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Quarter 4 finals > Psych > Flashcards

Psych Flashcards

1
Q

Tx most effective against Negative sx

A

Atypical antipsychotics

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2
Q

Psychotic Disorders (5)

A 
Delusional disorder
Brief Psychotic disorder
Schizophreniform disorder
Schizophrenia
Schizoaffective disorder
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3
Q

Delusional disorder

A

Poor insight
Psycho-social fx NOT markedly impaired

Non-bizarre delusions, plausible but false

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4
Q

Delusional disorder DSM5

A

Non bizarre delusions fr >1 month

Fx not impaired

Behavior not odd

Mood episodes (if present) are brief relative to delusion

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5
Q

Delusional disorder subtypes

A

Erotomanic- another person is in love with the pt

Grandiose- big head

Jealous

Persecutory- thinks someone is out to get them

Somatic- physical defect or medical condition

Mixed

Unspecified

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6
Q

Brief Psychotic Disorder

A

Sudden onset of at least 1 positive sx

lasting 1 day- 1 month, then return to normal

Emotional, labile, confused

Onset late 20s-early 30s
(may be w marked stress or post partum)

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7
Q

Brief Psychotic Disorder- worry about

A

High risk of Suicide

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8
Q

Brief Psychotic Disorder DSM5

A

Presence of 1 or more: delusions, hallucinations, disorg speech, grossly disorg/catatonic behavior

lasting 1 day-1 month, with eventual FULL RETURN TO NORMAL fx

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9
Q

Schizenophreniform Disorder

A

Essential features same as Schizophrenia, but
SHORTER DURATION
1-6 months

1/3 recover
2/3 progress to Schizophrenia

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10
Q

Schizophreniform disorder DSM5

A

Presence of TWO or more: Delusions, hallucinations, disorg speech, grossly disorg/catatonic behavior

lasting 1 month-6 months

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11
Q

Schizophrenia

A

Heritability 70-90%
1st deg relative risk is 10x that of other population

Males have earlier age of onset 18-25 YO
females: 25-35 YO

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12
Q

Schizophrenia

A

Neg sx often appear first
Decreased life expectancy- Men 15 years, women 12 years earlier

d/t ischemic heart dz, and CA

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13
Q

Schizophrenia DSM5

A

at least 1 month of 2+ of the following: delusions, hallucinations, disorg speech, disorg/catatonic behavior, negative sx

Social/job dysfunction

lasting 6 MONTHS

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14
Q

Prognosis with Schizophrenia is BETTER if:

A

female, later onset
acute onset w precip factor
brief duration, early intervention, tx compliance
positive sx
mood disturbance, family hx of mood disorder
high SES, married, good support system
Good pre-morbid functioning

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15
Q

Schizoaffective disorder

A

Schizophrenia
PLUS
A mood disorder

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16
Q

Schizoaffective disorder subtypes

A

Bipolar or Depressed

Delusions/hallucinations 2 wks and normal mood

more common in women (esp depressed)

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17
Q

Schizoaffective prognosis is

A

better than Schizoaphrenia

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18
Q

Schizoaffective Disorder DSM5

A

Meet criteria for Schizophrenia and ALSO has Major depressive, Manic, or Mixed episode

must have 2+ wks of delusions/hallucinations without prominent mood

mood sx present for sig portion of illness

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19
Q

Tx for Psychotic disorders

A

Start antipsych at low dose

Avoid use of 2 antipsychotics

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20
Q

When do things start to improve?

A

Hallucinations over days

Negative sx, delusions, cognitive def take much longer IF they improve

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21
Q

Indications for hospitalization

A

DTS
DTO
Command hallucinations
Unable to care for self

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22
Q

1st gen, conventional tx

Dopamine blockers (D2 receptor blockade)

used inpatient; IV

A

Chlorpromazine (Thorazine)

Haloperidol (Haldol)

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23
Q

Atypical Antipsychotics (2nd gen)

used outpatient

A 
Aripiprazole (Abilify)
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
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24
Q

SE of Clozapine (Clozaril)

A

Agranulocytosis

regular CBC and WBC monitoring (weekly initially)

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25
Q

SE of Olanzapine (Zyprexa)

A

Zyprexa DM

Weight gain

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26
Q

SE of Risperidone (Risperdal)

A

Prolactin, EPS

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27
Q

All Atypical Antipsych have a BLACK BOX WARNING for

A

Elderly

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28
Q

EPS- Extrapyramidal sx

A 
Acute dystonic rxn
Parkinsonism
Akathisia
Tardive dyskinesia
NMS (lead pipe rigid)
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29
Q

