Psych Flashcards
Defense mechanism: Splitting
Seeing the world in black & white (people or groups are either wholly good or wholly bad)– common in patients with borderline personality disorder
Defense mechanism: Projection
Transplanting your own unacceptable impulses on to another person (a pt who has sexual desires for her doc accusing him of having desires for her)
Defense mechanism: Reaction formation
The redirection of an unacceptable impulse into the opposite (a former smoker who avidly enforces a no smoking rule)
Defense mechanism : Sublimation
One of the mature defense mechanisms, involves channeling an unacceptable behavior into an acceptable form (a pt with sexually explicit thoughts becoming a sex therapist)
Defense mechanism : Acting out
Expressing unacceptable thoughts via actions (throwing a tantrum)
Defense mechanism : Intellectualization
Suppressing one’s feelings by thinking about the problem
pt with chronic fatigue, unhappiness, low energy, anhedonia (not caring) for 4 years, no suicidal thoughts, no changes in eating or sleeping, no concentration changes…
Dysthymic disorder —-> depressed mood most days for at least 2 years*, a low intensity mood disorder that responds well to antidepressants
(not MDD – have to have 5 or more of the “SIGECAPS” criteria for 2 weeks or more)
What are the mature defense mechanisms?
“SASH”
Sublimation
Altruism
Suppression
Humor
Defense mech: Dissociation
Temporary drastic change in personality or behavior to avoid emotional stress (classic w/ child or sex abuse victims)
Defense mech: Displacement
fellings or ideas are transferred to some neutral person (ie: parent blames child for something spouse did)
Defense mech: Fixation
partially remaining at a more childish level of development
Defense mech: Identification
modeling behavior after a more powerful person (though not necessarily admired)
Defense mech: Isolation of affect
separating feelings from events (ie: witness describing a murder without showing emotion)
Defense mech: Rationalization
proclaiming logical reasons for actions actually done for a different reason (ie: get fired – say you didn’t like the job anyway)
Defense mech: Regression
going back to earlier modes of dealing with the world (ie: child who reverts back to bedwetting even after he has been potty trained)
Defense mech: Repression
INVOLUNTARY withholding of an idea or feeling
Defense mech: Altruism
alleviating your guilty feelings by doing nice things for others
Defense mech: Suppression
VOLUNTARILY withholding an idea or feeling from awareness ( the more ‘mature’ form) 00 ie: choosing not to worry about Step 1 until the day before
Child w/ poor muscle tone, language skills, lack of trust, weight loss, illnesses…
Long term deprivation of affection to the child
Most common form of child mistreatment, poor hygiene, malnutrition, social withdrawl, failure to thrive
neglect (failure to provide food, shelter, supervision, education, affection) –> REPORTABLE JUST LIKE ABUSE
boy who destroys property, steals, violates social norms repeatedly, under age 18
Conduct disorder
defiant toward authority figures, but generally stays within social norms in other areas
Oppositional defiant disorder
to be diagnosed w/ Tourette’s , you must have ‘tics’ for more than ___________
1 year
language impairment in a young boy, below normal intelligence, focuses on objects not people
Autism
milder than Autism, normal intelligence but problems socially
Asperger’s
X-linked mutation in MECP-2 gene, only effects girls, loss of development, regression around age 1-4 , classic “hand-wringing” behavior
Rett’s syndrome
similar to Rett’s, but more common in boys and onset is age 3-4
Child disintegrative disorder (“Hellers”)
anterograde amnesia caused by Thiamine (B1) deficiency, destruction of the mamillary bodies
Korsakoff’s amnesia – seen in alcoholics
waxing & waning level of consciousness with acute onset, often reversible, often w/ visual hallucinations, can be secondary to infection, trauma, substance abuse, will have an abnormal EEG if you did one…
Delirium (very common in hospitalized patients)
gradual decline in cognition with no changes in LOC, memory loss, aphasia, personality changes, impaired judgment, can be caused by Alzhiemers, HIV, Picks dz, Stroke… would have a normal EEG
Dementia (usually irreversible)
Auditory hallucinations are common in what dz?
Schizophrenia
Olfactory hallucinations assoc with ____
epilepsy or brain tumor
Tactile halucinations are assoc w/ _____
alcohol withdrawal or cocaine abuse (bugs crawling on skin)
chronic mental disorder w/ periods of psychosis, disturbed behavior and thought, decline in functioning for GREATER THAN 6 MONTHS – has + and - symptoms
Schizophrenia
Positive symptoms of Schizophrenia
delusions, hallucinations, disorganized speech, disorganized / catatonic behavior
Negative symptoms of schizophrenia
flat affect, social withdrawal, no motivation, lack of speech or thought
Schizophrenia symptoms that last btw 1-6 months (but not more than 6 mos)
Schizophreniform disorder
Schizophrenia symptoms for at least 2 weeks, PLUS a mood disorder (mania or depression or both)
Schizoaffective disorder
an untrue belief that is persistant > 1 month but is not totally bizzare
Delusional disorder
an untrue belief that is persistant > 1 month but is not totally bizzare
Delusional disorder
What are the mature defense mechanisms?
