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ICM2 > Psych > Flashcards

Psych Flashcards

1
Q

Echolalia

A

Repeating questions

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2
Q

Neologisms

A

New words

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3
Q

Dissociation

A

Split off mental contents from conscious awareness

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4
Q

Projection

A

Unconsciously reject and attribute unacceptable aspects of the self to others

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5
Q

Reaction formation

A

Adopting ideas and behaviors that are the opposite of impulses harbored un-/consciously

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6
Q

Sublimation

A

Unacceptable conscious drives are redirected to personally/socially acceptable channels

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7
Q

Anxiety disorders: Features

A

Familial pattern of 30-50% concordance in identical twins

Disrupted limbic circuits with less cortical modulation

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8
Q

Treatment of anxiety disorders

A

Strengthen prefrontal cortex (therapy)
Increase serotonin levels (SSRIs for anxiety/SNRIs for lethargy)
Increase GABA inhibition in amygdala/hippocampus (benzodiazepines)

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9
Q

MAOIs do what?

What other things do this?

A

Increase Nor, Dopa, and Sero levels

Cocaine, Ecstasy, Exercise

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10
Q

Wellbutrin does what?

A

Increases Nor & Dopa

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11
Q

Panic disorders

A

Recurrent, unexpected panic attacks not due to organic causes
Usual onset as teen/young adult
Treat with therapy & SSRIs, TriCycs, Benzos, MAOIs
Responds to lower doses than depression

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12
Q

Social anxiety disorders

A

Marked and persistent fear of social situations for >6mths that significantly interferes with life.
Onset usually 11-15yo
More common in females

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13
Q

Generalized anxiety disorder

A

General anxiety symptoms lasting >6mths interfering with functioning.
Early onset more common in women, associated with childhood fears
Can treat with therapy & benzos, SSRIs, buspirone

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14
Q

OCD

A

Less activity and control in extrapyramidal and basal ganglia pathways
SSRIs are most effective in higher doses

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15
Q

PTSD

A

Severe trauma re-experienced
Therapy, SSRIs help ~50%, anticonvulsants may be helpful
Most common in abused patients, military

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16
Q

Schizophrenia

A

~1% of population
Onset 15-25
Chronic
Affected thought process and content on mental status exam = disorder of impaired thought
Psychotic: Hallucinations, delusions, disorganization
Restricted/inappropriate affect, avolition, alogia
Cognitive impairment in attention, processing information
Patient has lost touch with reality and lacks insight into condition due to frontal, parietal lobe abnormality
Psychosocial dysfunction, lack of relationships
Attitude: Suspicious, guarded
Appearance: Disheveled, inappropriate for weather
Behavior: Awkward, Parkinsonian gait/tremors
Mood and Affect: Flat, irritable, hostile
Thought processes: Tangential, word salad
Thought content: Distorted reality, paranoid, delusions of thought broadcasting, auditory hallucinations
Accelerated brain gray matter loss
Increased morbidity and mortality

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17
Q

ASD (Autism)

A

Persistent difficulties in social interaction, non-/verbal communication, and repetitive behaviors
Symptoms present early in development (6mths-2yrs), but may not manifest until social demands exceed limitations
Language delay
Restricted, repetitive behaviors - insistence on sameness
More common in boys
Unknown etiology, BUT NOT BAD PARENTING
M-CHAT survey of child’s habits, behaviors for screening
Vaccines not related to occurrence

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18
Q

ADHD

A

Symptoms start Block Nor, Dop reuptake) and behavioral interventions together are best

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19
Q

1st gen antipsychotics

A

E.g. Haldol, Prolixin
Effective at sedating psychotic patients
Long-term Parkinsonian side effects are irreversible

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20
Q

2nd gen antipsychotics

A

E.g. Abilify, Seroquel

Fewer psychological side effects, however insulin resistance and T2DM may develop

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21
Q

Purpose of defense mechanisms

A

To unconsciously provide relief from emotional conflict and anxiety

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22
Q

Somatoform disorders

A

Patient has physical symptoms that cause significant distress and impairment that are far in excess of what would be expected based on patient history, physical, and labs
More common in females

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23
Q

Somatization vs. Somatoform illness

A

Somatization = tendency to experience and communicate psychological/emotional distress as physical symptoms
Somatoform illness = somatization causing significant dysfunction in patient’s life

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24
Q

Facititious disorder

A

Symptoms are produced/feigned in order to appear ill without a perceivable benefit
Can be imposed on self or others (usually mothers to children)
Patient may be evasive/argumentative, dramatic with history, have multiple malpractice claims, predict their own decline before discharge, or be unwilling to undergo testing
Most patients sign out rather than accept diagnosis

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25
Q

Malingering

A

Symptoms are produced/feigned in response to external incentive (discrepancy between claimed disability and physical exam)
Uncooperative, associated with antisocial personality disorder

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26
Q

Somatic symptom disorder

How to manage?

