Psych DIT Flashcards
Erickson’s stages of development 8
birth - 1.5 yrs - Trust vs mistrust
1.5 -3 yrs Autonomy vs shame (potty train, feeding)
3yrs- 5yrs - Initiative vs guilt
6yrs - 12yrs Industry vs inferiority
12yrs - 18 yrs Identity vs role confusion
18yrs - 35 yrs Isolation vs intimacy
35yrs - 55 yrs Generativitty vs self absorption
55yrs - death Integrity vs despair
Maslovs hierarchy of needs (5)
Physiological needs Safety Belonging and love Esteem (confidence) Self actualization (creativity, morality)
Cognitive behavioral therapy principle
that thoughts -> emotions
∆thought you can ∆ the emotion; need to identify the thought first though through journaling, challenging beliefs, mindfulness, relaxation
Psychoanalysis
analysis of dreams, fantasies, associations and verbal/physical expression of thoughts
confront and recognize inner conflict
Kluver Bucy syndrome due to?
Characterized by (4)
bilateral lesion of the amygdala( part of the limbic system)
hyperorality
hypersexuality
disinhibited behavior/lack of fear
docile
Amygdalas job?
receive input from a lot a of parts (limbic, neocortex, sensory)
transmit back to the cortical areas
- > changes in sympathetic and anti sympathetic
- BP. HR, GI rage, sexual response, licking chewing etc
bilateral lesion in Kluver Bucy syndrome
Limbic systems job(5)
Fucking Fighting Fleeing Feeding Feeling
also long term memory
-connect to prefrontal cortex as well so have emotional response to intellectual stimulation
Kid presents with bald spot of hair which he says relieves stress
Dx?
Rx?
trichotillomania - hair pulling disorder
-more common in girls
Rx - cognitive behavioral therapy
-flouoxitine or clomipramine if not working
ADHD medications (3)
methyphenidate - ritalin
dextramphetamine - adderol
- Increases NE release
atomoxetine - straterra
-SNRI
Characteristics of severe autism spectrum disorder
Patient is disengaged w/ the social world finding more interest in objects than people
lack of responsiveness to others, poor eye contact, absent social smile
impaired communication, language delay, repetitive phrases
ritualistic behavior (hand flapping/spinning)
Infant presents with weakness, poor language skills that is untrusting and has lost weight. Maybe is sick a lot. Be concerned of
Infant deprivation effect
Must report to CPS. > 6 months can have
Can lead to disinhibited social engagement disorder
Bruising that may lead one to suspect child abuse
buttocks, cheek or torsue
just need suspicion, CPS job to prove. My job to report
-child neglect is also reportable
ADHD is features limited (2) and characterized by (3)
Onset by what time
Limited attention and restraint
characterized by hyperactivity, impulsivity and inattention
onset before age 12
Conduct disorder is?
behavior that violates the basic rights of others
<18 otherwise antisocial personality disorder
Oppositional defient disorder
Retative behavior where the child has problems with authority figures, hostile and vindictive
no serious violations though
Tourettes syndrome(2)
Rx (3)
Verbal and motor ticks that persist > 1 yr, onset before 18
coprolalia - swearing (only 20%)
Fluphenazine, pimozide, Terabenazine
Disruptive mood dysregulation disorder
baseline irritability
recurrent temper tantrums
symptums present for a yr.
onset before 10 and diagnosed between 6-10
Childhood onset fluency disorder
stuttering
Rett Syndrome
presentation and acquired how
X linked dominant
Seen in only girls where you lose major milestones round age 1-4,
loss of verbal skills, mental retardation, ataxia, stereotype hand within*** (bring hand up to mouth)
Aspergers is characterized by?
all absorbing interests and repetitive behavior, problems w/ social relationships (maybe verbal/cognitive deficits)
Normal intelligence and NO language impairment
Anorexia nervosa diagnosed by(3)
associated complications
- distorted body image
- intense fear of gaining weight
- Low body mass - BMI <17
Can have purging behavior
Can see - amennorrha, metatarsal fractures w/ early onset osteoporosis, electrolyte imbalances,
Can have Depression
Rx: difficult
Bulemia nervosa diagnosed by (2)
Associated w/(3)
episodes of uncontrolled waiting followed by purging episodes to prevent weight gain
-normal weight
also hypokalemic hypochloreimic metabolic alkalosisarotitis, enamel erosions, russels signs,
Rx maybe SSRI - fluoxetine
Gender identity disorder
Severe persistent cross gender identification that may cause significant distress and /or impaired functioning.