Palliative care

A

relieving pain without dealing with underlying cause

-not trying to treat the medical condition

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30
Q

Palliative care is for those expected to pass away in

A

the next few years

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31
Q

5 emotional stages of dying

A 
Denial-isolation
Anger
Bargaining
Depression
Acceptance
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32
Q

Hospice care

A

when it goes from Serious illness –> Terminal condition

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33
Q

Hospice

A

More intense focus on alleviating fear, anxiety, physical sx, emotional/spiritual distress

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34
Q

Life expectancy over the last 40 years has increased from

A

68—> 78

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35
Q

MDs overestimate life exp by

A

3x-5x d/t

difficulty imparting bad news
avoid dashing Hope

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36
Q

Seniors list these as top desires when living with chronic illness

A

Maintain independence
Be free of pain
Not be burden to family

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37
Q

Hospice care, for those with

A

<6 mo to live

38
Q

Palliative team- interdiscp

A 
Social worker
Psychologist
Pharmacist
Nurse
Clergy
Recreation therapist
Medical provider
39
Q

Goal of Care conversations

A

What is your understanding of your condition?
Goals?
Fears?
What if your health worsens?
What are the critical abilities you can’t imagine living without?
What are you willing to tolerate as far as further tx?

40
Q

Communication in serious illness with

SPIKES

A 
Set up convo
Perception (what pt knows)
Invitation to discuss
Knowledge (inform pt)
Emotional response
Strategy, support, summary
41
Q

Sex

A

Biological make up
does not change
XX or XY

42
Q

Gender

A

What you can change- how you identify

43
Q

Sexuality

A

who you are attracted to- M or F

44
Q

Cisgender

A

Happy with biological, gender does align

45
Q

Non binary, Genderqueer, Agender

A

Done feel M or F

46
Q

Gender dysphoria

A

the stress felt when body doesn’t match what you feel

47
Q

Intersex

A

born with ambiguous genitalia or sex organs of both sexes

48
Q

Cross dresser

A

enjoys wearing the clothing, but may not want to actually change to that gender

49
Q

Gender Dysphoria DMS5

A

Marked incongruence for at least 6 MONTHS, and at least TWO of the following:

  • marked incongruence
  • strong desire to rid ones own
  • strong desire for other gender characteristics
  • strong desire to be treated as other gender
  • strong conviction that one has feelings/reactions of the other gender
  • associated w SIGNIFICANT DISTRESS
50
Q

If someone wants to change genders, they are offered INFORMED CONSENT

A

PCP perform initial assmt, physical and mental health, Refer to SPECIALIST

make sure pt knows exactly what they are doing before starting meds/ surgery

51
Q

Behavioral Health Model (aka Standards Model)

A

Adding extra step

Letter of referral from Psychologist to assist in medical transition

52
Q

WPATH- The World Professional Association for Transgender Health

A

Standards of Care Version 7

evolved to better support pt’s autonomy in choosing WHETHER OR NOT TO SEEK PSYCHOLOGISTS CARE FOR MEDICAL TRANSITION

53
Q

Surgeons decision whether they require

A

psychologist letter or not

54
Q

TransMale

A

F—> Male

55
Q

Changing into male

A

may take several mo to become noticeable, and 3-5 years to be complete

56
Q

PERMANENT changes of TransMale

A 
Pitch of voice
Hair-thicker/dark
Grow facial hair
Balding pattern
Increase clitoris size
57
Q

TEMPORARY changes of TransMale

A 
Menses
Weight gain
Muscle mass
UE strength
More physical energy
Skin changes
Sex drive
Mood
58
Q

Risk of Testosterone therapy

A 
Loss of fertility 
(but do NOT use as birth control, could still get pregnant)
Cholesterol changes
High BP
--> increased risk of Cardiovascular dz
59
Q

Risks (summarized) of transforming into Male with testosterone

A

High: Erythrocytosis (hematocrit >50%) –> clots

Moderate: Liver dysfx, CAD, CVD, HTN, Breast/uterine CA

60
Q

with Breast/Uterine CA

A

not d/t Testosterone directly, rather that the pt stops getting the screening exams that they should be as a female

