PSYCH Flashcards
1
Q
What is a false belief or wrong judgement held with conviction despite incovertible evidence to the contrary
A
delusion
2
Q
what is an unconscious separation of a group of mental processes from the rest of the conscious awareness
A
dissociation
3
Q
disturbance in amount, quality or timing of sleep
A
dysomnia
4
Q
higher levels of cognitive/mental functioning including planning, abstraction, inductive reasoning and organizing
A
executive functioning
5
Q
subjective perception of an object or an event when no such stimulus or situation exsists
A
hallucination
6
Q
a misinterpretation or false perception of a real sensory stimulus
A
illusion
7
Q
absence of interest in or pleasure from performance of acts that would ordinarily be enjoyable
A
anhedonia
8
Q
medication used to treat anxiety
A
anxiolytic
9
Q
syndrome of psychomotor retardation characterized by periods of physical rigidity and lack of response to outside stimuli
A
catatonia
10
Q
state in which the individual interprets and regards everything in relation to himself and not to others
A
narcissism
11
Q
mental or behavioral disorder causing gross distortion or disorganization of a persons mental capacity; a defective response and capacity to recognize reality, communicate and relate to others to the degree of interfering with a persons capacity to cope with ordinary demands of everyday life
A
psychosis
12
Q
what are some causes of PTSD
A
sexual
trauma to someone in close interpersonal network
interpersonal violence
organized violence
other violent events (MVA or natural disaster)
13
Q
what areas of the brain has MRI studies shown a decreased volume in?
A
left amygdala (fear center)
hippocampus (memories)
anterior cingulate cortex
14
Q
what might be the cause of someone who has affective dysregulation, cognitive impairment, behavioral responses to regular stimuli such as flashbacks, severe anxiety, fleeing, or combative behavior?
A
PTSD
15
Q
how long must symptoms of PTSD be present for following trauma for psychiatry to make a diagnosis
A
at least 4 weeks (one month)
16
Q
what is the treatment for PTSD
A
psychotherapy:
- exposure therapy
- CBT
- EMDR (eye movement desensitization and reprocessing)
Medications:
- Antidepressants (SSRI - Setraline)
- Prazosin for nightmares
- beta blockers for tremors/ sympathetic resp.
- antipsychotics for comorbid psychosis
AVOID BENZODIAZEPINES DUE TO SAFETY &DEPENDENCY
17
Q
What are some differentials to consider when evaluation of a patient with weight loss
A
hyperthyroidism
malignancy
GI diseases
Chronic infectious disease
affective disorders (depression)
18
Q
what is the diagnosis criteria for someone who may have anorexia
A
- restriction of energy intake that leads to low body weight
- intense fear of gaining weight or becoming fat or persistent behavior that prevents weight gain, depite being underweight
- distorted perception of body weight and shape, undue influence of weiht and shape on self worth
19
Q
what could be found on examination of someone suspected to have anorexia
A
low bmi (< 17.5)
emaciation
hypothermia
bradycardia
hypotension
hypoactive bowel sounds
xerosis (dry scaly skin)
brittle hair and hair loss
lanugo body hair
abd distention
20
Q
what is recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain
A
bulimia nervosa
21
Q
what are some clinical findings of someone with bulimia nervosa
A
dehydration
menstral irregularities
mallory-weiss
pharyngitis
erosion of dental enamel
ECG changes may occur
22
Q
what is it called when someone eats nonfood substances and is often associated with iron deficiency anemia
A
PICA
23
Q
what is repeated regurgitation of food that is not due to GERD, pyloric stenosis, or another medical condition
A
rumination disorder
24
Q
what is substance abuse
A
psychological dependence or craving
physiologic dependence
tolerance
25
what is the third leading preventable cause of death in the united states
alcohol use disorder
26
men under 65, how many drinks can they have in a week to be considered at risk for alcohol use disorder
more than 14 standard drinks per week
- standard drink = 5oz wine or 12 oz beer
more than 4 drinks on any day
27
women under 65, how many drinks per week puts them at risk for alcohol use disorder
more than 7 standard drinks per week
more than 3 drinks on any day
28
when evaluating for alcohol use disorder what questions will you ask
CAGE
- CUT DOWN on drinking?
