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Psychiatry > Psych Pathology > Flashcards

Psych Pathology Flashcards

1
Q

cognitive disorders

A

result of CNS impairment and affect memory, attention, orientation and judgment

categories:
1) delirium
2) dementia
3) amnestic

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2
Q

causes of delirium

A

I’M DELIRIOUS

Impaired delivery (infarction, hemorrhage)
Metabolic
Drugs (alcohol, anticholinergics, benzodiazepines, antihypertensives)
Endocrinopathy
Liver Disease
Infrastructure (of cortical neurons)
Renal failure (electrolyte imbalance, uremia etc)
Infection
Oxygen (lack of)
Urinary tract infection
Sensory deprivation

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3
Q

amnestic disorders

A

memory impairment without impaired consciousness or other cognitive function

often caused by underlying medical disorder

  • CVA
  • MS
  • HSV encephalitis
  • tumor
  • hypoxia
  • hypoglycemia
  • serizures
  • substance abuse
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4
Q

anterograde amnesia

A

unable to make new memories and remember things that occur after the CNS insult

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5
Q

retrograde amnesia

A

inability to recall old memories from before the CNS insult

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6
Q

schizophrenia

A

episodes of psychosis and abnormal behavior lasting > 6months

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7
Q

subtypes of schizophrenia (no longer listed in the DSM-V)

A 
catatonic 
paranoid 
disorganized 
undifferentiated 
residual
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8
Q

catatonic schizophrenia

A

motor disturbances with strange posturing; incoherent speech; can involve extreme motion or no motion

no longer listed in the DSM-V

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9
Q

paranoid schizophrenia

A

delusions
better social functioning than other subtypes
best prognosis

no longer listed in the DSM-V

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10
Q

disorganized schizophrenia

A

inappropriate emotional responses, disheveled appearance.
severe impairment
poor prognosis

no longer listed in the DSM-V

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11
Q

undifferentiated

A

characteristics of multiple subtypes

no longer listed in the DSM-V

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12
Q

residual

A

one or more psychotic episodes in the past, residual flat affect, withdrawal, odd behavior or thinking, but no severe psychotic symptoms

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13
Q

positive symptoms

A

thoughts, sensory perceptions, or behaviors in a person with a psychiatric disorder that are abnormal within the person’s culture

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14
Q

negative symptoms

A

thoughts, sensory perceptions, or behaviors that are present in a normal person but are absent in a patient with mental illness

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15
Q

schizophrenia presentation

A

POSITIVE SYMPTOMS

1) delusions
2) loose associations
3) strange behavior
4) hallucinations (typically auditory)

NEGATIVE SYMPTOMS

1) social withdrawal
2) flat affect
3) lack of motivation (avolition)
4) thought blocking
5) poverty of speech (alogia)

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16
Q

Schizophrenia Diagnostic Criteria

A

2 or more present in the last 1 month…

Hallucinations 
Delusions 
Disorganized speech
Disorganized behavior 
Negative symptoms
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17
Q

major mood disorders

A

bipolar disorder

major depressive disorder

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18
Q

bipolar disorder

A

presence of at least one manic or hypomanic episode

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19
Q

major depressive disorder

A

occurrence of two or more major depressive episodes
each lasting > 2 weeks
along with a symptom free period at least 2months

5.8% lifetime prevalence

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20
Q

anhedonia

A

loss of interest or pleasure in one’s typical activities of daily life

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21
Q

SIG E CAPS

mnemonic? and for what disorder?

A 
Sleep disturbances 
Loss of Interests 
Guilt or feelings of worthlessness 
Loss of Energy 
Loss of Concentration 
Appetite changes 
Psychomotor retardation or agitation 
Suicidal ideation

DEPRESSION

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22
Q

brief psychotic disorder

A

similar to schizophrenia but lasts <1month and is often preceded by stressful psychosocial events or factors

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23
Q

schizophreniform disorder

A

same presentation as brief psychotic disorder but psychotic and residual symptoms last 1-6 months

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24
Q

schizoaffective disorder

A

schizophrenia with mood disorder symptoms. psychotic symptoms must at times be present with mood disorder symptoms (vs. mood disorder with psychotic features)

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25
Q

substance-induced psychotic disorder

A

related to the use of stimulants, hallucinogens, or withdrawal from sedatives; usually visual or tactile hallucinations and delusions

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26
Q

DIG FAST

mneumonic? what disorder?

