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ICM II > Psych > Flashcards

Psych Flashcards

1
Q

Two things one should cover in a psych interview that might not normally be covered?

A
  1. Feelings

2. Relationships

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2
Q

Reasons confidentiality should not be kept in a psych interview

A

Admissions of:

  1. Abuse
  2. Suicidal ideation/homicidal ideation
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3
Q

What is the term to describe a historian that’s not the patient?

A

Collateral source

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4
Q

What events during early life should be asked about in a psych interview?

A
  1. Pregnancy and delivery
  2. Temparment and important family events
  3. Relationships
  4. Culture and relationships
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5
Q

A list of what should be made during a psych interview?

A

Previous psychiatric issues as well as treatments; in chronological order

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6
Q

A substance history in a psych interview should include what substance that might not otherwise be asked?

A

Caffeine

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7
Q

What are the four pillars of communication that a interview should practice during a psych interview?

A
  1. Attentive silence
  2. Facilitation (encouraging comments)
  3. Summarization
  4. Clarification (drawing connections)
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8
Q

Terms for rate of speech

A
  1. Rapid
  2. Slow
  3. Halting
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9
Q

Terms for amount of speech

A
  1. Taciturn (saying little)
  2. Lacking spontaneity
  3. Grandiose
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10
Q

Terms for tone of speech

A
  1. Monotone
  2. Singsong
  3. Slurred
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11
Q

Terms for speech impairments

A
  1. Dysarthric (muscle speech problem)
  2. Stuttering
  3. Echolalia
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12
Q

Term for not comprehending speech clearly

A

Aphasic

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13
Q

Difference between mood and affect

A
  • Mood-how patient describes their emotional state

* Affect-how interview describes PTs emotional state

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14
Q

Labile affect

A

Sudden shifts in emotional state

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15
Q

Flat affect

A

Shallow or blunted emotional state

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16
Q

Tactile sensation of insects crawling over body

A

Formicaton

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17
Q

Feelings of movement in absence of movement (hallucination–not vertigo)

A

Kinesthetic hallucination

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18
Q

Hallucinations that occur while falling asleep

A

Hypnagogic hallucination

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19
Q

Hallucinations that occur while waking up

A

Hypnopompic hallucination

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20
Q

What are illusions

A

Misrepresentations of actually sensory input (occurs in schizophrenia but most common in delirium)

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21
Q

Depersonalization

A

Patients feel detached and unreal

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22
Q

Derealization

A

Objects in outside world feel altered, distorted, unreal

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23
Q

Shift of ideas from one to another with no logical connection

A

Loose associations

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24
Q

Patient wanders off subject but with clear connections between thoughts

A

Tangential thinking

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25
Q

Patient loses point of what they are saying but stay on the general topic

A

Circumstantiality

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26
Q

Patients mind goes blank

A

Blocking

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27
Q

Repetition of the same word or phrases, even when directed to stop

A

Perseveration

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28
Q

Direct repetition of interviewers words

A

Echolalia

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29
Q

Rapid speech with quick changes of ideas

A

Flight of ideas

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30
Q

Delusions

A

False beliefs that are outside of the PTs culture

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31
Q

Obsessions

A

Realized intrusive thoughts, ideas, impulses

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32
Q

Axis I: clinical syndromes (major disorders)

A
  1. Organic mental disorder
  2. Schizophrenia
  3. Depression
  4. Substance abuse
  5. etc
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33
Q

Axis II: General medical disorders (personality and developmental disorders)

A
  1. Maladaptive personality disorders
  2. Defense mechanisms
  3. Mental retardation
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34
Q

Axis III: General medical disorders

A

Physical disorders that might not be causing psych symptoms but that will affect the treatment

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35
Q

Axis IV: Psychosocial and environmental problems (stress that could trigger disorders)

A

Stresses that may affect the context in which the disorder developed
• PTSD

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36
Q

What is panic anxiety?

A

Anxiety that arises quickly and does not have particular content associated with it

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37
Q

Generalized anxiety disorder?

A

Worry about actual circumstances, events, or conflicts

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38
Q

What is panic disorder

A

Recurrent panic attacks with autonomic arousal

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39
Q

What are treatments for panic disorder?

