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USLME Kiss my ass and pray > Psych DIT > Flashcards

Psych DIT Flashcards

1
Q

Erickson’s stages of development 8

A

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

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2
Q

Maslovs hierarchy of needs (5)

A 
Physiological needs
Safety
Belonging and love
Esteem (confidence)
Self actualization (creativity, morality)
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3
Q

Cognitive behavioral therapy principle

A

that thoughts -> emotions

∆thought you can ∆ the emotion; need to identify the thought first though through journaling, challenging beliefs, mindfulness, relaxation

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4
Q

Psychoanalysis

A

analysis of dreams, fantasies, associations and verbal/physical expression of thoughts

confront and recognize inner conflict

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5
Q

Kluver Bucy syndrome due to?

Characterized by (4)

A

bilateral lesion of the amygdala( part of the limbic system)

hyperorality
hypersexuality
disinhibited behavior/lack of fear
docile

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6
Q

Amygdalas job?

A

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

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7
Q

Limbic systems job(5)

A 
Fucking
Fighting
Fleeing
Feeding
Feeling

also long term memory
-connect to prefrontal cortex as well so have emotional response to intellectual stimulation

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8
Q

Kid presents with bald spot of hair which he says relieves stress

Dx?

Rx?

A

trichotillomania - hair pulling disorder
-more common in girls

Rx - cognitive behavioral therapy
-flouoxitine or clomipramine if not working

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9
Q

ADHD medications (3)

A

methyphenidate - ritalin
dextramphetamine - adderol
- Increases NE release

atomoxetine - straterra
-SNRI

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10
Q

Characteristics of severe autism spectrum disorder

A

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)

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11
Q

Infant presents with weakness, poor language skills that is untrusting and has lost weight. Maybe is sick a lot. Be concerned of

A

Infant deprivation effect

Must report to CPS. > 6 months can have

Can lead to disinhibited social engagement disorder

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12
Q

Bruising that may lead one to suspect child abuse

A

buttocks, cheek or torsue

just need suspicion, CPS job to prove. My job to report
-child neglect is also reportable

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13
Q

ADHD is features limited (2) and characterized by (3)

Onset by what time

A

Limited attention and restraint

characterized by hyperactivity, impulsivity and inattention

onset before age 12

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14
Q

Conduct disorder is?

A

behavior that violates the basic rights of others

<18 otherwise antisocial personality disorder

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15
Q

Oppositional defient disorder

A

Retative behavior where the child has problems with authority figures, hostile and vindictive

no serious violations though

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16
Q

Tourettes syndrome(2)

Rx (3)

A

Verbal and motor ticks that persist > 1 yr, onset before 18

coprolalia - swearing (only 20%)

Fluphenazine, pimozide, Terabenazine

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17
Q

Disruptive mood dysregulation disorder

A

baseline irritability
recurrent temper tantrums
symptums present for a yr.

onset before 10 and diagnosed between 6-10

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18
Q

Childhood onset fluency disorder

A

stuttering

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19
Q

Rett Syndrome

presentation and acquired how

A

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)

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20
Q

Aspergers is characterized by?

A

all absorbing interests and repetitive behavior, problems w/ social relationships (maybe verbal/cognitive deficits)

Normal intelligence and NO language impairment

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21
Q

Anorexia nervosa diagnosed by(3)

associated complications

A
  1. distorted body image
  2. intense fear of gaining weight
  3. 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

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22
Q

Bulemia nervosa diagnosed by (2)

Associated w/(3)

A

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

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23
Q

Gender identity disorder

A

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

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24
Q

Transvestite

A

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.