A

Frequent doctor visits
May refuse to acknowledge psychological contribution to symptoms
Excessive use of analgesics for pain
Common co-morbid depressive symptoms
Manage with single physician, regular followup, discussing stressors, full physical exam, and realistic goals to reduce pain and increase function

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27
Q

Illness anxiety disorder

How to manage?

A

Excess worry regarding mild/absent symptoms
Prev. hypochondriasis
4 D’s: Disease fear, preoccupation, conviction; and Disability
Manage by identifying stressors, refer for supportive and cognitive therapy, SSRIs

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28
Q

Conversion disorder

Best management?

A

Requires clear evidence of incompatibility with neurological disease
At least 1 symptom (e.g. pseudoseizures) of altered voluntary motor/sensory function that is incompatible with neurological syndromes
Symptoms are distractible and don’t cause atrophy
Sensory symptoms may split at midline
Indifference about major disability
Outcomes improve with identifiable trauma/stressor at onset, anxiety/depression treatment, and framing the issue as “stress related” to the patient

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29
Q

Common examples of psychological factors affecting other medical conditions?

A

Anxiety and asthma
Occupational stress and hypertension
Alcohol abuse and liver disease

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30
Q

Cluster A personality disorders

A

Odd, eccentric behavior
Paranoid
Schizoid
Schizotypal

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31
Q

Cluster B personality disorders

A 
Dramatic, erratic emotional behavior
Antisocial
Borderline
Histrionic
Narcissistic
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32
Q

Cluster C personality disorders

A

Anxious and fearful behavior
Avoidant
Dependent
Obsessive-compulsive

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33
Q

Personality

A

Enduring pattern of thinking, feeling, and behaving uniquely recognizable in each individual

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34
Q

Personality disorders in general are due to … causing impairment in … ?
Other important features?

A

Use of limited coping strategies regardless of adaptability
Cognition, social functioning, and impulse control
Generally lifelong and diagnosed in adults who are egosytonic (think everything is fine)

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35
Q

Paranoid Personality Disorder

A

Scan environment for signs of slight
See/make hidden meanings
Bear grudges
Use projection

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36
Q

Schizoid Personality Disorder

A

Loner indifferent to others’ responses

Non-goal directed fantasies

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37
Q

Schizotypal Personality Disorder

A 
Unusual loner with social anxiety and odd beliefs, speech, and perceptions
Has ideas (not delusions) of reference
Uses magical (superstitious) thinking
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38
Q

Antisocial Personality Disorder

A

Deficits in conscience:
Defies social norms, irresponsible, without empathy or remorse
Act out, rationalize

39
Q

Borderline Personality Disorder

A

Fractured identity manifested in anger, mood swings, self-injurious acts, and intense relationships
Use splitting things as good/bad and projection

40
Q

Histrionic Personality Disorder

A

Lives to convince others
Dramatic, seductive, must be center of attention, preoccupied with appearance, “shallow”
Use repression and physical conversion

41
Q

Narcissistic Personality Disorder

A

Self-absorbed, entitled, exploitative
Lacks empathy
Uses denial and projection

42
Q

Avoidant Personality Disorder

A

Sensitive to rejection, but interested in interaction

Views self as socially inept, needs lots of reassurance

43
Q

Dependent Personality Disorder

A 
Needs someone else to nurture/care for
Fearful of independence
Stays in relationships or quickly finds new ones
No anger
Uses denial, repression
44
Q

Obsessive/Compulsive Personality Disorder

A

Lives for structure/control, perfectionist
Emotionally constricted
Uses isolation, reaction formation, undoing

45
Q

Isolation of affect (defense mechanism)

A

Attempt to avoid painful thought/feeling by objectifying and emotionally detaching oneself from it

46
Q

“Reward center” of mesolimbic dopamine system affected in all addicts either in-/directly

A

Nucleus accumbens

47
Q

Alcohol - mechanism of action

A

Indirectly stimulates dopamine release in NuAcc
Directly stimulates GABA-a receptor (disinhibits)
Inhibits NMDA receptor (excitatory transmitter)

48
Q

Cocaine - mechanism of action

A

Blocks reuptake of dopamine
Stimulates release of noradrenaline
Blocks Na+ channels (cardiac signs)

49
Q

Amphetamines - mechanism of action

A

Directly stimulate dopamine release

50
Q

Opiates - mechanism of action

A

Bind to mu, sigma, and kappa receptors centrally and peripherally
Indirectly stimulate release of dopamine in VTA

