Psych First Aid Flashcards
What is classical conditioning?
Learning in which a natural response is elicited by a conditioned or learned stimulus that was previously coupled to an unconditioned stimulus
Ex. Salivation (natural response) elicited by bell ringing (learned stimulus) that was previously coupled to food (unconditioned stimulus)
What is operant conditioning?
Learning in which a particular action is elicited because it produces a punishment or reward, this usually deals with a voluntary response (Types are: positive reinforcement, negative reinforcement, punishment, extinction)
What is positive reinforcement?
Action for a desired reward (mouse pushes button to get food)
What is negative reinforcement?
Target behavior is followed by removal of the aversive stimulus (mouse now pushes button to turn off a loud ass sound)
What is punishment?
Repeated application of aversive stimulus to remove unwanted behavior
What is extinction?
Discontinuation of all reinforcement (positive and negative) that will eventually eliminate behavior. Can occur in both operant and classical conditioning.
What is transference?
Patient projects feelings about formative or important person to doc
What is countertransference?
Doc projects feelings about formative or important person to patient
What are ego defenses?
Unconscious mental processes used to resolve conflict and prevent undesirable feelings.
What is acting out?
Expressing unacceptable feelings and thoughts through actions (tantrum)
What is dissociation?
Temporary drastic changes in personality/memory/consciousness/motor behavior to avoid an emotional stress
What can happen with extreme dissociation (ego defense)?
Dissociative identity disorder, a multiple personality disorder
What is denial?
Straight up avoiding the awareness of a painful reality (this is common in AIDS/cancer diagnosis)
What is displacement?
Transferring avoided ideas and feelings to neutral person/object (mom yelling at her kid because dad yelled at mom… FINISH YOUR VEGETABLES!!!)
What is fixation?
Partially remaining at a childish level of development (vs regression), this is like men fixating on sports games (dag gummit UT, when you gonna win a game?)
What is identification?
Modeling a behavior after another person who is more powerful (not necessarily admiration, example is an abused child who identifies with an abuser)
What is isolation (of affect)?
Separating feelings from ideas and events (ability to describe murder in detail with no emotional response, war vets…. Frank Underwood)
What is projection?
Attributing an unacceptable internal impulse to an external source (vs displacement) (A guy who wants to get with another girl says his girlfriend is cheating on him to break up with her and get his mack on)
What is rationalization?
Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self blame (claiming you didn’t like your car anyway after rear ending the shit out of someone)
What is reaction formation?
Replacing a warded-off idea/feeling by an (unconscious) emphasis on its opposite (A patient who is sexually promiscuous enters a monastery) (vs. sublimation)
What is regression?
Turning back the maturational clock and going back to earlier modes of ealing with the world (vs fixation) (This is seen with children under stress; bedwetting when hospitalize in a potty trained patient)
What is repression?
Involuntary withholding an idea or feeling from conscious awareness (vs. suppression) (not remembering a conflict or experience)
What is splitting? What can it be seen in?
Believing that people are all bad or all good due to intolerance of ambiguity, can be seen in borderline personality disorder
What are the mature ego defenses?
Sublimation, Altruism, Humor, Suppression (Mature adults wear a SASH)
What is Sublimation?
Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s values (vs. reaction formation)… Simpler: Using anger toward something (certain professors) as motivation to do well on a test (taking a negative to a positive, society likes this)
What is Altruism?
Alleviating guilty feelings by unsolicited generosity toward others (Mafia boss donates to charity)
What is Humor?
Appreciating the amusing nature of an anxiety-provoking or adverse stimulations (Nervous M2’s make a joke of how much shit there is to know for STEP 1)
What is suppression?
Intentional withholding of an idea or feeling from conscious awareness (vs. repression is voluntary vs involuntary; vs. denial is the fact that in denial you think it never happened, here you know it happened/will happen) (Choosing not to worry about studying for step until March 15th - MISTAKE!)
DIT Bonus: What is blocking?
