Psych Flashcards
1
Q
What is the key difference between classical and operant conditioning?
A
- classical involves an involuntary response
- operant involves a voluntary response
2
Q
What is operant conditioning?
A
learning which occurs because the given action produces a punishment or reward
3
Q
What are the unconditioned and conditioned stimuli and response in a case of classical conditioning?
A
- US: ring the bell
- UR: eat
- CS: ring the bell
- CR: salivate
4
Q
What is reinforcement?
A
- the act of following a target behavior with either a desired reward or removal of an aversive stimulus
- remember, both positive and negative reinforcement are meant to increase the frequency of the response
5
Q
What is the difference between positive and a negative reinforcement?
A
- both are meant to increase the frequency of the response
- postive means providing a reward whereas negative means removing an aversive stimulus
6
Q
The opposite of reinforcement is what?
A
punishment
7
Q
What is negative punishment?
A
the removal of a desired stimulus used to extinguish an unwanted behavior
8
Q
What is extinction?
A
a phenomenon of both classical and operant conditioning in which discontinuation of reinforcement, positive or negative, eventually leads to elimination of the associated behavior
9
Q
What is transference?
A
a situation in which the patient projects feelings about a formative or important person onto the physician (e.g. psychiatrist is seen as a parent)
10
Q
What is countertransference?
A
a situation in which the doctor projects feelings about a formative or other important person onto the patient (e.g. patient is seen as younger sibling)
11
Q
What are ego defenses? List several mechanisms.
A
- they are mental processes, both conscious and unconscious, used to resolve conflict and prevent undesirable feelings
- includes acting out, denial, displacement, dissociation, fixation, idealization, and identification
12
Q
What is meant by acting out in the context of ego defenses?
A
expressing unacceptable feelings and thoughts through actions
13
Q
What is meant by denial in the context of ego defenses?
A
avoiding the awareness of some painful reality
14
Q
What is meant by displacement in the context of ego defenses?
A
- transferring avoided ideas and feelings to a neutral person or object
- different from projection
- example: mother yells at her child because her husband yelled at her
15
Q
What is meant by dissociation in the context of ego defenses?
A
- a temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
- dissociative identify disorder would be the extreme of this
16
Q
What is meant by fixation in the context of ego defenses?
A
- partially remaining at a more childish level of development
- different than regression
17
Q
What is meant by idealization in the context of ego defenses?
A
expressing extremely positive thoughts of self and others while ignoring negative ones
18
Q
What is meant by identification in the context of ego defenses?
A
- modeling behavior after another person who is more powerful
- prime example is an abused child later becoming a child abuser
19
Q
The idea that victims of child abuse often later become child abusers is an example of what ego defense mechanism?
A
identification (modeling behavior after another person who is more powerful)
20
Q
What is meant by intellectualization in the context of ego defenses?
A
- the use of facts and logic to emotionally distance oneself from a stressful situation
- perfect example is a patient who focuses only on rates of survival after receiving a cancer diagnosis
21
Q
What is meant by isolation of affect in the context of ego defenses?
A
- separating feelings from ideas and events
- e.g. a murderer describing in graphic detail what he did without emotional response
22
Q
What is meant by passive aggression in the context of ego defenses?
A
failing to meet the needs or expectations of others as an indirect show of opposition
23
Q
What is meant by projection in the context of ego defenses?
A
- attributing an unacceptable internal impulse to an external source
- e.g. a man who wants to cheat on his wife accuses her of being unfaithful
24
Q
What is meant by rationalization in the context of ego defenses?
A
proclaiming logical reasons for actions actually performed for other reasons, most often to avoid self-blame
25
What is meant by reaction formation in the context of ego defenses?
- replacing a warded-off idea or feeling by an unconsciously derived emphasis on it's opposite
- i.e. a patient with libidinous thoughts entering the monastery
26
What is meant by regression in the context of ego defenses?
involuntarily turning back the maturational clock and going back to earlier modes of dealing with the world
27
What is meant by repression in the context of ego defenses?
- involuntarily withholding an idea or feeling from conscious awareness
- differs from suppression which is more conscious
28
What is meant by splitting in the context of ego defenses? In which population is it commonly seen?
- believing that people are either all good or all bad at different times due to intolerance of ambiguity
- commonly seen in those with borderline personality disorder
- e.g. a patient says that all the nurses are cold and insensitive but the doctors are warm and friendly
29
How do repression and suppression differ in the context of ego defenses??
- repression is an unconscious act whereas suppression is more conscious
- furthermore, repression is an immature defense whereas suppression is a mature one
30
Ego defenses can be divided into what two categories?
immature and mature
31
Which ego defenses are considered "mature"?
- sublimation
- altruism
- suppression
- humor
32
What is meant by sublimation in the context of ego defenses?
- a mature defense in which an unacceptable wish is replaced by another course of action that is similar but does not conflict with one's value system
- e.g. teenager's aggression toward his father is redirected to perform well in sports
- in contrast to the immature response of reaction formation
33
What is meant by altruism in the context of ego defenses?
- a mature defense in which negative feelings are alleviated via unsolicited generosity
- e.g. a mafia boss makes a large donation to charity
34
What is meant by suppression in the context of ego defenses?
- a mature defense that involves intentionally withholding an idea or feeling from conscious awareness
- differs from repression in that it is conscious and meant to be temporary
35
What is meant by humor in the context of ego defenses?
a mature defense characterized by appreciating the amusing nature of an anxiety-provoking or adverse situation
36
What is meant by the phrase "infant deprivation effects"? What specific effects are seen?
- changes in infants that arise out of long-term deprivation of affection
- failure to thrive, poor language/social skills, lack of basic trust, and reactive attachment disorder (withdraws or is unresponsive to comfort)
- these can be remembered by the 4 W's: weak, wordless, wanting (socially), and wary
- the changes are typically irreversible if deprivation lasts more than 6 months and severe deprivation can even result in infant death
37
What percentage of deaths in children less than one year old can be attributed to physical abuse?
