PSYCH Flashcards
how does traumatic brain injury affect your iq?
IT DOESN’T
what is somatic symptom disorder characterized by?
what can be a potential cause
what population is it more common in
what is a good way to treat them?
- over amplification of symptoms that aren’t explained by physical exam findings; may or may not have condition that explains symptoms; peristent thoughts, increased anxiety about, or excess time/energy dedicated to symptoms; >6 months
- childhood abuse/sexual abuse, being sick is the only time they can reliably get love/attention/care
females
- maintain regular appointments (to help them talk through symptoms and not reinforce their cycle of going when they are sick), cbt
what is very effective in treating severe neuroleptic malignant syndrome?
ELECTROCONVULSIVE THERAPY
how does post partum blues and post partum depression
- happens within 1-2 weeks following pregnancy and resolves on its own
- happens within pregnancy or 1-4 weeks after as a major depressive episode that can prevent ability to take care of baby and self
what is isolation of affect
inability to express emotions about a negative event even though you fully understand the significance/severity of the event
what are the effects of pcp intoxication
- alertered/distored perception
- elevated mood/ violent mood swings
- pcp psychosis (esp with chronic use or ppl with schizophrenia and bpd)
- poor decision making
- reduce pain sensitivity
define infertility
inability to conceive after 12 months or after 6 months if you are older than 35
name the main tracts that dopamine affects and how antipsychotics are implicated
- meso-limbic/cortical (vta to limbic and prefrontal) : implicated in treatment for schizo
- nigrostriatal: extrapyramidal symptoms
- tuberoinfundibular: connection between hypothalamus and pituitary, responsible for prolactinemia
- area postrema: can be effective anti-emetic
describe features of paranoid personality disorder
what cluster is it
is psychosis possible?
- distrust of everyone;
- mistrusting of coworkers loyalty for no reason
- mistake benign comments as something worse
- suspicious of significant others
- always counterremark if attacked
- holds grudges
A
yes, but brief, no prolonged preiods of delusions, hallucination or disorganized though
describe features of schizotypal personality disorder
what cluster is it
is psychosis possible?
- Ideas of reference (excluding delusions of reference).
- Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).
- Unusual perceptual experiences, including bodily illusions.
- Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
- Suspiciousness or paranoid ideation.
- Inappropriate or constricted affect.
- Behavior or appearance that is odd, eccentric, or peculiar.
- Lack of close friends or confidants other than first-degree relatives.
- Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
A
yes, brief under stress
what is altruism
avoiding negative personal feelings by doing good for others
how can you treat asd and ptsd?
what medication should you avoid
- asd: cbt, sleep aids and anxiolytics
- ptsd: trauma based therapies, sertralline paroxetine, venlafaxine, sleep aid, anxiolytics
NO BENZOS
what is the difference between majorr depressive disorder and dysthymic/progressive depressive disorder
major depressive disorder has a much more significant depression with suicidal ideation and impairment in ability to function; it also usually resolved in a year if untreated
progressive depressive disorder is a milder form of depression usually without suicideal ideation or impairment in every day life but does n’t resolve in a year, can be baseline for a long period of itme
what is rumination disorder
what population is it associated with
what should you rule out beforehand
what is the treatment
- disorder that involves regurgitating food, with potentially rechewing or reswallowing; last about a month and can be out of patient’s control
- intellectual disability, children, infants
- gi motility disorder, malnutrition or underlying cause
- behavioral or family therapy
name 3 drugs you can use to treat alcohol dependence?