Gender - psychosocial, Sex - mechanical parts
Transsexual -> desire to live as the other sex -> actions such as surgery and hormone replacement
Transvestite
Sexual arousal that comes w/ wearing women clothes.
Not the same transsexual. No desire to become a female. Does not feel trapped in the wrong sex.
Medications for preventing relapse in alcoholics (5)
Alcoholics anonomous Naltrexone - blocks endogenous opiates Disulfiram Topiramate Acamprosate
Why is giving glucose to a hypoglycemic drunk a bad idea
Probably have thiamine deficiency and glucose metabolism uses thiamine as a cofactor. Exacerbates underlying condition
Wernicke ecephalopathy characterized by (4)
thiamine deficiency
confusion
nystagmus
ataxia
opthalmoplegia
sluggish pupillary refexes
coma and death if untreated
Korsakoff includes memory issues
Korsakoff syndrome characterized by (4)
Anterograde amnesia
Retrograde amnesia
Confabulation
Hallucinations
More specific test for recent alcohol abuse
serum gamma gultamyltransferase
Delerium tremins is?
Sets in?
severe alcohol withdrawal
Seen as autonomic hyperactivity(hyper/hypo tension) and seizures, nightmares, disorientation, hallucination diaphoresis
2-3 days after
Rx benzodiazepine
Withdrawal of alcohol symptoms
Agitation anxiety insomnia tremor tachycardia
Alcohol acts on what receptor
Acute recovery?
GABA
time and supportive, if severe(Delerium tremens) lang acting benzodiazapine
hemorrhage and necrosis of which 2 structures seen in Wernicke-korsakoff
Mammillary bodies*
medial thalamus
post op constipation and or respiratory depression due to what drug effect
opiods
Sever depression, HA, fatigue, insomina/hypersomina, hunger-> withdrawal due to
Cocaine withdrawal
Pinpoint pupils, N/V, seizures due to intoxication w/
opioids - heroin
belligerience, impulsiveness, nystagmus, homicidal idealizations, psychosis due to
PCP intoxication
HA, anxiety/depression and weight gain due to this drug effect
Nicotine/caffeine withdraw
Anxiety/depression, delusions hallucinations and withdrawal due to this drug effect
LCD use
euphoria, social withdrawal, impaired judgement, hallucinations due to
Marijuana use
rebound anxiety, tremors, seizures that may be life threatening due to this drug effect
Alcohol withdrawal
also benzos/barbs
anxiety, piloerection, yawing, fever, rhinorrhea, nausea and diarrhea due to
opioiod withdrawal
PCP overdose Rx w/
benzodiazapines, maybe haloperidol
Alcohol overdose Rx w/
time and fluids, respiratory support, Benzos if delirium tremins
Barbituate overdose Rx
no reversal agent, supportive
Benzodizapine overdose Rx
flumenazil, be wary of seizures
Drug overdoses that result in miosis(2)
organophosphate poisoning
opioid overdose
Nystagmus key for what drug overdose
PCP
Ecstasy overdose characterized by(5)
euphoira decreased anxiety jaw clenching sense of intimacy tachycardia
-increased serotonin released
dry mouth and conjunctival injections that may lead to increase social withdrawal with time
marijuana use
methadone use
long acting low dose opioid agonist that limits “high”
useful for heroin relapse prevention
Suboxone use
partial agonist combined with an antagonist -> useful for relapse prevention
Naloxone and buprenophine
hallucinations vs delusions vs illusions
hallucinations - perceptions w/out stimuli
Delusions - falls beliefs
illusions - misinterpretations of stimuli
Visual hallucinations more associated w?
