Psych Exam 2 Flashcards
dispositional crises
acute response to an external situational stressor
crises of anticipated life transitions
normal life-cycle transition that may be anticipated but over which the individual may feel lack of control
crises from traumatic stress
unexpected, external stressor
maturational/developmental crises
unresolved conflicts in life
psychiatric emergency
general functioning has been compromised and the individual is incompetent or unable to assume personal responsibility
signs of anger
frowning, clenched fists, low-pitched voice, easily offended, etc (refer to lecture notes if you need more!)
signs of aggression
pacing, threats, loud voice, panic, etc (refer to lecture notes if you need more!)
factors for assessing violent behavior
past history of violence, client diagnosis, current behaviors
common diagnoses associated with violence
substance abuse, schizophrenia, mood disorders, dementia, personality disorders
prodromal syndrome
current behaviors that are predictive of impending violence- rigid posture, grim, arguing, pounding & slamming
substance abuse according to DSM-IV TR
evidence of tolerance, withdrawal, and a great deal of time is spent obtaining the substance, using, recovering, and daily activities are compromised
what Erikson stage are substance abusers in?
identity vs. role confusion
what Freud stage are substance abusers in?
oral
phase 1 of alcoholism
prealcoholic phase- alcohol used to relieve everyday stress and tensions of life
phase 2 of alcoholism
early alcoholic phase- begins with blackouts, alcohol is now required by person
phase 3 of alcoholism
crucial phase- person has lost control
phase 4 of alcoholism
chronic phase- emotional and physical disintegration; more intoxicated days than sober days
acute alcoholic myopathy
vitamin B deficiency; muscle pain, swelling, weakness, red urine
chronic alcoholic myopathy
gradual wasting and weakness in skeletal muscles
Wernicke’s encephalopathy
most serious form of thiamine deficiency in alcoholics
Korsakoff’s psychosis
syndrome of confusion, loss of recent memory
alcoholic cardiomyopathy
enlargement of heart and weakened
acute pancreatitis with alcoholism
occurs one to two days after binge
chronic acute pancreatitis with alcoholism
leads to pancreatic insufficiency; steatorrhea (fatty stools), diabetes, malnutrition
cirrhosis
end stage of alcoholic liver disease caused by long term alcohol use
esophageal varices
veins in esophagus become distended
alcohol intoxication occurs at
100-200 mg/dL
alcohol withdrawal occurs
within 4-12 hours of cessation or reduction in heavy alcohol use
CAGE
have you ever felt the need to Cut down on drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about your drinking? Have you ever had a drink first thing in the morning (Eye opener)
Disulfiram (Antabuse)
drug that makes you sick or can even cause death is copious amounts of alcohol is consumed
psychopharmacology for alcohol
benzodiazepines, anticonvulsants, thiamine
CNS depressant psychopharmacology
will bring you up- luminal, benzodiazepines
CNS stimulant psychopharmacology
will bring you down- tranquilizers, anticonvulsants, antidepressants
what part of the brain controls appetite?
hypothalamus
anorexia commonly occurs when in life?
12 to 30 years of age
bulimia commonly occurs when in life?
late adolescence or early adulthood
which is more popular? Anorexia or bulimia?