40%
38
Who is most often the perpetrator in instances of physical child abuse? Who is most often the perpetrator of sexual child abuse?
- the biological mother is most often the physical abuser
| - a male known to the victim is most often the sexual abuser
39
At what age does the incidence of child sexual abuse peak?
between the ages of 9-12
40
What kind of fraction is pathognomonic for child abuse?
a spiral fracture
41
Polymicrobial septicemia in children is almost always attributable to what?
Munchausen's by proxy
42
What is the most common form of child maltreatment?
neglect
43
Vulnerable Child Syndrome
- an instance in which the parents perceive their child as especially susceptible to illness or injury
- usually follows a serious illness or life-threatening event
- can result in missed school days or overuse of medical services
44
ADHD
- an early-onset disorder of limited attention span and poor impulse control that begins before age 12
- characterized by hyperactivity, impulsivity, and/or inattention in multiple settings
- normal intelligence but often struggle at school
- persists into adulthood in nearly half of all cases
- treat with stimulants like methylphenidate with or without CBT
45
What is the preferred treatment for ADHD?
methylphenidate
46
Autism Spectrum Disorder
- a disorder of poor social interaction, social communication deficits, restricted interests, and repetitive or ritualized behaviors
- may be accompanied by intellectually disability and only rarely accompanied by unusual abilities (savants)
- associated with larger head and brain size
- must present in early childhood
- more common in boys
47
Rett Syndrome
- an X-linked dominant disorder seen almost exclusively in girls because affected males die in utero or shortly after birth
- presents around age 1-4 with regression, including loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing
48
Conduct Disorder
- repetitive and pervasive behavior violating the basic rights of others or social norms
- many patients often meet criteria for antisocial personality disorder after reaching the age of 18
- treatment is CBT
49
Those with what childhood disorder often progress to antisocial personality disorder in adulthood?
conduct disorder
50
Oppositional Defiant Disorder
- an enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
- treatment is CBT
51
Separation Anxiety Disoder
- an overwhelming fear of separation from home or loss of attachment figure
- commonly presents between 7-9 with factitious physical complaints to avoid going to or staying at school
- treatment involves CBT, play therapy, and family therapy
52
Tourette Syndrome
- a disorder of sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist longer than one year with an onset before age 18
- Coprolalia is only seen in 20% of cases
- associated with OCD and ADHD
- treatment is psychoeducation and behavioral therapy
- for intractable and distressing tics, high-potency antipsychotics, tetrabenazine, guanfacine, and clonidine can be used
53
What is coprolalia?
a form of Tourette syndrome characterized by involuntary obscene speech
54
Schizophrenia is associated with what NT changes?
an increase in dopamine
55
Parkinson disease is associated with what NT changes?
a decrease in dopamine and increase in ACh
56
Huntington disease is associated with what NT changes?
a decrease in GABA and ACh and an increase in DA
57
Depression is associated with what NT changes?
a decrease in NE, serotonin, and dopamine
58
Anxiety disorders are associated with what NT changes?
an increase in NE and a decrease in both GABA and serotonin
59
Alzheimer's disease is associated with what NT changes?
an increase in glutamate and a decrease in ACh
60
In what order is orientation most often lost?
- first lost is orientation to time
- second is to place
- last is to person
61
What is retrograde amnesia?
the inability to remember things that occurred before a CNS insult
62
What is anterograde amnesia?
the inability to form new memories
63
Korsakoff Syndrome
- anterograde amnesia caused by a vitamin B1 deficiency and associated with destruction of the mammillary bodies
- patients often compensate with confabulation
- most often seen in alcoholics as a late neuropsychologist manifestation of Wernicke encephalopathy
64
What are dissociative amnesia and dissociative fugue?
- the inability to recall important personal information, most often in a period following severe trauma or stress
- may be accompanied by a dissociative fugue, which is abrupt travel or wandering in the setting of dissociative amnesia
65
Dissociative Identify Disorder
- also known as multiple personality disorder
- associated with a history of sexual abuse, PTSD, depression, substance abuse, borderline personality disorder, and somatoform conditions
- more common in women
66
What is depersonalization disorder? How does it differ from derealization disorder?
- persistent feelings of detachment or estrangement from one's own body, thoughts, perceptions, and actions
- by contrast, derealization is a persistent feeling of detachment from one's environment
67
What are the criteria for delirium?
- acute and fluctuating course
- inattention
- disorder thinking or altered level of consciousness
68
What kind of EEG is common in those suffering from delirium?
a diffuse, slowing EEG
69
How is delirium treated?
- focus on treating the underlying condition
| - use haloperidol as needed and benzodiazepines for alcohol withdrawal
70
How does dementia differ from delirium?
- dementia has a more chronic, gradual, progressive course than delirium
- those with dementia also suffer greater functional deficits (ADLs and IADLs)
- EEG can be helpful in distinguishing the two because the EEG for a demented patient is usually normal but diffuse slowing EEGs are common for delirious patients
71
What are five reversible causes of dementia?
- hypothyroidism
- depression
- vitamin B12 deficiency
- normal pressure hydrocephalus
- neurosyphilis
72
When assessing patients for dementia, be sure to screen them for what else?
pseudodementia, including depression, hypothyroidism, and B12 deficiency
73
How is psychosis defined?
as a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking
74
What are delusions?
unique, false beliefs that persist despite the facts
75
What is a referential delusion?
the belief that a neutral event has a special or personal meaning
76
What is an erotomanic delusion?
one in which the person believes another is in love with him or her
77
What is a somatic delusion?
the belief that one's bodily functioning, sensation, or appearance is grossly abnormal
78
What are hallucinations? How does this differ from an illusion?
