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
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
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
4
Q
anterograde amnesia
A
unable to make new memories and remember things that occur after the CNS insult
5
Q
retrograde amnesia
A
inability to recall old memories from before the CNS insult
6
Q
schizophrenia
A
episodes of psychosis and abnormal behavior lasting > 6months
7
Q
subtypes of schizophrenia (no longer listed in the DSM-V)
A
catatonic paranoid disorganized undifferentiated residual
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
9
Q
paranoid schizophrenia
A
delusions
better social functioning than other subtypes
best prognosis
no longer listed in the DSM-V
10
Q
disorganized schizophrenia
A
inappropriate emotional responses, disheveled appearance.
severe impairment
poor prognosis
no longer listed in the DSM-V
11
Q
undifferentiated
A
characteristics of multiple subtypes
no longer listed in the DSM-V
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
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
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
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)
16
Q
Schizophrenia Diagnostic Criteria
A
2 or more present in the last 1 month…
Hallucinations Delusions Disorganized speech Disorganized behavior Negative symptoms
17
Q
major mood disorders
A
bipolar disorder
major depressive disorder
18
Q
bipolar disorder
A
presence of at least one manic or hypomanic episode
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
20
Q
anhedonia
A
loss of interest or pleasure in one’s typical activities of daily life
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
22
Q
brief psychotic disorder
A
similar to schizophrenia but lasts <1month and is often preceded by stressful psychosocial events or factors
23
Q
schizophreniform disorder
A
same presentation as brief psychotic disorder but psychotic and residual symptoms last 1-6 months
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)
25
substance-induced psychotic disorder
related to the use of stimulants, hallucinogens, or withdrawal from sedatives; usually visual or tactile hallucinations and delusions
26
DIG FAST
mneumonic? what disorder?
Distractibility
Insomnia (decreased need for sleep)
Grandiosity
Flight of ideas
Increased Activity/psychomotor Agitation
Pressured Speech
Thoughtlessness/pleasure seeking/decreased judgment
MANIA
27
bipolar I disorder
episodes of mania and depression. associated with suicidality
28
bipolar II disorder
episodes of hypomania and depression
29
cyclothymic disorder
cyclic mood shifts between dysthymia and hypomania for at least 2 years
30
Cluster A, personality disorder description
avoid social situations and are unable to develop meaningful relationships
"weird": odd, eccentric
Accusatory, Aloof, Awkward
31
Cluster B, personality disorder description
emotional lability
"wild": dramatic, emotional, erratic
"Bad to the Bone"
32
Cluster C, personality disorder description
"worried": anxious, fearful
| Cowardly, Compulsive, Clingy
33
Cluster A examples
paranoid
schizoid
schizotypal
34
Cluster B examples
borderline
antisocial
narcissistic
histrionic
35
Cluster C examples
avoidant
dependent
obsessive-compulsive personality disorder (OCPD)
36
PRAISE
mneumonic? disorder?
```
Paranoid ideas
Relationship instability
Abandonment fears, angry outburst
Impulsiveness
Suicidal gestures
Emptiness
```
BORDERLINE-PERSONALITY DISORDER
37
histrionic
```
need to be CENTER OF ATTENTION
SEDUCTIVE and flirtacious
ASSUMED INTIMACY
Unable to maintain intimate relationships
REGRESSION defense mechanism
```
CLUSTER B
38
acute stress disorder
anxiety symptoms occurring within 1 month of trauma and lasting for <1 month
39
PTSD definition
anxiety symptoms occurring within 1 month of trauma and lasting for > 1 month
40
PTSD mneumonic for diagnostic criteria
PTSD is HARD
Hyperarousal
Avoidant of triggers
Reexperience traumatic event continually
Distress that interferes with daily functioning
41
PSTD treatment
Psychosocial Therapy
- exposure therapy (tx of choice)
- relaxation techniques
- support groups
- psychotherapy
Pharmacologic Therapy
- SSRI
- MAOI
- Benzodiazepines
- Anticonvulsants
42
Anorexia Nervosa vs. Bulima Nervosa
| WEIGHT
A: underweight (>15% below normal)
B: normal weight
43
Anorexia Nervosa vs. Bulima Nervosa
| CHARACTERISTICS
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
Anorexia Nervosa vs. Bulima Nervosa