A

Distractibility
Insomnia (decreased need for sleep)
Grandiosity
Flight of ideas
Increased Activity/psychomotor Agitation
Pressured Speech
Thoughtlessness/pleasure seeking/decreased judgment

MANIA

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27
Q

bipolar I disorder

A

episodes of mania and depression. associated with suicidality

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28
Q

bipolar II disorder

A

episodes of hypomania and depression

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29
Q

cyclothymic disorder

A

cyclic mood shifts between dysthymia and hypomania for at least 2 years

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30
Q

Cluster A, personality disorder description

A

avoid social situations and are unable to develop meaningful relationships

“weird”: odd, eccentric
Accusatory, Aloof, Awkward

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31
Q

Cluster B, personality disorder description

A

emotional lability

“wild”: dramatic, emotional, erratic
“Bad to the Bone”

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32
Q

Cluster C, personality disorder description

A

“worried”: anxious, fearful

Cowardly, Compulsive, Clingy

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33
Q

Cluster A examples

A

paranoid
schizoid
schizotypal

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34
Q

Cluster B examples

A

borderline
antisocial
narcissistic
histrionic

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35
Q

Cluster C examples

A

avoidant
dependent
obsessive-compulsive personality disorder (OCPD)

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36
Q

PRAISE

mneumonic? disorder?

A 
Paranoid ideas 
Relationship instability 
Abandonment fears, angry outburst 
Impulsiveness 
Suicidal gestures 
Emptiness

BORDERLINE-PERSONALITY DISORDER

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37
Q

histrionic

A 
need to be CENTER OF ATTENTION 
SEDUCTIVE and flirtacious 
ASSUMED INTIMACY 
Unable to maintain intimate relationships 
REGRESSION defense mechanism

CLUSTER B

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38
Q

acute stress disorder

A

anxiety symptoms occurring within 1 month of trauma and lasting for <1 month

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39
Q

PTSD definition

A

anxiety symptoms occurring within 1 month of trauma and lasting for > 1 month

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40
Q

PTSD mneumonic for diagnostic criteria

A

PTSD is HARD

Hyperarousal
Avoidant of triggers
Reexperience traumatic event continually
Distress that interferes with daily functioning

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41
Q

PSTD treatment

A

Psychosocial Therapy

  • exposure therapy (tx of choice)
  • relaxation techniques
  • support groups
  • psychotherapy

Pharmacologic Therapy

  • SSRI
  • MAOI
  • Benzodiazepines
  • Anticonvulsants
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42
Q

Anorexia Nervosa vs. Bulima Nervosa

WEIGHT

A

A: underweight (>15% below normal)
B: normal weight

43
Q

Anorexia Nervosa vs. Bulima Nervosa

CHARACTERISTICS

A

A: restrictive type: starve and exercise vigorously
binge eating/purging type: binge then purge or use laxatives/diuretics

B: purging type: similar to A
nonpurging type: fast or exercise excessively

44
Q

Anorexia Nervosa vs. Bulima Nervosa

MORTALITY AND PROGNOSIS

A

A: Mortality ~10%
B: better prognosis that A

45
Q

Anorexia Nervosa vs. Bulima Nervosa

Ego-dystonic or ego-syntonic

A

A: egosyntonic
B: egodystonic

46
Q

Anorexia Nervosa Medical Complications

A

Amenorrhea
Electrolyte abnormalities (hyperkalemia, hypochloremia, alkalosis)
Hypercholesterolemia
Cardiac abnormalities (arrhythmias, cardiac arrest)
Melanosis coli (due to laxative abuse)
Leukopenia
Osteoporosis

