx
False
T/F: CBT & antidepressants (e.g., SSRI) have been shown to be equally effective in the tx of panic dx
True
What is true about the Tx of GAD (i.e., C&C meds)
SSRI/SNRI all have same degree of efficacy (just pick one)
T/F: CBT has been shown to be more efficacious in the tx of GAD
False
{{BLANK}} is 2nd amongst all diseases/injuries leading to disability
MDD
What is the main goal of treating MDD (initially)?
If untreated, try to Tx & make episode short –> remission more likely
What is true about MDD recurrence?
High rate (esp. if long 1st episode & untreated)
{{BLANK}} is 2-3 x higher in primary care and PCPs tend to be the sole provider for many (> 50%) pts w/ mental illness
MDD
Expalin the Dx criteria for MDD (superficial explanation)
SIG E CAPS
* Sleep
* Interests
* Guilt
* Energy
* Concentration
* Appetite
* Psychomotor agitation/retardation
* Suicidal ideation
NOTE: must also have depressed mood
Is MDD heritable? Why or why not?
- Yes (40%)
- 1st degree FMH = 2-4x risk
Depression is a Dx sign for {{BLANK}} cancer before the patient even knows about their cancer
Pancreatic cancer
What is important about the Tx of adjustment disorder?
identify the stressor & refer to therapist
What adjustment disorders are more common in children?
Conduct & Conduct w/ emotions
When initiating pharmacotherapy for a mental illness you should keep in mind to?
Lowest dose, shortest duration
In depression, remission occurs more often if you {{BLANK}}
initiate pharmacotherapy
The most important characteristics of therapy for tx of depression is?
Relationship between therapist & Pt
{{BLANK}} is an effective treatment for depression but requires general anesthesia and is reserved for refractory cases
ECT
{{BLANK}} blocks ECT facilitated muscle movements
Succinylcholine (effects only seen on EEG)
What are notable SE/ADR from ECT?
- Acute confusion
- Anterograde amnesia
- Retrograde amnesia
{{BLANK}} is more effective than any other tx for MDD
ECT (70-90%)
What does rapid cycling mean in BP?
≥ 4 mood episodes within 12 months
T/F: A BP pt is less likely to have another manic episode after the first
False, 90% have recurrent mood episodes
A manic episode in a BP pt typically precedes
Depressive episode
In BP pts, they have a high-risk of dying by?
Suicide
15x higher than normal; 25% completed suicides are due to BP
What is true when you compare suicides between BP I & BP II?
In BP II, suicides are more lethal
What is the mnemonic used in BP Dx?
DIG FAST
* Distractable
* Insomnia
* Grandiosity
* Flight of ideas
* Activity (increased)
* Social (increased)
* Traumatic experiences
If a pt is hospitalized due to their manic episode, what do they have?
BP I
BP II = hypomania = no hospital
To Dx BP II, the pt must exhibit both?
- Hypomania
- Depression
Seasonal affective disorder is most common?
- winter
- northern latitudes (E.g., NY)
What is the Tx for seasonal affective disorder?
10,000 lux light x 30 mins per day
Must hit pupil but don’t look straight into it the entire time
Why should someone w/ BP be maintained on a mood stabilizer even after S/Sx resolution?
- Relapse is 85% x 5 years
- Tx reduces suicidality & violent behavior
{{BLANK}} must be maintained at a level of 0.8-1.2 x 5 days to know if it is working but has shown to reduce the risk of suicide in PB patients
Lithium
Caution: hydration should be maintained (increase/decrease – affects tx
You will know if valproate has reached target levels of 50-125 within {{BLANK}} days
3 days
lithium x 5 days
{{BLANK}} is a mood stabilizer that carries the risk of SJS/TENS that can be fatal
Lamotrigine
What is the main diff between sensory dilirium & dementia?
- Delirium: resolves
- Dementia: progressive
How common is delirium?
End of life > ICU > nursing home/acute care facility > old age
Most Dx’d w/ AZD are?
- 75-84: 53%
- ≥ 85: 40%
AZD is repsonsible for 60-90% of dementias
What is the avg. survival time after Dx of AZD?
10 years
up to 20 years in some cases
What do AZD pts typically die from?
Aspiration
What are common characteristics of the late-stage AZD pt?
- Mutism
- Bed-bound
What is the avg survival time after Dx of Frontotemporal neurocognitive Dx?
3-4 yrs after Dx
6-11 yrs after initial Sx appearance
What are risk factors of frontotemporal neurocognitive disorder?
- 40% have FMH of early-onset NCD
- 10% autosomal dominant pattern
A person with lewy body dementia (NCD) given a regular dose of antipsychotics can display what reaction?
Increased SE/ADR
* They are more sensitive
* This reaction can help lead to Dx
What is the avg. survival time for NCD – lewy body dementia?
5-7 yrs after clinical presentation
{{BLANK}} is typically present for at least 1-year prior to the onset of motor sx in lewy body dementia
cognitive decline –> motor decline
What are risk factors for vascular NCD?