51
Q

Substance use disorder

A

Maladaptive pattern of substance use leading to clinically significant impairment/distress over at least 3 months

Criteria:

  1. Increasing amounts or increasing time period of use
  2. Unsuccessful at cutting down
  3. Lots of time spent to obtain
  4. Craving
  5. Failure to fulfill obligations (work, school, home)
  6. Continued use despite problems
  7. Giving up/reducing important social/recreational/occupational activites
  8. Recurrent use in hazardous situations
  9. Continued use despite insight into problem
  10. Tolerance
  11. Withdrawal

Patient may intentionally hide this from you

52
Q

How to diagnose substance abuse?

A

Take a good history - smell, hepatomegaly, mental status, track marks, weight loss, withdrawal symptoms, pupil size
CAGE:
Have you ever tried to Cut down?
Have you been Annoyed by criticism?
Have you felt Guilty of things done while intoxicated?
Have you had an Eye-opening experience?
Mildly elevated AST, ALT (100s)

53
Q

How to present substance abuse diagnosis?

A

Don’t present diagnosis while patient is intoxicated
Don’t argue with/threaten/shame patient
Don’t hedge (only partially explain) diagnosis
Don’t expect rapid change

State the diagnosis
Express concern
Explain this is a disease, not a moral weakness
Explain treatment is possible, but there is individual responsibility
Develop a plan

54
Q

Drugs requiring detox?

A

Alcohol, opiates, sedative hypnotics

55
Q

Disulfiram

A

Inhibits aldehyde dehydrogenase –> aldehyde accumulation on alcohol consumption
Causes flushing, nausea, hypotension, hepatotoxicity

56
Q

Naltrexone

A

Blocks mu-opioid receptor
May decrease risk and length of relapse
Hepatotoxicity

57
Q

Methadone and Buprenorphine

A

Replaces opiates
Administered in controlled setting combined with counseling and other interventions –> Most successful treatment for heroin addiction

58
Q

Major depressive episode - criteria

A 
Depressed mood, or anger/irritability
Anhedonia (^^^at least one of these two^^^)
Weight/appetite change
In-/hypersomnia, not restful
Psychomotor agitation/retardation
Fatigue
Feelings of guilt/worthlessness/hopelessness, nihilistic delusions
Diminished ability to think/concentrate
Recurrent thoughts of suicide
^^^At least 5 every day for 2 weeks^^^
Impairment/distress
No organic cause
No schizophrenia
(May present with non-specific somatic complaints)
59
Q

Major depressive episode - pathogenesis

A

Genetic contribution, variable sensitivity to life stressors
Increased cortisol/CRH secreation (Dexomethosone suppression test)
~15% of population in lifetime

60
Q

Suicidality risks?

A

Family history, previous attempts, male

61
Q

Manic episode - diagnosis

A 
Elevated or irritable mood characterized by at least 3 of the following with "marked impairment" in functioning:
Grandiosity
Little need for sleep
More talkative
Racing thoughts
Distractability
Increased activities/agitation and risk-taking
Impulsiveness

Patient compliance is low since they may feel pleasure in manic state

62
Q

Mixed episode

A

Patient satisfies criteria of both manic and major depressive episodes over 1 week

63
Q

Hypomanic episode

A

4 days plus 3-4 symptoms of manic episode

Moderate or mild impairment in function, but may also ENHANCE function

64
Q

Major Depressive Disorder

A

Episodes of depressed mood daily for >2wks
Ser, Nor, and Dop implicated
Treat with Cognitive Behavioral Therapy and SSRI/SNRI/TCA/MAOI
ECT or TMS for memory loss
Address suicidality with direct questioning
Educate patient to adhere to meds and that this is a disorder, not a character weakness

65
Q

Dysthymic Disorder

A

Chronic ongoing (>1yr) mild depressive symptoms

66
Q

Bipolar I

A

Mixed episodes of mania and depression within the same week

67
Q

Bipolar II

A

History of depression with hypomanic episodes

68
Q

Cyclothymia

A

Cyclic hypomanic and depressive episodes

69
Q

Bipolar disorders - Pathogenesis

A

“Kindling effect” - over time patient is more susceptible to episodes

70
Q

Bipolar disorders - Treatment

A

Mania: Mood stabilizers (lithium, valproic acid)
Depression: Atypical antipsychotics (Seroquel, Symbyax)

71
Q

Diseases that may cause depression

A

Endocrine: Hypothyroidism, Cushing’s disease
Neuro: CVA (esp. frontal), Parkinson’s, Huntington’s, AZD
Infectious: HIV, hepatitis, mono, flu
Neoplastic: lung, pancreas, CNS
Metabolic: Folate/B12 deficiency, high Ca++, low Mg++
Other: Alcoholism, drugs/other causes of CNS depression

72
Q

Drugs causing mania

A

Stimulants, decongestants, weight loss preps
Dopamine agonists (L-DOPA)
Antidepressants
Steroids

73
Q

Diseases causing mania

A 
Endocrine: Hyperthyroidism
Neuro: Temporal lobe seizures or CVA, MS, Huntington's
Infectious: HIV, encephalitis
Neoplastic: CNS
Metabolic: Low Ca++
74
Q

Important general history questions related to depression?

