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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
SE of Olanzapine (Zyprexa)
Zyprexa DM | Weight gain
26
SE of Risperidone (Risperdal)
Prolactin, EPS
27
All Atypical Antipsych have a BLACK BOX WARNING for
Elderly
28
EPS- Extrapyramidal sx
``` Acute dystonic rxn Parkinsonism Akathisia Tardive dyskinesia NMS (lead pipe rigid) ```
29
Palliative care
relieving pain without dealing with underlying cause -not trying to treat the medical condition
30
Palliative care is for those expected to pass away in
the next few years
31
5 emotional stages of dying
``` Denial-isolation Anger Bargaining Depression Acceptance ```
32
Hospice care
when it goes from Serious illness --> Terminal condition
33
Hospice
More intense focus on alleviating fear, anxiety, physical sx, emotional/spiritual distress
34
Life expectancy over the last 40 years has increased from
68---> 78
35
MDs overestimate life exp by
3x-5x d/t difficulty imparting bad news avoid dashing Hope
36
Seniors list these as top desires when living with chronic illness
Maintain independence Be free of pain Not be burden to family
37
Hospice care, for those with
<6 mo to live
38
Palliative team- interdiscp
``` Social worker Psychologist Pharmacist Nurse Clergy Recreation therapist Medical provider ```
39
Goal of Care conversations
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
Communication in serious illness with | SPIKES
``` Set up convo Perception (what pt knows) Invitation to discuss Knowledge (inform pt) Emotional response Strategy, support, summary ```
41
Sex
Biological make up does not change XX or XY
42
Gender
What you can change- how you identify
43
Sexuality
who you are attracted to- M or F
44
Cisgender
Happy with biological, gender does align
45
Non binary, Genderqueer, Agender
Done feel M or F
46
Gender dysphoria
the stress felt when body doesn't match what you feel
47
Intersex
born with ambiguous genitalia or sex organs of both sexes
48
Cross dresser
enjoys wearing the clothing, but may not want to actually change to that gender
49
Gender Dysphoria DMS5
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
If someone wants to change genders, they are offered INFORMED CONSENT
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
Behavioral Health Model (aka Standards Model)
Adding extra step | Letter of referral from Psychologist to assist in medical transition
52
WPATH- The World Professional Association for Transgender Health
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
Surgeons decision whether they require
psychologist letter or not
54
TransMale
F---> Male
55
Changing into male
may take several mo to become noticeable, and 3-5 years to be complete
56
PERMANENT changes of TransMale
``` Pitch of voice Hair-thicker/dark Grow facial hair Balding pattern Increase clitoris size ```
57
TEMPORARY changes of TransMale
``` Menses Weight gain Muscle mass UE strength More physical energy Skin changes Sex drive Mood ```
58
Risk of Testosterone therapy
``` Loss of fertility (but do NOT use as birth control, could still get pregnant) Cholesterol changes High BP --> increased risk of Cardiovascular dz ```
59
Risks (summarized) of transforming into Male with testosterone
High: Erythrocytosis (hematocrit >50%) --> clots Moderate: Liver dysfx, CAD, CVD, HTN, Breast/uterine CA
60
with Breast/Uterine CA
not d/t Testosterone directly, rather that the pt stops getting the screening exams that they should be as a female
61
TransFemale PERMANENT changes
Breast growth Testicles smaller Infertile as testes produce less sperm
62
TransFemale TEMPORARY changes
``` 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
Risks (summarized) of Estrogen therapy when transforming into Female
Very high risk: CLOT (thromboembolic dz) Moderate: Mactoprolactin, breast CA, CAD, CVD, Cholelithiasis, Hypertriglyceridemia
64
Those on Estrogen will also need Androgen blocker (Spironolactone) RISK/SE
``` Increased urine production/freq Drop in BP Lightheaded Inc thirst Inc in K+, leading to: -muscle weakness -nerve probs -heart arrhythmias ```
65
Forms of testosterone
Test Cypionate or Enthanate (injectable) Topical gel Patch
66
Estrogen comes in
Pills, patches, and injectable injectable and pills both same cost and very effective
67
Androgen blockers help with: shrinking testes stopping erections breast growth
Spironolactone | Finasteride
68
Screening for Transgender Males
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
Screening for Transgender Females
every 3 mo in 1st year then yearly Estradiol goal during first year 100-200
70
Total T is measured
in BOTH
71
Bone Mineral Density conducted at
60 YO for those who have stopped hormone therapy
72
Vaginoplasty
building a vagina using penile tissue or colon graft complicatoins: urethral stenosis, fistula, hair growth inside vagina
73
Mammoplasty
building breasts complications: capsule formation, implant rupture
74
Mastectomy
removing breasts "top surgery" complication: nipple necrosis, skin flap complication, contour irregularities, scarring
75
Metoidoplasty
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
Phalloplasty
building a penis from forearm, thigh, or flank area erectile prosthesis implanted complication: urethral stenosis, fistula, flap loss, necrosis
77
Scrotoplasty
building scrotum from labia majora, testicular implants complications: infection
78
the 6 neurocog disorders
"PALLES" ``` Perceptive-motor Attention Learning/memory Language Executive fx Social ```
79
Risk factors for Delirium
``` age >70 poor fx status hearing/visual impairment dehydration sleep dep metabolic derangement infection polypharmacy ```
80
Dementia/Major neurocog disorder
significant cognitive decline | interfere w independence in everyday activities
81
Specify dementia on basis of interference
Mild: diff with housework Moderate: diff with basic activities Severe: fully dependent
82
Mild neurocog disorder
does not interfere with independence
83
Alzheimers
insidious, gradual onset usually after 50 YO higher rates in repeated head trauma or Down syndrome Familial Myoclonus and gait disorder: late findings
84
Frontotemporal degeneration
Either a behavioral or language variant disinhibition, apathy, loss of sympathy, stereotyped behavior, hyperorality decline in speech, word finding, naming, grammar, comprehension
85
Lewy body disease
Fluctuating cognition Recurrent visual halluciations Spontaneous features of Parkinsonism REM sleep disorder Do NOT give these pts Antipsychotics
86
Prion disease
Rapid progression Myoclonus or Ataxia MAD COW DISEASE usualy course <6 mo, psych sx, EEG pattern QUICK DETERIORATION
87
HIV
forgetfulness, slowness, poor problem solving | Tremor, ataxia common
88
Huntingon Dz
Autosomal dominant 30s-40s Choreiform movement "Boxcar ventricles"
89
Tx of Dementia management
Cholinesterase Inhibitor - Donepazil (Aricept) - Galantamine (Razadyne) - Rivastigmine (Exelon) NMDA antagonist -Memantine (Namenda)
90
Supplements that may have small benefit with Dementia
Vit E/Selegiline Anti-oxidants Anti-inflammatory

Quarter 4 finals (11 decks)

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