Psych Flashcards
involuntary response learned stimulus
classical conditioning
voluntary response punishment or reward involved
operant conditioning
desired action followed by reward
positive reinforcement
desired action followed by removal of punishment
negative reinforcement
aversive stimuli (punishment)
positive punishment
removal of positive stimuli (reward)
negative punishment
discontinuation of +/– stimuli (reinforcement) eventually eliminates the behavior
extinction
patient projecting feelings onto doctor
transference
Doctor projects feelings onto patient
countertransference
coping with actions rather than reflecting on feelings
acting out (ego defense)
not accepting the painful truth
Denial (ego defense)
redirect emotions or actions to a neutral person or object
Displacement (ego defense) *lashing out on someone else over what another person did to hurt you
temporary drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress
Dissociation (ego defense)
Partially remaining at a more childish level of development (vs regression)
Fixation (ego defense) *adult tantrum
Expressing extremely positive thoughts of self and others while ignoring negative thoughts.
Idealization
Largely unconscious assumption of the characteristics, qualities, or traits of another person or group
Identification
Separating feelings from ideas or events
Isolation of affect
Asserting plausible explanations for events that actually occurred for other reasons, usually to avoid self-blame
Rationalization
Replacing a warded-off idea or feeling with an emphasis on its opposite (vs sublimation).
Reaction formation ex) step mom is extremely nurturing to a child she resents
Involuntarily turning back the maturational clock to behaviors previously demonstrated under stress (vs fixation which is voluntary).
Regression
Involuntarily with holding an idea or feeling from conscious awareness (vs suppression which is voluntary)
Repression
Believing that people are either all good or all bad at different times due to intolerance of ambiguity. Common in borderline personality disorder.
Splitting
Replacing an unacceptable wish with a course of action that is similar to the wish but socially acceptable (vs reaction formation).
Sublimation (mature ego defense)
Alleviating negative feelings via unsolicited generosity which provides gratification (vs reaction formation)
Altruism (mature ego defense)
Intentionally withholding an idea or feeling from conscious awareness (vs repression); temporary
Suppression (mature ego defense)
lightheartedly expressing uncomfortable feelings to shift the internal focus away from the distress
Humor (mature ego defense)
Long term deprivation of affection for greater than 6 months can lead to (2)
irreversible changes Infant death
infant is with drawn/unresponsive to comfort
Reactive attachment disorder
child indiscriminately attaches to strangers
Disinhibited social engagement
Characterized by subdural hematomas or retinal hemorrhage
Shaken Baby syndrome
STIs, UTIs, and genital, anal, or oral trauma. Absence of trauma does not exclude from differential
Sexual abuse (peak incidence 9-12)
Most common form of child maltreatment.
Child Neglect
Parents perceive the child as especially susceptible to illness or injury (vs factitious disorder imposed on another). Usually follows a serious illness or life-threatening event. Can result in missed school or overuse of medical services.
Vulnerable Child Syndrome
Commonly coexists with oppositional defiant disorder.
ADHD
ADHD requires what specific criteria to diagnose
≥6 months of limited attention span in ≥2 settings (school, home, church)
Repetitive/ Ritualized behavior
Autism
Adverse reaction to changes or certain stimuli
Autism
May be accompanied by intellectual disability or above average performance in a particular subject/skill
Autism
Associated with an increased head and or brain size more common in boys
Autism
Aside from Stimulants (Methylphenidate) what are alternative treatments to ADHD (3)
Atomoxetine Guanfancy Clonidine
Repetitive, pervasive behavior violating societal norms or the basic rights of others (eg, aggression toward people and animals, destruction of property, theft). After age 18, often reclassified as antisocial personality disorder.
Conduct disorder Treat with CBT
Onset before age 10. Severe, recurrent temper outbursts out of proportion to situation. Child is constantly angry and irritable between outbursts.
Disruptive Mood Dysregulation Disorder Treatment: CBT, stimulants, antipsychotics
Enduring pattern of anger and irritability with argumentative, vindictive, and defiant behavior toward authority figures
Oppositional Defiant Disorder
Onset before the age of 5. Lasts ≥1 month refrains speech in certain situations commonly exists with social anxiety disorder development of language skills not typically impaired
Selective mutism
Lasts ≥4 weeks Can be normal up to age 3-4 Overwhelming fear of separation from home or attachment figures. May lead to factitious physical complaints to avoid school.