47
Q

Anorexia Nervosa Treatment

A

Inpatient monitoring of weight gain

behavioral and family therapy

48
Q

Bulima Nervosa Presentation

A

Electrolyte abnormalities
cardiac arrhythmias
dental erosions and reddened knuckles
hypertrophy of salivary glands

49
Q

Binge Eating Disorder Criteria

3 or more needed

A

Rapid Eating
Eating when not hungry
Consuming excessive amount of food
Feeling embarrassed or guilty about behavior; tend to eat alone

50
Q

dementia

A

progressive and usually irreversible impairment of cognitive function and memory

unlike delirium level of consciousness does not vary throughout the day

51
Q

causes of dementia

A 
alzheimers (50-60%) 
vascular dementia (10-20%) 
prion-related disease (CJD) 
huntingtons 
picks 
lewy body
52
Q

alzheimers

  • course
  • symptoms
  • characteristic
A
  • course: very slow (years)
  • symptoms: memory loss and cognitive disturbances
  • characteristic: cortical atrophy
53
Q

prion-related disease (CJD)

  • course
  • symptoms
  • characteristic
A
  • course: rapids (weeks to months)
  • symptoms: myoclonus and extrapyramidal signs (ataxia)
  • characteristic: spongiform encephalopathy, axonal degeneration
54
Q

huntingtons

  • course
  • symptoms
  • characteristic
A
  • course: intermediate
  • symptoms: early age presentation (usually over 40)
  • characteristic: AD, trinucleotide repeat expansion, caudate nucleus
55
Q

picks

  • course
  • symptoms
  • characteristic
A
  • course: slow
  • symptoms: personality changes
  • characteristic: frontal and temporal lobes symptoms
56
Q

multiple cerebral infarcts

  • course
  • symptoms
  • characteristic
A
  • course: depends (months-years)
  • symptoms: depends on localization of infarcts
  • characteristic: anywhere
57
Q

lewy body

  • course
  • symptoms
  • characteristic
A
  • course: slow
  • symptoms: fluctuating cognitive impairment
  • characteristic: substantia nigra
58
Q

treatable causes of dementia

A 
hypoxia 
hypothyroidism 
lead toxicity 
lyme disease 
meningitis 
neurosypilis 
medications 
malnutrition -> B12 or thiamine deficiencies -> dementia-like
59
Q

ADHD
prevalence?
male or female predominance?
cause?

A 
3-5% 
more common in males
multifactorial: 
-genetic 
-psychosocial
-toxin exposure 
-prenatal trauma 
-neurologic factors
60
Q

ADHD

diagnositic criteria

A

exhibit symptoms for 6 months and symptom onset must occur before 7

61
Q

ADHD

hyperactivity symptoms

A 
unable to stay seated 
unable to play quietly 
constantly fidgets 
talks excessively 
runs around
62
Q

ADHD

inattention symptoms

A 
disorganized 
unable to complete a task 
forgetful 
easily distracted 
constantly makes careless mistakes 
does not listen when spoken to
63
Q

ADHD

impulsivity symptoms

A

interrupts or intrudes on others
has difficulty waiting for turn
blurts out answers

64
Q

ADHD treatment

A

psychotherapy
pharmacotherapy: Ritalin (first line), SSRIs and TCAs= tricyclic antidepressants (adjunctive therapy)

parenting skills training

65
Q

substance abuse

A

maladaptive pattern of substance use that leads to clinically significant impairment or distress for a period of at least 1 year manifested in ONE of the following:

a) use resulting in failure to fulfill major obligations
b) substance use in potentially dangerous situations
c) legal problems related to substance abuse
d) continued use despite the knowledge that substance use leads to significantly impaired social and personal life

66
Q

substance dependence definition

A

maladaptive pattern of substance use that leads to clinically significant impairment or distress for a period of at least 1 year manifested in at least THREE criteria falling under one or both categories:

