Psych Flashcards
1
Q
Classical conditioning
- what is it
- example
A
- learning in which a natural response is elicited by a conditioned response that previously was presented in conjunction with an unconditioned stimulus
- salivating when a bell is rung because it was previously presented with food
2
Q
Operant conditioning
- what is it
- reinforcement
- punishment
- extinction
A
- learning in what action is elicited because it produces a punishment or reward
- behavior is followed by reward
- repeated application of aversive stimulus or removal of reward to extinguish unwanted behavior
- Discontinuation of reinforcement eliminates behavior
3
Q
Transference and countertransference
- what are they and ex
A
- transference: pt projects feelings about formative or other important persons onto physician (psychiatrist is seen as parent
- counter: doctor projects feelings about another person onto pt (pt reminds physician of younger sibling)
4
Q
Ego defenses immature
- acting out: what is it; ex
- denial: what is it; ex
- displacement: what is it; ex
- dissociation: what is it; ex
- fixation
- idealization
- identification
- intellectualization
- isolation
- passive aggression
- projection
- rationalization
- reaction formation
- regression
- repression
- splitting
A
- acting out: subconsciously coping w/ stressors or emotionl conflict using actions rather than reflections or feelings; pt skips therapy apt after deep discomfort from dealing w/ past
- denial: avoiding awareness of some painful reality; pt w/ CA plans a full-time work schedule despite being warned or significant fatigue during chemo
- displacement: redirection of emotions or impulses to neutral person or object; teacher is yelled at by principal and instead of confronting principal the teacher yells at husband later
- dissociation: temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress; victim of sexual abuse suddenly appear numb when exposed to her abuser
- fixation: partially remaining at a more childish level of development; surgeon throwing tantrum bc case took too long
- idealization: expressing extremely positive thoughts of self and others while ignoring negative thoughts; pt boasts about physician and accomplishments while ignoring flaws
- identification: largely unconscious assumption of characteristics, qualities, or traits of other person or group; resident starts to put stethoscope in pocket like fav physician instead of wearing around neck like he used to
- intellect: using facts and logic to emotionally distance oneself from stressful situation; pt diagnosed w/ CA discussed pathophys of dx
- isolation: separating feelings from ideas and events; describing murder in graphic detail w/o emotion
- passive: demonstrating hostile feelings in confrontational manner; disgruntled employee repeatedly late
- projection: attributing an unacceptable internal impulse to external source; man who wants to cheat on wife accuses his wife being unfaithful
- rationalization: asserting plausible explanation for events that actually occurred for other reasons, usually to avoid self blame; after getting fired claiming that job wasn’t important
- reaction formation: replacing warded off idea or feeling w/ emphasis on its opposite; a patient w/ lustful thoughts enters a monastery
- regression: involuntarily turning back the maturational clock to earlier modes of dealing with the world; seen in children under stress such as bedwetting
- repression: involuntarily withholding an idea or feeling from conscious awareness; 20 yr old does not remember going to counseling during parents divorce 10 yrs earlier
- splitting: believing people are either all good or all bad at different times; pt says all nurses are cold and insensitive but doctors are warm and friendly
5
Q
Ego defenses mature
- sublimation
- altruism
- suppression
- humor
A
- sublimation: replacing an unacceptable wish w/ course of action that is similar to wish but socially acceptable; teenagers aggression bc of parents high expectation is channeled into excelling in sports
- altriusm: alleviating negative feelings via unsolicited generosity which provides gratification; mafia boss makes large donation to charity
- suppression: intentionally withholding an idea or feeling from conscious awareness; choosing to not worry about big game until time to plat
- humor: lightheartedly expressing uncomfortable feelings to sift internal focus away from distress; nervous medical student jokes about boards
6
Q
Infant deprivation effects
- deprivation of
