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Neuro Round 2 wk 2+ > Psych Guy > Flashcards

Psych Guy Flashcards

1
Q

What are three big things you must always ask?

A

hallucinations

homicidal ideations

suicidal ideations

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2
Q

What is the SAMCELS acronym?

A

sleep

appetite

memory

concentration

energy

libido

suicidal ideation

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3
Q

trait - personality matrix

A

axis II

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4
Q

psychological stressors

A

axis IV

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5
Q

state- acute presentations of ssx

A

axis I

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6
Q

medical dx

A

axis III

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7
Q

global assessment of function (GAF)

A

axis V

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8
Q

greatest risk of a behavior is..

A

prior of that behavior

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9
Q

individual presents with medical symptoms that are not consciously created and occur due to unresolved unconscious conflict

A

somatoform disorder

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10
Q

pt consciously feigns symptoms to be in the sick role for unconscious reasons

A

factitious disorder

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11
Q

individuals who consciously create ssx of mental or physical illness for the conscious purpose of monetary gain or to avoid an unwanted consequence

A

malingering

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12
Q

alteration or decrement in voluntary motor function or neuro fx that does not have a true underlying medical or neuro cause

A

conversion disorder

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13
Q

one or more somatic compaints, disrupt life, pain may be predominant complaint, longer than 6 mo

A

somatic symptom disorder

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14
Q

preoccupation with the possibility of having an illness or developing and illness

A

illness anxiety disorder

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15
Q

somatization and conversion disorder are key examples of…

A

repression

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16
Q

medications diverted from legal use to illegal use

A

diversion

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17
Q

What is the CAGE acronym for etoh abuse?

A

Cut down

annoyed by people

guilty

eye opener

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18
Q

What two lab values are often elevated in alcohol abusers?

A

GGT - gamma-glutamyltranspeptidase

MCV - mean corpuscular volume

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19
Q

Wernicke-Korsakoff syndrome has what added bonus psych ssx?

A

confabulation

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20
Q

etoh withdrawal experiencing seizures 7-36 hours after last drink

A

complicated withdrawal

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21
Q

What drug can you tx etoh withdrawal with?

A

chlordiazepoxide

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22
Q

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

A

adjustment disorder

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23
Q

What qualifies as major depressive disorder?

A

5 of 9 disturbances in their lives most of the day, every day, for two consecutive weeks

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24
Q

What is atypical depression?

A

increased sleep, increased appetite, decreased energy

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25
Q

in kids typical depression they may be misdiagnosed with

A

ADHD

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26
Q

in adolescents atypical depression may be misdiagnosed as

A

oppositional defiant disorder

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27
Q

What are the hallmarks of persistent depressive disorder?

A

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

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28
Q

disruptive mood dysregulation disorder will have first episode when?

where?

what?

A

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

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29
Q

What type of bipolar disorder is at least 1 manic episode

A

type 1

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30
Q

Bipolar type II has

A

at least one hypomanic episode with at least one depressive episode

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31
Q

Type III bipolar disorder is…

A

mixed - irritability, excitability, agitation, depressed mood, happy mood

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32
Q

cyclothymic disorder is

A

cycling between hypomania and dysthymia

for at least 2 years in adults and 1 year in kids

no major depressive episode nor manic episode

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33
Q

A hypomanic episode is not …

A

severe enough to cause impairment in social or occupational life or result in hospitalization

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34
Q

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

A

selective mutism

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35
Q

physical ssx of anxiousness occur simply at the thought of the activity

A

social phobia/social anxiety disorder

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36
Q

What is the timing that goes with a panic attack?

A

peak in 4 min and top out at 10 min

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37
Q

In adults, generalized anxiety disorder is how many ssx? in kids?

A

adults must have 3/6

kids only have to have 1

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38
Q

foster kid without attachment to anyone

A

reactive attachment disorder

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39
Q

Disinhibited Social Engagement disorder

A

kid attaches to every one easily

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40
Q

How long does acute stress disorder last?

A

last a minimum of 2 days and max 30 days

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41
Q

What are the structural components of Freud?

A

super ego, ego, id

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42
Q

What is the only component to exist soley in the unconscious?

A

id

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43
Q

Freud’s theories do not include

A

subconscious

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44
Q

What part of the structural theory is created/put in place by societal and familial constructs?

A

super ego

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45
Q

What are the seven defense mechanisms?

A
  • denial
  • displacement
  • identification
  • projection
  • reaction formation
  • repression
  • sublimation
46
Q

redirecting emotions to a substitute target

A

displacement

47
Q

defining self by identifying with others

A

identification

48
Q

attributing uncomfortable feelings to others

A

projection

49
Q

overacting in the opposite way to the fear or conflict

A

reaction formation

50
Q

redirecting socially inappropriate libidinal impulses into socially acceptable actions

A

sublimation

51
Q

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

A

paranoid personality disorder

52
Q

What are Cluster A personality disorder types?

A

paranoid

schizoid

schizotypal

53
Q

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

A

schizoid personality disorder

54
Q

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

A

schizotypal personality disorder

55
Q

cluster B personality disorders include

A

borderline

antisocial

histrionic

narcissistic

56
Q

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

A

borderline personality disorder

57
Q

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

A

antisocial personality disorder

58
Q

What is used to treat borderline personality disorder?