PHYSICAL DEPENDENCE

PSYCHOLOGIC/SOCIAL/BEHAVORIAL EFFECTS

67
Q

substance dependence

physical dependence criteria

A

PHYSICAL DEPENDENCE:

1) tolerance: increased dosage of the substance is needed to achieve desired effect
2) withdrawal: development of a specific set of symptoms after cessation or decreased dose after prolonged period of use
3) use in larger amounts and for longer periods of time than intended

68
Q

substance dependence

psychologic/social/behaviorial criteria

A

PSYCHOLOGIC/SOCIAL/BEHAVORIAL EFFECTS

1) desire to decrease usage
2) spends significant amount of time and effort to acquire the substance
3) neglects other aspects of life due to use
4) continues to use the substance despite significant impairment it causes

69
Q

depressants definition & examples

A

drugs that depress the CNS by increasing the activity of GABA

1) alcohol
2) barbiturates
3) benzodiazepines

70
Q

telescoping

A

later onset with accelerated negative effects

ex. women and alcohol abuse; alcohol-related brain damage more readily seen in women as opposed to men

71
Q

wernicke encephalopathy

A

reversible
thiamine deficiency

manifests: COAT 
Confusion 
Opthalmoplegia 
Ataxia 
Thiamine deficiency
72
Q

korsakoff syndrome

A

chronic, irreversible
assoc. w/ periventricular hemorrhage or necrosis of the mammillary bodies

manifests RACK 
Retrograde amnesia 
Anterograde amnesia 
Confabulation 
Korsakoff psychosis
73
Q

alcohol intoxication
units?
levels/stages of impairment?

A

ex. BAL @ 80-100mg/dL = .08-.1% (legal limit in most states)

@ 100-150mg/dL = .1-.15% –> ataxic gait, poor balance
@ 400mg/dL = .4% –> respiratory depression

74
Q

alcohol intoxication management

A

check ABCs
intubate
monitor electrolytes, glucose levels, and acid-base status

75
Q

alcohol withdrawal symptoms? .

how early can they manifest?

A 
anxiety 
tremor 
insomnia 
irritability 
tachycardia 
anorexia 
hyperreflexia 
fever 
seizures 
hypotension 
hallucinations (tactile and visual) 
delirium

earliest symptoms: 6-24 hrs after last drink

76
Q

management of alcohol withdrawal

A

1) benzodiazepines (tapering doses) to treat delirium tremens
2) thiamine, folic acid, and vitamins to treat malnutrition
3) magnesium sulfate or carbamazepine for postwithdrawal seizures

4)

77
Q

delirium tremens

A

MEDICAL EMERGENCY
seizures with altered mental status
high mortality (15-20%)

occurs ~72 hours after last drink

78
Q

treatment for chronic alcohol dependence

A

1) AA
2) psychotherapy
3) disulfram (inhibits acetaldehyde dehydrogenase -> conditioning the patient negatively against alcohol consumption)
4) naltrexone (mu-opiod receptor antagonist -> reduce cravings)
5) benzodiazepines
6) haloperidol

79
Q

benzodiazepines are used to treat?

A

anxiety disorders
seizures

they are readily available and thus commonly abused

80
Q

barbiturates are used to treat?

A

epilepsy treatment

anesthetics

81
Q

barbiturate and benzodiapine intoxication symptoms

A 
drowsiness 
impaired coordination and judgment 
ataxia 
mood lability (frequent mood changes)
nystagmus

severe intoxication

  • respiratory depression
  • coma
  • death
82
Q

treatment for barbiturate and benzodiapine intoxication

A

sodium bicarbonate (to increase renal excretion of barbiturate)

flumazenil (benzodiazepine antagonist)