Auditory hallucinations more associated w?
visual hallucinations more associated w/ medical illness - drug intoxication, dementia
auditory more associated w/ psychotic illness
Formication associated w/(2)
tactile hallucinations (bugs crawling all over you)
alcohol and cocaine withdrawal
Hypnagoic vs hypnopompic hallucinations
hypnaGOic hallucinations occur when Going to bed
hypnopompic hallucinations occur when waking up
Positive symptoms of schizophrenia associated with what change in what tract vs negative symtoms
positive associated w/ increased dopamine in the mesolimbic tract
negative associations associated w. decreased dopamine in the mesocortical tract
Timeline of schizophrenia, schizophreniform and brief psychotic episode
schizophrenia is > 6 months
schizophreniform is 1-6 months
brief psychotic episode is < 1 month
Positive symptom sof schizophrenia (4)
delusions*
hallucinations- auditory*
disorganized speech - loose associations*
disorganized behavior (catatonic)
Negative symptoms of schizophrenia (4)
flat affect
social withdrawal
stop in thought/ speech - alogoia
lack of motivation
Timeline of diagnosis of schizophrenia and risk factors
early 20s in men and later 20s-30s in females
Some genetic risk - 50% in monozygotic twins
pschyoactive drug use in adolescence
schizoaffective disorder
Episode of psychosis lasting at least 2 weeks prior to onset of mood disorder (major depressive, maniac or mixed0
Delusional disorder
timing?
Differs from schizo how?
the persistent belief in an idea that is not true lasting for at least a month.
Functioning otherwise not impaired
High potency typical antipsychotics (5)
Haloperidol Fluphenazine trifluperazine thiothixene loxapine
Low potency typical anipsychotics (2)
Chlorpromazine
thioridazine
Atypical antipsychotics (5)
clozapone olanzapine risperidone quetiapine apripiprazole
low potency antipsychotics typically have what side effects compared to high potency (4)
antimuscarinic
High potency has
- extrapyramidal symptomsand
- risk of neuroleptic malignant syndrome
- endocrine dysruptino - hyperprolactinemia
Uses of typical antipsychoitcs(4)
Schizophrenia
agitation
touretts -fluphenazine
acute mania
Timeline of HP typical antipsychotics
initially
-acute dystonia
-toricollis (twisting head movement)
(treat w/ antimuscarinics - >benztropamine)
1 month
- akensia
2 months
- bradykinesia
- akathriesis (restless)
4 months tardive dyskenisa
Tardive dyskeneisa presentation
Rx?
systematic lip smacking and face movement that occurs after 4 months on a typical antipsychotic
not an extrapyramidal side effect
Rx - stop the medication, usually irreversible
Neuroleptic malignant syndrome presentation (6)
Rx (2)
excessive muscle movement and rigidity brought on by high potency antipsychotic use
- Delerium
- autonomic instability
- myoglobinuria
- hyperpyrexia
- rigidity
- autonomic instability
Treat w/ dantrolene or bromocriptine (D2 agonist)
Atypical antipsychotic use over typical
side effect profile due to?
helps return some negative symptoms of sychophrenia but still has better action w/ the positive symptoms
some spill over w/ H1 and alpha -> hypotension, sedation and weight gain but not as bad as the typical antipsychotics
biggest risk of one atypical antipsychotic
Clozapine and agranulocytosis
- need weekly checks
also in general have weigh gain
which atypical antipsychotic is their increased risk of metabolic disorder and DM
Olanzaprine
mania characterized by what symptoms
must last how long?
DIG FAST
Distractable Impulsive Grandiosity (delusions, self worth) Flight of ideas Agitation/activity Sleed (decreased) Talkative (pressured speech)
must last 1 week -> impairment w/ function
hypomania differs from mania how?
less severe symptoms in that it does not impair functioning
only needs to present for 4 days
Bipolar Type I vs Bipolar Type II
Type I - Episode of Mania w or w/o depression
Type II hypomania w/ depression
Cyclothymic disorder
Timeline?
