PSYCH Flashcards

Question

schizophrenia ## Footnote what are the qualifications to dx this? 5 1 1

Answer 1

**_2 or more_** 1. **_DELUSIONS_**: fixed false beliefs 2 **_hallucinations_**: unusual auditory/visual/olfactory sensory input 3. **_disorganized speech_**: can't stay on topic, can't provide related answer, muttering 4. **_grossly disorganized behavior_**: unpredictable behavior, decreased self care, inappropriate sexual behavior 5 **_negative sxs_**: blunted affect, poor posture, lack of goal drive activities **_plus interferes with live_** **_PLUS 6+ months!!_**

Answer 2

antipsychotics!!!

Answer 3

**_sxs the exact same but the length of time differentiates_** schizoprenia: 6+ mo schizophreniform: 1-6 mo bried psychotic episode: 1 day-1 month

Answer 4

baseline of psychosis with interepisodes of mood disorders with at least **_2 week period between_** where return to baseline of psychosis ## Footnote \*\*psychotic and mood sxs, but flucuates between two\*\* TX: 1. **_second generation antipsychotics DOC_** 2. mood stabalizers 3. antidepressants

Answer 5

delusions about **_plausible events, that although unlikely, COULD occur_** ## Footnote Ex: meeting the president having sex in dumpster secret relationship with other ONLY ONE IN THE DSM-5 where functioning NOT impaired SEEK CLINICAL CARE WHEN: 1. anxiety about delusion too much 2. discovery of delusion by friend 3. threats/illegal activity regarding their delusion

Answer 6

tearfullness depressed mood vandalism reckless driving fighting anxiety BUZZ WORD: "**_NERVOUS BREAKDOWN_**"

Answer 7

maladaptive behavior or emotional sxs that occur **_WITHIN 3 months after stressful life event and end within 6 months of the event_** NOT DUE TO BEAREAVEMENT!!! **adolesencents stressors**: parental rejection and divorce, problems at school, and leaving home **adult stressors**; marital disocord/divroce, financial difficulties, job loss, parenthood, natural disasters, cancer dx as stressor resolves, coping skills develop and sxs disappear TX: 1. CBT or psychodynamic therapy imrove coping skills, strengthening defense mechanisms, and changing the way the person interacts with stressful situation Example: 28-yr-old female becomes bitter and angry when her husband of 5 years leaves her for a younger man. One week later, the woman quits her job without giving notice, and begins drinking heavily. She telephones friends over the next several weeks and tells them how she has passive suicidal ideation. She also makes several threatening calls to the new boyfriend.

Answer 8

**_2+ week time frame that MUST include_** 1. depressed mood 2. loss of interest or pleasure \*\*MUST HAVE 5 and is Chronic course with relapse\*\*\* Significant weight loss when not dieting or weight gain change in 5% of body weight or decrease in appetite everyday Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day Fatigue or loss of energy everyday Feelings of worthlessness or excessive or inappropriate guilt nearly every day Diminished ability to think or concentrate, or indecisiveness Recurrent thoughts of death, suicidal ideation, or attempt

Answer 9

1. antidepressants ## Footnote \*\*\*must continue for 4-6 weeks and must be continued for over 6 months to prevent relapse\*\*\* **_A. SSRI FIRST LINE_** SE: GI upset, heacahe, sexual dysfunction **_B. MAOI_** required tyramine free diet no BEER, WINE, cheese 2. Electroconvulsive shock therapy effective in all MMD but reserved for depression or those who can't take medications _memory loss and amnesia MC but returns after 6 months_

Answer 10

fall/winter with lessening daylight hours _remits in spring_ MC cold climates and women 20-40 y/o Tx: 1. light therapy 2. SSRI/buproprion

Answer 11

1. overeating and weight gain 2. oversleeping 3. reactive mood-can get cheered up with specific events 4. oversensitivity to interpersonal rejection 5. leaden paralysis-heavy feeling in arms or legs

Answer 12

1. **_depression worse in Am ~2hrs prior to ususally awakening_** 2. psychomotor agitation or retardation 3. significant weight loss and anorexia 4. excessive or inappropriate guild \*\*\*nearly complete inability to cheer them up\*\*\* TX: 1. SSRI 2. consider ECT because it is 50% of hospitalizaed patients

Answer 13

during pregnancy or within 4 weeks of delivery ## Footnote Tx: SERTRALINE SSRI SAFTEST OPTION!!!