Separation Anxiety Disorder
Lasting for ≥6 months despite focused intervention. The inability to acquire or use information from a specific subject (math, reading, writing) at the expected proficiency level for age. General functioning and intelligence are normal
Specific learning Disability
Persists >1 year, onset before 18 years Sudden, recurrent, nonrhythmic, stereotyped motor and vocal tics
Tourette Syndrome
Coprolalia
involuntary obscene speech
Associated with OCD and ADHD
Tourette Syndrome
Treatment: psycho-education, behavioraltherapy. For intractable and distressing tics use (4):
High potency antipsychotics (haloperidol, fluphenazine) Tetrabenazine, α2-agonists (guanfancy, clonidine) Atypical antipsychotics
Fluid/Electrolyte imbalance, Hypoglycemia, Hypoxia, and nutritional deficiencies are common causes of
loss of Orientation (Time, Place, Person, Situation)
Amnesia (anterograde>retrograde) and disorientation Confabulations are characteristic. Caused by vitaminB1 deficiency. Manifestation of Wernicke encephalopathy in alcoholics
Korsakoff Syndrome *destruction of the limbic system, especially mammillary bodies and anterior thalamus
Hallucinations occur while GOing to sleep. Common in Narcolepsy
Hypnagogic Hallucinations
Hallucinations occur while waking up from sleep
HypnoPOMPic Hallucinations (POMPed to get up in the morning)
Type of rare hallucination sometimes seen in epilepsy
Gustatory Hallucination
often occurs as an aura of temporal lobe epilepsy and in brain tumors
Olfactory Hallucination (ex: smelling burning rubber)
common in alcoholic withdrawl and stimulant use
Tactile Hallucinations ex: Cocaine Crawlies type of delusional parasitosis where they feel like they have bugs crawling on their skin
Visual hallucinations are more commonly due to
medical illness rather than psychiatric illness
Auditory hallucinations are more commonly due to
psychiatric illness rather than medical illness
firmly held believes despite evidence to the contrary and are not typical of a patient’s culture or religion.
Delusions
Psychosis es cuando una persona tiene un percepción de realidad distorsionado caracterizado posiblemente por 3 cosas:
- Delusions 2. Hallucinations 3. Disorganized thoughts/speech
Tear in the esophagus due to (induced/or not) vomiting causing hematemisis
Mallory Weiss Syndrome (seen in bulimia and alcoholism)
Dorsal Hand Calluses from induced vomiting
Russel Sign (seen in bulimia)
Parotid Gland enlargement (increased amylase) & enamel erosion
Seen in Bulimia
Eating disorder where BMI is normal or slightly elevated
Bulimia
≥3 months binge eating and compensatory purging
Bulimia
Eating disorder that is contraindicates Bupropion and why?
Bulimia (increased risk of seizures due to hypokalemia/hypochloremia)
Low BMI Caloric Restriction possible purging behaviors
Anorexia
≥3 months recurring laxative or diuretic abuse or induced vomiting preceded by binge eating
Binge eating/ Purging type of Anorexia
Dieting, Fasting, and/or Over-exercising NO: binging or purging
Restricting type of Anorexia
Complications include Seizures, Rhabdomyolysis, and cardiac due to increased insulin and decreased K+, Mg2+, Phosphate from a sudden increase in caloric intake
Refeeding syndrome *malnourished patients (anorexic, homeless, alcoholics)
at least weekly for ≥3 months episodes of over eating without purging
Binge eating disorder treat with psychotherapy (1st line)
≥1 month Recurring episodes of eating non-food substances
Pica Psychotherapy and nutritional rehabilitation are first line
Associated with Malnutrition, Iron deficiency anemia, developmental disabilities and emotional trauma Common in pregnancy and kids
Pica
List the five stages of change
Chronic alcohol use downregulates inhibitory ___ receptors and upregulates excitatory _______ receptors. Therefore, sudden cessation of alcohol leads to CNS overexcitation (eg, agitation, disorientation, tremulousness, autonomic hyperactivity).
GABA A
NMDA glutamate
*Sudden cessation of alcohol leads to decreased GABA activity and increased glutamate activity, resulting in CNS overexcitation
typically one of the earliest symptoms of alcohol withdrawal.