- HTN
- DM
- Smoking
- Obesity
- High Chol
- High homocysteine
- A-fib
TBIs can lead to {{BLANK}} and {{BLANK}}
Sequela
depression; aggression
In alcohol abuse, most NCDs are maintained within the first {{BLANK}} months unless the person did not reach abstinence until after 50 yo
30-40% within first 2 months
{{BLANK}} infection can lead to NCD
HIV; 30-50% display NCD
Rapid progression; infants & children may display delay
In HD, {{BLANK}} abnormalities can predate motor abnormalities by ~15 yrs
psych/congitive –> motor
How do obsessions & compulsions interact w/ one another?
- Obsession: they try to suppress
- Compulsion: attempt to neutralize w/ action
Commonly, a {{BLANK}} disorder is seen in OCD patients
Tic
Similar to BP, {{BLANK}} is a common component in OCD
suicidality
25% attempt; 50% think about it
1st line for OCD?
CBT
What is true regarding pharmacotherapy in OCD?
Pts need higher dose SSRI or clomipramine
If a patient has a comorbid eating disorder along w/ body dysmorphia, what is treated first?
Eating disorder (more deadly)
When is body dysmorphia typically Dx’d?
before 18 yo (2/3 of pts)
Hoarding is typically seen in {{BLANK}} adults
older
{{BLANK}} is when someone finds pleasure in the pulling of hairs (e.g., scalp, eyelashes, etc.)
Trichotillomania
{{BLANK}} is when someone is constantly picking their skin leaving lesions and even eating the skin
Excoriation
Excoriation typically begins w/ a {{BLANK}} condition
Dermatologic (acne)
In what domains is someone abnormal regarding general personality disorder?
- Cognition
- Affectivity
- Interpersonal functioning
- Impulse control
How common are personality disorders in the U.S.?
15% of U.S. population
C&C paranoid personality disorder versus delusion.
- Paranoid = lot of people
- Delusion = subset or individual
How do people with paranoid personality disorder acquire confirmation?
They are “combative” in conversation & receive hostility from others that confirms their expectations
They expect/suspect people/world is out to get them
Why do you not commonly see individuals for schizoid personality dx?
- Lack of social skills
- Lack of desire for social life
- Prefer isolation
- Longers
They don’t usually present because they are okay
C&C schizotypal versus schizoid.
- Schizotypal = magical
- Schizoid = loner
When do you typically run into a person w/ schizotypal dx? (clincally setting)
- 30-50% have MDD
- You see them for that
Psycopaths & sociopaths are typical of {{BLANK}} disorder
Antisocial personality disorder
What is the only Dx where a person must of had S/Sx/Dx of another illness?
- Antisocial personality disorder
- Dx/Hx of Conduct disorder (< 15 yo)
Where is the highest prevalence of antisocial personality disorder patients?
- Prisons, jails, SUD clinics, etc.
- Think, Wolf of Wallstreat, Bernie Madoff
People w/ {{BLANK}} disorder present a superficial charm, grandiosity, and expertise to ordinary people
Antisocial personality disorder
They are really callous, cynical, self-inflated, expoitative
A person w/ antisocial personality disorder can become more stable after?
reaching 4th decade of life
Someone w/ {{BLANK}} disorder is more likely to die from violent/traumatic means
Antisocial personality disorder
What is a classic case of borderline personality disorder?
- Relationship w/ ups/downs
- They or partner creates (e.g., I’m going to leave)
- They threaten suicide or attempt to get partner back
- Cycle continues
Relationships of someone w/ borderline personality disorder will improve after?
- 30-40 yo
- Better functioning w/o major cyclic pattern
- Also, 10-yrs outpatient Tx, 50% no longer qualify for Dx
1st line for borderline personality disorder?
DBT
{{BLANK}} are hypersexual and get depressed if not the center of attention
Histrionic personality disorder
C&C narcissistic versus borderline
- Narcissistic: what they present
- Borderline: internal (what they can get)
The true issue of narcissistic personality disorder is?
- vulnerable self-esteem
- Very sensitive to criticism
Criticism can haunt them and leave them enraged
What happens as a person w/ narcissistic personality disorder ages?
They are bothered by new onset of physical limitations
T/F: narcissistic adolescent children will grow up to have worse S/Sx
False, it typically goes away
Individuals w/ {{BLANK}} disorder want love and companionship but are afraid of rejection
Avoidant personality disorder
How do people w/ avoidant personality dx get confirmation?
- Act fearful/intense
- Elicit ridicule/derision from others
- Confirms their worries
Individuals w/ {{BLANK}} disorder have a major self-doubt & want to solely rely on someone for their life
Dependent personality disorder
Who are characteristic OCPD patients?
- High achievers (e.g., med students)
Why does a person w/ OPCD have trouble w/ relationships?
They are more logical than emotional
Why do people w/ OPCD have trouble getting tasks completed?
Difficulty in prioritization
{{BLANK}} is the 1st line Tx for personality disorders
Psychotherapy
{{BLANK}} is most effective psychotherapy for BPD
DBT
* Decrease suicidality
* Decrease hospitalizations
C&C illness anxiety dx versus somatic dx
- Somatic: they complain about Sx only not dx
- Illness: say they have dx
A child walks in on their parents having sex, they then report they are blind. What dx do they have?