Temporary inhibiting thinking about continuing to build more tension (word for word); Seen in schizos
DIT Bonus: What is anticipation? (mature defense)
Realistically planning for a future discomfort
DIT Bonus: What is intellectualization?
Uses intellectual processes to avoid affective expression
DIT Bonus: What is a schizoid fantasy?
Avoiding interpersonal intimacy to resolve conflict and receive gratification
DIT Bonus: What is escapism?
Having a completely different life pretty much; think about TV and video games (World of Warcraft)
What are the effects of infant deprivation?
Long term deprivation of affection result in: decreased uncle tone, poor language/social skills, lack of basic trust, anaclitic depression, weight loss, and physical illness (4 W’s mnemonic)
What are the 4 W’s of infant deprivation?
Weak, Wordless, Wanting, Wary
How long does it take for irreversible changes in infant deprivation? What can result from severe deprivation?
> 6 months, infant death
What are the two types of child abuse?
Physical and Sexual?
As a physician what is your responsibility in child abuse?
You are legally obligated with the SUSPICION of child abuse to report the abuse in an effort to keep the child from being sent home with an abuser
What is some evidence of physical abuse?
Healed fractures on xray (think locations like scapula and ribs and big bones; kids break weak bones all the time from playing, not these bones - SPIRAL FRACTURES), burns (cigarettes/scalding), patten marks/bruising (from an object), retinal hemorrhage/detachment, subdural hematoma (crescent shape; I like my babies shaken; bridging vein rupture)
Who is usually the abuser in a physical abuse case?
Biological mother (most children are <3)
What is some evidence of sexual abuse?
Genital, anal, or oral trauma; STD’s/UTI’s
Who is usually the abuser in a sexual abuse case?
Someone known to victim (not necessarily dad), and male (peaks around 9-12 yrs old)
What is child neglect?
Failure to provide a child with adequate food, shelter, supervision, education, and/or affection; it is the MC type of child abuse
Do you report child neglect?
Fuck you if you don’t
What is some evidence of child neglect?
Poor hygiene, malnutrition, withdrawal, impaired social/emotional development, failure to thrive
What are the childhood and early onset disorders?
ADHD, conduct disorder, oppositional defiant disorder, tourette syndrome, separation anxiety disorder, and trichotillomania (DIT Bonus!)
When does ADHD start by?
Onset before Age 12
What is ADHD?
Limited attention span and poor impulse control; hyperactivity, impulsivity, and/or inattention in multiple settings. No mental retardation but still coexists with difficulty at school. Continues into adulthood in 1/2 of individuals (100% of med students)
What brain findings are associated with ADHD?
Decreased frontal lobe volume/metabolism
What is the treatment of ADHD?
Seek to increase NE so; Methylphenidate/Amphetamines (increase NE release), atomoxetine (SNRI), and behavioral interventions
What is conduct disorder? What happens if it persists past age 18?
Repetitive and pervasive behavior violating the basic rights of others; after age 18 they will fit criteria for Antisocial Personality Disorder (only difference is age)
What is oppositional defiant disorder?
Enduring pattern of hostile, defiant behavior toward authority figures int he absence of serious violations of social norms
What is the difference between conduct disorder and oppositional defiant disorder?
CD = HARM ODD = NO HARM
When does tourette syndrome start?
Onset before 18 (can’t claim this when you yell out the wrong answer on rounds anymore)
What is tourette syndrome characterized by?
Sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for GREATER THAN 1 YEAR.
What is the shouting of obscenities in tourettes?
Coprolalia (not too common, 10-20%, and it also literally means excrement mouth)
What diseases is tourettes associated with?
OCD and ADHD
What is the treatment for tourettes?
Antipsychotics and behavioral therapy
Antipsychotics block dopamine D2 (increase cAMP); Fluphenazine, Pimozide, Tetrabenazine
What is separation anxiety disorder? When does it begin?
Common onset at 7-9 years. Overwhelming fear of separation from home/loss of attachment figure. Can lead to faking sick to stay home from school.
What is the treatment for Separation anxiety?
SSRI’s, relaxation techniques, behavioral interventions
What is trichotillomania?