A
  • Antidepressants
  • Benzodiazapines
  • Cognitive behavior therapy
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40
Q

What is agoraphobia

A

Fear of being in a place where escape might be difficult or impossible

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41
Q

What is treatment for generalized anxiety disorder?

A
  • SSRI
  • SNRI
  • Buspirone
  • Benzodiazepines
  • B-adrenergic
  • Cognitive behavioral therapy
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42
Q

What are treatments for OCD

A
  • Drug therapy

* Psychotherapy

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43
Q

What is the duration for PTSD?

A

Greater than one month

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44
Q

Acute stress disorder

A

What is the diagnosis for PTSD-like syndrome that lasts 2 days to 4 weeks?

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45
Q

What condition is mitral valve prolapse often correlated with?

A

Anxiety

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46
Q

What is Axis V?

A
  • The GAF

* This is a score that shows how illness impacts PT and family (this can show progress of treatment)

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47
Q

What is supportive psychotherapy

A

Encourages teaching defensive strategies that are as adaptive as possible

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48
Q

What is psychodynamic psychotherapy

A

Uncover the psychological meaning of the anxiety and resolving unconscious conflict

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49
Q

What is systemic desensitization

A
  • Teach relaxation

* Teach patient to visualize scene and pair it with comforting thoughts

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50
Q

SSRIs

A
  • Antidepressants
  • As effective as tricyclics
  • Can be used for anxiety disorders
  • Safer and less side effects
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51
Q

SNRIs

A
  • For panic, anxiety, social phobias

* Side effects similar to SSRIs (maybe increased blood pressure)

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52
Q

Tricyclic antidepressants

A
  • For generalized and panic anxiety, OCD

* Side effects - anticholinergic effects

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53
Q

MAOIs

A
  • Atypical depression, panic disorders, social phobias, anxiety disorders
  • More side effects with other drugs and food than SSRIs, SNRIs, used as a last line treatment
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54
Q

Buspirone

A
  • Serotonin agonist
  • For GAD
  • Unlike benzos, not a rapid onset of action
  • Generally well tolerated (maybe serotonin syndrome when put with MAOIs)
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55
Q

Benzodiazepines

A
  • Increased GABA action
  • Sedation, tolerance, dependence, respiratory depression
  • Diazapam, lorazapam
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56
Q

Antipsychotic drugs

A
  • Can be used to augment SSRIs, SNRIs for anxiety, PTSD, OCD

* Can produce tardive dyskinesis (which can outweigh benefits)

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57
Q

B-blockers for anxiety

A

This can be used to help with anxiety in patients that experience sympathetic symptoms with their attacks

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58
Q

What two psych conditions has NE been implicated in?

A
  1. Too little → depression

2. Too much → mania

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59
Q

How is dopamine linked to depression?

A
  • Not as strongly as NE and serotonin

* Buproprion is dopaminergic

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60
Q

Low serotonin levels have been implicated with that?

A

Depression and mood disorders

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61
Q

What psych condition can be hypothyroid be mistaken for?

A

Depression

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62
Q

What psych condition can hyperthyroidism be mistaken for?

A

Mania

63
Q

What is kindling?

A

Repeated subthreshold stimulation of the brain that leads to seizure activity

64
Q

What are the four types of mood episodes?

A
  1. Major depressive episode
  2. Manic episode
  3. Mixed episode
  4. Hypomanic episode
65
Q

MDE criteria?

A
  1. Depressed state or lack of interest
  2. Somatic symptoms (neurovegetative) like sleep disturbances, changes in eating, etc.
  3. Persists at least 2 weeks
66
Q

Manic episode criteria?

A 
Elevated or irritable mood that lasts > 5 days
• Grandiosity
• Need little sleep
• Pressured speech (racing, flighty)
• Easily distracted, inattentive 
• Increase in goal related activities
67
Q

Mixed episode criteria?

A

Period during which patient has both depressive and manic episodes over 1 week

68
Q

What is a hypomanic episode?

A
  • Similar to manic but less severe
  • Lasts at least 4 days
  • Can’t have psychotic symptoms (delusions, etc)
69
Q

How do you diagnose major depressive disorder (not event)?

A

Have one or more MDE without mania, hypomania, or mixed episode

70
Q

What are some common features that can be seen with major depressive disorder?

A
  1. Psychotic features
  2. Melancholic features (more profound neurovegitaton)
  3. Catatonic
  4. Atypical
  5. Post partum onset
71
Q

How high is recurrence after a major depressive episode?