Answer 14

mania: occurs for over 7 days ## Footnote hypomania: occurs for over over 4 days \*\*all the sxs in the DSM five are the same but the time frame and the intensitiy are different\*\* **_MANIA: they are very severe changes that caused marked impariement in social and occupational functioning and NEED HOSPITALIZATION to prevent harm to themselves or others!!! can have psychotic features_** **_HYPOMANIA: same sxs but they cause a CHANGE IN FUNCTIONING that is UNCHARACTERISTIC of the individual...can be noticed by others_**

Answer 15

1. **_distractable_** attention easily drawn to unimportant or irrelevant stimuli 2. **_Insomnia_** feel rested after only 3 hours of sleep 3. **_Grandiosity_**increased self esteem 4. **_Flight of ideas_** racing thoughts 5. **_Activities (goal directed)/ agitation_** socially, at work, school or sexually 6. **_sexual exploit/risky behavior_** unrestrained buying sprees, many sexual partners, foolish buisness investments 7. **_talkative (overly)_** \*\*keep in mind the sxs between Bipolar 1 and bipolar 2 are the same but severity is what differntiating\*\*

Answer 16

characterized by HYPOMANIA but NOT mania ## Footnote **_HYPOMANIA: same sxs but they cause a CHANGE IN FUNCTIONING that is UNCHARACTERISTIC of the individual...can be noticed by others_**

Answer 17

MANIA IS HALLMARK ## Footnote they are very **_severe changes that caused marked impariement in social and occupational_** functioning and **_NEED HOSPITALIZATION_** to prevent harm to themselves or others!!! can have psychotic features avg dx age: 30 y/o \*\*keep in mind hypomania episodes can also occur **_but 1 episode of mania qualifies it as bipolar 1_**\*\*

Answer 18

1. MOOD STABALIZERS ## Footnote **_LITHIUM DOC_** **_also consider VALOPROIC ACID_** 2. 2nd gernation antipsychotics for acute mania piseridone, topiramate, lamotrigine **_\*\*\*\*CAUTION: antidepression medications if given to bipolar pt who was misdxed with depression can make mania worse!!\*\*_**

Answer 19

**deeply ingrained inflexible pattern that are maladaptive and cause significant impairment in social or job functions** orginates in adolescence or earlier (2 yrs), broken into 3 clusters with 3 types underneath A. don't fit in with social norms B. they can be ego-dystonic (AWARE)or egosyntonic (UNAWARE) C. environmental or genetic components that drive their expression/developement

Answer 20

MOST COMMON conflict between the person and the environment they know they have a problem and they want to fix it "aware of condition"

Answer 21

no conflict between person and environment aka they don't know they have it and rarely seek help "unaware of condition" these people have maladaptive lives that have many legal and psychosocial consequences

Answer 22

behavior that is markedly different than society - cognition - affect - interpersonal functioning - impulse control - pattern is inflexible and pervasive - long in duration of presence bck to adolescence, early as 2

Answer 23

they are viewed as some of the most difficult to tx as they don't have _ANY_ medication that is FDA approved for these conditions....many are used off label for these!!

Answer 24

dialectical behavioral therapy used for _borderline personality disorder_

Answer 25

1. Cluster A-weird wacky eccentric and odd ## Footnote A. paranoid B. schizoid C. cschizotypal 2. Cluster B-dramatic emotional erratic and wild A. antisocial B. borderline C. histrionic D. Narcissistic 3. Cluster C-anxious fearful and worried A. dependent B. obcessive compulsive C. avoidant

Answer 26

1. distrust 2. assume peoples motives are bad 3. things even strangers actions are a character assasination 4. extreme suspicion causes strained interpersonal relationship 5. holds grudges for long time 6. suspects exploitation Ex: 1. provider who doubts patients story and history, feels partners don't have their back, tries to have microcontrol 2. patient lacks trust in authority figure, feels provider has their own sense of agenda

Answer 27

1. blunted affect "flat and expressionless" 2. feeling of detachmen 3. _happy being alone_ and don't think anything of it 4. don't want relationships 5. precieved as emotionally cold EX: 1. provider: true loner at heart and sole, don't make close relationships ith coworkers or patients and feel FINE about it 2. patient: no desitre to stay healthy for provider, often hard to read and the provider thinks "_what do they think of me"?_

Answer 28

1. discomfort from the actual interaction 2. cognitive distortion, odd speaking, experience strange preceptual occurences 3. odd beliefs-trash can has meaning/can see the future 4. eccentric behavior/dress 5. magical thinking, telepathy, supersitions 1. "seers" of medicine, sees themselves as highly intuitive 2. patient will rely on what feels right, incapable of dealing with any stress

Answer 29

1. originates in childhood as misconduct like sexual physical abuse, setting fires, and harming animals 2. need to be 18+ to dx 3. disregard for violation of law and rights of others 4. impulsive with lack of remorse 5. don't care about their or others welfare 6. charming in interview \*\*\*often end up in jail!!\*\* 1. physician: norms don't apply to them, very little regar for feelings of others and feel little to no responsibility 2. patient: physically threatening, always someone eleses fault

Answer 30

1. instability of self image, mood, affect, behavior 2. mood swings, impulsitivity common 3. polarized relationships seen as either good or bad 4. _self mutilation like cutting and MANIPULATIVE sucide common--don't want to kill themselves_ 5. desperately tries to avoid abandoment and don't tolerate being alone but lash out at friends and family 6. evaluation/devaluation-effort to avoid feelings of emptiness or abandoment **MUST BE 18+ to dx!!** physician: marked instability of affect, mood, and responses patient: very manipulative, will place you on pedestal then kick it out from under ou with the slightest challenge