Compulsive hair puling MC in young girls (do not confuse with allopecia areata); you will see hairs of varying length
How do you treat trichotillomania?
Education, behavioral therapy, SSRI (Fluoxetine), TCA (Clomipramine)
What are pervasive developmental disorders?
Difficulties with language and failure to acquire/early loss of social skills (Autism/Rett disorder)
What is Autism?
Child “living in their own world”, symptoms must be evident PRIOR TO AGE 3 w/ lack of responsiveness to others, impaired communication, peculiar repetitive rituals, fascination with mundane objects, and may or may not be accompanied by intellectual disability (MC in boys, rare to be a savant)
What is childhood disintegration?
Normal development until about age 2, then regression…. so close
What is Rett disorder and inheritance?
X-linked exclusively in girls (affect males will die in utero or shortly after). Symptoms age 1-4, regression leading to loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand wringing (ALL DAMN DAY LONG); slowed head growth from age 5mo-4yrs (DIT bonus fact)
What are the NT changes of Alzheimers?
decreased ACh
What are the NT changes of Anxiety?
Increased NE; Decreased GABA + 5-HT
What are the NT changes of Depression?
Decreased NE + 5-HT + Dopa
What are the NT changes of Huntington?
Increased Dopa; Decreased GABA + ACh
What are the NT changes of Parkinson?
Increased 5-HT + ACh; Decreased Dopa
What are the NT changes of Schizophrenia?
Increased Dopa
Why is knowing NT changes important?
Makes the pharmacology a shitload easier
What is orientation?
The ability for a person to know who you are and where they are.
What is the order of loss of orientation?
Time –> Place –> Person –> Situation (AOX3 is normal, 4 is extra)
What is retrograde amnesia?
Inability to remember before the event
What is anterograde amnesia?
Inability to remember after the event (no new memory)
What is Korsakoff amnesia?
Classic anterograde amnesia caused by thiamine deficiency and the associated destruction of maxillary bodies, can include some retrograde, seen in alcoholics and associated with confabulation
What is Dissociative amnesia?
Inability to recall important personal information, usually subsequent to severe trauma or stress (can be associated w/ fugue)
What is dissociative fugue?
Abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances (war, natural disaster, etc)
What is Aspergers?
A mild form of Autism characterized by normal intelligence with decreased social skills; they have all absorbing interests, and will always have problems with relationships
What are cognitive disorders?
Significant change in cognition (memory, attention, language, judgement) from previous level of functioning, associated w/ CNS abnormalities, a general medical condition, medication, or substance use. Delirium and Dementia.
What timeframe is Delirium?
Rapid/Acute
What is Delirium characterized by?
A “Waxing and waning” level of consciousness w/ acute onset; rapid decrease in attention span and level of arousal. REVERSIBLE AND ACUTE
What are the symptoms of delirium?
Disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep cycles; patient has an abnormal EEG
What causes delirium?
Usually secondary to another illness, it is the MC inpatient setting (called “ICU psychosis”)
What is the treatment of delirium?
Treat the underlying concern; optimize brain condition (O2, hydration, pain), and Antipsychotics = Haloperidol (inverse agonist of dopamine)
What two causes should you check for in a delirious patient?
Drugs (Diphenhydramine = anticholinergic = MAD AS A HATTER) and UTI’s
What is the T-A-DA approach to the management of a delirious patient?
Tolerate, Anticipate, Don’t Agitate
What is dementia?
It is a GRADUAL loss in intellectual ability that does not affect the level of consciousness
What is dementia characterized by?
Memory oss, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement, loss of executive function
Can a patient w/ dementia develop delirium?
Yes, dementia isn’t a gain of function disease, but for real, example: a patient with alzheimer disease who develops pneumonia is at increased risk for delirium
What is the MCC of dementia in the elderly?
Alzheimers
What causes of dementia are always irreversible?
Alzheimers, Lewy Body Dementia, Huntington, Pick Disease, infarcts, CJD, chronic substance abuse
What causes of dementia can be reversible if caught?