- hallucinations are perceptions in the absence of any
external stimuli
- whereas illusions are misperceptions of real external stimuli
79
Under what circumstances are visual and auditory hallucinations most common?
- visual are more commonly a feature of a medical illness
| - auditory are more commonly a feature of a psychiatric illness
80
Under what circumstances are olfactory hallucinations most common?
as an aura preceding temporal lobe epilepsy or in those with brain tumors
81
Under what circumstances are tactile hallucinations most common?
in the settings of alcohol withdrawal and stimulant use (e.g. delusional parasitosis aka "cocaine crawlies")
82
What is a hypnagogic hallucination? What are they most often a feature of?
one that occurs while going to sleep, sometimes seen in cases of narcolepsy
83
What is a hypnopompic hallucination? What are they most often a feature of?
one that occurs while waking from sleep, sometimes seen in cases of narcolepsy
84
Schizophrenia
- diagnosis requires two of the following including one of the first three for more than 6 months: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms
- associated with increased dopaminergic activity, decreased dendritic branching, and ventriculomegaly
- lifetime prevalence is 1.5% with no gender or racial differences but presents earlier in men than women (early 20s v. late 20s/early 30s)
- treat with atypical antipsychotics like risperidone
- associated with frequent cannabis use in teens and increases risk for suicide
85
What physical, neurologic changes are seen in those with schizophrenia?
- increased dopaminergic activity
- decreased dendritic branching
- ventriculomegaly
86
What are the criteria for diagnosing schizophrenia?
two or more of the following, including one of the first three, for a period lasting longer than six months
- delusions
- hallucinations
- disorganized thought
- disorganized or catatonic behavior
- negative symptoms
87
What is a brief psychotic disorder?
- symptoms of schizophrenia lasting less than one month
- two of the following including one of the first three for less than 1 month: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms
- usually stress-related
88
What is the relationship between schizoaffective disorder, brief psychotic disorder, schizophreniform disorder, and schizophrenia?
- schizoaffective is more than 2 weeks of hallucinations or delusions without a major mood episode plus periods with a major mood episode
- brief psychotic disorder is schizophrenia for less than one month
- schizophreniform disorder is schizophrenia for 1-6 months
- schizophrenia is symptoms lasting more than 6 months
89
What is schizoaffective disorder?
- more than 2 weeks of hallucinations or delusions without a major mood episode
- plus periods of schizophrenic symptoms with concurrent major mood episodes
90
What is delusional disorder?
a fixed, persistent, false belief system lasting more than one month without otherwise impaired functioning
91
What is folie a deux?
a delusion shared by individuals in a close relationship
92
What is mood disorder?
- an abnormal range of moods or internal emotional states and loss of control over them
- severity of moods causes distress and impaired social and occupational functioning
- includes major depressive disorder, bipolar disorder, dysthymic disorder, and cyclothymic disorder
- may have superimposed psychotic features
93
What is a manic episode? What are the diagnostic requirements?
- a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least one week
- diagnosis requires hospitalization or at least three of the following: distractibility, irresponsibility, grandiosity, flight of ideas, decreased need for sleep, talkativeness or pressured speech, and psychomotor agitation or an increase in goal-directives activity
94
How is a hypomanic episode defined?
- like a manic episode except the disturbance is not severe enough to caused marked impairment in daily living or necessitate hospitalization
- lasts at least four consecutive days
95
What is another name for bipolar disorder?
manic depression
96
How does bipolar I differ from bipolar II?
- I is the presence of at least one manic episode with or without a hypomanic or depressive episode
- II is the experience of a hypomanic episode and a depressive episode without a manic episode
97
Bipolar Disorder
- defined by the presence of a manic or hypomanic episode and can involve depressive episodes
- most often, the patient's mood and functioning return to normal between episodes
- patients have a high risk for suicide, but anti-depressants can precipitate mania and should not be used
- treat with mood stabilizers (lithium, valproic acid, carbamazepine) and atypical antipsychotics
98
Which class of medications should not be used in those with bipolar disorder? Why?
anti-depressants because of their ability to precipitate a manic episode
99
What is the preferred treatment for bipolar disorder?
- mood stabilizers like lithium, valproic acid, carbamazepine
- atypical antipsychotics
100
What is cyclothymic disorder?
a milder form of bipolar disorder lasting at least two years over the course of which the patient experiences fluctuations between mild depressive and hypomanic symptoms (i.e. longer, milder cycling course)
101
What are the diagnostic criteria for major depressive disorder?
5 or more of the following for two or more weeks with reported depression or anhedonia being one:
- depressed mood
- sleep disturbance
- loss of interest
- guilt or feelings of worthlessness
- fatigue
- difficulty concentrating
- appetite or weight changes
- psychomotor retardation or agitation
- suicidal ideations
102
Major Depressive Disorder
- diagnosis requires 5 or more symptoms lasting more than two weeks including either depression or anhedonia
- often have changes in their sleep patterns including: less slow-wave sleep, less REM latency, increased REM early in sleep cycle, increased total REM, repeated awakenings, and early-morning wakening
- first line therapy is SSRIs and CBT
- second line therapy is SNRIs, mirtazapine, and bupropion
- ECT can be used in select patients, often with good results
103
What changes in sleep are often seen in those with depression?
- less slow wave sleep
- less REM latency, more REM early in the night, and more total REM
- repeated nighttime awakenings and terminal insomnia (early wakening)
104
What are the first three lines of therapy for depression?
1) CBT and an SSRI
2) SNRI, mirtazapine, or bupropion
3) ECT
105
What is persistent depressive disorder?
- aka dysthymia
| - is a milder form of depression lasting at least two years
106
What is unique about "depression with atypical features"?