“SASH”
Sublimation
Altruism
Suppression
Humor
anterograde amnesia caused by Thiamine (B1) deficiency, destruction of the mamillary bodies
Korsakoff’s amnesia – seen in alcoholics
waxing & waning level of consciousness with acute onset, often reversible, often w/ visual hallucinations, can be secondary to infection, trauma, substance abuse, will have an abnormal EEG if you did one…
Delirium (very common in hospitalized patients)
gradual decline in cognition with no changes in LOC, memory loss, aphasia, personality changes, impaired judgment, can be caused by Alzhiemers, HIV, Picks dz, Stroke… would have a normal EEG
Dementia (usually irreversible)
Auditory hallucinations are common in what dz?
Schizophrenia
Olfactory hallucinations assoc with ____
epilepsy or brain tumor
Tactile halucinations are assoc w/ _____
alcohol withdrawal or cocaine abuse (bugs crawling on skin)
chronic mental disorder w/ periods of psychosis, disturbed behavior and thought, decline in functioning for GREATER THAN 6 MONTHS – has + and - symptoms
Schizophrenia
Positive symptoms of Schizophrenia
delusions, hallucinations, disorganized speech, disorganized / catatonic behavior
Negative symptoms of schizophrenia
flat affect, social withdrawal, no motivation, lack of speech or thought
Schizophrenia symptoms that last btw 1-6 months (but not more than 6 mos)
Schizophreniform disorder
Schizophrenia symptoms for at least 2 weeks, PLUS a mood disorder (mania or depression or both)
Schizoaffective disorder
an untrue belief that is persistant > 1 month but is not totally bizzare
Delusional disorder
Presence of 2 or more distinct identities or personality states , common in women with a history of sexual abuse
Dissociative identity disorder
An abrupt change in location, inability to recall past, confusion, assumption of a new identity, and the patient doesn’t remember this state after its over—- associated with trauma, natural disasters …
Dissociative fugue state
Distinct period of abnormally elevated, expansive or irritable mood lasting at least 1 week, must have 3 or more of the traits
Manic episode
Must have 3 of these:
Distractibility Irresponsibility Grandiosity Flight of ideas/ racing thoughts Agitation, increased activity Decreased need for sleep Talkativeness or pressured speech
Like a manic episode, still lasts longer than 1 week but doesn’t affect the persons life enough to warrant hospitalization
Hypomanic episode
Only need one manic or hypomanic episode for diagnosis
Bipolar disorder
Depressive symptoms for longer than 2 weeks with episodes that usually last 6-12 months (must include patient reported depression or anhedonia plus 4 of the SIGECAPS)
Major depressive disorder
SIGECAPS for depression
Sleep disturbance Interest loss (anhedonia) Guilt Energy loss Concentration loss Appetite/ weight changes Psychomotor retardation Suicidal ideations
Milder form of depression, lasts 2 years or more
Dysthymia
Most common form of depression, characterized by hypersomnia, overeating, mood reactivity, but can experience improved mood in response to positive events
Atypical depression
Treatment for atypical depression
MAOIs, or SSRIs
Hypervigilance, avoidance, distress, and re-experiencing event for > 1 month
PTSD
PTSD symptoms for <1 month
Acute stress disorder
Anxiety that isn’t related to any specific person or thing, lasts longer than 6 months , includes sleep disturbances, fatigue, GI distress….
Generalized anxiety disorder
Pt consciously fakes a disorder in order to obtain a secondary gain (drugs, getting out of work)
Malingering
Pt consciously fakes symptoms in order to obtain a primary gain (attention for being sick)
Factitious disorder
Munchausens and Munchausens by proxy are categories of ____________________ disorder
Factitious disorder ( they want attention for being sick or for their child being sick)
Cluster A personality disorders
“Weird”
1- paranoid – distrustful, accusatory, projection is common
2- schizoid – voluntary social withdrawal, content being alone, limited emotional expression
3- schizotypal – odd beliefs, magical thinking, awkward
Cluster B personality disorders
“Wild”
1- antisocial – sociopaths, criminals, > 18 years old
2- borderline – splitting is common, females, unstable mood, impulsive
3- histrionic – attention seekers, theatric
4- narcissistic – requires excessive admiration, sense of entitlement
Cluster C personality disorders
“Worried”
1- avoidant – socially inhibited, timid, but desires to be social**, sensitive to rejection
2- obsessive- compulsive – needs order, control, perfection
3- dependent – submissive, clingy, low self confidence
Personality type that is socially inhibited, timid, feels inadequate BUT desires to have relationships ((compared to Schizoid which do not want relationships))
Avoidant personality
