PSYCH Flashcards
A worried parent comes to you because they found their 6 year old boy recently lighting small fires in his backyard. Additionally, he was found stabbing rabbits. What d/o do you suspect?
Conduct disorder (anti-social d/o but patient is under 18)
A parent presents to you with their 7 year old son who has had numerous notes sent home to her from her son’s teacher, saying that he often “talks back” to her in class. He rarely listens to both the parent and the teacher. What d/o do you suspect?
Oppositional defiant disorder
A 6 y.o. girl is constantly telling her mom that she has a stomach ache and cannot go to school. She is usually found playing in her backyard 10 minutes later. What d/o do you suspect?
Separation anxiety disorder
A worried parent presents to you with her 3 year old son who she said in the past year started wetting the bed again. He was initially able to speak and walk fine until the past couple months and is now barely able to crawl. What d/o do you suspecct?
Childhood disintegrative d/o –marked regression in multiple areas of functioning after at least 2 years of apparently normal development. More common in boys.
Neurotransmitter changes seen in anxiety
Increased NE
Decreased GABA
Decreased 5-HT
Neurotransmitter changes seen in depression
Decreased NE
Decreased 5-HT
Decreased dopamine
Neurotransmitter changes seen in Alzheimer’s disease
Decreased ACh
Neurotransmitter changes seen in Huntington’s disease
Decreased GABA
Decreased ACh
Increased dopamine
Neurotransmitter changes seen in Parkinson’s disease
Decreased dopamine
Increased 5-HT
Increased ACh
Russell’s sign
Seen in bulimics – dorsal hand calluses from induced vomiting
What name is given to chronic compulsive hair pulling common in young girls?
Trichotillomania
What is the difference between binge eating d/o and compulsive eating d/o?
In both, purging is NOT present.
Binge eating: patients have negative feelings towards food but eat anyway.
Compulsive eating: fantasizes about food constantly
What electrolyte changes are seen in patients with excessive purging over time?
Hypokalemic hypochloremic metabolic alkalosis
Drug that causes constricted pupils
Opioids
3 types of drugs that cause pupillary dilation
Amphetamines
Cocaine
LSD
Also: muscarinic antagonists like atropine
Both of these drug intoxications can cause severe depression, headache, fatigue, insomnia/hypersomnia, and hunger
Cocaine
Amphetamine
An overdose of this drug can cause pinpoint pupils, N/V, and seizures
Opioid OD
An overdose of this drug can cause belligerence, impulsiveness, nystagmus, homicidal ideations, and psychosis
PCP OD
Intoxication with this drug can cause anxiety/depression, delusions, hallucinations, and flashbacks
LSD intoxication
Withdrawal from these 3 drugs can cause rebound anxiety, tremors, and seizures; it is life-threatening
Alcohol
Benzos
Barbiturates
Withdrawal of this substance can cause anxiety, piloerection, yawning, fever, rhinorrhea, nausea, and diarrhea
Opioid withdrawal
A woman has believed she has been married to Brad Pitt for the past 3 months. Other than this belief, her functioning appears normal and her work is not affected by this belief. What disorder does she most likely suffer from?
Delusional disorder
A woman believes her neighbors are spying on her and have even set up cameras to watch her daily activities. You bring in the husband, expecting him to tell you he thinks she is being ridiculous. Instead, he backs up her beliefs and completely shares them. What phenomenon is this?
Folie a deux –shared psychotic disorder. Development of delusions in a person in a close relationship wit hsomeone with delusional disorder.
When do hypnagogic hallucinations occur?
While GOING to sleep. Usually auditory. Associated with narcolepsy.
When do hypnopompic hallucinations occur?
While waking from sleep. Associated with narcolepsy.
Which hallucinations are more commonly a feature of medical illness? Which are more commonly a feature of psychiatric illness?
Visual = medical illness Auditory = psychiatric illness
Tactile hallucinations, such as the feeling that you have bugs crawling all over your skin, are common with which 2 drugs?
Alcohol (withdrawal)
Cocaine abusers
Difference between hallucinations, delusions, and illusions.
In hallucinations, you have a perception of something being there that is not actually there. Delusions are false beliefs about oneself or others that persist despite the facts. Illusions are misinterpretations of something that is actually there, such as believing a coatrack to be a person.