- characterized by the ability to react emotionally to positive events (but only for a brief time), reversed vegetative symptoms (hypersomnia and hyperplasia), leaden paralysis (heavy feeling in arms and legs), and long-standing interpersonal rejection sensitivity
- it is the most common subtype of depression
- treatment is largely the same as MDD
107
To be considered postpartum, a mood disturbance must occur when?
within 4 weeks of delivery
108
Postpartum "Blues"
- characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery
- treatment is supportive as it usually resolves in 10 days
- follow-up for possible postpartum depression
- 50 to 85% incidence rate
109
Postpartum Depression
- depressed affect, anxiety, and poor concentration arising within 4 weeks of delivery
- treat with CBT and SSRIs
- 10-15% incidence
110
Postpartum Psychosis
- mood-congruent delusions, hallucinations, and thoughts of harming the baby or self
- risk factors include history of bipolar or psychotic disorder, first pregnancy, family history, and recent discontinuation of a psychotropic medication
- treat with hospitalization and initiation of atypical antipsychotics; ECT if necessary
111
What is the difference between normal and pathologic grief?
- normal is characterized by shock, denial, guilt, sadness, yearning, and somatic symptoms
- pathologic grief is persistent and causes functional impairment
112
Describe normal grief.
- feelings of shock, denial, guilt, sadness, yearning, and somatic symptoms
- hallucinations of the deceased are common
- duration varies but is usually less than 6 months
113
What are the uses of ECT?
- refractory depression
- depression with psychotic symptoms
- acutely suicidal patients
- pregnant patients
114
What are the adverse effects of ECT?
- disorientation
- temporary headache
- partial anterograde/retrograde amnesia
115
What are risk factors for suicide completion?
SAD PERSONS
- sex (male)
- age (young adult and elderly)
- depression
- previous attempt
- ethanol or drug use
- rational thinking loss (psychosis)
- sickness (medical illness)
- organized plan
- no spots or other social support
- stated future intent
116
What is the most common method of suicide in the US?
firearms
117
What is the preferred treatment for anxiety disorders?
CBT, SSRIs, or SNRIs
118
Panic Disorder
- recurrent panic attacks defined as periods of intense fear and discomfort peaking in 10 minutes with at least four of the following: palpitations, paresthesia, depersonalization nor derealization, abdominal distress or nausea, intense fear of dying, intense fear of losing control, light-headedness, chest pain, chills, choking, sweating, shaking, shortness of breath
- additionally, requires a period of 1 month after the attack in which there is persistent fear of another attack, worry about the consequences of the attack, or behavioral change related to attacks
- there is a strong genetic component
- first line therapy is CBT, SSRIs, and venlafaxine; benzodiazepines can be used in an acute setting
119
Specific Phobia
- a severe, persistent fear or anxiety due to presence or anticipation of a specific object or situation that the person realizes is excessive
- treated with systematic desensitization
120
Social Anxiety Disorder
- exaggerated fear of embarrassment in social situations
| - treat with CBT, SSRIs, venlafaxine; or try a benzo or beta blocker for only occasional anxiety-inducing situations
121
Agoraphobia
- the exaggerated fear of open or enclosed places such as public transportation, lines/crowds, or leaving home
- associated with panic disorder
- treated with CBT, SSRIs, and MAOIs
122
Generalized Anxiety Disorder
- anxiety lasting more than 6 months unrelated to a specific person, place, or thing characterized by restlessness, irritability, sleep disturbance, fatigue, muscle tension, and/or difficulty concentration
- treat with CBT, SSRIs, or SNRIs as first line; Buspirone, TCAs, and benzos are second line
123
Adjustment Disorder
- emotional symptoms causing impairment following an identifiable psychosocial stressor and lasting less than 6 months (unless the stressor is also chronic)
- treat with CBT and SSRIs
124
Obsessive-Compulsive Disoder
- recurring, intrusive thoughts, feelings, or sensations that cause severe distress and are relieved, in part, by the performance of repetitive actions
- ego-dystonic meaning the behavior is inconsistent with one's own beliefs and attitudes
- associated with Tourette's syndrome
- treat with CBT, SSRs, and clomipramine
125
Body Dysmorphic Disorder
- a preoccupation with minor or imagined defects in appearance which lead to significant emotional distress or impaired functioning
- these patients may seek cosmetic treatment often
- treat with CBT
126
How is PTSD treated?
CBT, SSRIs, and venlafaxine
127
What is the difference between PTSD and acute stress disorder?
- PTSD lasts more than one month whereas acute stress disorder last less than one month
- additionally, PTSD usually requires pharmacological treatment with CBT, but acute stress disorder does not
128
Malingering
- consciously faking, profoundly exaggerating, or claiming to have disorders in order to attain a specific external gain such as avoiding work or obtaining compensation
- often have poor compliance with treatment or follow-up of diagnostic tests
- complaints cease after the gain
129
How does malingering differ from factitious disorders?
malingerers are seeking an external gain whereas those with a factitious disorder are seeking a primary (internal, unconscious) gain
130
Munchausen Syndrome
- also known as factitious disorder imposed on self
- chronic, conscious creation of physical and/or psychological symptoms in order to assume the "sick role" and get medical attention for the purposes of a primary gain
- usually characterized by a history of multiple hospital admissions and willingness to undergo invasive procedures
131
Munchausen by Proxy
- aka factitious disorder imposed on another
- when an illness in a child or elderly patient is caused or fabricated by the caregiver with the purpose of assuming the sick role by proxy
- qualifies as a form of child/elder abuse
132
What do somatic symptom disorders have in common?
