Psych Guy Flashcards
What are three big things you must always ask?
hallucinations
homicidal ideations
suicidal ideations
What is the SAMCELS acronym?
sleep
appetite
memory
concentration
energy
libido
suicidal ideation
trait - personality matrix
axis II
psychological stressors
axis IV
state- acute presentations of ssx
axis I
medical dx
axis III
global assessment of function (GAF)
axis V
greatest risk of a behavior is..
prior of that behavior
individual presents with medical symptoms that are not consciously created and occur due to unresolved unconscious conflict
somatoform disorder
pt consciously feigns symptoms to be in the sick role for unconscious reasons
factitious disorder
individuals who consciously create ssx of mental or physical illness for the conscious purpose of monetary gain or to avoid an unwanted consequence
malingering
alteration or decrement in voluntary motor function or neuro fx that does not have a true underlying medical or neuro cause
conversion disorder
one or more somatic compaints, disrupt life, pain may be predominant complaint, longer than 6 mo
somatic symptom disorder
preoccupation with the possibility of having an illness or developing and illness
illness anxiety disorder
somatization and conversion disorder are key examples of…
repression
medications diverted from legal use to illegal use
diversion
What is the CAGE acronym for etoh abuse?
Cut down
annoyed by people
guilty
eye opener
What two lab values are often elevated in alcohol abusers?
GGT - gamma-glutamyltranspeptidase
MCV - mean corpuscular volume
Wernicke-Korsakoff syndrome has what added bonus psych ssx?
confabulation
etoh withdrawal experiencing seizures 7-36 hours after last drink
complicated withdrawal
What drug can you tx etoh withdrawal with?
chlordiazepoxide
readily identifiable psychosocial stressor withing the past 3 months and is not a major depressive episode; individual having difficulty adjusting to the event or situation
adjustment disorder
What qualifies as major depressive disorder?
5 of 9 disturbances in their lives most of the day, every day, for two consecutive weeks
What is atypical depression?
increased sleep, increased appetite, decreased energy
in kids typical depression they may be misdiagnosed with
ADHD
in adolescents atypical depression may be misdiagnosed as
oppositional defiant disorder
What are the hallmarks of persistent depressive disorder?
depressed mood for more than one year in kids and greater than 2 years for adults
during the 2 year period the individual cannot have returned to euthymia for more than 2 months during that time
no major depressive epsidoe has occurred during the first 2 years of the disorder
2 or more SAMCEL changes
disruptive mood dysregulation disorder will have first episode when?
where?
what?
6-10 yo
in at least 2 of the childhood’s 3 settings
must have an inter-ictal mood of irritability or anger that is observable by others most of the day
irritable angry kid most of the time
What type of bipolar disorder is at least 1 manic episode
type 1
Bipolar type II has
at least one hypomanic episode with at least one depressive episode
Type III bipolar disorder is…
mixed - irritability, excitability, agitation, depressed mood, happy mood
cyclothymic disorder is
cycling between hypomania and dysthymia
for at least 2 years in adults and 1 year in kids
no major depressive episode nor manic episode
A hypomanic episode is not …
severe enough to cause impairment in social or occupational life or result in hospitalization
a minimum of one month of consistently refraining from speaking in specific social situations where one is customarily expected to converse such as school or work
selective mutism
physical ssx of anxiousness occur simply at the thought of the activity
social phobia/social anxiety disorder
What is the timing that goes with a panic attack?
peak in 4 min and top out at 10 min
In adults, generalized anxiety disorder is how many ssx? in kids?
adults must have 3/6
kids only have to have 1
foster kid without attachment to anyone
reactive attachment disorder
Disinhibited Social Engagement disorder
kid attaches to every one easily
How long does acute stress disorder last?
last a minimum of 2 days and max 30 days
What are the structural components of Freud?
super ego, ego, id
What is the only component to exist soley in the unconscious?
id
Freud’s theories do not include
subconscious
What part of the structural theory is created/put in place by societal and familial constructs?
super ego
What are the seven defense mechanisms?