NPH, vitamin B12 def, hypothyroidism, neurosyphilis, HIV (partially)
Is dementia normal?
NO! It is NOT normal but is common as you age
What common thing can present like dementia in the elderly?
Depression - they start to lose things and have decreased performance
What is psychosis?
A distorted perception of reality characterized by delusions, hallucinations, disorganized thinking, or illusions (DIT BONUS!); Can occur in patients with medical/psychiatric illness or both
What is a hallucination?
Perceptions in the absence of stimuli (seeing something that isn’t there at all)
What is a delusion?
Unique, false beliefs about oneself or others that persist despite facts (aliens trying to communicate with you)
What is disorganized speech?
Words and ideas strung together based on sounds, puns, or “loose associations”. (doritos –> dori from finding nemo –> ellen degeneres –> hates penis…. therefore, penis)
What is an illusion?
Something that is there but is misinterpreted.
What are the types of hallucinations?
Visual auditory, olfactory, gustatory, tactile, hypnagogic, hypnopompic
What is visual hallucination more commonly a feature of?
Medial illness/dementia
What is auditory hallucination more commonly a feature of?
Psychiatric illness
What is olfactory hallucination associated with (Specifically burnt rubber)?
Psychomotor epilepsy (rubber) and brain tumors
What is tactic hallucination? When does it occur?
Common in EtOH withdrawal (formication = bugs crawling on skin) and cocaine abusers (cocaine crawlies)
What is hypnagogic hallucination?
Occur while GOing to sleep
What is hypnopompic hallucination
Occur while waking up (POMPous upon awakening)
What is schizophrenia?
A chronic mental disorder with periods of having psychosis, disturbed behavior and though, and decline in functioning that lasts MORE THAN 6 MONTHS (before this it is called other things).
What are the NT findings in schizophrenia? What is it associated with in the brain?
Increased Dopamine; Decreased dendritic branching
What does the diagnosis of schizophrenia require?
2 or more of the following: Delusions Hallucinations (usually auditory) Disorganized speech (loose associations) Disorganized/catatonic behavior Flat Affect, social withdrawal, lack of motivation, lack of speech or thought
What is the difference between positive and negative symptoms?
Positive symptoms ADD behavior, negative symptoms SUBTRACT behavior
What can contribute to the etiology of schizophrenia?
Genetics and environment, frequent cannabis use (teens), LSD, cocaine, amphetamines
DIT BONUS: In utero viral infectons, Toxin exposure, birth trauma
Who gets it more, men or women? blacks or whites? age of presentation differences?
Men = females
Blacks = whites
Men get it teens to early 20’s, females 20’s-30’s (10 year gap)
What are schizophrenic patients at an increased risk for?
Suicide
What brain findings are found on CT?
Brains are smaller w/ enlarged ventricles and thinner cortex
What is a brief psychotic disorder?
Subset of schizophrenia, lasts LESS THAN 1 MONTH and usually stress related
What is a schizophreniform disorder?
Same things as schizophrenia except 1-6 months duration
What is schizoaffective disorder?
AT LEAST 2 WEEKS of stable mood w/ psychotic symptoms, plus a major depressive, manic, or mixed episode; 2 subtypes = bipolar and depressive
What is a delusional disorder?
Fixed, persistent, untrue belief system lasting LONGER THAN 1 MONTH, functioning is otherwise not impaired (compared to schizophrenics who do have impaired function)
What is a shared psychotic delusion?
When a couple is delusional together (real fuckin cute ya’ll)
What is dissociative identity disorder?
Formerly known as multiple personality disorder; presence of 2 or more distinct identities or personalities, MC in women, associated w/ history of sexual abuse, PTSD, depression, borderline personality, and somatoform conditions (remember sex abuse here)
What is depersonalization/derealization disorder?
Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions…. “out of body experience”
What is a mood disorder?
Abnormal range of moods or internal emotional states and loss of control over them, severity causes distress and impairment in social and occupational function (Includes major depressive, bipolar, dysthymic, cyclothymic)
What is a manic episode?