- physical symptoms causing significant distress and impairment which are unconscious produced
- differs from Munchausen's in that both the illness and motivation are unconscious drives and the symptoms are not intentionally produced or feigned
- more common in women
133
Somatic Symptom Disorder
- characterized by a variety of bodily complaints lasting months to years
- associated with excessive, persistent thoughts and anxiety about symptoms
- like other somatic disorders, these symptoms are not intentionally produced or feigned and the drive is unconscious
- may co-occur with a medical illness
134
Conversion Disorder
- the loss of sensory or motor function, most often following an acute stressor
- patient is aware of but sometimes indifferent toward the symptoms
- like other somatic disorders, these symptoms are not intentionally produced or feigned and the drive is unconscious
- more common in females, adolescents, and young adults
135
Illness Anxiety Disorder
- the excessive preoccupation with acquiring or having a serious illness, often despite medical evaluation and reassurance
- few somatic symptoms
- like other somatic disorders, it is unintentionally and unconsciously driven
136
Pseudocyesis
- the false, non delusional belief of being pregnant
- may have signs and symptoms of pregnancy
- like other somatic disorders, it is unintentionally and unconsciously driven
137
What is a "personality trait"?
an enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself
138
What is a personality disorder?
- an inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning
- the individual is usually not aware of the problem
- usually presents by early adulthood
- divided into three clusters A, B, and C, which are somewhat grouped into "weird, wild, and worried"
139
Cluster A personality disorders are grouped according to what shared quality?
- being odd or eccentric
- inability to develop meaningful social relationships
- no psychosis
140
What other disorder are cluster A personality disorders genetically related to?
Schizophrenia
141
Paranoid Personality Disorder
- pervasive distrust or suspiciousness
| - projection is the major defense mechanism
142
Schizoid Personality Disorder
- voluntary social withdrawal and limited emotional expression
- content with this social isolation, which is how it is distinguished from avoidant personality disorder
143
Which personality disorders are included in group A?
- paranoid
- schizoid
- schizotypal
144
Schizotypal Personality Disorder
- eccentric appearance, odd beliefs, or magical thinking
| - experience interpersonal awkwardness
145
What other disorder are cluster B personality disorders genetically related to?
mood disorders and substance abuse
146
Antisocial Personality Disorder
- a disregard for and violation of others' rights, criminality, or impulsivity
- must be over 18 years old and have a history of conduct disorder before the age of 15
- considered conduct disorder if less than 18 years old
- more common in men than women
147
Borderline Personality Disorder
- unstable mood and interpersonal relationships, impulsivity, self-mutilation, suicidality, and sense of emptiness
- treated with dialectical behavior therapy
- splitting is a major defense mechanisms in these individuals
- more common in females than males
148
Histrionic Personality Disorder
excessive emotionality and excitability, attention seeking, sexually provocative, and overly concerned with appearance
149
Narcissistic Personality Disorder
- grandiosity, sense of entitlement, lack of empathy, requires excessive admiration
- often demand the best and react to criticism with rage
150
Give a one or two word summary for each of the personality disorders:
- paranoid
- schizoid
- schizotypal
- antisocial
- borderline
- histrionic
- narcissistic
- avoidant
- obsessive-compulsive
- dependent
- paranoid: suspicious
- schizoid: voluntarily withdrawn
- schizotypal: magical thinking
- antisocial: violation of other's rights
- borderline: unstable mood and relationships
- histrionic: emotional and attention seeking
- narcissistic: entitled
- avoidant: hypersensitive to rejection
- obsessive-compulsive: ordered and controlling
- dependent: submissive and clingy
151
Cluster C personality disorders are genetically related to what other group of disorders?
anxiety disorders
152
Describe someone with avoidant personality disorder.
- hypersensitive to reject and thus socially inhibited and timid with feelings of inadequacy
- differs from schizoid in that these individuals desire relationships with others
153
What is ego-syntonic?
behaviors that are consistent with one's own beliefs and attitudes (seen in OCPD but not OCD)
154
Describe someone with dependent personality disorder.
- submissive and clingy with an excessive need to be taken care of, often having low self-confidence
- these patients are often at risk for getting stuck in abusive relationships
155
Anorexia Nervosa
- excessive dieting, exercise, or binge eating/purging with a BMI less than 18.5 in addition to an intense fear of gaining weight and a distortion or overvaluation of body image
- associated with diminished bone density, severe weight loss, metatarsal stress fractures, amenorrhea (loss of pulsatile GnRH), lanugo, anemia, and electrolyte disturbances
- commonly coexists with depression
- psychotherapy and nutritional rehab are first line but refeeding syndrome can occur in significantly malnourished patients
156
What is refeeding syndrome?
- a complication that may arise when treating very malnourished individuals
- the rise in insulin leads to hypophosphatemia, which contributes to cardiac complications
157
Bulimia Nervosa
- binge eating with recurrent inappropriate compensatory behaviors occurring weekly for at least three months in addition to overvaluation of body image
- body weight is often maintained with the normal range but associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, and dorsal hand calluses (Russell sign)
- treat with psychotherapy, nutritional rehab as necessary, and antidepressants
158
What is a positive Russell sign?
finding calluses on the dorsal hand, typically because the individual is inducing vomiting
159
Binge Eating Disorder
- regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors
- increases the risk for diabetes
- treat with psychotherapy; add an SSRI if necessary
160
Gender Dysphoria
- a strong, persistent cross-gender identification that leads to persistent discomfort with sex assigned at birth, causing significant distress and/or impairing functioning
- can also be seen in those who have undergone gender reassignment surgery
161
What is the difference between transsexualism and transvestism?