83
Q

cocaine

A

alkaloid extract
prevents dopamine reuptake

use can result in sudden cardiac death (coronary vasoconstriction leading to MI or arrhythmia)

maternal use can lead to placenta abruption

84
Q

cocaine overdose treatment

A

alpha-adrenergic antagonist for cardiac symptoms

benzos for agitations

sodium bicarb if prolonged QRS

haloperidol to treat psychosis

85
Q

types of amphetamines

A

1) classic: stimulate dopamine release at the presynaptic terminal and used for ADHD and narcolepsy treatment
ex. dextroamphetamine, methylphenidate, methamphetamine)

2) designer/substituted: have both stimulant and hallucinogenic effects due to release of dopamine AND serotonin
ex. MDMA (ectasy), MDEA (eve)

86
Q

caffeine

A

adenosine antagonist
stimulant on dopaminergic stimulant

intoxication symptoms: insomnia, anxiety, restlessness, twitching, rambling speech, flushed face, diuresis, GI disturbances

87
Q

> 1 g caffeine leads to the following symptoms

A

tinnitus
severe agitation
cardiac arrhythmia

88
Q

caffeine withdrawal symptoms

A

headache
anxiety
depression
drowsiness

89
Q

examples of opiates?

mechanism of action?

A

morphine
heroin
methadone (synthetic)

stimulate mu-opioid receptors and effect sedation and analgesia

also effect dopaminergic system -> addictive and rewarding effects

90
Q

phencyclidine (PCP) “angel dust” mechanism

A

hallucinogen
anesthic and stimulant effects

acts on NMDA glutamate receptors and activates dopaminergic neurons

does not produce withdrawal symptoms

91
Q

lsergic acid diethylamide (LSD) mechanism

A

acts on serotonin receptors

does not produce withdrawal symptoms

92
Q

opiate overdose classic triad

A

respiratory depression
altered mental status
miosis (pinpoint pupils)

93
Q

when does anxiety become pathologic?

A

1) reaction is out of proportion to the severity of the threat
2) interferes with daily living

94
Q

anxiety Ddx

A

1) medical condition leading to anxiety
2) general anxiety disorder
3) PTSD
4) panic disorder
5) phobias (social or specific)
6) OCD
7) major depressive disorder

95
Q

general anxiety disorder

diagnostic criteria

A

1) excessive anxiety about various aspects of life
2) symptoms have to be present for more than 6 mo. and severely affect daily life
3) patient unable to ease anxiety
4) anxiety accompanied by at least THREE of the following

  • feeling of being on the edge
  • fatigue
  • difficulty concentrating
  • irritability
  • sleep disturbance
  • muscle tension
96
Q

general anxiety disorder

treatment

A

1) cognitive behavioral therapy
2) pharmacotherapy

  • benzos (short term and low dose)
  • buspirone
  • SSRIs
  • SNRIs: venlafaxine (extended release)
97
Q

defining feature of panic disorder

A

unexpected and recurrent episodes (twice or more per week) of panic attacks that develop abruptly and last ~30minutes

98
Q

presentation of panic disorder

A 
SOB 
chest pain/discomfort 
palpitations/increased heart rate 
sweating, shaking 
nausea/abdominal discomfort 
feelings of choking, going crazy, losing control or dying 
fear of additional attacks 
numbness/tingling 
chills/hot flashes 
light-headedness 
depersonalization
99
Q

agoraphobia

A

extreme fear of being in a place where escape is difficult

100
Q

panic disorder treatment

A

1) psychosocial therapy
2) pharmacotherapy
- antidepressants: SSRI, TCA, MAOi
- benzos

101
Q

social phobia

A

extreme fear of social situations in which an individual has to interact with unknown people or i subject to scrutiny by others thus resulting in embarrassment or humiliation

102
Q

specific phobia

A

extreme or irrational fear of a specific object or situation

  • situational
  • animal/insect/environmental
  • other (injections, blood)
103
Q

obsessions

A

persistent and recurrent thoughts that cause great anxiety

104
Q

compulsions

A

repetitive and inflexible actions that are done by the patient in an attempt to eliminate anxiety

Psychiatry (5 decks)

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