acamprosate
naltrexone
disulfuram
what is hoarding disorder
- difficulty discarding possessions, with significant distress caused if you try to get rid of them
causes significiant impairment
describe the pathways of the brain involved instimulant abuse
- dopaminergic activaiton of mesolimbic and mesocortical pathways
- vta to nucleus accumbans (reward and reinforcement) and to prefrontal cortex (focus, judgment, adhd focus)
who is more likely to get a substance use disorder : men or women
men
what is the inheritance /etiology of rett syndrome
what population is it common in
what are the features
- mostly denovo mutation in MECP2, can be x linked
- females (almost never in men)
- 6-18 months of normal/stagnated development, followed by rapid regression of acquired skills; seizures and handwringing very common, motor deterioration
what physical development happens in the first year of life
growth ten inches
weight triples
cerebellum matures, myelination, ossifying of bone
crawling
purposeful grasping
describe reactive attachment disorder
- a condition in which a child (older than 9 months) doesn’t seek or react or emotional support or affection from caregivers
- doesn’t have much positive affect or much emotional response to others
- also may have period of irritability or fearfulness or sadness that don’t seem to be caused by anything (acting out)
name in decreasing order of affinity of what caffeine can bind to
what is the mechanism of action
a2a (adenosine) receptor >a1 >a3 >camp phosphodiesterase
- a2a GPCR is most commonly involved in inhibiting motor activity via the indirect pathway, but caffeine blocks this receptor, –> increased Ca thereby causing movement
what contains memories that are not immediately available but can be retrieved readily and brought to consciousness
- preconsciousness
what is cognitive behavioral therapy
- therapy directed at examining automatic negative distorted thoughts and testing the validity of those assumptions as a way to realize they are wrong and bring about change
define the following
flooding
implosion
aversion therapy
flooding: full on exposure all at once to maladaptive anxiety/phobia; very effective but v intolerable
implosion: imagining/fantasizing the maladaptive anxiety
associating something noxious with addictive substance to stop addiction
what are obsessions and compulsions
what is the three variants of ocd
obsessions: persistent intrusive thoughts that cuase anxiety/distress
compulsions: behaviors/mental acts done to relieve anxiety from obsessions
ocd with good/fair insight: aware that obsessions are not or probably not true
ocd with poor insight: think that obsessions are probably true
ocd with absent insight/delusional beliefs: belive obsessions are completely true
what are the stages of language for babies
Cooing – 2 – 4 months
Babbling – 6 months
10 – 12 months can comprehend simple words
12 -13 months – first few words
2 years- 250-400 words, can understand that words represent things
what are signs of a stimulant overdose?
what can you do to treat?
- htn, tachycardia, dilated pupils, seizures, tremors, arrhythmia, paranoia, anxiety, psychosis
- supportive, most likely to die from cardiac causes, so treat that
nitroprusside, nitro, hydralazine, alpha blocker like phentolamine
benzos for anxiety
anti psychotics if psychotic
what is the minnesota multiphasic personality inventory 2 ? (MMPI 2)
is it an objective or subjective measure?
what is considered a normal score on a measure? what are critical areas for an abnormal score
what are the three validity measures?
what are clinical measures ( name at least 5)
- tests for potential psychopathology
- objective
- 50= normal, 35 or 65 enters critical area (so above or below the mean)
- L= lie, F= frequency of unusual responses, K= suppressor/defensiveness
- Paranoia Psychasthenia Schizophrenia Hypomania Social Introversion Hypochondriasis Depression Hysteria Psychopathic Deviance Masculinity-Femininity
name symptoms of neuroleptic malignant syndrome (mnemonic)
what two lab findings would you see?
how long does it last?
how do you treat it?
what are risk factors
CAME
- consciousness altered
- autonomic dysfunction (labile bp, tachycardia, tachypnea) sweating)
- Muscle rigidity
- Elevated temperature
elevated cpk (sometimes 4x as high as normal) elevated wbc
2 weeks if taken oral meds
4 weeks if taking depot
- supportive care! (hydration, anti pyretics,, maybe heparin, cooling techniques), stop neuroleptics, lithium, anticholinergics, d2 blockers, ECT (FOR SEVERE CASES V EFFECTIVE), maybe dantrolene, maybe dopamine agonist like bromocriptine
- previous nms, lithium, malnourished, dehydrated, iron deficiency
what are two prenatal risk factors for adhd?
what are things that can cause/increase risk for adhd
- smoking, etoh use
- thyroid disorder, malnourished, constipation, lead, recreational stimulants, theophylline, phenobarbital, phenytoin, cns infection
name three clusters of psychiatric disorders that are commonly seen today
- mood and anxiety disordesr
alcohol and drug disorders
mood and alcohol disorder
what anatomical findings have been found with schizophrenia
- large lateral/third ventricle
- cortical atrophy (prefrontal cortex, temporal lobe, anterior limbic structures)
name effects of amphetamines/stimulants?