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25
Q

Medications for preventing relapse in alcoholics (5)

A 
Alcoholics anonomous
Naltrexone - blocks endogenous opiates
Disulfiram
Topiramate
Acamprosate
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26
Q

Why is giving glucose to a hypoglycemic drunk a bad idea

A

Probably have thiamine deficiency and glucose metabolism uses thiamine as a cofactor. Exacerbates underlying condition

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27
Q

Wernicke ecephalopathy characterized by (4)

A

thiamine deficiency

confusion
nystagmus
ataxia
opthalmoplegia

sluggish pupillary refexes
coma and death if untreated
Korsakoff includes memory issues

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28
Q

Korsakoff syndrome characterized by (4)

A

Anterograde amnesia
Retrograde amnesia
Confabulation
Hallucinations

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29
Q

More specific test for recent alcohol abuse

A

serum gamma gultamyltransferase

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30
Q

Delerium tremins is?

Sets in?

A

severe alcohol withdrawal

Seen as autonomic hyperactivity(hyper/hypo tension) and seizures, nightmares, disorientation, hallucination diaphoresis

2-3 days after

Rx benzodiazepine

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31
Q

Withdrawal of alcohol symptoms

A 
Agitation
anxiety
insomnia
tremor
tachycardia
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32
Q

Alcohol acts on what receptor

Acute recovery?

A

GABA

time and supportive, if severe(Delerium tremens) lang acting benzodiazapine

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33
Q

hemorrhage and necrosis of which 2 structures seen in Wernicke-korsakoff

A

Mammillary bodies*

medial thalamus

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34
Q

post op constipation and or respiratory depression due to what drug effect

A

opiods

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35
Q

Sever depression, HA, fatigue, insomina/hypersomina, hunger-> withdrawal due to

A

Cocaine withdrawal

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36
Q

Pinpoint pupils, N/V, seizures due to intoxication w/

A

opioids - heroin

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37
Q

belligerience, impulsiveness, nystagmus, homicidal idealizations, psychosis due to

A

PCP intoxication

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38
Q

HA, anxiety/depression and weight gain due to this drug effect

A

Nicotine/caffeine withdraw

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39
Q

Anxiety/depression, delusions hallucinations and withdrawal due to this drug effect

A

LCD use

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40
Q

euphoria, social withdrawal, impaired judgement, hallucinations due to

A

Marijuana use

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41
Q

rebound anxiety, tremors, seizures that may be life threatening due to this drug effect

A

Alcohol withdrawal

also benzos/barbs

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42
Q

anxiety, piloerection, yawing, fever, rhinorrhea, nausea and diarrhea due to

A

opioiod withdrawal

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43
Q

PCP overdose Rx w/

A

benzodiazapines, maybe haloperidol

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44
Q

Alcohol overdose Rx w/

A

time and fluids, respiratory support, Benzos if delirium tremins

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45
Q

Barbituate overdose Rx

A

no reversal agent, supportive

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46
Q

Benzodizapine overdose Rx

A

flumenazil, be wary of seizures

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47
Q

Drug overdoses that result in miosis(2)

A

organophosphate poisoning

opioid overdose

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48
Q

Nystagmus key for what drug overdose

A

PCP

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49
Q

Ecstasy overdose characterized by(5)

A 
euphoira
decreased anxiety
jaw clenching
sense of intimacy
tachycardia

-increased serotonin released

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50
Q

dry mouth and conjunctival injections that may lead to increase social withdrawal with time

A

marijuana use

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51
Q

methadone use

A

long acting low dose opioid agonist that limits “high”

useful for heroin relapse prevention

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52
Q

Suboxone use

A

partial agonist combined with an antagonist -> useful for relapse prevention

Naloxone and buprenophine

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53
Q

hallucinations vs delusions vs illusions

A

hallucinations - perceptions w/out stimuli
Delusions - falls beliefs
illusions - misinterpretations of stimuli

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54
Q

Visual hallucinations more associated w?

Auditory hallucinations more associated w?