- have people ANNOYED you by criticizing your drinking
- have you felt bad or GUILTY
- drink in the morning EYE OPENER
29
What is a complication of alcohol use disorder
wernicke korsakoff syndrome
30
what is wernicke korsakoff syndrom caused by
due to a deficiency of thiamine (Vitamin B)
31
what is the most common symptom of wernicke encephalopathy acute syndrome
confusion and nystagmus
Others: gait ataxia, wide based gait, slow short steps,
32
what is the wernicke encephalopathy acute syndrome triad
encephalopathy
disorientation/inattentiveness
oculomotor dysfunction
nystagmus
33
what is a consequence of wernicke encephalopathy which causes anterograde and retrograde amnesia
korsakoff
34
what are the physical signs of alcohol withdrawl
tachycardia
hypertension
tremor
35
mild symptoms of alcohol withdrawl typically resolve in how many days
one to two
36
in severe cases of alcohol withdrawal hallucination's or seizures can occur what is the time frame for each
hallucinations: within 12-24 hrs resolves in 1-2 days
seizures: typically tonic clonic within 6 to 48 hours of last drink
37
what is the kindling effect
risk of seizures increases with repeated withdrawals
38
what begins within 72-96 hours after last drink and presents with fluctuating disturbances in attention and cognition, may include hallucinations and severe forms may include agitation, fever, tachycardia, htn, or drenching sweats
delirium due to alcohol withdrawl
39
how would delirium due to alcohol withdrawl be treated
benzos and support
(diazepam)
40
what is the leading cause of mortality worldwide
tobacco use
41
nicotine withdrawal is perhaps the greatest barrier of quiting, when does this occur
peaks in the first 3 days and slowly subsides over a course of one month
- associated with increased appetite, weight gain, depression, insomnia, irritability, anxiety and restlessness
42
what is the treatment for nicotine withdrawal
nicotine replacement therapy
- long acting: patch
- short acting: gum
Buproprion (wellbutrin)
- inhibits reuptake of norepinephrine and dopamine as well as acts as nicotinic receptor antagonist
Varenicline (chantix)
- stimulates dopamine activity but to a much smaller degree than nicotine
- reduces cravings and withdrawal sx
43
when do the effects of cannabis occur
occurs in 10-20 minutes and last 23 hour
44
what is the source of marijuana
cannabis sativa
45
when is marijuana detected in most urine tests
4-6 days for short term users
20-50 days in long term users
46
what is the treatment of choice for acute opiod intoxication
naloxone
47
what are the findings of someone who may have acute opioid toxicity
v/s: HR decrease or increase, decreased BP/RR/Temp
GI: decreased b/s
Neuro: sedation
Miosis
48
what mimics acute opioid toxicity and is not uncommon and is easily correctable
hypoglycemia
49
how does acute stimulant intoxication present
sweating
tachycardia
elevated b/p
mydriasis
hyperactive
confusion
disorientation
50
what could alert the clinician to cocaine use
unexplained nasal bleeding
headaches
fatigue
insomnia
anxiety
depression
chronic hoarseness
51
what are the three different mood states with bipolar
mania
hypomania
major depression
52
which mood state of bipolar is a distinct period of abnormally or persistently elevated, expansive or irritable mood and persistently increased activity or energy, lasting at least one week and presents most of the day nearly every day
mania
53
what is the acronym used to remember the symptoms of mania
DIGFAST
Distractibilty
indiscretions
grandiosty
flight of ideas
activity increase
sleeplessness
talkative
54
which phase of bipolar is less severe, thought form is more organized - quick and creative thinking is common. Easier to engage in conversation, less risky behavior, no hallucinations, no psychotic sx
hypomania
55
how many symptoms must be present in a TWO week period for major depression phase of bipolar
five
- depressed mood
- diminished interest
- weight loss/gain
- insomnia/hypersomnia
- psychomotor
- decreased energy
- guit/feeling worthless
- impaired concentration
- thoughts of suicide
56
if a patient is suspected to have bipolar disorder and is agitated what can the IDC do prior to medevac
try to talk them down
Haloperidol
57
what is the maintenance therapy that is usually employed by psychiatrist for BPD
mood stabilizer or antipsychotic
- lithium
- valproic acid
- lamotrigine (lamictal)
- Quetiapine (Seroquel)
58
what is the most common psychiatric disorder in the general population
depression
59
what are some risk factors associated with depression
family history
female gender
childbirth
childhood trauma
stressfull life events
poor social support
serious medical illness
substance abuse
60
what is an example of a depression screening tool
PHQ-9
61
what somatic symptoms are associated with depression
headache
abdominal pain
pelvic pain
back pain
62
what pneumonic is used by PCM's to quickly screen for depression
SIGECAPS
- sleep changes (increased during the day, decreased at night)
- interest loss ( that used to interest them)
- guilt - worthlessness ( devalue self)
- energy - lack ( fatigue)
- concentration (reduced concentration)