- increased arousal
- alpha and beta activation
- increased attention
- increased athletic performance
- decreased appetite
- euphoria
what are end organ damages due to alcohol?
- hepatitis, cirrhosis, pancreatitis, pontine demyelination syndrome, cardiomyopathy
what is illness anxiety disorder
- what are the two types
what other two conditions is it associated with
how do you treat
- significant worry/anxiety about potentially getting a disease (disease phobia) without having physical symptoms; associated with excessive health relatd bhaviors (ex: keep listenign to pulse)
- those that will go to doctors af because of their preoccupation and those that will avoid doctors due to fear and will go to alternative doctors/self medicate
- ocd and depression
- cbt and regular maintained appointments
how does transcortical magnetic stimulation work
- uses magnetic field to create an electrical current that depolarizes large neurons that are perpendicular to the field
- can be excitatory or inhibitory
what drugs can cause neuroleptic malignant syndrome?
- all neuroleptics AKA ANTIPSYCHOTICS
- any d2 blocker (promethazine, prochlorperazine, droperidol, metaclopramide)
- withdrawing a dopamine agonist too quickly
give an example of an organic volatile nitrite?
what effects does it produce
- VASODILATION (can cause significant hypotention in the brain)
- blood pooling in extremities (diziness +erection)
- smooth muscle relaxation
what is cyproheptadine? what can it be used to treat?
- anti serotonin drug serotonin syndrome (not much evidence that it works)
what is premature ejaculation
what is the treatment
when a man ejaculates wthin a minute before he wants to
- cbt sex therapy etc also pinch when you feel like ejaculating and stop until you are calmer
describe the “Incentive salience” model of addiction
what role does dopamine play
- visual or auditory cues associating with drug effects/drug seeking behavior cause increase activation of motivation pathways and can then control behavior on their own
- dopamine, which usually increased in response to reward, can shift and increased in presence of the cue , creating incentive salience (it’s a learning nt, it helps attach the cue to the reward)
what is the dopamine hypothesis of schizophrenia
what supports and doesn’t support it?
- schizophrenia is due to excess dopamine
- giving amphetamines causes schizophrenia delusions
- giving bromocriptine doesn’t cause delusions
what are the four cluster b personalities
what is something special about this cluster
- antisocial, borderline, histrionic, narcissistic
(bad, borderline, flamBoyant, Best)
- mellows with age
where in the country is suicide the highest?
how about the lowest?
- mid west
new england and cali
what population is stimulants contraindicated for
name three indications for stimulants
- htn and heart failure
- weight control, narcolepsy, adhd
what is the active metabolite of diazepam?
what modification of a diazepam derivative causes it to be cleared faster?
- desmethyl diazepam
- hydroxylation (ex: oxazepam has shorter half life)
what is selective mutism
- consistent inability to speak in a specific situation for >1 month that is not associated with a lack of comfort with or lack of knowledge of the spoken language or the situation
- impairs educational/occupational achievment
name the two parts of the social consequences aspect of the definition of a substance use disorder
- inability to complete work/school obligations due to being high
- continuing to use substance despite negative social feedback or interpersonal problems
how does ect work (4)
- increases turnover of serotonin, norepi, and dopamine
- downregulates 5ht and norepi receptors
- ehances gabaergic inhibition of hyperactive moa circuits (frontal lobe, limbic system and subcortical basal ganglia)
- reset diencephalon neuronal tone
where is etoh absorbed?
what would increase absorption
what woudl decrease absorption?