- results in
A
- affection
- failure to thrive, poor language, lack of basic trust, reactive attachment disorder, disinhibited social engagement
7
Q
Child abuse
- physical
- sexual
- emotional
A
- fractures, bruises, burns, w/ injuries in diff stages of healing; usually biological mothers; 40% deaths related to child abuse or neglect occur in children < 1 yr old
- STI, UTI, genital or oral trauma, children often exhibit sex knowledge or behavior incongruent w/ age; known to victim, male, peak is 9 to 12
- babies or young children may lack bond w/ caregiver but are overly affectionate w/ less familiar adults, older children prone to angry outbursts; male or female caregivers; 80% of young adult victims of childhood abuse meet criteria for > 1 psych illness by age 21
8
Q
Child neglect
- what is it
- most common form
- what has to be done
A
- failure to provide a child w/ adequate food, shelter, supervision, education, and or affection
- poor hygiene, malnutrition, withdrawal
- must be reported
9
Q
Vulnerable child syndrome
- what is it
- happens after
- sxs
A
- parents perceive the child as susceptible to illness of injury
- serious illness or life threatening event
- missed school or overuse of med services
10
Q
Childhood disorders
- ADHD: age, what is it, sxs
- autism: sxs
- conduct disorder: what is it
- disruptive mood dysregulation disorder: onset, what is it, tx
- intellectual disability: what is it
- oppositional defiant disorder: what is it, tx
- selective mute: onset, what is it, tx
- separation anxiety disorder: what is it, sequlae
- specific learning disorder: onset, what is it, tx
- tourette syndrome: age, what is it, coprolalia
A
- ADHD: onset before 12, greater than 6 months of limited attention span and poor impulse control; hyperactivity, impulsivity or inattention
- Autism: Poor social interaction, communication deficits, repetitive behaviors; can have intellectual disabilities
- Conduct: repetitive, pervasive behavior violating societal norms (aggression towards people, destruction of property, theft)
- Disruptive: onset before age 10; severe recurrent temper outbursts out of proportion to situation; child constantly angry and irritable between outbursts; tx: stimulant and anti-psych
- Intellectual: global cog deficits that affect reasoning, memory, abstract thinking
- Opp: enduring pattern of hostile, defiant behavior toward authority figures w/o serious violation of social norms; tx: psychotherapy
- selective mute: onset before age 5; anxiety lasting more than 1 month involving refraining of speech in certain situations; tx: behavioral therapy
- separation anxiety: overwhelming fear of separation from home or attachment figure lasting more than 4 wks; can be normal behavior up to age 3-4, can lead to factitious physical complaints to avoid school; tx: CBT
- specific learning: onset during school age years; inability to acquire or use information from specific subject near age expected proficiency for more than 6 months despite intervention; tx: academic support, counseling
- tourette: before 18 yrs; sudden, rapid, recurrent, non-rhythmic motor or vocal tics that persist for more than a year; coprolalia (involuntary obsence speech); tx: high potency anti-psych
11
Q
Amnesia
- retrograde
- anterograde
- korsakoff syndrome
A
- inability to remember things that occurred before CNS insult
- inability to remember things that occurred after a CNS insult
- amnesia caused by vitamin B1 deficiency and associated w/ destruction of mamillary bodies
12
Q
Dissociative disorder
- depersonalization
- dissociative amnesia
- dissociative identity disorder
A
- persistent feelings of detachment or estrangement from ones own body, thoughts, perceptions and actions; intact reality testing
- inability to recall important personal info, usually subsequent to severe trauma or stress
- formerly known as multiple personality disorder; presence of more than 2 distinct identities or personality states; more common in women; associated w/ sex abuse, PTSD, depression, substance abuse
13
Q
Delirium
- what is it
- sxs
- cause
- when
- tx
A
- waxing and waning level of consciousness with acute onset
- disorganized thinking, hallucinations, misperceptions, disturbance in sleep and wake cycles
- usually secondary to other identifiable illness
- most common presentation of altered mental status in inpatient setting especially in ICU
- antipsychotics
14
Q
Pscyhosis
- delusions
- disorganized thoughts
- hallucinations
A
- distorted perception of reality