- transsexualism is the desire to live as the opposite sex, often through surgery or hormone treatment
- transvestism is not associated with gender dysphoria and is the desire tower the clothes of the opposite sex
162
Sleep Terror Disorder
- periods of terror with screaming in the middle of the night
- occurs during slow-wave/deep/stage N3 sleep and thus there is no memory of the arousal
- cause is unknown but it can be triggered by emotional stress, fever, or lack of sleep
- most often in children
- usually self-limited
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Narcolepsy
- disordered regulation of sleep-wake cycles
- the primary symptom is daytime sleepiness although these patients wake feeling rested
- caused by low hypocretin (aka orexin) production in the lateral hypothalamus
- associated with hypnagogic or hypnopompic hallucinations, nocturnal and narcoleptic sleep episodes (which importantly start with REM), and cataplexy
- has a strong genetic component
- treat with daytime stimulants and nighttime sodium oxybate
164
What is cataplexy?
the loss of all muscle tone following strong emotional stimulus such as laughter
165
What are the criteria for substance use disorder?
maladaptive pattern of use defined as two or more of the following in one year
- tolerance
- withdrawal
- substance taken in larger amounts, or over a longer time, than desired
- persistent desire or unsuccessful attempts to cut down
- significant energy spent obtaining, using, or recovering from substance
- important social, occupational, or recreational activities reduced because of use
- continued use despite knowing it causes physical or psychological problems
- craving
- recurrent use in physically dangerous situations
- failure to fulfill major obligations at work, school, or home due to use
- social or interpersonal conflicts related to substance use
166
What are the six stages of change?
precontemplation, contemplation, preparation, action, maintenance, relapse
167
What is the precontemplation stage of change?
not yet acknowledging that there is a problem
168
What is the contemplation stage of change?
acknowledging there is a problem, but not yet being ready or willing to make a change
169
What is a sensitive indicator of alcohol use?
serum gamma-glutamyltransferase
170
What is the most common cause of drug overdose death?
opioids
171
How is opioid overdose treated?
naloxone or naltrexone
172
How is barbiturate overdose treated?
with symptom management and maintenance of respiration; there is no specific antidote
173
How is benzodiazepine overdose treated?
with flumazenil, a benzo receptor antagonist
174
What is flumazenil? What is the major side effect?
- it is a competitive antagonist used in the treatment of benzodiazepine overdose
- it is rarely used because it can precipitate seizures
175
How do we treat delirium tremors?
long-actin benzodiazepines
176
How is opioid withdrawal treated?
with long-term support in the form of methadone or buprenorphine
177
What are the symptoms of benzodiazepine withdrawal?
- anxiety
- tremors
- seizures
- insomnia
- depression
- rebound anxiety
178
What dangers are associated with amphetamine use?
cardiac arrest and seizures
179
How is amphetamine overdose treated?
benzodiazepines to control both agitation and seizures
180
How is cocaine overdose treated?
- alpha blockers to limit cardiac effects and benzodiazepines
- beta-blockers are contraindicated
181
What are the symptoms of caffeine intoxication?
restlessness, diuresis, muscle twitching
182
What are the symptoms of caffeine withdrawal?
- headache
- difficulty concentrating
- flu-like symptoms
183
What are the symptoms of nicotine withdrawal? How is it treated?
- irritability, anxiety, restlessness, difficulty concentrating
- treat with nicotine replacement, bupropion (an atypical anti-depressant) or varenicline (a nicotinic agonist)
184
What are the symptoms of phencyclidine use? What is the most common complication? How is use treated?
- symptoms include violence, impulsivity, psychomotor agitation, nystagmus, tachycardia, hypertension, analgesia, psychosis, delirium, and seizures
- trauma is the most common complication
- treat with benzodiazepines and a rapid-acting anti-psychotic
185
What is dronabintol?
a THC isomer used as an antiemetic and appetite stimulant
186
Marijuana is typically detectable in urine for how long?
up to one month
187
What are the symptoms of marijuana withdrawal?
irritability, anxiety, depression, insomnia, restlessness, and decreased appetite
188
What are the life-threatening effects of MDMA?
hypertension, tachycardia, hyperthermia, hyponatremia, and serotonin syndrome
189
What is methadone?
a long-acting oral opiate used for opioid detox and long-term maintenance
190
What is naltrexone?
a long-acting opioid antagonist used for relapse prevention once a patient has detoxed from opioids
191
What is the naloxone + buprenorphine combination?
an antagonist and partial agonist use to treat opioid overdose
192
What role do methadone, naltrexone, and naloxone play in management of opioid use?
- methadone is to assist with detox and for long-term mainteance
- naltrexone is used for relapse prevention after detox
- naloxone is an antagonist used to treat overdose
193
What are the symptoms of alcohol withdrawal?
tremor, tachycardia, hypertension, sweating, nausea, malaise, deliriums tremens, aggression
194
What are the common complications of alcoholism?
- alcoholic cirrhosis
- hepatitis
- pancreatitis
- peripheral neuropathy
- testicular atrophy
195
How is alcoholism treated pharmacologically?
disulfiram, acamprosate, naltrexone, and supportive care
196
What is disulfiram?
an aldehyde dehydrogenase inhibitor used to condition alcoholics to abstain
197
Delirium Tremens
- a life-threatening syndrome of alcohol withdrawal that peaks 2-4 days after abstinence begins
- characterized by sympathetic overactivity (tachycardia, tremors, anxiety, seizures
- treat with long-acting benzodiazepines
198
Alcoholic Hallucinosis
- distinct from delirium tremens
- characterized by visual hallucinations 12-48 hours after abstinence begins
- treat with benzodiazepines
199
What is the difference between derlirium tremens and alcoholic hallucinosis?
- DT is a syndrome whereas alcoholic hallucinosis is simply the onset of hallucinations due to withdrawal
- additionally, alcoholic hallucinosis begins 12-48 hours after the last drink whereas DT begins 2-4 days after abstinence
200
What is the preferred class of drugs for ADHD?
stimulants like methylphenidate or amphetamines
201
What is the preferred class of drugs for alcohol withdrawal?
benzodiazepines
202
What is the preferred class of drugs for bipolar disorders?
lithium, valproic acid, atypical antipsychotics
203
What is the preferred class of drugs for bulimia nervosa?