A

Dialectal Behavioral Therapy (DBT)

59
Q

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

A

histrionic personality disorder

60
Q

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

A

narcissistic personality disorder

61
Q

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

A

dependent personality disorder

62
Q

characterized by emotional constriction, orderliness, perseverence, stubbornness, and indecisiveness

overly devoted to work to the exclusion of leisure activities

can’t delegate, being ‘anal’,

A

obessive compulsive personality disorder

63
Q

uses passivity to express aggression - kid asked to clean his room, says sure, then doesn’t do it

A

passive aggressive personality disorder

64
Q

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

A

avoidant personality disorder

65
Q

What are Cluster C personality disorders?

A

dependent

obsessive compulsive

passive aggressive

avoidant

66
Q

fixed false belief

A

delusion

67
Q

How long does a brief, psychotic disorder last?

A

1 to 30 days

68
Q

either delusions, hallucinations, disorganized speech, or grossly disorganized catatonic behavior

A

brief psychotic disorder

69
Q

individual has hallucinations, have been for 3-4 days

A

brief psychotic disorder

70
Q

Two or more of the following, between 1 month and 6 months duration

delusions, fixed false beliefs, hallucinations, disorganized speech, negative ssx

A

schizophreniform disorder

71
Q

if a dx is made without waiting for recovery, it should be qualified as..

A

‘provisional’

72
Q

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)

A

schizophrenia

73
Q

What must an individual also have disturbances in to be classified as scchizophrenia?

A

disturbance in social, occupational, or hygiene function from onset of the illness

74
Q

schizophrenia + mood disorders

A

schizoaffective disorder

75
Q

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

A

schizoaffective disorder

76
Q

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

A

delusional disorder

77
Q

misperception of a real stimulus

A

illusion

78
Q

perception without underlying stimulus, auditory, visual, tactile

A

hallucination

79
Q

disruption of this pathway can cause disruption in cognition and affect

A

mesocortical pathway

80
Q

disruption of this pathway can cause mood flattening

A

mesolimbic pathway

81
Q

disruption of this pathway creates the motor movement side effects of Parkinson’s tremor

A

nigrostriatal pathway

82
Q

disruption of this pathway can lead to disturbances ins exual functioning, gynecomastia in males and galactorrhea in females

A

tuberoinfundibular pathway

83
Q

What are the 5 basic reasons to assess lab values in psych cases?

A
  1. r/o physiologic cause
  2. r/o illicit substances
  3. establish a baseline of phys before rx
  4. assess safety of rx and possible AE
  5. assess therapeutic range of rx
84
Q

People with thyroid dysfunction may present with what psych issue?

A

depression or hypomania/mania

85
Q

A pt with pheochromocytoma may present with what psych disorder?

A

anxiety or panic disorder

86
Q

Pts with syphilis or HIV may present with what psych ssx?

A

confusion, hallucinations, mood lability, depression, and or dementia

87
Q

What could be the first presenting symptoms of a tumor of the head of the pancreas?

A

depressive symptoms

88
Q

Pts with sz disorder may present with ssx congruent with …

A

hallucinations, thought disorder, mood disorder/mood lability and or confusion/dementia

89
Q

Pts with liver dysfunction may present with symptoms congruent with…

A

thought disorder, confusion, and or mood disorder

hepatic encephalopathy

90
Q

If a pt is presenting with a delirium it is imperative to..

A

discover the underlying physiologic cause and to tx that

91
Q

What lab do you get if you are concerned for hepatic encephalopathy?

A

ammonia level

92
Q

What labs do I get prior to initiating medication in psych?

A
  • 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
93
Q

What are some extra labs to consider in psych cases?

A
  • catecholamines - pheo
  • hormone levels
  • vit D
  • folate/b12
  • lead levels/heavy metals
94
Q

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?

A

TSH

95
Q

Pt wants to save all his new clothes with tags, just like his dad did. What am I thinking?

A

genetic predisposition or learned behavior

96
Q

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?

A

r/o pheo

catecholamines

97
Q

What is the triad of burnout?

A
  • emotional exhaustion
  • depersonalization
  • sense of decreased personal accomplishment
98
Q

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?

A

electroconvulsive therapy

99
Q

What are some predictors of violent behavior?

A
  • best predictor: previous violent behavior
  • childhood aggression
  • alcohol - disinhibition
100
Q

Cutting is most commonly found among what personality disorder?

A

borderline personality disorder

101
Q

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?

A
  • hx of conduct disorder
102
Q

What are the two components of ASD?

A
  • deficits in social communication and social interaction
  • presence of restricted-repetitive behaviors, interests, and activities
103
Q

What are hallmarks of ADHD?

A
  • 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

104
Q

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?

A

tourette’s disorder

105
Q

either motor or vocal tics are present but not both

A

persistent (chronic) motor or vocal tic disorder

106
Q

either motor or vocal tics present for less than one year

A

provisional tic disorder

107
Q

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?

A

oppositional defiant disorder

108
Q

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

A

intermittent explosive disorder

109
Q

12 yo Britt is a bully, physically and social media, burning garages, shop lifting, breaking rules, skipping school

A

Conduct disorder

110
Q

What is the ADHD continuum?

A
  • ADHD
    • oppositional/defiant disorder
      • conduct disorder
        • antisocial personality disorder
111
Q

If you can only ask one question in a psych eval, what should you ask?

A

ask pt if they have any ideas of self-harm or suicide OR desire to harm someone else

Neuro Round 2 wk 2+ (16 decks)

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