- false, fixed, idiosyncratic beliefs that persist despite evidence of contrary and are not typical of pts culture or religion
- perceptions in absence of external stimuli
15
Q
Types of hallucinations
- auditory
- visual
- tactile
- olfactory
- gustatory
- hypnagogic
- hypnopompic
A
- more commonly due to psych illness
- more commonly due to medical illness
- common in EtOH withdrawal and stimulant use
- often occur as aura of temporal lobe epilepsy
- rare, but seen in epilepsy
- occurs while going to sleep, sometimes seen in narco
- occurs while waking from sleep
16
Q
Schizophrenia
- positive
- negative
- dx
- caused by
- risks
- TX
- brief psychotic disorder
- schizophreniform disorder
- schizoaffective disorder
- delusional disorder
- schizotypal personality disorder
A
- hallucination, delusions
- flat or blunted affect
- delusion, hallucination, disorganized speech, disorganized behavior, negative sxs; need 2 or more
- increase in dopamine and serotonin
- male (teens to early 20s) and female (20s to 30s)
- cannabis
- atypical antipsychotics are first line
- 1 or more sxs lasting less than a month
- more than 2 sxs lasting 1-6 months
- sxs of both schizo and mood disorders, must have 2 weeks of schizo sxs w/o manic or depressive episode
- cluster A personality that falls on schizo spectrum
17
Q
Mood disorder
A
- characterized by abnormal range of moods or internal emotional states and loss of control over them
- episodic superimposed psych features may be present
18
Q
Manic episode
- what is it
- sxs
A
- distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increase in acitivty or energy lasting more than a week
- distractibility, impulsivity, grandiosity, flight of ideas, agitation, decrease need for sleep, talkativeness or pressured speech
19
Q
Hypomanic episode
- what is it
- does not contain
- time frame
A
- similar to manic episode but not severe enough to caused marked impairment in socal or occupational functioning or to necessitate hospitalization
- no psych features
- lasts less than 4 days
20
Q
Bipolar disorder
- I
- II
- between episodes
- suicide
- tx
- cyclothymic disorder
A
- > 1 manic episode +/- hypomanic or depressed episode
- > 1 hypomanic and depressive episode
- mood and function normalize
- high risk
- mood stabilizers: lithium, valproic acid, lamotrigene) or atypical antipschotics
- milder form of bipolar fluctuating between mild depressive and hypomanic sxs; must last more than 2 years w/ sxs present at least half the time with any remission shorter than 2 months
21
Q
Major depressive Disorder
- what is it
- screen for
- sxs
- MDD w/ psch fx
- persistent depressive disorder
- MDD w/ seasonal pattern
A
- episode of 5 or more of 9 characteristic sxs lasting more than 2 weeks
- hx of manic or hypomanic episodes to r/o bipolar
- Depressed mood, sleep disturbance, loss of interest, guilt/feeling of worthlessnesss, energy loss/fatigue, concentration problems, appetite/weight changes, psychomotor retardation, suicidal ideation
- MDD w/ hallucinations or delisions; antidepressant w/ atypical antipsych
- 2 depressive sxs lasting more than 2 years w/o being consecutive for more than 2 months
- lasting more than 2 years with more than 2 depressive episodes associated with seasonal pattern and absence of nonseasonal depressive episodes
22
Q
Depression w/ atypical fx
- mood
- other sxs
- TX
A
- mostly depression but can have transient moods in response to positive events
- hypersomnia, hyperphagia, leaden paralysis
- CBT and SSRI
23
Q
Peripartum mood disturbances
- maternal blues: incidence, sxs, when, resolves, tx
- MDD w/ peripartum onset: incidence, sxs
- postpartum psychosis: incidence, what is it, risk, tx
A
- 50-85% incidence rate; depressed affect, tearful, fatigue; 2-3 days after delivery; resolves within 10 days; tx: supportive
- 10-15%; depressed affect, anxiety, and poor concentration for > 2 wks; CBT and SSRI
- 0.1 - 0.2%; mood congruent delusions, hallucinations, and thoughts of harming the baby or self; hx bipolar/psych disorder, first pregnancy, family hx, recent discontinuation of psychotropic meds; hospitalization and initiation of atypical antipsychotic
24
Q
Grief
- 5 stages
- other sxs
- duration
- complicated
A
- denial, anger, bargaining, depression, acceptance
- shock, guilt, sadness, anxiety, yearning
- 6-12 months
- persistent, causes functional impairment
25
Q
Electroconvulsive therapy
- what is it
- side effects
A
- induces tonic-clonic seizure while pt under anesthesia and NM blockade
- disorientation, headache, amnesia resolving in 6 mnths