hypomania and minor depression over the course of 2 years
only 2 months a normal mood allowed
Rx for Bipolar (3)
Lithium
Antipsychotics - atypical
- Apiprazole
- Olanzapine
- Risperidone
Anti epileptics
- valproic acid
- carbamazapine
- lamotrigune
Lithiums side effects(7)
tremors teratogen - ebsteins anomaly heart block polyuria - ADH antagonist -> nephrogenic DI Sedation hypothyroidism goiter
Narrow TI
Diagnosis of Depression (9)
need at least 5 for 2 weeks
SIG E CAPS + depressed mood*
Sleep changes Interest decreased (anhedonia)* Guilty/worthless Energy is down Concentration is down Appetite changes Psychomotor retardation/agitation Suicidal idealation
When symptoms of depression last at least 2 years this calls
persistent depressive disorder
can’t be non depressed > 2months during that time
may only be minor
Atypical depression is (4)
The most common subtype of depression
- Hyperphagia
- Hypersomnia
- Mood reactivity
- rejection hypersensitivity
Seasonal pattern sub type of depression you need to have
2 years of temporal changes in mood w/ 2 MDD in that time
Responds positively to light
peripartum subtype of depression diagnosis
diagnosis of depression w/in 4 weeks of giving birth
- meets 5/9 criteria for >2weeks
- longer than the post partum blues (resolves in 10-14 days and starts w/in couple days after birth)
psychosis is a rare complication
electroconvulsive therapy indications(3)
Side effects (2)
refractive depression, pregnancy, catatonic schizophrenia
Retrograde/anterograde memory loss that resolves in 6 months
disoreintation
Risk factors for completing suicide(10)
SAD PERSONS
Sex - male Age - 45 Depression Prior attempts Ethanol Rational thought absent Sickness (chronic) Organized plan No social support Stated attempt
SSRIs are used for what other than depression? (6)
GAD panic disorder bulimia- fluoxitine OCD social phobias PTSD
Serotinin syndrome is due to?
presents as? (5)
Use of an SSRI w/ another drug that increases Serotinonin in the body like
- St johns wart and Kava Kava
- Triptans
- MAOIs, TCAs, SNRIs
- tryptophan
- amphetamine
Seen as: Myoclonic(neuromuscular changes) autonomic instability (tachy, cardio collapse) mental status changes; with fever , flushing diarrhea
RX for seratonin syndrome
Benzodiazapines and cooling
Side effects of SSRIs(2)
sexual dysfunction Serotonin syndrome (excess -> autonomic instab, neuro muscular changes, mental status changes)
SNRIs (3)
cymbalata
venlafaxine
milacipran - fibromyalgia only
SSRIs(4)
fluoxetine
paroxetine
citalopram
sertraline
Clinical use of SNRIs in addition to depression (2)
GAD
duloxetine - diabetic peripheral neuropathy/fibromyalgia
SFX w/ SNRIs(3)
Increased BP
stimulent -> increased NE
sedation and nausea
TCA(7)
Amitriptyline nortriptyline imipramine desipiramine clomipramine doxepin amoxapine
Other uses of TCAs other than depression
fibromyalgia
-amytriptyline
OCD
-clomipramine
bedwetting
-imipramine
Side effects of TCAs(4)
sedation
Alpha 1 blocking
- hypotension
Antimuscarinic
- dry mouth
- sedation
- tachy
- urinary retention
Overdose - convulsions, Coma, cardiotoxicity
TCA overdose be concerned w/ (6)
Rx
Cardiotoxicity
Convulsions
coma
fever,
confusion/hallucinations
respiratory depression
Rx: NaHCO3 (alkalize the urine)
MAOi(4)
trancyproamine
Phenelzine
isocarboxazid
selegiline (MAOI B for Parkinsons rx)
What is tyramine and why is it a bad idea w/ MAOIs?
substance found in aged foods that leads to increased NE on its own. Normally broken down by MAOI.
On medication this process is inhibited leading to excess NE release -> hypertensive crisis (stroke, cardiac arrhythmia)
Medication primary used for insomnia but may cause priaprism
Trazadone a tetracyclic
Antidepressant of choice that may increase appetite
Mirtazapine an alpha 2 antagonist tetracyclic
medication that increases dopamine and NE
buproprion
- good choice for those convened w/ side effects
- aslo smokers
Buproprion carries an increase risk w/ what patients
those prone to seizures
-bulemics
Toxicity w/ mirtazapine (3)
sedation
increased hunger
dry mouth
Rx for Panic Disorder (4)
Cognitive behavioral therapy
beta blockers
benzos
SSRI
Panic disorder described as (2)
recurrent panic attacks
anxiety of future panic attacks
Agoraphobia
anxiety w/ fear of open places
Social anxiety disorder
exaggerated fear of embarrassment in social situations
- public speaking, bathrooms
Rx w/ beta blockers or SSRIs
Obsessive compulsive disorder presents as
Rx?(2)
recurrent intrusive thoughts or obsessions that are relieved by ritualized actions or compulsions
SSRI and clomipramine (TCAs)
PTSD and timeline
recurrent flashbacks to traumatic events in the life -> nightmares, intense fear, helplessness
hyper vigelent
has to last greater than 1 month
Rx - CBT and SSRIs
Acute stress disorder
like PTSD but lasts only 2 days - 1 month; longer is PTSD
Generalized anxiety disorder presents as?