- denial
- displacement
- identification
- projection
- reaction formation
- repression
- sublimation
redirecting emotions to a substitute target
displacement
defining self by identifying with others
identification
attributing uncomfortable feelings to others
projection
overacting in the opposite way to the fear or conflict
reaction formation
redirecting socially inappropriate libidinal impulses into socially acceptable actions
sublimation
long standing suspiscion and distrust of others; assign responsibility to others for all the wrongs that have befallen them and do not easily forget what they perceive to be an insult
pts doubt the loyalty of others and believe that half the world is out to take advantage of the other half
paranoid personality disorder
What are Cluster A personality disorder types?
paranoid
schizoid
schizotypal
lifelong pattern of social withdrawal. uncomfortable with human interaction and are viewed as eccentric, isolated and lonely
emotionally unattached, lack any close friends, and have little interest in intimacy or sexual closeness
schizoid personality disorder
exceedingly odd behavior, ideas, and presentation to others
keep to themselves and have magical thinking
considered to have a small amount of paranoid personality disorder plus a dash of schizoid personality
often believe in magical elements of the universe - extrasensory perception, astrology, numerology, and other arcane disciplines
victims of unethical charlatans who prey on their beliefs
schizotypal personality disorder
cluster B personality disorders include
borderline
antisocial
histrionic
narcissistic
hallmarks of instability in relationships and self identity, unchecked impulsivity
figuratively stand on the border between neurosis and psychosis
unstable in affect, mood, behavior, object relations, and self-image resulting from instability in sense of self and relationship with others
prone to self-cutting and other self-inflicted injurious behaviors
borderline personality disorder
continued antisocial or criminal acts; pt is unable to respect the rights of others or conform to social norms;
tend to be warm, ingratiating, and charming; they are confidence (con) artists who easily win over their victims and fleece them of money, services, or emotional attachment
antisocial personality disorder
What is used to treat borderline personality disorder?
Dialectal Behavioral Therapy (DBT)
theatrical, woe is me individual, presentation out of everything, flamboyant, colorful,
can’t make emotional relationships, shallow, sexually seductive and read deeper meaning into relationships than what is most likely there
histrionic personality disorder
self-centered, egocentric, heightened sense of self-importance with grandiose feelings of being unique
see themselves as special and require admiration of others.
unable to recognize the needs of others
become enraged when they are questioned or embarrassed
narcissistic personality disorder
individuals subordinate their needs to those of others, lack self-confidence, and feel uncomfortable being alone
unable to make decisions wihtout an excessive amount of advice and
and reassurance from others
hesitant to express their own opionions for fear of losing approval and support
dependent personality disorder
characterized by emotional constriction, orderliness, perseverence, stubbornness, and indecisiveness
overly devoted to work to the exclusion of leisure activities
can’t delegate, being ‘anal’,
obessive compulsive personality disorder
uses passivity to express aggression - kid asked to clean his room, says sure, then doesn’t do it
passive aggressive personality disorder
extreme sensitivity to rejection
leads to social withdrawal even though these people want to be included in social events and socially connected
you cant fire me, i quit
avoidant personality disorder
What are Cluster C personality disorders?
dependent
obsessive compulsive
passive aggressive
avoidant
fixed false belief
delusion
How long does a brief, psychotic disorder last?
1 to 30 days
either delusions, hallucinations, disorganized speech, or grossly disorganized catatonic behavior
brief psychotic disorder
individual has hallucinations, have been for 3-4 days
brief psychotic disorder
Two or more of the following, between 1 month and 6 months duration
delusions, fixed false beliefs, hallucinations, disorganized speech, negative ssx
schizophreniform disorder
if a dx is made without waiting for recovery, it should be qualified as..
‘provisional’
Pt must experience 2 or more of the following for at least one month, each must be significantly present during the month
delusions, hallucinations, disorganized or catatonic behavior, negative ssx
ssx must persist for at least 6 mo (unless successfully tx’d)
schizophrenia
What must an individual also have disturbances in to be classified as scchizophrenia?
disturbance in social, occupational, or hygiene function from onset of the illness
schizophrenia + mood disorders
schizoaffective disorder
there must be a 2 week period where either delusions or hallucinations are present WITHOUT mood symptoms DURING THE LIFETIME DURATION OF THE ILLNESS
recurrent depressive episodes intermittent with psychosis
schizoaffective disorder
an individual suffers from at least one circumscribed fixed, false belief for AT LEAST ONE MONTH
does not meet criterion A for Schizophrenia AND
apart from the fixed false belief, the individual’s functioning is neither markedly impaired
delusional disorder
misperception of a real stimulus
illusion
perception without underlying stimulus, auditory, visual, tactile
hallucination
disruption of this pathway can cause disruption in cognition and affect
mesocortical pathway
disruption of this pathway can cause mood flattening
mesolimbic pathway
disruption of this pathway creates the motor movement side effects of Parkinson’s tremor
nigrostriatal pathway
disruption of this pathway can lead to disturbances ins exual functioning, gynecomastia in males and galactorrhea in females
tuberoinfundibular pathway
What are the 5 basic reasons to assess lab values in psych cases?