- small intestine
- increased concentration of drink (or drinking more)
- food
name the criteria for intellectual disability
- must have limitation in both of the following BEFORE the age of 18:
- intellectual functioning (aka IQ less than 70)
- adaptive behavior
- — conceptual (reading, writing, math, language, memory, judgment)
- — social (communication, empathy, following rules)
- — practical (activities of daily living, health and safety, occupational skills)
where are the wanting/motivation pathways in the brain vs the liking/valuation pathways
- base of brain (nucleus accumbans, VTA, etc)
- front of the brain
describe the difference between positive reinforcement, negative reinforcement, and punishment in regards to operant conditioning?
- positive: giving a reward in response to a behavior in order to increase frequency of behavior
- negative: removing a noxious stimulus in response to doing behavior in order to increase frequency of behavior
- punishment: taking away something positive or giving something negative in order to discourage a behavior
wat are the three greatest risk factors for post partum depression
1) previous history of post partum depression
2) history of peri natal depression
3) history of depression
what population is most likely to have a paraphillic disorder
males, heterosexual
name the criteria for global developmental delay
- must have delay two of the following BEFORE the age of 5-6:
- fine motor
- gross motor
- social/personal
- activities of daily living
- cognitive function
what is the underarousal hypothesis of adhd
- hypothesis that the brains of children with adhd are actually underaroused/asleep, so if you give stimulants, you can improve their conditions
(also have low levels of serotonin, norepi, and dopamine)
what are common comorbid conditions for anorexia?
what are common comorbid conditions for bulimia
major deprssive disorders, panic disorder, ocd, personality disorder
substance abuse, and borderline personality disorder
name three types of schedules for giving a reinforcement and rank them in order of increasing ability to cause extinction
1) variable ratio/interval- give reinforcement randomly, more compelled to keep doing behavior since they don’t know when they will get reward
2) fixed ratio- give reinforcement after set number of times doing behavior
3) continuous- give reinforcement after each time they do behavior
in regards to family therapy, what is the term where there are no proper boundaries of family members?
enmeshment
what is post partum psychosis
what is the treatment
psychosis after pregnancy that can have confusion, delusions and erratic behavior
immediate hospitalization, psychiatric emergency
what is the difference between fluid and crystallized intelligence?
how does age influence them?
- fluid: mental processes (declines with age) (not affected by a poor childhood exposure)
- crystallized: knowledge base (increases with age) (affected by poor childhood exposure to culture/knowledge)
what is the effect of iq on schizophrenia
the lower the predicted iq, the higher the risk of getting schizophrenia (6x risk)
what are piaget’s stages of development
- sensorimotor (0-2)- learning object permanence, experiencing the world through senses and motion
- preoperational- (2-7) pretend play and everything is egocentric
- concrete operational- (7-11) can understand conservation and math
- formal operational (11- onward)- can form abstract thought, reason, and form moral reasoning
what mental health diagnoses put you at increased risk for suicide? (for men and women)
men: bipolar, unipolar depression, schizophrenia
women: schizophrenia, bipolar
what is body dysmorphic disorder?
- preoccupation with a perceived physical defect on your body that is not very perceptable to other people
- results in you doing certain behaviors like looking in themirror repetitively, skin picking, grooming or mental acts (comparing your body to others)
describe features of patau syndrome and what is the cuase
- trisomy 13
- intellectual disability
- congenital heart defect
- rocker bottom feet
- polydactyly or syndactyly
- microcephaly
- malformed low set ears
- hyper or hypotonia
- small eyes
what eating disorder is associated with underweight
anorexia nervosa
what is suboxone
what can it be used to treat?
- naloxone and buprenorphine
- opioid withdrawal
what is the difference between panic attack and panic disorder
what is the treatmnt
- panic attack is a one time thing
- panic disorder is at least 1 panic attack followed up by at least a month of preocupation/fear about getting another with subsequent maladaptive behavior
cbt, ssri, benzo
name in increasing order of potency: fentanyl, morphine, heroin
morphine < heroin < fentanyl
heroin 3x> morphine
fentanyl 80x> morphine
what is more likely to cause withdrawal symptoms faster: a short acting drug or long acting drug?
what is more likely to cause more severe withdrawal symptoms : short or long acting?
what is more likely to have longer lasting withdrawal symptoms
- short acting
- short acting
- long acting
in classical conditioning, what do you need to make sure the association between the conditioned stimulus and response don’t go away? what is it called when it goes away?