Distint period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistent increased activity or energy lasting AT LEAST ONE WEEK
How do you diagnose a manic episodes?
remember that manics DIG FAST!! (3 of the following) Distractibility Irresponsibility (please w/o consequence) Grandiosity (I'm Jesus) Flight of ideas (racing thoughts) Activity/Agitation (goal oriented) Sleep (decrease) Talktativeness/pressure speech
What is a hypomanic episode?
Like manic except mood disturbance is not severe enough to cause marked impairment in social/occupational function, no need to hospitalize. No psychotic features. AT LEAST 4 CONSECUTIVE DAYS
What is bipolar I disorder?
Presence of at least 1 manic episode with/without a hypomanic or depressive episode
What is bipolar II disorder?
Presence of a hypomanic and depressive episode w/ a manic episode
Does the patient’s mood return to normal between bipolar episodes?
Yes
What can use of antidepressants lead to in a bipolar patient?
Increased Dopa, 5-HT, NE = increased mania
Are bipolar patients at high suicide risk?
Yes
What is the treatment for bipolar?
Mood stabilizers (lithium, valproic acid, carbamazepine and atypical antipyschotics)
What is cyclothymic disorder?
Dysthymia and hypomania, milder bipolar lasting AT LEAST 2 YEARS (notice there was no time frame for bipolar, just on the manic episode = 1 week)
What is major depressive disorder?
May be self-limited, with major depressive episodes LASTING 6-12 MONTHS
What are major depressive episodes characterized by?
AT LEAST 5 of the 9 symptoms of (SIG E CAPS + Depressed mood for 2 OR MORE WEEKS
What must symptoms of major depressive episodes include, regardless of how many SIGECAPS they get?
Patient reported depressed mood or anhedonia
What is SIGECAPS? (*= one of these required for Dx)
Sleep Disturbance Loss of Interest (adhedonia)* Guilt or feelings of worthlessness Energy loss and fatigue Concentration problems Appetite/weight changes (gain or loss) Psychomotor retardation/agitation Suicidal Idealations Depressed mood* (self reported)
What sleep changes are seen in depression?
Decreased: slow wave sleep, REM latency
Increased: REM early in sleep cycle, total REM
Repeated nighttime awakenings, early-morning awakening (important screening question)
What is persistent depressive disorder? (Dysthymia)
Depression, milder, AT LEAST 2 YEARS
What is seasonal affective disorder?
Symptoms associated with seasons, improves w/ full spectrum light (don’t forget to go outside)
What is atypical depression?
Differs from classical b/c it is characterized by mood reactivity, so you are able to experience a brief improved mood in response to positive events; “reversed vegetative” = hypersomnia and weight gain; leaden paralysis; and long standing interpersonal rejection sensitivity
Is atypical depression common?
Yes, it’s the most common subtype
What is the treatment of atypical depression?
MAO inhibitors and SSRI’s
What is the timeframe for postpartum mood disturbances?
Within 4 weeks
What is Maternal (postpartum) blues?
50-85% incidence = depressed affect, tearfulness, and fatigue usually 2-3 DAYS AFTER deliver and RESOLVES WITHIN 10 DAYS
What is tx for maternal postpartum blues?
Supportive (3 hugs) and f/u to assess for postpartum depression
What is postpartum depression?
10-15% incidence = depressed affect, anxiety, poor concentration starting 4 weeks after delivery and LASTS 2 WEEKS TO A YEAR+
What is tx for postpartum depression?
Antidepressions/psychotherapy
What is postpartum psychosis?
.1-.2% incidence rate (but will probably be overrepresented on multiple choice tests…) = delusions, hallucinations, confusion, unusual behavior, and possible homocidal/suicide attempts LASTS DAYS TO 4-6 WEEKS
What is tx of postpartum psychosis?
Antipsychotics, antidepressants, possible inpatient hospitalization
What must you check for in postpartum psychosis?
Child Safety! Mom is fuckin nuts!
What is normal bereavement?
Normal bereavement characterized by shock, denial, guilt, and somatic symptoms. Duration can vary, up to 6-12 months.