61
Q

TransFemale PERMANENT changes

A

Breast growth
Testicles smaller
Infertile as testes produce less sperm

62
Q

TransFemale TEMPORARY changes

A 
loss muscle mass,strength
weight gain
skin/acne decrease
facial/body hair softer
balding
reduced sex drive
decreased erection strength
change in mood/thinking
63
Q

Risks (summarized) of Estrogen therapy when transforming into Female

A

Very high risk: CLOT (thromboembolic dz)

Moderate: Mactoprolactin, breast CA, CAD, CVD, Cholelithiasis, Hypertriglyceridemia

64
Q

Those on Estrogen will also need Androgen blocker (Spironolactone)

RISK/SE

A 
Increased urine production/freq
Drop in BP
Lightheaded
Inc thirst
Inc in K+, leading to:
-muscle weakness
-nerve probs
-heart arrhythmias
65
Q

Forms of testosterone

A

Test Cypionate or Enthanate (injectable)

Topical gel

Patch

66
Q

Estrogen comes in

A

Pills, patches, and injectable

injectable and pills both same cost and very effective

67
Q

Androgen blockers help with:

shrinking testes
stopping erections
breast growth

A

Spironolactone

Finasteride

68
Q

Screening for Transgender Males

A

every 3 mo during 1st year
then yearly

total T (goal 400-700)
H and H
Body weight
BP
Lipids
Pap/cervical exam
Osteoporosis screen
69
Q

Screening for Transgender Females

A

every 3 mo in 1st year
then yearly

Estradiol goal during first year 100-200

70
Q

Total T is measured

71
Q

Bone Mineral Density conducted at

A

60 YO for those who have stopped hormone therapy

72
Q

Vaginoplasty

A

building a vagina

using penile tissue or colon graft

complicatoins: urethral stenosis, fistula, hair growth inside vagina

73
Q

Mammoplasty

A

building breasts

complications: capsule formation, implant rupture

74
Q

Mastectomy

A

removing breasts
“top surgery”

complication: nipple necrosis, skin flap complication, contour irregularities, scarring

75
Q

Metoidoplasty

A

creating a penis

pull enlarged clitoris forward to create phallus of penis

no new material- just freeing up the clitoris and bringing urethra forward

76
Q

Phalloplasty

A

building a penis from forearm, thigh, or flank area

erectile prosthesis implanted

complication: urethral stenosis, fistula, flap loss, necrosis

77
Q

Scrotoplasty

A

building scrotum from labia majora, testicular implants

complications: infection

78
Q

the 6 neurocog disorders

A

“PALLES”

Perceptive-motor
Attention
Learning/memory
Language
Executive fx
Social
79
Q

Risk factors for Delirium

A 
age >70
poor fx status
hearing/visual impairment
dehydration
sleep dep
metabolic derangement
infection
polypharmacy
80
Q

Dementia/Major neurocog disorder

A

significant cognitive decline

interfere w independence in everyday activities

81
Q

Specify dementia on basis of interference

A

Mild: diff with housework
Moderate: diff with basic activities
Severe: fully dependent

82
Q

Mild neurocog disorder

A

does not interfere with independence

83
Q

Alzheimers

A

insidious, gradual onset
usually after 50 YO
higher rates in repeated head trauma or Down syndrome
Familial
Myoclonus and gait disorder: late findings

84
Q

Frontotemporal degeneration

A

Either a behavioral or language variant

disinhibition, apathy, loss of sympathy, stereotyped behavior, hyperorality

decline in speech, word finding, naming, grammar, comprehension

85
Q

Lewy body disease

A

Fluctuating cognition
Recurrent visual halluciations
Spontaneous features of Parkinsonism
REM sleep disorder

Do NOT give these pts Antipsychotics

86
Q

Prion disease

A

Rapid progression
Myoclonus or Ataxia
MAD COW DISEASE

usualy course <6 mo, psych sx, EEG pattern

QUICK DETERIORATION

87
Q

HIV

A

forgetfulness, slowness, poor problem solving

Tremor, ataxia common

88
Q

Huntingon Dz

A

Autosomal dominant
30s-40s
Choreiform movement
“Boxcar ventricles”

89
Q

Tx of Dementia management

A

Cholinesterase Inhibitor

  • Donepazil (Aricept)
  • Galantamine (Razadyne)
  • Rivastigmine (Exelon)

NMDA antagonist
-Memantine (Namenda)

90
Q

Supplements that may have small benefit with Dementia

A

Vit E/Selegiline
Anti-oxidants
Anti-inflammatory

Quarter 4 finals (11 decks)

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