A

50% will have recurrence

72
Q

What is the only real criteria for BPD I?

A
  • One manic episode

* Most have depression episodes too though

73
Q

Clinical features of a manic episode?

A
  • Delusions or hallucinations

* Disorganization

74
Q

Percentage of BPD I patients that complete suicide

A

25%

75
Q

What is BPD II?

A

At least MDE and one hypomanic episode

76
Q

What is cyclothymic disorder?

A
  • The same as dysthymic disorder but with hypomanic episodes

* I think this is less severe than BPD II because there is hypomania and depression but not a major depressive disorder

77
Q

What is melancholia?

A

Almost complete loss of all joy and happiness with a few other symptoms

78
Q

Delirium vs confusion

A

Delirium is a special type of confusion where individual experiences distorted perceptions, hallucinations, vivid dreams, intense emotions

79
Q

What is amneisa?

A

Inability to form memories and it assumes that hearing, cognition is otherwise working normally

80
Q

What is dementia?

A

Loss of ability to reason. Deterioration of cognitive function.

81
Q

What type of memory is most prone disease?

A

Short term memory

82
Q

What is Pick’s disease?

A

Degeneration of the frontal and temporal lobes (similar to Alzheimers except for it’s distribution)

83
Q

Time course of delirium?

A

Typically over hours to days and fluctuates over this period

84
Q

What is apraxia?

A

Loss of ability to execute previously learned complex motor commands

85
Q

What is agnosia?

A

Failure to recognize or identify previously known objects

86
Q

Can you have delirium and dementia at the same time?

A
  • Yes and this is known as delirium with dementia

* The new cause of delirium should be investigated

87
Q

What is confabulation?

A

PT’s have memory deficits (amnesia) and therefore generate stories to fill in the gaps

88
Q

Huntington’s Disease?

A
  • Loss of GABA neurons in basal ganglia (caudate)

* Choreoathetosis and dementia

89
Q

What is substance dependence?

A

Pathologic pattern of substance use or abuse that results in distress or impairment

90
Q

What is tolerance?

A
  • Increased amount to reach same desired effect

* Same amount has less of an effect

91
Q

What is withdrawal?

A
  • A predefined set of symptoms that occur when a substance is stopped
  • When a person takes the substance in order to avoid symptoms
92
Q

What is a substance induced disorder?

A

A diverse group of physical and mental syndromes that occur in response to psychoactive substances or their withdrawal
• Substance intoxication
• Substance withdrawal

93
Q

Illness vs disorder in psychiatry?

A
  • Legal implications
  • Disorder not a mental illness (personality disorder, etc)
  • Illness is (schizophrenia, MDD)
94
Q

Cluster A personality disorders

A 
WEIRD
Odd or eccentric behaviors (these don't bother the patient but bother everybody else) 
• Projection
• Fantasy
• Paranoia
95
Q

Paranoid personality disorder (cluster A)

A

Person who is afraid of a lot of things

96
Q

Schizoid personality disorder (cluster A)

A

Shy person that prefers to stay home, especially avoids emotional interactions

97
Q

Schizotypal personality disorder (cluster A)

A
  • Magical thinking
  • Very weird character, low capacity for social interactions, behavioral eccentricities
  • No psychosis (so not schizophrenia)
98
Q

Cluster B personality disorder

A 
WILD
Dramatic, emotional, erratic 
• Dissociation from unpleasant thoughts
• Denial
• Splitting objects into all good or bad
• Acts out thoughts and feelings
99
Q

Dissociation vs denial

A
  • Dissociation-person does not recognize existence of something (alcoholic-I don’t drink)
  • Denial-person knows something exists but says it’s not important (alcoholic-I drink but its not a problem)
100
Q

Splitting

A

Person sees things abnormally (sees things as all good or all bad)

101
Q

Antisocial personality (cluster B)

A

Person that doesn’t care about anyone or anything so they disregards rights and feelings of others

102
Q

Borderline personality disorder (cluster B)

A 
Unstableness in every aspect of their life
• Impulsive 
• Self-mutilating behaviors
• Object splitting
• Unstable affects
103
Q

Narcissistic personality disorder (cluster B)

A

Expects admiration from other people and does not have admiration or respect for other people

104
Q

Histrionic personality disorder (cluster B)

A
  • Excessive emotionality

* Attention seeking behavior (Ms. Piggy)

105
Q

Cluster C personality disorder

A 
WORRIED
Anxious and fearful
• Isolation from emotions
• Passive aggressive behaviors
• Hypochondriasis
106
Q

Avoidant personality disorder (cluster C)

A
  • Social inhibition
  • Feeling inadequate
  • Hypersensitivity to negative evaluation (McFly)
107
Q

Dependent personality disorder (cluster C)

A

Meek, dependent personality

108
Q

What cluster is OCD in?