- appetite ( decline or increase)
- psychomotor agitation ( anxious/lethargic)
- suicide/death preoccupation
63
what is the most important complication of depression
suicide
64
when inquiring about suicidal behavior what questions are you asking
specific nature of ideation
intent, plan, ability to carry out that plan
personal history of suicide attempts
family history of suicide attempts or suicide
65
for new onset depression, what labs will be ordered
cbc
chem
ua
thyroid function
hcg
66
what is the mainstay of treatment for depression
psychotherapy
pharmacotherapy
or both (best results)
67
what are the two classes of medication that are typically used in the treatment of depression
SSRI - fluoxetine, paroxetine, escitalopram, citalopram
SNRI - venlafaxine, duloxetine
68
what are some common side effects of antidepressants
sexual dysfunction
drowsiness
weight gain
insomnia
anxiety
dizziness
headache
dry mouth
blurred vision
nausea
rash
tremor
constipation
abd pain/stomach upset
69
what are the two important mood disorders that are commonly encountered
adjustment disorder
postpartum depression
70
what is commonly seen in the navy and occurs in the context of a recent stressor but does not meet the criteria of major depressive disorder
adjustment disorder
71
how long before symptoms of adjustment disorder resolve after life stressor is removed
resolves within six months when stressor is removed
72
when does post partum depression usually occur
usually occurs within 12 months after delivery
73
what is the diagnostic criteria for post partum depression
the same as major depressive disorder
- at least 5 symptoms for at least 2 weeks
74
what is the treatment for post partum depression
mild-mod: psychotherapy such as CBT as the initial treatment especially if breastfeeding
CBT unsuccessful or more severe: SSRI/Bupropion/mirtazapine (remeron)
SSRI: paroxetine (paxil) or sertraline (zoloft) appears to have least effect on infants
75
what is characterized by excessive and persitent worry that is hard to control, causes significant distress and occurs more days than not for at least 6 months
generalized anxiety disorder (GAD)
76
what other psychiatric conditions are common with generalized anxiety
depression
specific phobias
medically unexplained chronic pain
77
what is the clinical manifestation of generalized anxiety
hypoarousal and muscle tension is common
poor sleep
fatigue
difficulty relaxing
headaches
pain in neck, shoulder and back
78
what screening form is used for generalized anxiety
GAD 7
79
what is the treatment for generalized anxiety
CBT, medication or both
- SSRI and SNRI are typical medication classes used as a first line
80
what is panic disorder
people who experience multiple panic attacks
81
what is a spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour
panic attack
82
what is the dsm-5 diagnostic criteria for panic disorder
an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following 13 symptoms occur
- palpitations
- sweating
- trembling/shaking
- SOB
- chest pain/discomfort
- nausea
- dizzy
- chills or heat sensation
- fear of going crazy
- fear of dying
83
what is agoraphobia
fear and anxiety lead to avoidance of situations that may lead to panic
84
what is the treatment for panic attacks
anxiolytics
- benzodiazepines: clonazepam/lorezepam/diazepam/alprazolam (but should be avoided due to addiction risk)
- SSRI: reduce the frequency of panic attacks/severity of anxiety/ degree of phobic
85
what are two broad categories of delusions
bizarre- belief family member have been replaced by body-doubles
non-bizarre: belief spouse is cheating despite overwhelming evidence of the contrary
86
what is a wakeful sensory experience of content that is not actually present
hallucination
87
what is misinterpretations of sensory experience
illusion
88
what is the most common hallucination manifestation
auditory - hearing voices
89
what are some medical conditions associated with psychosis
delirium
endocrine disorder- thyroid/adrenal
hepatic or renal
infections - HIV/syphilis/LYME
demyelinating - MS or lupus
Neuro- TBI/Tumor/seizure
vitamin deficiency - B12
90
what is involuntary contractions of muscles associated with psychosis
dystonia
91
what is the treatment for dystonia
benadryl
92
what occurs after greater than 6 months of treatment of an antipsychotic and is involuntary movements of the face, sucking or smacking lips, movements of tongue, facial grimace, or odd movements of extremities
tardive dyskinesia
93
what is the treatment for sleep disorder
sleep hygiene is first line
medications are best for acute - used when sleep hygiene is inaffective
antihistamines are beneficial and produce no dependency - hydroxyzine or diphenhydramine
trazodone- long term
94
personality disorder is clustered how
A, B, C
95
what are two personality types in cluster B
borderline personality disorder(BPD)
antisocial personality disorder (ASPD)
96
what is the disorder that is instability of interpersonal relationships, self-imagine and emotions. Tend to view others as all good or all bad, and suicidal threats, gestures and attempts are more common
Boarderline
97