A

visual hallucinations more associated w/ medical illness - drug intoxication, dementia

auditory more associated w/ psychotic illness

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55
Q

Formication associated w/(2)

A

tactile hallucinations (bugs crawling all over you)

alcohol and cocaine withdrawal

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56
Q

Hypnagoic vs hypnopompic hallucinations

A

hypnaGOic hallucinations occur when Going to bed

hypnopompic hallucinations occur when waking up

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57
Q

Positive symptoms of schizophrenia associated with what change in what tract vs negative symtoms

A

positive associated w/ increased dopamine in the mesolimbic tract

negative associations associated w. decreased dopamine in the mesocortical tract

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58
Q

Timeline of schizophrenia, schizophreniform and brief psychotic episode

A

schizophrenia is > 6 months

schizophreniform is 1-6 months

brief psychotic episode is < 1 month

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59
Q

Positive symptom sof schizophrenia (4)

A

delusions*
hallucinations- auditory*
disorganized speech - loose associations*
disorganized behavior (catatonic)

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60
Q

Negative symptoms of schizophrenia (4)

A

flat affect
social withdrawal
stop in thought/ speech - alogoia
lack of motivation

61
Q

Timeline of diagnosis of schizophrenia and risk factors

A

early 20s in men and later 20s-30s in females

Some genetic risk - 50% in monozygotic twins
pschyoactive drug use in adolescence

62
Q

schizoaffective disorder

A

Episode of psychosis lasting at least 2 weeks prior to onset of mood disorder (major depressive, maniac or mixed0

63
Q

Delusional disorder

timing?

Differs from schizo how?

A

the persistent belief in an idea that is not true lasting for at least a month.

Functioning otherwise not impaired

64
Q

High potency typical antipsychotics (5)

A 
Haloperidol
Fluphenazine
trifluperazine
thiothixene
loxapine
65
Q

Low potency typical anipsychotics (2)

A

Chlorpromazine

thioridazine

66
Q

Atypical antipsychotics (5)

A 
clozapone
olanzapine
risperidone
quetiapine
apripiprazole
67
Q

low potency antipsychotics typically have what side effects compared to high potency (4)

A

antimuscarinic

High potency has

  • extrapyramidal symptomsand
  • risk of neuroleptic malignant syndrome
  • endocrine dysruptino - hyperprolactinemia
68
Q

Uses of typical antipsychoitcs(4)

A

Schizophrenia
agitation
touretts -fluphenazine
acute mania

69
Q

Timeline of HP typical antipsychotics

A

initially
-acute dystonia
-toricollis (twisting head movement)
(treat w/ antimuscarinics - >benztropamine)

1 month
- akensia

2 months

  • bradykinesia
  • akathriesis (restless)

4 months tardive dyskenisa

70
Q

Tardive dyskeneisa presentation

Rx?

A

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

71
Q

Neuroleptic malignant syndrome presentation (6)

Rx (2)

A

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)

72
Q

Atypical antipsychotic use over typical

side effect profile due to?

A

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

73
Q

biggest risk of one atypical antipsychotic

A

Clozapine and agranulocytosis
- need weekly checks

also in general have weigh gain

74
Q

which atypical antipsychotic is their increased risk of metabolic disorder and DM

A

Olanzaprine

75
Q

mania characterized by what symptoms

must last how long?

A

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

76
Q

hypomania differs from mania how?

A

less severe symptoms in that it does not impair functioning

only needs to present for 4 days

77
Q

Bipolar Type I vs Bipolar Type II

A

Type I - Episode of Mania w or w/o depression

Type II hypomania w/ depression

78
Q

Cyclothymic disorder

Timeline?

A

hypomania and minor depression over the course of 2 years

only 2 months a normal mood allowed

79
Q

Rx for Bipolar (3)

A

Lithium

Antipsychotics - atypical

  • Apiprazole
  • Olanzapine
  • Risperidone

Anti epileptics

  • valproic acid
  • carbamazapine
  • lamotrigune
80
Q

Lithiums side effects(7)

A 
tremors
teratogen - ebsteins anomaly
heart block
polyuria - ADH antagonist -> nephrogenic DI
Sedation
hypothyroidism
goiter

Narrow TI

81
Q

Diagnosis of Depression (9)

A

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
82
Q

When symptoms of depression last at least 2 years this calls

A

persistent depressive disorder

can’t be non depressed > 2months during that time
may only be minor

83
Q

Atypical depression is (4)