Timeline
uncontrollable anxiety for at leas 6 months that is not identifiable in any one thing (vs adjustment disorder, also timeline is different)
-> sleep disturbance, fatigue, difficulty concentrating
Rx - Busprione
Adjustment disorder timeline
emotional symptoms causing impairment due to an identifiable event - divorce, illness
lasts less than 6 months;
> 6 months in presence of chronic stressor
Malingering
playing the sick role for secondary gain (time off money)
The motivation is conscious and has poor compliance in treatment
Factitious disorder (2 types)
in general patient veins being sick due to some unconscious motivation (likes the sick role); no secondary gain
- called munchausen’s syndrome when chronic
- called munchausns syndrome by proxy when an adult does it to a kid ( now called factitious disorder imposed on another)
Somatic symptom disorder
timeline
used to be called somatoform disorder
1 symptoms causing explicit distress and anxiety despite no identifiable physical cause lasting 6 months
if primarily pain - > w/ predominate pain
Conversion
Sudden loss of Voluntary sensory or motor function (NOT PAIN); can be paralysis, blindness, mutism, pseudosiezures
Patient is aware but may be indifferent
Illness anxiety disorder
new name for hypochondriacs
Body dysmorphic disorder
preoccupation with perceived defects in normal anatomy that leads to significant emotional distress
unacceptable feelings and thoughts are expressed through actions
acting out
temporary drastic change in personality, memory or conscious to avoid emotional stress
dissociation
can lead to dissociative identity disorder
avoidance of awareness of a painful reality
denial
avoided ideas and feelings are transferred to some neutral object or person
displacement
remaining at a more childish level of development
fixation
modeling behavior of someone perceived as more powerful
identification
separation of feelings from ideas and events
isolation
war vet and cold details
unacceptable thoughts and actions are perceived to be held by others
projection
if I’m racist so are you
proclaiming logical reasons for action to avoid self blame
rationalization
ideas that are distressing are replaced by or warded off by actions (unconsciously) to the opposite
reaction formation
turning back the maturational clock to an earlier stage
regression
involunary (unconscious) withholding of an idea or feeling to prevent anxiety
repression
suppression is voluntary
categorizing people as either all bad or all good
splitting
seen in borderline patients
guilty feelings alleviated by unsolicited generosity to others
altrusism
appreciating amusing nature of an anxiety producing event
humor
replacing an unacceptable behavior with socially acceptable alternatives to release tension w/out violating morality
sublimation
conscious of action (vs reaction formation)
holding back adverse thought consciously to stop interference with function
suppression
vs repression which is unconcious
Schizoid personality disorder
avoids social circumstance and likes it that way
A
Paranoid personality disorder
consistent beliefs of persecution and distrust. Uses a lot of projection
A
Schizotypal personality disorder
odd behavior and beliefs, eccentric or magical thinking
may be avoidant in addition but not predominant
A
Antisocial personailty disorder
lack of empathy, persistent disregard and violation of the rights of others
<18 - conduct disorder
B
Histrionic personality disorder
easily excitable, and emotional, attention seeking and sexually provocative
B
Borderline personality disorder
unstable mood and relationships, impulsive, self mutilationand boredom
commonly uses splitting
B
Narcisstic
grandiosity and sense of entitlement, low empathy
B
Avoidant personality disorder
hypersensitivity to rejection and socially inhibited timid, feeling of inadequacy; Desires relationships with others
social anxiety disorder is fear of embarrassment
obsessive compulsive personality disorder
preoccupation with order, perfection and control, egocentric (vs disorder -> ritualized habits to relieve obsessions)
Dependent personality disorder
submissive and clinging, excessive need to be taken crd of, low self confidence