body weight < 85% of ideal for height, decreased bone density, excessive dieting / + or - purging, amenorrhea for > 3 months, anemia…
Anorexia nervosa
binge eating / purging, body weight often maintained around a ‘normal’ range, assoc with parotitis, enamel erosion, metabolic alkalosis
Bulimia nervosa
Lab AST is twice the value of ALT and serum gamma-glutamyltransferase is elevated
signs of Alcohol intoxication
treatment fot Delirium tremens (DT’s)
benzodiazepines
Intoxication w/ these drugs cause pupillary constriction (miosis) – “pinpoint pupils”
Opioids ( morphine, heroin, methadone)
Treatment for Opioid intoxication (Heroin, Morphine…)
Naloxone, Naltrexone
Sweating, dilated pupils, N/V, fever, runny nose – all signs of _____ withdrawal
Opiod withdrawal (tx = symptomatic)
these drugs can cause marked respiratory depression
Barbiturates
have a smaller risk of respiratory depression and treatment for intoxication is Flumazenil
Benzodiazepines
Intoxication with _____, ______ & ________ can cause pupillary dilation (mydriasis)
Amphetamines, LSD & Cocaine
this drug can cause angina, premature labor, pupillary dilation, hallucinations and sudden cardiac death
Cocaine
this drug can cause belligerence, aggression, agitation, nystagmus, tachycardia, homicidality
PCP
this drug can cause flashbacks, pupillary dilation, visual hallucinations
LSD
Heroin users are at risk for ______
hepatitis, abscesses, overdose, AIDS, right sided endoarditis
Methadone use
for Heroin detox, long term maintenance
confusion, ophthalmoplegia & ataxia
Wernicke’s encephalopathy
how Disulfiram works
causes Acetaldehyde to build up by blocking Acetaldehyde DH –> makes pt feel very sick if they consume any alcohol
life threatening alcohol withdrawal syndrome, peaks 2-5 days after last drink, tactile hallucinations
Delirium tremens (treat with Benzos)
SSRI’s —> used to treat a huge variety of psych disorders EXCEPT ____ & ______
bipolar or schizophrenia (use mood stabilizers and antipsychotics for these)
What are the “mood stabilizers” used to treat bipolar?
Lithium, Valproic acid, Carbamazepine
CNS stimulates (amphetamines) act by ________________________
increasing NE & dopamine at the synaptic cleft
Used for ADHD, narcolepsy & appetite control
What are the TYPICAL antipsychotics?
Haloperidol, and anything that ends in
“-azine”
- they all block Dopamine (D2) receptors, increasing cAMP
- treat the + schizo symptoms, psychosis, mania, & Tourette’s
What are the main side effects of the Typical Antipsychotics? (haloperidol + “-azines”)
Extrapyramidal side effects (dystonia, akinesia (like parkinson’s) , restlessness, tardive dyskinesia)
and also SE’s from blocking muscarinic, alpha and histamine receptors (dry mouth, constipation, hypotension, sedation)
and hyperprolactinemia and galactorrhea
What are the ATYPICAL antipsychotics?
Olanzapine, Clozapine, Quetipine, Risperidone, Aripiprazole, Ziprasidone
“It’s Atypical for OLd CLosets to QUietly RIsper from A to Z”
-can treat both the + and - effects of Schizo
–have less severe side effects so these are preferred!
Mechanism of Atypical antipsychotics?
not totally understood (effect various receptors)
the atypical antipsychotic __________________ can cause granulocytosis so you must monitor WBC count
Clozapine
“Clozapine traps granulocytes in the closet”
Lithium mechanism & side effects
mechanism = inhibits IP3 cascade
Side effects = “LMNOP”
Lithium causes Movement (tremors) Nephrogenic DI hypOthyroidism Pregnancy probs (Epstein's anomaly)
Buspirone mechanism and use
stimulates 5HT 1A receptors – used for generalized anxiety disorder
Amitriptyline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, Amoxapine
Tri- cyclic Antidepressants
end in “-iptyline” or “-ipramine” mostly
Mechanism of TCA’s
block the reuptake of NE and Serotonin
-used for MDD, bedwetting (Imipramine) , OCD (clomipramine) & fibromyalgia
SSRI mechanism & side effects
block the reuptake of Serotonin only
SE’s = sexual dysfunction, Serotonin syndrome ((hyperthermia, flushing, diarrhea, siezures))
Name the SSRI’s
Fluoxetine
Paroxetine
Sertraline
Citalopram
Pt starts taking an antidepressant and comes to you 2 weeks later complaining that they are not working…. what do you advise them?
Antidepressants usually take 4-8 weeks to have an effect!
SNRI mechanism and SE’s (Venlafaxine, Duloxetine)
block Serotonin and NE reuptake
SE’s – less than SSRI’s, may have incr in BP
- used for depression ((*Duloxetine can also be used for diabetic peripheral neuropathy))
MAOI’s mechanism
increase the levels of NE, Dopamine and Serotonin (**do not eat Tyramine containing foods when on b/c will cause HTN crisis)
What are the MAOI’s
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline
“MAO Takes Pride In Shanghai”
What are the atypical antidepressants?
Bupropion – incrs NE & Dopamine
Mirtazapine – alpha 2 blocker
Maprotiline –blocks NE reuptake
Trazodone – blocks Serotonin reuptake