Tremulousness
the most severe manifestation of alcohol withdrawal and typically begins 48-96 hours after the last drink.
Delirium tremens
_____ withdrawal is marked by mydriasis, abdominal pain, diarrhea, piloerection, lacrimation, and yawning.
Opioid
The mu-opioid antagonist ______ is a first-line pharmacotherapy for moderate-to-severe alcohol use disorder, and works by preventing the reinforcing effects of alcohol use.
naltrexone
______ disorder is characterized by recurrent episodes of explosive verbal or physical aggression. The aggressive behaviors are impulsive and grossly out of proportion to the provocation.
Intermittent explosive
______ can produce psychotic symptoms (eg, paranoid delusions), euphoria, and agitation. Physical signs indicating sympathetic stimulation (eg, tachycardia, diaphoresis, mydriasis) can assist in differentiating cocaine intoxication from primary psychiatric disorders.
Cocaine intoxication
______ disorder is characterized by excessive concern about having a serious, undiagnosed disease, despite few or no symptoms and negative medical workup.
Illness anxiety
Patients experiencing a major depressive episode should be carefully screened for past manic episodes to rule out bipolar disorder. _______ monotherapy should be avoided in patients with bipolar disorder due to the risk of precipitating mania.
Antidepressant
waxing and waning levels of consciousness with acute onset
Low attention span
Low level of arousal
Delerium
*REVERSIBLE
Positive Schizophrenia Symptoms (5)
hallucinations
delusions
unusual thought processes
disorganized speech
bizarre behavior
Negative Schizophrenia symptoms:
flat or blunted affect
apathy
anhedonia (no pleasure)
alogia
social withdrawal
reduced ability to understand or make plans
diminished working memory
inattention
Cognitive symptoms of schizophrenia
Diagnosis of Schizophrenia requires
___ of the following active symptoms, including ___ from symptoms #1–3:
- Delusions
- Hallucinations, often auditory
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
≥2
≥1
Diagnosis of schizophrenia
Requires __ months of active symptoms over the past __ months
≥1 month
6
Schizophrenia is associated with altered dopaminergic activity, _______serotonergic activity, and _____ dendritic branching.
Ventriculomegaly on brain imaging
increased
decreased
what is first line for Scizophrenia treatment?
Risperidone (atypical)
Negative symptoms often persist after treatment, despite resolution of positive symptoms
Brief psychotic disorder ___ positive symptom(s) lasting
___ month, usually stress-related.
≥1
<1
Schizophreniform disorder
___ symptoms
lasting ____ months.
≥2
1–6
Shares symptoms with both schizophrenia and mood disorders (major depressive or bipolar disorder).
To differentiate from a mood disorder with psychotic features, patient must have _____ of psychotic symptoms without a manic or depressive episode.
Schizoaffective disorder
>2 weeks
1 or more delusion(s) lasting __ month, but without a mood disorder or other psychotic symptoms.
Daily functioning, including socialization, maybe impacted by the pathological, fixed belief but is otherwise unaffected.
Can be shared by individuals inclose relationships (folieàdeux).
Delusional disorder
more than 1 month
disorder involves the conscious and deceptive feigning or self-production of physical or psychological symptoms to obtain attention and medical care from health care personnel.
Factitious
is differentiated from factitious disorder by the intentional falsification of symptoms for personal gain (eg, financial benefits, time off from work). In contrast, factitious disorder requires the absence of obvious rewards.
Malingering
≥1 unexplained symptoms; excessive thoughts, anxiety & behaviors in response to symptoms
Somatic Symptom disorder
Minimal to no symptoms; preoccupation with idea of having a serious illness
illness anxiety disorder
Fear of Scrutiny
Social Anxiety Disorder
Recurrent Unexpected panic attacks
Panic Disorder
nightmares
flashbacks
intrusive thoughts
irritability
sleep distrubance
>1 month
recent trauma
PTSD
Marked anxiety about a specific object or situation for more than 6 months with avoidant behavior
specific phobia
Managed with regular visits with same provider
reassure illness has been ruled out
somatic symptom disorder
Sad and worried feelings without functional impairment at work, school, or home
Normal Sadness
Chronic Depressed mood for ≥2 months
dysthimia
Social/Family support
Religion
Pregnancy
Parenthood
are all what?
Protective factors against suicide
Number one greatest risk factor for suicide?
Previous Attempt