What might present as someone who has a disregard for and violation of rights of others, unstable work history, history of arrests, financial depends on others, alcohol abuse, marital problems, wildness in childhood, poor military performance, pathological lying or suicide attempts
antisocial
98
what is the treatment for personality disorders
social - hospitals/halfway house/self help
behavioral - reinforcement with praise or reward
psychological - group therapy
medical - hospitalization
99
marked pattern of inattention and/or hyperactivity-impulsivity must interfere with functioning in at least how many settings
2
work, school, home
100
in order to be diagnosed with ADHD symptoms must be present before what age
7 years old
adults must have childhood onset by age 12, persistent and current symptoms to be diagnosed
101
what is the treatment for ADHD
medications are the mainstay of treatment
- methylphenidate (ritalin/concerta/metadate)
- amphetamines (adderall, vyvanse)
102
what aspect of the brain is most susceptible to damage due to being near the sphenoid ridge
hipocampus
frontal lobe is also susceptible to countercoup injury
103
how are head injuries rated
using the glascow coma scale
104
what is loss of recall immediately before the event
retrograde amnesia
105
what is loss of recall immediately after the head trauma
anterograde amnesia
106
symptoms attributed to post concussion syndrome are greatest when
first 7 to 10 days
107
what is the treatment for gender dysmorphia
psychotherapy - support a a social gender transition and the initiation of biomedical tx
Medical - horomone therapy
108
what are some causes of erectile dysfunction
increased age
depression
smoking
diabetes
htn
nervous tissue disorder
social anxiety
PTSD
109
treatment for erectile dysfunction
psychological and organic
- phosphodiesterase type 5 inhibitors
stendra
viagra
cialis
levitra
110
treatment of female orgasmic disorder
often related to depression and cognitive - behavioral therapy involving changing negative thoughts and attitudes toward sex
111
treatment for female arousal disorder
sex therapy and cognitive intervention
bupropion has been reported to increase various indices of sexual responsiveness in women with low sexual desire
112
genito-pelvic pain and penetration disorder includes four common comorbid symptoms
difficulty having intercourse
genito-pelvic pain
fear of pain from vaginal penetration
tension of pelvic floor muscles
113
treatment for genito-pelvic pain
psychotherapy treatment involving acknowledging the pain and cognitive behavioral management
114
what is an absence of desire for sexual activity and persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies for at least 6 months
male hypoactive sexual desire disorder
115
what might be the cause of male hypoactive sexual desire disorder
hypogonadism
transient stress or interpersonal conflict
mood disorder
schizophrenia
substance abuse
medications
normal age related decline in sexual desire
116
what is the treatment for male hypoactive sexual desire disorder
CBT combined with sex therapy with the main goal being to educate patient how to communicate his sexual prefrences to the partner
117
what is a recurrent pattern of ejaculation occuring during partnered sexual activity within approx. 1 minutes following vaginal penetration and before individual wished and is present for at least 6 months
premature ejaculation
118
what is the most important complication in mental health
suicide
119
patients with what illness have a suicide rate over 30 times that of the general population
AIDS
120
what should be included in suicide prevention training
warning signs
supervisors getting to know their personnel
watching for changes in: behavior, attitude, or performance
121
what can be used as a guide for asking questions and answers will help identify whether someone is at risk for suicide
columbia-suicide severity rating scale (C-SSRS)
122
what is available for structured intervention for rescuers and survivors involved in incidents likely to produce traumatic stress
SPRINT
special psychiatric rapid intervention team
123
what are the components of a mental status exam
physical appearance and behavior
state of consciousness
cognitive abilities
speech and language skills
124
What is tested by asking the patient to listen and repeat a sentence or series of numbers
Immediate recall
125
What is tested by giving the patient a short time to view four or five objects, saying you will ask them in a few minutes. Ten minutes later you ask the patient to list the objects
Recent memory
126
What is tested by asking the patient about verifiable past events
Remote memory
127
What is tested by asking the patient to spell the word WORLD forward and backward or their ability to perform arithmetic calculations?
Attention span
128
What is a standardized brief screening tool to assess cognitive function and to detect changes over time. It consists of 11 items measuring orientation, registration, attention, and calculation, recall and language
Mini mental state exam or Folstein test
129
By asking a patient to provide a solution to a hypothetical situation, what is this testing?