A

The most common subtype of depression

  • Hyperphagia
  • Hypersomnia
  • Mood reactivity
  • rejection hypersensitivity
84
Q

Seasonal pattern sub type of depression you need to have

A

2 years of temporal changes in mood w/ 2 MDD in that time

Responds positively to light

85
Q

peripartum subtype of depression diagnosis

A

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

86
Q

electroconvulsive therapy indications(3)

Side effects (2)

A

refractive depression, pregnancy, catatonic schizophrenia

Retrograde/anterograde memory loss that resolves in 6 months

disoreintation

87
Q

Risk factors for completing suicide(10)

A

SAD PERSONS

Sex - male
Age - 45
Depression
Prior attempts
Ethanol
Rational thought absent
Sickness (chronic)
Organized plan
No social support
Stated attempt
88
Q

SSRIs are used for what other than depression? (6)

A 
GAD
panic disorder
bulimia- fluoxitine
OCD
social phobias
PTSD
89
Q

Serotinin syndrome is due to?

presents as? (5)

A

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
90
Q

RX for seratonin syndrome

A

Benzodiazapines and cooling

91
Q

Side effects of SSRIs(2)

A 
sexual dysfunction
Serotonin syndrome (excess -> autonomic instab, neuro muscular changes, mental status changes)
92
Q

SNRIs (3)

A

cymbalata
venlafaxine

milacipran - fibromyalgia only

93
Q

SSRIs(4)

A

fluoxetine
paroxetine
citalopram
sertraline

94
Q

Clinical use of SNRIs in addition to depression (2)

A

GAD

duloxetine - diabetic peripheral neuropathy/fibromyalgia

95
Q

SFX w/ SNRIs(3)

A

Increased BP
stimulent -> increased NE
sedation and nausea

96
Q

TCA(7)

A 
Amitriptyline
nortriptyline
imipramine
desipiramine
clomipramine
doxepin
amoxapine
97
Q

Other uses of TCAs other than depression

A

fibromyalgia
-amytriptyline

OCD
-clomipramine

bedwetting
-imipramine

98
Q

Side effects of TCAs(4)

A

sedation

Alpha 1 blocking
- hypotension

Antimuscarinic

  • dry mouth
  • sedation
  • tachy
  • urinary retention

Overdose - convulsions, Coma, cardiotoxicity

99
Q

TCA overdose be concerned w/ (6)

Rx

A

Cardiotoxicity
Convulsions
coma

fever,
confusion/hallucinations
respiratory depression

Rx: NaHCO3 (alkalize the urine)

100
Q

MAOi(4)

A

trancyproamine
Phenelzine
isocarboxazid
selegiline (MAOI B for Parkinsons rx)

101
Q

What is tyramine and why is it a bad idea w/ MAOIs?

A

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)

102
Q

Medication primary used for insomnia but may cause priaprism

A

Trazadone a tetracyclic

103
Q

Antidepressant of choice that may increase appetite

A

Mirtazapine an alpha 2 antagonist tetracyclic

104
Q

medication that increases dopamine and NE

A

buproprion

  • good choice for those convened w/ side effects
  • aslo smokers
105
Q

Buproprion carries an increase risk w/ what patients

A

those prone to seizures

-bulemics

106
Q

Toxicity w/ mirtazapine (3)

A

sedation
increased hunger
dry mouth

107
Q

Rx for Panic Disorder (4)

A

Cognitive behavioral therapy

beta blockers
benzos
SSRI

108
Q

Panic disorder described as (2)

A

recurrent panic attacks

anxiety of future panic attacks

109
Q

Agoraphobia

A

anxiety w/ fear of open places

110
Q

Social anxiety disorder

A

exaggerated fear of embarrassment in social situations
- public speaking, bathrooms
Rx w/ beta blockers or SSRIs

111
Q

Obsessive compulsive disorder presents as

Rx?(2)

A

recurrent intrusive thoughts or obsessions that are relieved by ritualized actions or compulsions

SSRI and clomipramine (TCAs)

112
Q

PTSD and timeline

A

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

113
Q

Acute stress disorder

A

like PTSD but lasts only 2 days - 1 month; longer is PTSD

114
Q

Generalized anxiety disorder presents as?