38 y.o. man with long hx of psychiatric illness is brought to the ER by ambulance. His appearance is unkempt and he laughs inappropriately. During the interview, his speech is incoherent. Which psychiatric illness do you suspect?
Schizophrenia, disorganized type.
On your psychiatric rotation, you come across a patient who is immobile in bed and generally unresponsive. When you try to talk to him, he simply repeats words that you use back to you with flat affect. What psychiatric illness do you suspect he suffers from?
Schizophrenia, catatonic type. Repeating words back to you = echolalia.
24 y.o. female is brought in to your office by her boyfriend, who said that ever since her miscarriage 2 weeks ago, she has been acting differently. She stopped eating, began dressing in all black and had hallucinations at night, feeling like bugs were crawling all over her skin. She even began sleeping on the couch due to this fear. What psychiatric illness do you suspect?
Brief psychotic disorder –
Positive sx of schizophrenia
Think of these as adding something that was not previously there.
Delusions, hallucinations (auditory, usually), disorganized speech, loose associations, disorganized or catatonic behavior
Negative sx of schizophrenia
Taking away something that was previously there.
Flat affect, social withdrawal, lack of motivation and speech, thought block, poor grooming
What are the criteria for the dx of mania?
DIG FAST Distractibility Irresponsibility Grandiosity Flight of ideas Activity/agitation Decreased sleep Talkativeness
Schizophreniform
Schizophrenia symptoms lasting >1 month but <6 months.
This patient is content with living in the woods and tells you he does not like people. He also rarely smiles or shows emotion. However, he does not have any psychotic episodes. What personality disorder do you suspect?
Schizoid
This patient is socially awkward and often dresses in abstract outfits. He regularly participates in the renaissance fair, getting much more involved than most. What personality d/o do you suspect?
Schizotypal
40 y.o. woman tells you during one of her office visits that she is in love with you. You refer her to someone else, and she attempts suicide. What type of personality d/o do you suspect?
Borderline
Splitting is the major defense mechanism.
A 55 y.o. woman comes to your office wearing all black including a black miniskirt and black feather boa. She also is wearing an excessive amount of lipstick and you notice her having conversations with many of the other patients in the waiting room. What type of personality d/o do you suspect?
Histrionic
40 y.o. man tells you that he is a virgin and has never even had a girlfriend. He expresses desire for intimacy, but tells you that he is far too afraid of women turning him down. What personality d/o do you suspect?
Avoidant
A 60 y.o. man admitted for chest pain jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack. What defense mechanism is he using?
Denial
Which defense mechanism underlies all other defense mechanisms?
Repression
A 65 year old asks her husband to stay in the hospital overnight with her because she is afraid to be alone. What defense mechanism is she using?
Regression
A man yells at his family when he has had a bad day at work. What defense mechanism is he using?
Displacement
A child abuser was himself abused as a child. What defense mechanism is this?
Identification
A veteran can describe horrific war details without any emotion. What defense mechansim is this?
Isolation
A patient presents to the ER saying they have suddenly lost function of their arm. They appear ambivalent about this, and all tests and PE come back negative. What d/o do you suspect?
Conversion d/o
A nurse has episodes of hypoglycemia. Blood analysis reveals no elevation in C-protein. What is her dx?
Munchausens OR malingering.
Munchausens is she is injecting herself with insulin without knowing why.
Malingering is she is injecting herself with insulin to get out of work.
A patient uses his aggression to succeed in business ventures. What defense mechanism is this?
Sublimation
A closet homosexual hates homosexuals because of the way they make him feel. What defense mechanism is this?
Projection
Dr. Frasier Crane uses intellectual processes to avoid affective expression. What defense mechanism is this?
Intellectualization
The belief that people are either all good or all bad is which defense mechanism?
Splitting
A patient often changes her character or personal identity in order to avoid personal distress. What defense mechanism is this?
Disassociation
A patient constantly tries to offer an explanation for her unacceptable beliefs and behaviors. What defense mechanism is this?
Rationalization
A recovering heroine addict is overhead bashing heroine addicts for their lack of self control. What defense mechanism is he using?
Reaction formation –a thought is avoided and replaced by an unconscious emphasis on the opposite