What are some symptoms of normal bereavement?
Simple hallucinations (hearing name called), depressive symptoms, delusions, and hallucinations
What does pathologic grief include?
Intense grief, prolonged (>6-12 mo.); or grief that is delayed, inhibited, or denied. You may experience depressive symptoms, delusions, and hallucinations.
What is ECT a treatment option for? What is it?
Treatment for major depressive disorder refractory to other treatment and for pregnant women with major depressive disorder… Also consider when immediate response is necessary (suicide). It produces a painless seizure in a knocked out patient
What are adverse effects of ECT?
Disorientation, temporary h/a, and partial/retrograde amnesia usually resolving in 6 months
What are the risk factors for suicide? (mnemonic)
SAD PERSONS kill themselves
Sex (females try more, men succeed more)
Age (45)
Depression
Previous attempt
Ethanol or drug use
Rational thinking loss
Sickness (illness/3 or more Rx meds)
Organized plan to do it
No spouse/children
Social support lacking
Stated attempt ("I'm gonna do it!")What disorders/situations did DIT say were more likely for suicide?
Schizophrenia
Access to gun
Borderline personality disorder
Think about Dx of a new dz, especially cancer or something terminal
What is anxiety disorder?
Inappropriate experience of fear/worry and its physical manifestations when the source of the fear/worry is either not real or insufficient to account for the severity - interfere with daily functioning (panic disorder, phobias, generalized anxiety disorder)
What is panic disorder?
Defined by the pretense of recurrent panic attacks (intense fear and discomfort peaking in 10 minutes with 4 from the PANICS mnemonic)
What is the PANICS mnemonic for panic disorder?
Palpitations, Paresthesias
Abdominal distress
Nausea
Intense fear of dying/loss of control, lightheaded
Chest pain, chills, choking, disconnectedness
Sweating, Shaking, SOB
Symptoms are the manifestations of fear!
What is the diagnosis of Panic Disorder based on?
Attack followed by 1 month of 1 or more of the following: concern about attacks, worrying about consequences of attacks, behavioral changes related to attacks
What is the Tx for panic disorder?
Cognitive behavioral therapy, SSRI, venlafaxine, benzos
What can be used for a person afraid of public speaking?
Beta blockers; If asthmatic use cardioselective (A-M), otherwise propanolol works
What is a specific phobia?
Fear that is excessive or unreasonable and interferes with normal function, cued by presence or anticipation of a specific object/situation. The person knows the fear is excessive, tx with desensitization
What is a social anxiety disorder?
Exaggerated fear of embarrassment in social situations; tx with SSRI
What is agoraphobia?
Exaggerated fear of open or closed places, using public transport, being in line/crowds, leaving home alone
What is generalized anxiety disorder?
Uncontrollable anxiety for AT LEAST 6 MONTHS that is unrelated to anything
What is the treatment of generalized anxiety disorder?
SSRI, SNRI, Busiprone, cognitive behavioral therapy
What is adjustment disorder?
Emotional symptoms causing impairment following a psycosocial stressor (Divorse/illness) and lasting LESS THAN 6 MONTHS (diagnosis can be >6 months if the event is dragged on)
What is OCD?
Recurring intrusive thoughts, feelings, or sensations that cause severe distress and are partially relieved by performance of the actions. They are behaviors inconsistent with the person’s own beliefs (not the same as OC personality disorder)
What is the treatment of OCD?
SSRI and climipramine
What is body dysmorphic disorder?
Obsession with minor or imagined defect in appearance, leads to lots of surgical procedures and emotional distress that impairs functioning (somatic disorder)
What is PTSD?
Persistent reexperiencing of a previous traumatic event; can involve nightmares, flashbacks, fear, helplessness, horror. Leads to avoidance of stimuli that increase the arousal. MORE THAN 1 MONTH OF DISTURBANCE. Can begin any time after event.
What is treatment for PTSD?
Psychotherapy/SSRI
What is acute stress disorder?
PTSD but only between 3 days and a month
What are PTSD patients at risk for? (DIT BONUS!)