A

Sleep, appetite, enjoyment of activities, depressive thoughts, family history

75
Q

Organic brain syndromes - cause

A

Disorders of the cerebrum

76
Q

Delirium

A

Confusion in which the individual experiences terrifying hallucinations, usually with increased psychomotor activity

77
Q

Amnesia

A

Loss of ability to form memories despite alert state of mind

78
Q

Dementia

A

Loss of ability to reason without disturbance of perception

79
Q

Always supplement a history of someone with a probable brain/psychiatric disorder with what?

A

Information from a person other than the patient

80
Q

Causes of acute confusion?

A

Medical illness - uremia, hypoxia, hypoglycemia, hyponatremia; high fever; heart failure; PTSD
Drug intoxication
Nervous system disease - CVA, tumor, abscess; subdural hematoma; meningitis; encephalitis

81
Q

Causes of delirium?

A

Medical illness - typhoid, pneumonia, septicemia, rheumatic fever, alcoholism
Nervous system disease - vascular, neoplastic; cerebral contusion; meningitis; subarachnoid hemorrhage; encephalitis

82
Q

Causes of dementias?

A

(Lots)
Associated w/labs/other diseases: Hypothyroidism, Cushing’s, nutritional deficiency (Trp, thiamine, B12), Wilson’s, chronic intoxication
Associated w/other neuro signs: CVA, tumor, trauma, hydrocephalus, Huntington’s, Tay-Sach’s, prion disease
Only evidence of neuro disease: AZD

83
Q

Eating disorder risk factors

A 
Genetics
Environment - higher in cultures valuing thinness
Social - teasing
Psychological stress - means of coping
Female gender
Early puberty
Perfectionist personality
Low self-esteem
Family troubles
84
Q

Eating disorder protective factors

A 
High self-esteem
Participation in non-elite sports
Successful in multiple areas
Good family and social support
Well-developed problem solving skills
85
Q

Anorexia Nervosa diagnosis

A

Restriction of energy intake leading to body weight lower than minimally normal or expected
Intense fear of gaining weight, becoming fat
Disturbance in experience of body weight or shape
Undue influence of body weight/shape on self-evaluation

86
Q

Subtypes of anorexia

A

Restricting type - for last 3 months, no binge eating or purging have occurred
Binge Eating/Purging type

87
Q

Bulimia Nervosa

A

Recurrent episodes of binge eating together with a sense of a lack of control with inappropriate compensatory behaviors to prevent weight gain, >1/wk for 3mths
Self-evaluation unduly influenced by body shape/weight

88
Q

Binge-eating disorder

A

Recurrent binge eating episodes without inappropriate compensatory behavior as in bulimia

89
Q

Symptoms of eating disorders

A

Menstrual irregularities
Abdominal pain/bloating
Cold intolerance and constipation (more AN)
Fatigue
GERD (BN)
Palpitations, syncope (due to orthostatic hypotension)

90
Q

Anorexia physical exam findings

A 
Acrocyanosis
Bradycardia
Emaciation
Orthostatic hypotension
Lanugo, alopecia
Hypothermia
Flat affect
Salivary gland enlargement
91
Q

Bulimia physical exam findings

A

Salivary gland enlargement
Calluses on knuckles from inducing emission
Mouth sores, enamel erosion from acid
Orthostatic hypotension
Mallory-Weiss tear of esophageal mucosa –> Blood in vomit

92
Q

Clinical components of refeeding syndrome

A

Hypophosphatemia, -kalemia, -magnesaemia
Deficiencies of vitamins, other trace minerals
Volume overload, edema

93
Q

Labs for suspected eating disorder

A 
CBC, ESR (normochromic, -cytic anemia; low glucose)
CMP (hyponatremia, liver enzymes?)
Urinalysis (water loading?)
Mg
Urine B-hGC (pregnant?)
FSH, LH, etc.
Serum amylase (high if purging)
Stool for blood (inflammatory bowel?)

ICM2 (5 decks)

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