A

Cluster C

109
Q

Dissociative identity disorder (used to be multiple personality disorder)

A
  • Person has multiple personalities (alternate realities in which they exist)
  • Host personality-normal self-spends most time here
  • Altered personalities-patient will flip into these randomly
  • Each “altered” serves a purpose
  • Generally felt that this occurs when a PT is sexually abused as a child – defense mechanism (allows them to endure the abuse)
110
Q

What is critical distinction between AN and BN?

A

Body weight (AN are underweight, BN are normal weight)

111
Q

AN rates?

A

1% of women (males make up 10% of total)

112
Q

BN rates?

A

1-3% of women (males make up 10% of total)

113
Q

Binge-eating rates?

A
  • 2% of women
  • 1% of men
  • 10% of total are in morbidly obese category
114
Q

Factors that can lead to increased incidence in eating disorders?

A
  • Higher incidence in monozygotic twins
  • Psychological (coping mechanism)
  • Familial incidence
  • Environmental (cultures that value thinness)
  • Social teasing leads to increased rates
115
Q

Risk factors for eating disorder?

A
  • Female
  • Early puberty
  • Perfectionist personality
  • Low self-esteem
  • Difficulties with communication, conflict resolution
  • Drive to excel in sports
116
Q

AN diagnostic criteria?

A
  • Restriction of energy intact leading to low body weight
  • Intense fear of becoming fat
  • Disturbances in which ones body weight or image is experienced
117
Q

Restricting type AN?

A

During last 3 months, no binge eating or purging

118
Q

Binging type AN?

A

History binge eating and purging

119
Q

Levels of AN?

A
  • Mild >17
  • Moderate 16-17
  • Severe 15-16
  • Extreme <15
120
Q

BN diagnostic criteria?

A
  • Recurrent episodes of binge eating
  • Sense of lack of control over eating during period
  • Recurrent inappropriate compensatory behaviors (purging, laxatives)
  • Episodes at least once a week for 3 months
  • Self-image unduly influenced by body image
121
Q

Levels of severity for BN

A
  • Mild 1-3
  • Mod 4-7
  • Severe 8-13
  • Extreme 14+
122
Q

Binge-eating disorder criteria?

A
  • Recurrent episodes of binge eating
  • More rapid eating
  • Eating until completely full
  • Eating when not hungry
  • Eating alone because of embarrassment
  • Feeling depressed about eating
123
Q

Common symptom of eating disorder in female patients only?

A

Amenorrhea or disturbances in menstrual cycle

124
Q

Odd symptoms associated with AN

A
  • Acrocyanosis (blueness of fingers and toes)
  • Bradycardia
  • Hypotension
  • Lanugo (fine hair)
  • Edema of extremities
  • Flat affect
  • Alopecia
  • Salivary gland enlargement
125
Q

Odd symptoms associated with BN?

A
  • Salivary gland enlargement
  • Calluses on knuckles (Russell’s sign)-from gagging themselves
  • Mouth sores
  • Dental erosions
  • Hypotension (same with AN)
  • Edema of extremities (same with AN)
  • Mallory-Weiss tear
126
Q

AN lab findings?

A
  • Normocytic anemia
  • Hypoglycemia
  • Elevated cholesterol (for some reason)
  • Hyponatremia
  • Elevated liver enzymes
127
Q

BN lab findings?

A
  • Hypokalemia, hypochloremia with metabolic alkalosis (vomiting)
  • Hypokalemia with metabolic acidosis (laxative abuse)
  • Elevated serum amylase (from salivary gland)
128
Q

What do you have to be very aware of in patients with eating disorders?

A

Increased suicide risk

129
Q

What are additional lab tests you should get if you suspect eating disorder?