90x for somatisization
What is Malingering?
Consciously faking or profoundly exaggerating, or claiming to have a disorder for a secondary gain, generally have poor compliance w/ tx or tests. Complaints cease after gain (someone trying to get out of work)
What is a factitious disorder?
Patient consciously creating a physical and/or psychological symptoms in order to assume the rick role and get medical attention (Munchausen +/- by proxy)
What is munchausen syndrome?
Chronic factitious disorder with predominantly physical signs and symptoms, characterized by hx of multiple hospital admissions and willingness to receive surgical procedures
What is munchausen by proxy?
When illness in a child/elderly patient is caused by caregiver, motivation is to assume sick role by proxy, form of child/elder abuse
What is a somatic symptom or disorder?
Physical symptoms with no identifiable cause, both illness production and motivation an unconscious (vs factitious disorders). This is NOT intentional, more common in women
What is somatic symptom disorder?
Variety of complaints in one or more organ systems that last for months to years, associated with excessive, persistent thoughts and anxiety about symptoms. Can co-occur with real illness
What is conversion disorder?
Sudden loss of sensory or motor function, often following an acute stressor; patient is aware of but sometimes indifferent toward symptoms (IDGAF); more common in females, adolescents and young adults
What is an illness anxiety disorder (hypochondriasis)?
Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance
What is a personality trait?
An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself - this is who you are
What is a personality disorder?
Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning; person is usually not award they even have a problem. Usually presents by early adulthood and separated into A, B, and C (Weird, Wild, and Worried)
What category of disease has unexplained symptoms with no conscious attempt to deceive?
Somatoform disorders
What category of disease has unexplained symptoms with a conscious attempt to deceive for an external goal?
Malingering
What category of disease has unexplained symptoms with a conscious attempt to deceive for psychological gain?
Factitious disorder
What is common in the diagnosis of all personality disorders?
They must interfere with the ability to work with people and with every day life
What are cluster A personality disorders?
“Weird” (Accusatory, Aloof, Awkward); odd or eccentric, inability to develop meaningful social relationships. no psychosis; These are paranoid, schizoid, schizotypal
Is there a genetic association or cluster A with schizophrenia?
Yes
What is paranoid?
(Cluster A) Pervasive distrust and suspiciousness; projection is the major defense mechanism
What is schizoid?
(Cluster A) Voluntary social withdrawal, limited emotional expression, they WANT TO BE ISOLATED!!, Remember, Schizoid’s avoid.
What is schizotypal?
(Cluster A) Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness. (Schizotypals dress like pickles)
What are cluster B personality disorders?
“Wild” (Bad to the Bone) Dramatic, emotional, or erratic; They are antisocial, borderline, histrionic, and narcissistic.
Is there a genetic association of cluster B with mood disorders and substance abuse
Yes and Yes
What is antisocial?
(Cluster B) Disregard and violation of rights of others, criminality, impulsivity. Males > females; must be > 18 w/ a history of conduct disorder before age 15 (remember the difference btwn conduct disorder and oppositional defiant = harm vs no harm). This is just straight conduct disorder if <18!
Antisocial = Sociopath
What is borderline?
(Cluster B) Unstable mood and interpersonal relationships, impulsiveness, self-mutilation!, boredom, sense of emptiness. Females > males; splitting is the major defense mech here. Increased likelihood of suicide (see self-mutilation)
What is histrionic?
Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance (dressing to get attention, this is not Body Dysmorphic)
What is narcissistic?
Grandiosity, sense of entitlement, lack of empathy and requires admiration; often demands the best and is pissed with criticism.
What are cluster C personality disorders?
“Worried” (Cowardly, Compulsive, Clingy)
Anxious/fearful
Is there a genetic association of cluster C with anxiety disorders?
Yes
What is avoidant?
(Cluster C) Hypersensitivity to rejection, socially inhibited, timid, feelings of inadequacy, WANTS TO BE LOVED! (vs schizoid)
What is obsessive compulsive personality?