Conversion dx
remember, they display la belle indifference
C&C Malingering versus factitious disorder
- Factitious: they don’t want an external reward just looked at like a hero or “babied”
- Malingering: want an external reward (e.g., money)
Someone w/ rumination disorder is likely to suffer from {{BLANK}}
Intellectual disability
The #1 prerequisite to have anorexia nervosa is to display {{BLANK}}
Underweight (low BMI)
T/F: Someone w/ anorexia is typically always thinking about food
True
An overweight “model” presents to you w/ eroded enamel, calluses along their phalagneal dorsum (right hand) and enlarged parotid glands. What do you suspect?
Bulima nervosa
Weight Tx may initiate {{BLANK}} disorder
Bine-eating
Eat more after dieting/cheat meals
If you surroundings appear “dream-like” while in war you may have?
Derealization
If you feel like you are “outside your body” you may be experiencing?
Depersonalization
Roughly {{BLANK}}% of people w/ experience at least one episode of depersonalization/derealization in their lifetime
50%
What is the epidemiology behind PTSD?
- Veterans
- Females
C&C ASD versus PTSD
- ASD: Dx within 1 month
- PTSD: Dx 1-6 months
T/F: If adopted, a child will escape the increased risk of SUD (EtOH) assoc. w/ their FMH
False, FMH risk is inherited for EtOH abuse (3-4x more likely)
When does alcohol abuse typically present?
HINT: Traveling
Air travel (must D/C to travel on plane)
* Pt experiences agitation, anxiety, HA, diaphoresis
* May have seizures, hallucinations, delirium tremens
Cannabis-related Dx is more common in?
Native Americans & Alaska natives
Auditory hallucinations are most assoc. w/ {{BLANK}}
Schizophrenia
Visual hallucinations are most assoc. w/ {{BLANK}}
Substance use
Vertical nystagmus and strength are assoc. w/ {{BLANK}}
PCP
Why would someone experience a resurgence of lysergic acid after D/C of the drug?
Goes into adipose tissue & can get back into system to elicit effects
Pupillary dilation is seen w/ {{BLANK}}
Cocaine & Stimulants
Pupillary constriction is seen w/ {{BLANK}}
Opioids
What BZD is preferred to tx EtOH withdrawal in someone w/ liver dysfunction?
Lorazepam
Probably oxazepam & temazepam too
What BZD is preferred to Tx EtOH withdrawal if there is no increase in LFTs?
Chlordiazepoxide
C&C Bizarre versus non-bizarre delusions
- Bizarre: possible
- Non-bizarre: impossible (e.g., cat in anus watching me at night)
C&C Delusion vs hallucinations
- Delusions: belief
- Hallucinations: experience (w/o stimuli)
C&C Delusional vs schizophreniform vs schizphrenic disorders
- Delusional: 1 day to 1 month
- Schizophreniform: 1 month to 6 months
- Schizophrenia: > 6 months
{{BLANK}} delusion is the belief someone you watch on TV is in love w/ you
Erotomanic
{{BLANK}} delusions are the thought you are special to the human race (e.g., Jesus Christ 2.0)
Grandiose
{{BLANK}} delusions are the belief you have an unfaithful partner (w/o evidence)
Jealous
The most common delusion is?
Persecutory
In {{BLANK}} delusions, the person believes that someone/something is out to get them and may repeatedly sue them or resort to violence
Persecutory
In {{BLANK}} delusions the person believes a fould odor is coming from them (or infestation, parasite, etc.)
Somatic
What is the risk factors of schizophrenia?
- Late winter/early spring
- Urban environment
- Perinatal hypoxia
- Greater partneral age
What is true regarding suicide risk of schizophrenic patients?
Risk is higher after recent episode or hospitalization
MONITOR after
Why is life expectancy reduced in schizophrenic patients?
Metabolic effects
Why do majority of schizophrenic patients ingest tobacco/nicotine?
Works as an antipsychotic on nicotinic receptors
Risk of suicide w/ schizoaffective dx is increased when?
having depressive symptoms
Stimulant use can cause {{BLANK}} hallucinations making the person think bugs are crawling on them
Tactile
What should you do when someone is admitted for psychosis?
- Drug screen (7-25% of episodes are due to SUD)
- PMH
- Hx
{{BLANK}} reduce/eliminate S/Sx of schizophrenia in about 70% of patients
Antipsychotics
{{BLANK}} is the most effective anti-schizophrenic but has an increased risk of agranulocytosis
Clozapine
{{BLANK}} is a 2nd gen antipsychotic w/ an increased risk of gynecomastia
Risperidone
How do you initiate a LAI antipsychotic?
- Give inj.
- Give PO med x 2-4 wks
- Gives time for LAI to get into system
What is the Tx for catatonia?
Catatonia: mutism, posturing, grimacing; mind going to fast to talk
- BZD or ECT
- Slows mind down enough for them to display activity (e.g., talk)