- r/o physiologic cause
- r/o illicit substances
- establish a baseline of phys before rx
- assess safety of rx and possible AE
- assess therapeutic range of rx
People with thyroid dysfunction may present with what psych issue?
depression or hypomania/mania
A pt with pheochromocytoma may present with what psych disorder?
anxiety or panic disorder
Pts with syphilis or HIV may present with what psych ssx?
confusion, hallucinations, mood lability, depression, and or dementia
What could be the first presenting symptoms of a tumor of the head of the pancreas?
depressive symptoms
Pts with sz disorder may present with ssx congruent with …
hallucinations, thought disorder, mood disorder/mood lability and or confusion/dementia
Pts with liver dysfunction may present with symptoms congruent with…
thought disorder, confusion, and or mood disorder
hepatic encephalopathy
If a pt is presenting with a delirium it is imperative to..
discover the underlying physiologic cause and to tx that
What lab do you get if you are concerned for hepatic encephalopathy?
ammonia level
What labs do I get prior to initiating medication in psych?
- CBC
- retic and platelet ct
- CMP
- BUN/Cr
- LFTs
- Amylase/Lipase
- TSH
- Urine drug screen - not needed if pt reveals drug hx
- EKG
- Icon/Serum pregnancy test
What are some extra labs to consider in psych cases?
- catecholamines - pheo
- hormone levels
- vit D
- folate/b12
- lead levels/heavy metals
Pt is anxious and mildly depressed; previously dx’d with MDD and is on antidepressants;
facial edema and slowed DTRs
What lab test do you get?
TSH
Pt wants to save all his new clothes with tags, just like his dad did. What am I thinking?
genetic predisposition or learned behavior
Pt states for several months she has been experiencing loss of energy, episodes of rapid heart rate, increased BP and perspiring.
Suspect panic disorder, but what do we want to r/o first? What do we need to test?
r/o pheo
catecholamines
What is the triad of burnout?
- emotional exhaustion
- depersonalization
- sense of decreased personal accomplishment
What can you consider for your imminently suicidal pt whose medications are not working?
pt has MDD for years, numerous trials of SSRIs, SNRIs, TCAs, MAOIs, and atypicals - currently has thoughts of suicide with intent and plan
What do you do?
electroconvulsive therapy
What are some predictors of violent behavior?
- best predictor: previous violent behavior
- childhood aggression
- alcohol - disinhibition
Cutting is most commonly found among what personality disorder?
borderline personality disorder
19 yo to eval after bringing a gun to school. “wasn’t going to hurt anyone”
hx of ADHD, ADD, ODD, and conduct disorder
uses etoh and marijuana
What is his biggest risk factor of bringing a gun again or being violent at school?
- hx of conduct disorder
What are the two components of ASD?
- deficits in social communication and social interaction
- presence of restricted-repetitive behaviors, interests, and activities
What are hallmarks of ADHD?
- developmentally inappropriate poor attention span
- OR age-inappropriate features of hyperactivity and impulsivity
- OR both
persists at least 6 mo
causes impairment in academic or social areas
occurs in the child prior to 12 yo
Both motor and vocal tics are present, do not have to be present concurrently
can wax and wane but persist longer than one year since the first tic onset
onset before 18 yo
dx?
tourette’s disorder
either motor or vocal tics are present but not both
persistent (chronic) motor or vocal tic disorder
either motor or vocal tics present for less than one year
provisional tic disorder
10 yo in for assessment for 8 months, losing his temper, arguing with parents and teachers, go out of his way to annoy others, refuses to comply, blames others for mistakes
dx?
oppositional defiant disorder
verbal or physical aggression toward property, animals or other people
twice a week for 3 months, physical aggression does not result in damage or destruction to property or injury
OR
three behavioral outbursts resulting in damage or destruction to property or physical assault resulting in physical injury to animals or people occurring within a 12 mo period
intermittent explosive disorder
12 yo Britt is a bully, physically and social media, burning garages, shop lifting, breaking rules, skipping school
Conduct disorder
What is the ADHD continuum?
- ADHD
- oppositional/defiant disorder
- conduct disorder
- antisocial personality disorder
- conduct disorder
- oppositional/defiant disorder
If you can only ask one question in a psych eval, what should you ask?
ask pt if they have any ideas of self-harm or suicide OR desire to harm someone else