(Cluster C) Preoccupation with order, perfectionism, and control; ego-syntonic: behavior consistent with one’s own believes and attitudes. (OCD doesn’t like their own disorder, OCP doesn’t know they have it)
What is dependent?
(Cluster C) Submissive and clinging, excessive need to be taken care of, low self-confidence.
How do you “Keep schizo- straight”?
Schizoids (avoid, like the unibomber)
Schizotypal (schizoid + odd thinking, do weird things)
Schizophrenic (greater odd thinking than schizotypal)
Schizoaffective (schizophrenic psychotic symptoms + bipolar or depressive mood disorder)
What is the time course of schizophrenia?
6 mo - schizophrenia
What is anorexia nervosa?
Excessive dieting +/- purging, intense fear of gaining weight, distorted body image, increased exercise (BMI < 17).
What are some signs/consequences of anorexia nervosa?
Decreased bone density, severe weight loss, metatarsal stress fracture, amenorrhea, lanugo (fine body hair), anemia, electrolyte disturbances. Osteoporosis b/c decreased estrogen.
What age group is anorexia nervosa seen in?
Adolescent girls, it commonly coexists w/ depression
How do you treat anorexia nervosa?
Supportive, talking, no Rx tx if no depression
What is bulimia?
Binge eating +/- purging; it is often followed by self-induced vomiting or use of a laxative, diuretic, or emetic.
What are signs/consequences of bulimia?
Body weight often normal; Associated with parotids, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand callouses (from vomiting = Russells sign).
What age group is bulimia nervosa seen in?
Adolescent girls
What does the vomiting of bulimia lead to (labs wise)
Lose HCl when you vomit;
Hypokalemic Hypochloremic Metabolic Alkalosis
What is binge eating? (DIT BONUS!)
No purging, it is a coping mechanism; it has a deeper psychological may have negative feeling toward food
What is Compulsive eating? (DIT BONUS!)
No purging, OCD; you think about and fantasize about food, it is not a coping mech
What is Gender Dysphoria?
A strong, persistent cross-gender identification. Characterized by persistent discomfort with one’s sex assigned at birth. Causes significant distress and/or impaired functioning. Affected are often referred to as transgender.
What is the difference between sex and gender?
Sex is genetic, Gender is psychologic
What is transsexualism?
The desire to live as the opposite sex, often through surgery or hormone treatment
What is transvestism?
Paraphalia, NOT GENDER DYSPHORIA. Ex. This is wearing clothes of the opposite sex to get turned on.
Is homosexualism a form of gender dysphoria?
NO, men that are homosexual still identify themselves as men
What is sexual dysfunction?
Includes sexual desire disorders (hypoactive or sexual aversion), sexual arousal disorders (ED), orgasmic disorders (anorgasmia/PMEJ), and sexual pain disorders (dysparenunia and vaginismus)
What things cause sexual dysfunction? (Ddx)
Drugs (antihypertensives, neuroleptics, SSRI’sm EtOH), Diseases, Psychological
What are the 3 failures that can happen with ED? (DIT)
Failure to initiate (psychogenic, endocrinologic, neurologic)
Failure to fill (atherosclerosis)
Failure to store blood w/in lacunar network
Diabetes, atherosclerosis, and drug >80% of cases
What is sleep terror disorder?
Periods of terror with screaming in the middle of the night, occurs during slow wave (III and IV). Most common in children. There is no memory of arousal b/c not in REM. Triggers may include fear, stress. Self limited.
What is substance abuse disorder/dependence?
A maladaptive pattern of substance abuse defined as 2 or more of the following w/in 1 year Tolerance Withdrawal Take more and more, or over longer time Persistent desire Significan energy spent obtaining it Important things put off because of it
These things more serious Continued use in spite of problems Craving Use in dangerous situations Failure to do your job Relationships conflicted because of it
What are the stages in overcoming substance addiction?
Precontemplation - not acknowledging problem
Contemplation - acknowledge, not willing
Preparation - getting ready to change
Action - changing
Maintenance - maintaining behavior
Relapse (hopefully not) - returning to old behavior