Answer 31

1. emotion and attention seeking 2. need to be center of attention 3. often inappropriately provative and sexual 4. theatrical and overly dramatic 5. shallow and exagerated physician: nice looking, center of attention "who package" patient: demands attention and will get attention through exageration, need for constant reassurance they are the best patient

Answer 32

1. me first attitude 2. inflated self image with need for amiration 3. grandosity with lack of empathy 4. arogant with sense of entitlement 5. fantacies about unlimited success, beauty, and brillance physician: believes in his superiority, glory seeker "surgeon" patient: they are better than you, may be likeable but fragile selfesteem/ego

Answer 33

1. **_want relationships but too scared because of fear of rejection_** (contrasts with schizoid) 2. self-inadequate 3. interact with others as little as possible to avoid shame, ridicule, or rejection 4. great desire for companionship 5. social phobia common physician: people pleaser, rare in clinicial because of the high degree of contact that is required patient: easily hurt if they feel you are critisizing them or disapprove

Answer 34

1. eccessively clingy 2. need to be cared for 3. indecisive, need others to make decisions 4. dislike being alone 5. prone to domestic partnership abuse because not assertive 6. bounce from relationship to relationship 7. seeks excessive advice from others and need nuturance physician: difficulty making decisions, overly reliant on others patient: won't do anything without calling you first or talkig it over with lots of other people, avoid personal responsibility

Answer 35

1. Type A-rules, lists, details 2. perfectionalism to the point of demise, interferes with life 3. inflexibility 4. insists others join their ways which makes relationships hard 5. change in routine causes severe anxiety physician: high achiever, over devoted, everything is urgent patient: will often tell you in detail what they need and why and present EBM

Answer 36

cognitive behavioral disorder can add medication to this but question of effectiveness BUT for **borderline personality disorder** use _dialectical behavior therapy_ and _quetiapine to help with sxs_

Answer 37

**2 or more of the following within a 12 month period:** 1. Large amounts over a longer period than was intended 2. Persistent desire or unsuccessful efforts to cut down on the substance 3. A great deal of time is spent in activities to obtain the substance or use the substance 4. Craving or strong desire to use the substance Failure to fulfill the major role obligations at work, school, or home 5. Continued use despite recurrent social or interpersonal problems caused by the substance 6. Activities are given up or reduced because of use 7. Use is continued despite knowledge of having persistent or recurrent physical or psychosocial problems that are exacerbated by the substance 8. Tolerance 9. withdrawal **\*\*\*Severity is determined by the number of above sxs\*\*\*\***

Answer 38

1. **_physical dependence_** withdrawal sxs in the absence of the drug 2. **_addiction_** neurological disease with genetic and psychosocial contributions leading to compulsive use and craivings despite harmful consequences \*\*\*keep in mind these have genetic components, can be learned from childhood, mental illness predispostion, social forces such as peer influence, chronic pain RF\*\*\*\*\*

Answer 39

1. **_inpatient care_**-dual dx and detox 2. **_residential program_**: sober living with peers, integrated counseling 3. **_partial hospitalization program_**: outpatient substance abuse group therapy, couseling, vounteer groups _medical monitoring and prescription withdrawal aid_ 4. **_intensive outpatient program_**-group therapy, couseling, peer volunteer groups 5 **_outpatient visits-_** one on one subtance abuse counselor or combined mental health 6. **_peer support groups_**-AA/NA 7. **_medications for anti craving_** - naloxone - baclofen - antidepressants - opiate replacements

Answer 40

first few weeks are critical ## Footnote A. **_relapse prevention a form of CBT helps identify at risk behavior and helps with coping responses_** B. **_maintaining regular attendance and participating more actively at peer support groups and meetings have been associated with better outcomes_**

Answer 41

CIWA scale!

Answer 42

COWS score 1. _stage 1- up to 8 hours_ fear of withdrawing, anxiety, drug craving 2. _stage 2-8-24 hours_ insomnia, restlessness, anxiety, stomach cramps, diaphoresis, mydriasis 3. _stage 3-up to 3 days_ vomiting, diarrhea, fever, chills, tremors, muscle spasms, seizures, hyertension

Answer 43

1. suboxone (buprenorphine/naloxone) ## Footnote POSSIBLY SHORTER TAPER maitenence requires outpatient prescriber 2. subutex (buprenorphine) indicated in pregnancy 3. methadone harder to stop require clinical daily visits \*\*\*WITH ALL OF THESE FOR THE MOST COMFORTABLE CESSATION YOU WANT TO SLOWLY STEP DOWN FROM THE OPIATE DOSE OVER THE COURSE OF WEEKS TO MONTHS\*\*\*