SSRIs
204
What is the preferred class of drugs for depression?
SSRIs
205
What is the preferred class of drugs for generalized anxiety disorder?
SSRIs and SNRIs
206
What is the preferred class of drugs for obsessive-compulsive disorder?
SSRIs, venlafaxine, and clomipramine
207
What is the preferred class of drugs for panic disorder?
SSRIs, venlafaxine, benzodiazepines
208
What is the preferred class of drugs for PTSD?
SSRIs, venlafaxine
209
What is the preferred class of drugs for schizophrenia?
atypical antipsychotics
210
What is the preferred class of drugs for social anxiety disorder?
SSRIs, venlafaxine if chronic; beta blockers or benzos if performance-limited
211
What is the preferred class of drugs for Tourette syndrome?
antipsychotics, tetrabenazine
212
What is methylphenidate?
a CNS stimulant used in the treatment of things like ADHD
213
How do CNS stimulants work? What are their primary uses? List three.
- they increase catecholamines in the synaptic cleft, especially NE and DA
- they are used for ADHD, narcolpesy, and appetite control
- they include methylphenidate, dextroamphetamine, and methamphetamine
214
All typical antipsychotics work via what mechanism of action?
they block D2 receptors
215
List seven uses for antipsychotics.
- schizophrenia
- psychosis
- bipolar disorder
- delirium
- Tourette syndrome
- huntington disease
- OCD
216
What adverse effects are associated with typical anti-psychotics?
- extrapyramidal side effects (e.g. dyskinesias, parkinsonian features, etc.) - treat with benztropine, diphenhydramine, benzodiazepines
- endocrine side effects since DA controls prolactin secretion
- antagonist effects at muscarinic, a1, and histamine receptors (dry mouth, constipation, sedation, and orthostatic hypotension)
- may cause QT prolongation
- very lipid soluble, so stored in the fat and removed very slowly from the body
217
What is neuroleptic malignant syndrome?
- a toxicity of typical antipsychotics
- includes rigidity, myoglobinuria, autonomic instability, and hyperpyrexia (think FEVER: fever, encephalopathy, vitals unstable, enzymes increased, rigidity)
- treated with dantrolene (muscle relaxant) and D2 agonists like bromocriptine
218
What is tardive dyskinesia?
orofacial choreas that result form long-term use of typical antipsychotics
219
What drugs are typical anti-psychotics?
- those ending one "-azines" plus haloperidol
| - including trifluoperazine, fluphenazine, thioridazine, etc.
220
Which typical antipsychotics have high potency and which have low potency? What is the clinical effect of this difference?
- trifluoperazine, fluphenazine, and haloperidol have high potency and thus have neurologic side effects (EPS)
- chlorpromazine and thioridazine have low potency and thus have greater peripheral side effects (anti-cholinergic, anti-histamine, and a1-blocking effects)
221
Chlorpromazine
- a typical antipsychotic, which blocks D2 receptors
- used for schizophrenia, psychosis, bipolar disorder, delirium, Hungtington disease, OCD, and Tourette's
- has low potency so side effects are primarily anticholinergic, anti-histamine, and a1-blocking
- unique side effect is corneal deposits
222
What unique side effects are associated with chlorpromazine, thioridazine, and haloperidol?
- chlorpromazine: corneal deposits
- thioridazine: retinal deposits
- haloperidol: neuroleptic malignant syndrome and tardive dyskinesia
223
Describe the natural history of the extra-pyramidal side effects of typical anti-psychotics.
- in hours to days you'll see acute dystonia
- days to months: akathisia (restlessness) and Parkinsonism
- months to years: tardive dyskinesia
224
Haloperidol
- a typical antipsychotic, which blocks D2 receptors
- used for schizophrenia, psychosis, bipolar disorder, delirium, Hungtington disease, OCD, and Tourette's
- has high potency and thus side effects are largely CNS but hyperprolactinemia, antihistamine, anticholinergic, a1-blockade, and QT prolongation are also possible
- EPS side effects present with acute dystonia in hours to days, akathisia (restlessness) and parkinsonism in days to months, and tardive dyskinesia in months to years
- treat EPS side effects with benztropine, diphenhydramine, and benzodiazepines
- may also cause neuroleptic malignant syndrome of rigidity, myoglobinuria, autonomic instability, and hyperpyrexia, which can be treated with dantrolene (a muscle relaxant) and D2 agonsits
225
What is aripiprazole?
an atypical anti-psychotic
226
How are most atypical anti-psychotics named?
- suffix of "-apine" or "-idone"
| - also includes aripiprazole
227
What is the mechanism of action for atypical anti-psychotics?
- most are D2 antagonists (aripiprazole is a partial agonist)
- they have varied effects of 5-HT2, dopamine, a-, and H1 receptors
228
How does the benefit of typical antipsychotics compare to those of atypical anti-psychotics?
atypical have a greater impact on the negative symptoms while typical generally only improve the positive symptoms of schizophrenia
229
How are extra-pyramidal side effects treated?
benzodiazepines, benztropine, and diphenhydramine
230
Describe the general side effect profile for atypical anti-psychotics.
- prolonged QT intervale
- fewer EPS and anticholinergic side effects than typical anti-psychotics
- "-apines" are known to cause metabolic syndrome
- clozapine causes agranulocytosis so monitor WBC weekly
- risperidone is known for causing hyperprolactinemia
231
What is unique about clozapine compared to other typical antipsychotics?
it causes a profound agranulocytosis and therefore requires weekly monitoring via WBC
232
What is unique about risperidone compared to other typical antipsychotics?
it causes a more profound hyperprolactinemia, leading to gynecomastia, amenorrhea, or galactorrhea
233
What is the probable mechanism through which lithium functions?
it is believed to be related to inhibition of the phosphoinositol cascade
234
How is lithium used clinically?
it is a mood stabilizer for those with bipolar disorder and is meant to prevent relapse and treat acute manic events
235
What are the side effects of lithium?