- keep showing the unconditioned stimulus and conditioned stimulus together
- extinction
what is pseudocyesis?
what can be a risk factory
- patient is convinced she is pregnant when she isn’t
previous pregnancy loss, infertility
What are signs of opioid withdrawal? (mnemonic)
The CDC bans SeVeN opioids
Cravings Diarrhea Chills Sweating Nausea Vomiting
what type of receptor is the nicotinic receptor
where is it located in the brain
what happens when nicotine binds?
what system in the brain gets activated?
- excitatory pentameric ligand gated channel (Na, Ca)
- forebrain
- excites and quickly desensitizes
- limbic system, nucleus accumbans, amygadala, causes release of dopamine that is implicated in reward
what is contingency management?
- voucher system in which you give positive rewards/vouchers/take home methadone in exchange for abstinence and negative drug screens
- good to give positive feedback fo those who aren’t used to getting any, over time the habits become intrinsic
why does it take a few weeks for anti depressants to start working?
because they can bind to 5ht 1a autoreceptors in the presynaptic receptors, which decrease serotonin release, BUT they quickly desensitize, which takes a few weeks
what is the difference between supression and repression
suppression is intentionally pushing something aside/down so that you don’t have to deal with it
repression is unconsciously pushing something down so that you don’t have to deal with it (ex: don’t remember rape)
for mild intellectual disability:
what is the IQ range
describe their capability in conceptual, social, and practical
- IQ 50-70
- conceptual: impaired reading, financial planning, need help
- social: immature social and judgement skill; can be taken advantage of
- practical: can live independently and hold a job with simple skills required; may need help with family and healthcare planning
what age range do most babies become potty trained
15 months to 3 years
what are two proposed causes for perimenopausal depression and why? (2)
- decreasing hormone levels –> hot flashes/vaginal dryness –> sleep and mood disturbances
- peri menopause happens at time in life where women go through significant stressors : divorce, children leaving home, illness in spouse, parents dying
( also previous history of premenstrual or postpartum depression puts you at risk)
what reflex is when you drop a baby and they lift their arms
MORO
what is the mechanism of action for PCP?
what drug has the same mechanism of action
- noncompetitive allosteric inhibitor (antagonist) of glutamate/nmda receptor
ketamine
name the two parts of the pharmacological aspect of the definition of a substance use disorder
- tolerance (need a higher dose in order to achieve high
- withdrawal (symptoms when not using)
describe the allostasis or reward-deficiency hypothesis of addiction
- when you repeated use a substance, your baseline mood point gets lower and lower so that with each subsequent use, you have to drink more to feel good until eventually you are just drinking to feel normal
- there are also decreases in the reward systems in the brain (nucleus accumbans) so that nothing motivates you except the drug
describe disinhibited social engagment disorder
a child (> 9 months ) has no restraint in approaching strangers that are not their caregivers
- don’t check in with caregiver
- do familiar physical behaviors that are not socially appropriate
- is willing to go with another adult with limited hesitation
what medication, when given with opioids, is dangerous and can cause significant sedation
benzodiazepines
what is alexithymia
what condition is this common in?
inability to describe symptoms in words
somatic symptom disorder (can only express emotions through physical symptoms)
what is delayed ejaculation
what is the treatment
when you either have a delay in ejaculation or a marked infrequency or absence of ejaculation
- psychotherapy, cbt, dual sex therapy, analytically oriented sex therapy
what is excoriation?
skin picking with fingers or objects, can be anywhere on the body
not attributed to any hallucinations or other condition
autism spectrum disorder is thought to be due to a lack of normal ______
pruning (keeping the synapses you use and losing the synapses you don’t use)
what eating disorder is more likely to be evenly split between men and women
binge eating disorder
what is rationalization
distorting one’s perception of a negative event so that it seems reasonable
ex: do poor on an exam –> opportunity to do better
what are the four phases of human sexual response?
desire (fantasize, minutes to days)
excitement (foreplay, clitoral engorgement and vaginal lubricaiton, penis erection)
orgasmic phase (climax)
resolution phase (euphoria and relaxation)- women can orgasm multiple tiems before needing a refractory period, men need a 15 min refractory period after each orgasm
how does buprenorphine work?
what is one potentially dangerous side effect?