bulemia
anorexia
gross distortion of body image, preoccupation with food, refusal to eat
bulemia
compulsive, rapid ingestion of foods and then binging, most individuals are within normal weight range
phase one of schizophrenia
premorbid phase- social maladjustment, withdrawal, irritability, antagonistic thoughts and behaviors
phase two of schizophrenia
prodromal phase- deterioration in role functioning, social withdrawal, sleep disturbances
phase three of schizophrenia
schizophrenia- treatment usually begins here, delusions, impairment in daily life
phase four of schizophrenia
residual- usually post treatment, symptoms similar to prodromal phase, flat affect
biochemical influence in schizophrenia
dopamine- for all psychosis
biochemical influence in depression
serotonin
downward drift hypothesis
poor social conditions are seen as a consequence of, rather than a cause of, schizophrenia
disorganized schizophrenia
silliness and inappropriate giggling
catatonic stupor schizophrenia
extreme psychomotor retardation; patient usually mute and posturing is common
catatonic excitement schizophrenia
extreme psychomotor agitation; purposeless movements that must be monitered
paranoid schizophrenia
delusions of persecution or grandeur, auditory hallucinations
undifferentiated schizophrenia
does not meet criteria outlined for the other types of schizophrenia
schizoaffective disorder
schizophrenia with mood disorder
brief psychotic disorder
mostly occurs from substance abuse, symptoms persist less than one month and then returns to premorbid level of functioning
schizophreniform disorder
at least one month of symptoms, but fewer than six months
erotomanic delusion
believes someone of higher power is in love with them
grandiose delusion
irrational ideas of own worth, talent, knowledge, or power (I am batman, I am the president)
jealous delusion
irrational idea that sexual partner is unfaithful
persecutory delusion
believes he or she is being treated malevolently
somatic delusion
irrational belief that he or she has some type of physical defect, disorder, or disease
shared psychotic disorder
folie a deux- relationship with a person who already has a psychotic disorder with prominent delusions
delusions
positive- false personal beliefs
magical thinking
positive-his or her thoughts have control over specific situations or people
associative looseness
positive- shift of ideas from one unrelated topic to another
neologisms
positive- made up words that only have meaning to client
concrete thinking
positive- literal interpretations of the environment (it’s raining cats and dogs)
clang associations
positive- choice of words is associated with rhyming
word salad
positive- groups of words put in random fashion
circumstantiality
positive- delay in reaching point of communication because of unnecessary details
tangentiality
positive- inability to get to the point of communication due to introduction of new topics
mutism
positive- not speaking
perseveration
positive- persistent repetition of same word or idea in response to different questions
hallucinations
positive- not associated with real external stimuli
illusions
positive- misperceptions of real external stimuli
inappropriate affect
negative- emotions are incongruent with circumstances
bland or flat affect
negative- weak emotional tone
apathy
negative- lack of interest in environment
echolalia
negative- repeating words that are heard
echopraxia
negative- repeating movements that are observed
identification and imitation
taking on form or behavior one observes in another
depersonalization
feeling of unreality
emotional ambivalence
coexistence of opposite emotions toward same object, person, situation
autism
focus inward on fantasy world while distorting or excluding the external environment
waxy flexibility
passive yielding of all movable parts of the body to any effort made at placing them in certain positions
posturing
voluntary assumption of inappropriate/bizarre postures
anhedonia
negative- inability to experience pleasure
individual psychotherapy
long term- not good for psychotic
Assertive Community Treatment (ACT)
team approach in providing comprehensive psychiatric treatment, open 24 hours a day, 365 days a year
typicals
dopamine blockers, sedate
atypicals
weak dopamine blockers, less side effects, usually used for first time treatment
Thorazine
typical- antipsychotic
Haldol
typical- antipsychotic
Abilify
atypical- antipsychotic
Saphris
atypical- antipsychotic
Clozaril
atypical- antipsychotic; report weekly to have blood levels drawn to obtain weekly supply of drug
Fanapt
atypical- antipsychotic
Zyprexa
atypical- antipsychotic
Invega
atypical- antipsychotic
Seroquel
atypical- antipsychotic
Risperdal
atypical- antipsychotic
Geodon
atypical- antipsychotic
agranulocytosis
white blood cells can drop to very low levels; common with clozapine & typical meds
anticholinergic effects
dry mouth, blurred vision, constipation, urinary retention- more common with clozapine & typical meds
tardive dyskinesia
bizarre facial and tongue movements, difficulty swallowing, more common with typical meds & clozapine
neuroleptic malignant syndrome
observe for parkinsonian symptoms- more common with typical meds
depression levels off for women & men between the ages of
44 and 65
seasonality
more prevalent in spring and fall
major depressive disorder
symptoms for at least two weeks, no history of manic behavior
dysthymic disorder
mild, outpatient, chronically depressed mood for most of the day and for at least two years
learned helplessness
repeated failure to control life, leading to defeat and dependence on others
under age 3 depression
feeding problems, tantrums, lack of playfullness
ages 3 to 5 depression
accident proneness, phobias, excessive self-reproach
ages 6 to 8 depression
physical complaints, aggressive, clinging
ages 9 to 12 depression
morbid thoughts and excessive worrying
SSRI
first line of defense for depression, anorexia, bulimia, OCD, suicide, Hypochondriasis, body dysmorphic disorder- watch for serotonin syndrome, usually continued for six months and then reevaluated
transient depression
not necessarily dysfunctional, feeling the blues, some difficulty getting one’s mind off of disappointments
mild depression
normal grieving
moderate depression
helpless, powerless, retarded thinking process
severe depression
despair, worthlessness, flat affect, apathy, anhedonia, curled up position
what age groups are at high risk for suicide?