Timeline

A

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

115
Q

Adjustment disorder timeline

A

emotional symptoms causing impairment due to an identifiable event - divorce, illness

lasts less than 6 months;

> 6 months in presence of chronic stressor

116
Q

Malingering

A

playing the sick role for secondary gain (time off money)

The motivation is conscious and has poor compliance in treatment

117
Q

Factitious disorder (2 types)

A

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)
118
Q

Somatic symptom disorder

timeline

A

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

119
Q

Conversion

A

Sudden loss of Voluntary sensory or motor function (NOT PAIN); can be paralysis, blindness, mutism, pseudosiezures

Patient is aware but may be indifferent

120
Q

Illness anxiety disorder

A

new name for hypochondriacs

121
Q

Body dysmorphic disorder

A

preoccupation with perceived defects in normal anatomy that leads to significant emotional distress

122
Q

unacceptable feelings and thoughts are expressed through actions

A

acting out

123
Q

temporary drastic change in personality, memory or conscious to avoid emotional stress

A

dissociation

can lead to dissociative identity disorder

124
Q

avoidance of awareness of a painful reality

A

denial

125
Q

avoided ideas and feelings are transferred to some neutral object or person

A

displacement

126
Q

remaining at a more childish level of development

A

fixation

127
Q

modeling behavior of someone perceived as more powerful

A

identification

128
Q

separation of feelings from ideas and events

A

isolation

war vet and cold details

129
Q

unacceptable thoughts and actions are perceived to be held by others

A

projection

if I’m racist so are you

130
Q

proclaiming logical reasons for action to avoid self blame

A

rationalization

131
Q

ideas that are distressing are replaced by or warded off by actions (unconsciously) to the opposite

A

reaction formation

132
Q

turning back the maturational clock to an earlier stage

A

regression

133
Q

involunary (unconscious) withholding of an idea or feeling to prevent anxiety

A

repression

suppression is voluntary

134
Q

categorizing people as either all bad or all good

A

splitting

seen in borderline patients

135
Q

guilty feelings alleviated by unsolicited generosity to others

A

altrusism

136
Q

appreciating amusing nature of an anxiety producing event

A

humor

137
Q

replacing an unacceptable behavior with socially acceptable alternatives to release tension w/out violating morality

A

sublimation

conscious of action (vs reaction formation)

138
Q

holding back adverse thought consciously to stop interference with function

A

suppression

vs repression which is unconcious

139
Q

Schizoid personality disorder

A

avoids social circumstance and likes it that way

A

140
Q

Paranoid personality disorder

A

consistent beliefs of persecution and distrust. Uses a lot of projection

A

141
Q

Schizotypal personality disorder

A

odd behavior and beliefs, eccentric or magical thinking
may be avoidant in addition but not predominant

A

142
Q

Antisocial personailty disorder

A

lack of empathy, persistent disregard and violation of the rights of others
<18 - conduct disorder

B

143
Q

Histrionic personality disorder

A

easily excitable, and emotional, attention seeking and sexually provocative

B

144
Q

Borderline personality disorder

A

unstable mood and relationships, impulsive, self mutilationand boredom

commonly uses splitting

B

145
Q

Narcisstic

A

grandiosity and sense of entitlement, low empathy

B

146
Q

Avoidant personality disorder

A

hypersensitivity to rejection and socially inhibited timid, feeling of inadequacy; Desires relationships with others

social anxiety disorder is fear of embarrassment

147
Q

obsessive compulsive personality disorder

A

preoccupation with order, perfection and control, egocentric (vs disorder -> ritualized habits to relieve obsessions)

148
Q

Dependent personality disorder

A

submissive and clinging, excessive need to be taken crd of, low self confidence

USLME Kiss my ass and pray (33 decks)

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