- high affinity, low activity partial agonist of the mu receptor, great for withdrawal because it’s long acting with a slight agonist activity
- if you have a v strong depenence on full agonist opioids or it’s been a short interval since taking last taking opioid, this can actually precipitate withdrawal.
name some common psychological reactions to a medical diagnosis/illness?
arre they bad?
DDDAAO dependency depression denial Anxiety anger obsessive/compulsive
no, a little dependency/anxiety, anger, depression etc is normal and can actually help u be compliant/seek help
describe how depression can increase chance of CAD
- can cause silent ischemia
- increase autonomic imbalance
- increases cytokines
- increases arrhythmias
- effects platelets
- decreases heart variability
what is an opioid blockade an what does it refer to?
- refers to when treating a chronic opioid addiction, when you give buprenorphine or methadone, if you relapse and take heroin or another opioid, the receptor will be blocked so the drug won’t work and you can help break the cycle of reward that the drug gives as well as prevent and overdose/return of your addiction
what is the difference between somatic amplification and somatic deamplification?
- somatic amplification, you perceive pain as significantly worse than it is (nail between the toes)
- somatic de-amplification- you perceive pain as significantly less severe than it truly is (nail in the head)
how does malingering and factitious disorder differ?
- malingering is in order to gain something, but will most likely not be willing to go through alternative treatments
- factitious disorder is just in order to fool a doctor, they would also be willing to go through treatment
what is the cause of fragile x syndrome
what is the possible likelihood of inheritances
what are the features ?
- > 200 CGG repeats on fmr-1 gene on exon 1 (50-200 is premutation)
- full mother can pass down to daughters and sons –> all sons will get fragile x, 50% of daughts will get fragile x
- premutation mother can pass premutation to children or can pass full mutation to hildren –> sons will get it and 50% of daughts
- big and long head, large protruding ears, large gonads, moderate intellecual disability, speech delay, large chin, loose joints
for moderate intellectual disability:
what is the IQ range
describe their capability in conceptual, social, and practical
- 35-50
- conceptual: elementary school level
- social: good relationship verbally with family but social impairment, language impairment, poor judgment
- practical: can do personal care with support and teaching; can work if supported environment
what are the features of bipolar mania (7)
- grandiosity or inflated self esteem
- flight of ideas
- distractibility
- talkative
- increase in goal oriented work
- increased impulsivity (that could get you in trouble)
- decreased sleep
what are the freudian stages of development
oral (expore everything through your mouth)
anal (potty training era)
phallic/oedipal (sexual feelings for opposite sex parent)
latency (start relating to same sex parent and same sex peers)
genital (have sex)
what are the two types of psychoanalytic psychotherapy
insight oriented: helps you understand the dynamics of your disease so you can eventually get relief, better for people who want to get better and are more articulate/expressive
supportive: focuses on shifting from immature/poor defense mechanisms to mature/better mechanisms and help/encourage maintaining them; better for people who don’t function optimally
what is the difference between shaping and modeling
shaping: giving rewards for closer and closer approximations to the true behavior
modeling: teaching behavior by showing and them observing
name symptoms of serotonin syndrome
- restlessness, agitation, delirium
- MYOCLONUS(v specific sign), seizures, rigidity
- nausea vomiting DIARRHEA
- hyperthermia
- autonomic dysfunction (labile bp, tachycardia and tachypnea, sweating)
what mental illness increases mortality after an MI by 4x
depression