over 50 years of age and adolescents
Celexa
SSRI
Prozac
SSRI
Sarafem
SSRI
Paxil
SSRI
Zoloft
SSRI
Nardil
Monoamine Oxidase Inhibitor (MAOIs)
Parnate
Monoamine Oxidase Inhibitor (MAOIs)
MAOIs
can’t use with anything else, typically not a first line of defense
tricyclics
lowers BMR
unilateral ECT
less memory loss, less affective
bilateral ECT
more memory loss, more affective
bipolar I
mania
bipolar II
depression
cyclothymic disorder
hypomania and depressed, at least two year duration
what class of individuals is more likely to have bipolar disorder?
higher social classes
FIND
child scale to determine bipolar disorder: Frequency- symptoms occur most days of the week, Intensity- symptoms are severe enough to interfere with life, Number- symptoms occur 3 to 4 times a day, Duration- symptoms occur 4 or more hours a day
lithium
drug of choice for bipolar disorder- salt competes with sodium levels
atypical antipsychotic
used for noncompliance of patient with lithium
stage one bipolar
hypomania- not sufficiently severe, cheerful and expansive
stage two bipolar
acute mania- euphoria, excessive psychomotor, sexual interest, bizarre dress
stage three bipolar
delirious mania- severe clouding of consciousness, rare due to antipsychotic meds
why would you use antidepressants with care?
if person is severely depressed, antidepressant could give them enough energy to follow through on suicidal or dangerous behaviors
therapeutic range for lithium
.5-1.5 mEq/L
lithium
antimanic
Tegretol
anticonvulsant, mood stabilizer
Depakene
anticonvulsant, mood stabilizer
Depakote
anticonvulsant, mood stabilizer
generalized anxiety disorder
chronic, unrealistic, and excessive anxiety and worry
agoraphobia
fear of being in places and situations where escape might be difficult
obsessions
unwanted. intrusive, persistent ideas, may be associated with anxiety disorders
compulsions
unwanted repetitive behavior patterns or mental acts that are intended to reduce anxiety, not to provide pleasure or gratification
why do you need to wean client off of benzodiazepines and SSRIs slowly?
tolerance and addiction
systematic desensitization
client is gradually exposed to the phobic stimulus
implosion therapy
flooding- must imagine or participate in situations that they are scared of for extended amounts of time and relaxation technique is not part of this
Xanax
benzodiazepine
Klonopin
benzodiazepine
Valium
benzodiazepine
Ativan
benzodiazepine
why would we give an antihypertensive med to an anxious patient?
beta blocker to slow heart rate and blood pressure
PTSD treatment
benzodiazepine to SSRI
somatization disorder
perceiving an illness, disorder is chronic, substance abuse common
primary gain
client avoids unpleasant activity
secondary gain
symptoms promote emotional support or attention (sympathy)
tertiary gain
physical symptom may take such a position that the real issue is disregarded and remains unresolved (their life now revolves around issue)
hypochondriasis
believing you had a disease, anxiety, depression, OCD, antidepressant
la bella indifference
lack of concern that is out of keeping with the severity of the impairment- clue to physicians that problem is psychological, rather than physical
localized amnesia
inability to recall all incidents associated with the traumatic event for a specific period following the event
selective amnesia
inability to recall only certain incidents associated with traumatic event for a specific period following the event
continuous amnesia
inability to recall events occurring after a specific time up to and including the present
generalized amnesia
inability to recall anything that has happened during the individual’s entire lifetime
systematized amnesia
inability to recall events relating to a specific category of information, such as one’s family or one particular person or event
dissociative fugue
sudden, unexpected travel away from home or workplace and individual is unable to recall personal identity and assumption of a new identity is common
dissociative identity disorder (DID)
existence of two or more personalities with a single individual
depersonalization disorder
detachment from oneself or observing oneself from outside the body
depersonalization
disturbance in the perception of oneself
derealization
alteration in the perception of the external environment
Topamax
Anticonvulsant, mood stabilizer
Librium
Benzodiazepine
Restoril
Benzodiazepine
Luvox
SSRI
Lexapro
SSRI
Wellbutrin/Zypan
Tricyclic
Remeron
Tricyclic
Deseryl
Tricyclic
Effexor
Tricyclic
Buspar
Anxiolytic
symptoms of alcohol withdrawal
tremors in hands, nausea, tachycardia, anxiety, etc
symptoms of CNS stimulant withdrawal
cocaine & amphetamines: insomnia, vivid dreams, increased appetite, psychomotor retardation
Benzodiazepine
Anxiety, substance abuse, PTSD, phobia
symptoms of opioid withdrawal
heroin: nausea, muscle aches, diarrhea, fever