Judgment
130
In terms of coherence, what is it called when a patient repeats a word, phrase or gesture
Preservation
131
In terms of coherence, what is t called when a patient uses word substitution to avoid revealing a word that was forgotten
Circumlocution
132
In terms of coherence, what is it called when the patient has disordered words or sentences
Flight of ideas or loose association
133
In terms of coherence, what is it called when the patient uses words that only have meaning to the patient
Neologism
134
In terms of coherence, what is it called when the patients word choice is based on sound so that the words rhyme in a nonsensical way
Clang association
135
In terms of coherence, what is it called when the patient demonstrates repetition or uses another persons words
Echoalia
136
What is a speech disorder that can be repetitive or expressive, include hesitations nd other speech rhythm disturbances
Aphasia
137
When diagnosing bulimia nervosa, behaviors must occur how often
Occurring on average at least once per week for three months
138
What is the timeline requirements for the mania phase of bipolar?
A distinct period of abnormally or persistently elevated, expansive or irritable mood and persistently increased energy lasting at least ONE WEEK and presents most of the day, nearly every day
139
What is the time line that 5 or more symptoms of major depression must be present
5 or more in the same TWO week period
140
What medications are used to treat bipolar disorder long term
Antipsychotics
Lithium
Valproic acid
Lamotrigine (lamictal)
Quetiapine (Seroquel)
141
What ranks 2nd among all injuries and illnesses as cause of disability in the United States
Major depression
142
Adjustment disorder typically resolves when
Within 6 months when the stressor is removed
143
Excessive and persistent worrying that is hard to control and causes significant distress (i.e. anxiety) must occur for how long in order to be diagnosed with generalized anxiety disorder?
Occurs more days than not for at least SIX MONTHS
144
What is the treatment for generalized anxiety disorder
CBT, medications or both
SSRI’s and SNRI’s are typical medications used as first line
145
What is spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour
Panic attack
Panic disorder is when multiple recurrent episodes occur
146
How are panic attacks treated
Benzodiazepines - clonazepam, lorazepam, diazepam, alprazolam
Antihistamines - hydroxyzine
SSRI’s - reduce the frequency of attacks but will not break an active attack
147
What is belief that one is being harassed or followed by an outside entity
Persecutory delusions
148
What is belief that one is a billionaire
Grandiose delusion
149
What is belief that a famous person is in love with them
Erotomatic delusion
150
What is the belief that ones sinuses has been infested with worms
Somatic delusion
151
What is belief that a dialog on TV is talking directly to you
Delusion of reference
152
What is believing ones thoughts and movements are being controlled by a powerful outside force
Delusion of control
153
What is used as a screening tool to help determine if someone is suffering from an eating disorder
SCOFF
Do you make yourself SICK because you feel uncomfortably full
Do you worry you have lost CONTROL over how much you eat
Have you lost more than ONE stone (14 IBS) in a 3 month period
Would you say FOOD DOMINATES your life
154
What stage of tobacco cessation is when the person has achieved smoking cessation
Maintenance
155
What stage of tobacco cessation is when the are actively involved in a quit attempt
Action
156
What stage of tobacco cessation is when they are considering a quit attempt
Contemplation
157
What stage of tobacco cessation is when they are not ready to quit
Pre-contemplation
158
What is the greatest barrier to tobacco cessation
Nicotine withdrawal
159
What labs should be ordered for new onset depression
CBC
Chemistry
UA
Thyroid function test
Urine HCG
160
What vitamin deficiency can cause psychosis
B12
161
What type of infections can cause psychosis
HIV
Syphilis
Herpes encephalitis
Lyme disease
162
What demylenating conditions can cause psychosis
Multiple sclerosis and lupus
163
What neurological diseases can cause psychosis
Tbi
Tumor
Seizure
Stroke
164
What is a common cause of sleep disturbance
Depression
165
Insomnia can be a sign of what psychological disorder
Bipolar - mania phase
166
What is a DDX of ADHD
Oppositional defiant disorder/conduct disorder: characterized by pattern of negativistic, hostile, and defiant behavior
- Can co-occur with ADHD in 30-50% of cases
Bipolar or depression
Cognitive performance and learning disabilities
167
What is a significant factor in many suicide attempts
Alcohol
168
What age range does non-suicidal self injury occur in and why
Ages 12 to 14
- engaging in NSSI include to regulate emotion and elicit attention
169
What are the components of a mental health examination
Physical appearance and behavior
State of consciousness
Cognitive abilities
Speech and language skills