A
  • Magnesium
  • EKG
  • Thyroid function test
  • Bone densitometry
  • CBC with SED Rate (exclude something like Crohn’s)
  • B-hCG
  • Serum amylase
  • FSH, LH, estradiol, testosterone, prolactin
  • Guiac
  • GI endoscopy, CXR, Head CT
  • PPD
130
Q

What should you hospitalize a patient with eating disorder?

A
  • HR less than 40
  • Hypothermia
  • Hypotension
  • Hypokalemia
  • Dehydration
  • Prolonged QTc or arrhythmia
131
Q

What is the only FDA approved drug for BN?

A
  • Fluoxetine (Prozac) – SSRI

* Much higher dose than for depression

132
Q

What drug might be useful for AN?

A
  • Olanzapine (zyprexa)
  • Promotes weight gain and decreases obsessive thinking
  • It is hard to get AN patients to take medication
133
Q

Bupropion common name?

A

Wellbutrin

134
Q

What don’t you give to eating disorder patients and why?

A
  • Buproprion (Wellbutrin)

* Increased risk of seizures

135
Q

What is refeeding syndrome?

A
  • Clinical complications as a result of refeeding a patient after a prolonged absence of food
  • Stores of phosphate are depleted during prolonged starvation
  • When food is taken, insulin is increased, phosphate goes into cell
  • Lack of phosphate leads to hypoxia and cardiovascular collapse
136
Q

What are criteria for autism spectrum disorder?

A
  • Difficulties in social interactions (both verbal and non-verbal) and
  • Restricted, repetitive behaviors, interests, behaviors
137
Q

Who is more at risk for ASD?

A

Boys > girls

138
Q

Clinical features of ASD?

A
  • Language delay (receptive or expressive)
  • Impaired social communication and interaction (can be subtle)
  • Restricted repetitive behaviors (hand flapping)
  • Don’t transition well
  • Sensory perception issues (only soft cloths, only crunchy foods…)
  • Might have some motor delays
139
Q

When is ASD most often diagnosed?

A

2nd year of life

140
Q

What is thimerosal and what is it?

A

It is an agent found in many vaccines that had trace amounts of mercury. If a PT had a full schedule of vaccinations it would have been possible for them to have elevated mercury levels. There are now thimerosal-free options.

141
Q

What is illness?

A

Response of individual or family to symptoms?

142
Q

What is somatization?

A

Tendency to experience or communicate psychological or emotional distress as somatic symptoms?

143
Q

What is somatic symptom disorder?

A

Mental disorder characterized by physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder
• One or more somatic symptoms
• Significant distress
• Can’t be reassured

144
Q

Who is more at risk for somatic symptom disorder?

A
  • Females > males
  • Runs in families
  • Males show increased risk of substance issues and antisocial disorders
145
Q

Illness anxiety disorder?

A
  • Disease fear
  • Disease preoccupation
  • Disease conviction
  • Disability
146
Q

Functional Neurological Symptom Disorder (conversion disorder)

A

Causes patients to suffer from neurological symptoms, such as numbness, blindness, paralysis, or fits without a definable organic cause
• Distractibility
• Splitting of midline
• Gap between tested strength and function

147
Q

How often does conversion disorder typically last?

A

Typically resolves spontaneously after 2 weeks

148
Q

What is dysthymia?

A

A form of depression that is more mild but lasts longer than major depression.

149
Q

Hallmarks of serotonin syndrome?

A
  • Can be caused by a number of different medications or interactions
  • Possibly after OD
  • Has symptoms like HTN, anxiety, HA, etc
150
Q

Medical conditions that can have psychiatric symptoms

A
  • MS
  • Neurosyphilis
  • Thyroid problems
  • Nutritional deficiencies
151
Q

How can methylfolate sometimes aid in depression treatment?

A

You need folate to convert tryptophan to serotonin. Some PTs are genetically deficient. Methylfolate goes right to the brain and can aid in this conversion.

152
Q

What do hallucinogens act on?

A

Serotonin

153
Q

Hallucinogen persisting perception disorder

A

You have residual hallucinations even after discontinuation of hallucinogenic drug

154
Q

What are some symptoms of opiod overdose?

A
  • Constricted pupils (myosis)
  • Bradypnic (less than 12)
  • Mild hypotension and bradycardia

ICM II (10 decks)

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