LMNOP
- lithium
- movement (tremor)
- nephrogenic diabetes insipidus
- hypOthyroidism
- pregnancy problems (Ebstein anomaly)
236
Lithium toxicity is common in patients taking what drug? Why?
- it is excreted by the kidneys and most reabsorption occurs in the PCT through a Na co-transporter
- thiazides, then, lower sodium levels in the body and increase reabsorption in the PCT, driving excess lithium reabsorption as well
237
What is the mechanism and clinical use of buspirone? What are it's advantages over other second line drugs and what are its disadvantages?
- it simulates 5-HT-1A receptors
- used for generalized anxiety disorder
- it does not cause sedation, addiction, or tolerance and does not interact with alcohol like benzos or barbiturates
- does take two weeks to take effect, though
238
Serotonin Syndrome
- a syndrome that can arise from any drug that increases serotonin release
- this includes MAOIs, SNRIs, TCAs, and SSRIs
- characterized by the 3 A's: neuromuscular activity (clonus, hyperreflexia, hypertonia, tremor, seizure), autonomic stimulation, and agitation
- treat with cyproheptadine, a 5-HT2 receptor antagonsit
239
What is cyproheptadine?
a 5-HT2 antagonist used to treat serotonin syndrome
240
Describe the mechanism, clinical uses, and adverse effects of SNRIs. How are they named?
- they inhibit 5-HT and NE reuptake
- used for depression, GAD, and diabetic neuropathy; venlafaxine in particular is also indicated for social anxiety disorder, panic disorder, PTSD, and OCD
- the most common adverse effect is hypertension, but stimulant effects, sedation, and nausea are also possible
- most end in "-lafaxine" or "-nacipran" but duloxetine is also part of the class
241
Venlafaxine
- an SNRI
- more broadly used than the rest of the class, including for depression, GAD, diabetic neuropathy, social anxiety disorder, panic disorder, PTSD, and OCD
- most common adverse effect is hypertension but may also cause stimulant effects, sedation, or nausea
242
What are the four primary SSRIs to know?
- fluoxetine
- paroxetine
- sertraline
- citalopram
243
What are the clinical uses for SSRIs?
- depression
- GAD
- panic disorder
- OCD
- bulimia
- social anxiety disorder
- PTSD
- premature ejaculation
- premenstrual dysphoric disorder
244
What are the adverse effects of SSRIs?
- GI distress, SIADH, and sexual dysfunction, including lowered libido and anorgasmia
- better profile than TCAs
245
How long does it take for anti-depressants to usually have an effect?
4-8 weeks
246
How are TCAs named? What are the exceptions?
- most end in the suffix "triptyline" or "ipramine"
| - doxepin and amoxapine are exceptions to this rule
247
Describe the mechanism of action, clinical uses, and adverse effects associated with TCAs. Give examples of drug names.
- includes those ending in "triptyline" or "ipramine" plus doxepin and amoxapine
- work by blocking reuptake of NE and serotonin
- used for major depression, OCD, peripheral neuropathy, chronic pain, and migraine prophylaxis
- primary side effects a the "Tri C's": convulsions, coma, and cardiotoxicity
- may cause sedation, a1-antagonist effects, and anti-cholinergic effects or can cause prolonged QT (Na blocker)
- other side effects include respiratory depression, hyperpyrexia, confusion and hallucinations in the elderly
248
Amytriptyline
- a tertiary TCA
- blocks reuptake of NE and serotonin
- used for major depression, OCD, peripheral neuropathy, chronic pain, and migraine prophylaxis
- primarily causes anticholinergic side effects but can also prolong the QT interval
249
How are the cardiotoxic effects of TCAs managed?
with sodium bicarb since the effects are due to TCAs actions as sodium-channel blockers
250
Which TCA is preferred in the elderly? Why?
nortriptyline is preferred because it is a secondary TCA with fewer anticholinergic effects and thus less risk of confusion or hallucinations
251
Buproprion
- increases NE and DA through an unknown mechanism
- used for smoking cessation and as an atypical anti-depressant
- adverse effects include stimulant effects and headaches as well as seizures in anorexics or bulimics
- there are no sexual side effects, however, like typical anti-depressants
252
Mirtazapine
- has several mechanisms: a2 antagonist which increases NE and serotonin release, 5-HT2 and 5-HT3 antagonist, H1 antagonist
- used as an atypical anti-depressant
- may cause sedation, excessive appetite and weight gain, or dry mouth
253
Trazodone
- an atypical anti-depressant
- works by blocking 5-HT2, a1, and H1 receptors but also weakly inhibits serotonin reuptake
- used primarily for insomnia since high doses are needed for an anti-depressant effect
- toxicity: sedation, nausea, priapism, and postural hypotension
254
What is varenicline? What is it used for? What is it's primary adverse effect?
it is a nicotinic agonist used for smoking cessation but which is known for causing sleep disturbance
255
How do MAOIs work?
they non-selectively increase levels of NE, serotonin, and DA
256
What are the clinical indications for MAOIs?
atypical depression or anxiety
257
Name the important MAOIs.
- tranylcypromine
- phenelzine
- isocarboxazid
- selegiline
258
What adverse effects are linked with MAOIs?
- hypertensive crisis, particularly with the ingestion of tyramine
- CNS stimulation
259
What are the contraindications for MAOIs?
- SSRIs, TCAs, St. John's wort, meperidine, dextromethorphan
- you must wait 2 weeks after topping MAOIs before starting sertoonergic drugs or stopping dietary restrictions
- to prevent serotonin syndrome