| MORTALITY AND PROGNOSIS
A: Mortality ~10%
B: better prognosis that A
45
Anorexia Nervosa vs. Bulima Nervosa
| Ego-dystonic or ego-syntonic
A: egosyntonic
B: egodystonic
46
Anorexia Nervosa Medical Complications
Amenorrhea
Electrolyte abnormalities (hyperkalemia, hypochloremia, alkalosis)
Hypercholesterolemia
Cardiac abnormalities (arrhythmias, cardiac arrest)
Melanosis coli (due to laxative abuse)
Leukopenia
Osteoporosis
47
Anorexia Nervosa Treatment
Inpatient monitoring of weight gain
| behavioral and family therapy
48
Bulima Nervosa Presentation
Electrolyte abnormalities
cardiac arrhythmias
dental erosions and reddened knuckles
hypertrophy of salivary glands
49
Binge Eating Disorder Criteria
| 3 or more needed
Rapid Eating
Eating when not hungry
Consuming excessive amount of food
Feeling embarrassed or guilty about behavior; tend to eat alone
50
dementia
progressive and usually irreversible impairment of cognitive function and memory
unlike delirium level of consciousness does not vary throughout the day
51
causes of dementia
```
alzheimers (50-60%)
vascular dementia (10-20%)
prion-related disease (CJD)
huntingtons
picks
lewy body
```
52
alzheimers
- course
- symptoms
- characteristic
- course: very slow (years)
- symptoms: memory loss and cognitive disturbances
- characteristic: cortical atrophy
53
prion-related disease (CJD)
- course
- symptoms
- characteristic
- course: rapids (weeks to months)
- symptoms: myoclonus and extrapyramidal signs (ataxia)
- characteristic: spongiform encephalopathy, axonal degeneration
54
huntingtons
- course
- symptoms
- characteristic
- course: intermediate
- symptoms: early age presentation (usually over 40)
- characteristic: AD, trinucleotide repeat expansion, caudate nucleus
55
picks
- course
- symptoms
- characteristic
- course: slow
- symptoms: personality changes
- characteristic: frontal and temporal lobes symptoms
56
multiple cerebral infarcts
- course
- symptoms
- characteristic
- course: depends (months-years)
- symptoms: depends on localization of infarcts
- characteristic: anywhere
57
lewy body
- course
- symptoms
- characteristic
- course: slow
- symptoms: fluctuating cognitive impairment
- characteristic: substantia nigra
58
treatable causes of dementia
```
hypoxia
hypothyroidism
lead toxicity
lyme disease
meningitis
neurosypilis
medications
malnutrition -> B12 or thiamine deficiencies -> dementia-like
```
59
ADHD
prevalence?
male or female predominance?
cause?
```
3-5%
more common in males
multifactorial:
-genetic
-psychosocial
-toxin exposure
-prenatal trauma
-neurologic factors
```
60
ADHD
| diagnositic criteria
exhibit symptoms for 6 months and symptom onset must occur before 7
61
ADHD
| hyperactivity symptoms
```
unable to stay seated
unable to play quietly
constantly fidgets
talks excessively
runs around
```
62
ADHD
| inattention symptoms
```
disorganized
unable to complete a task
forgetful
easily distracted
constantly makes careless mistakes
does not listen when spoken to
```
63
ADHD
| impulsivity symptoms
interrupts or intrudes on others
has difficulty waiting for turn
blurts out answers
64
ADHD treatment
psychotherapy
pharmacotherapy: Ritalin (first line), SSRIs and TCAs= tricyclic antidepressants (adjunctive therapy)
parenting skills training
65
substance abuse
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
substance dependence definition
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
substance dependence
| physical dependence criteria
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
substance dependence
| psychologic/social/behaviorial criteria
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
depressants definition & examples
drugs that depress the CNS by increasing the activity of GABA
1) alcohol
2) barbiturates
3) benzodiazepines
70
telescoping
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
wernicke encephalopathy
reversible
thiamine deficiency
```
manifests: COAT
Confusion
Opthalmoplegia
Ataxia
Thiamine deficiency
```
72
korsakoff syndrome
chronic, irreversible
assoc. w/ periventricular hemorrhage or necrosis of the mammillary bodies
```
manifests RACK
Retrograde amnesia
Anterograde amnesia
Confabulation
Korsakoff psychosis
```
73
alcohol intoxication
units?
levels/stages of impairment?
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
alcohol intoxication management
check ABCs
intubate
monitor electrolytes, glucose levels, and acid-base status
75
alcohol withdrawal symptoms? .
| how early can they manifest?
```
anxiety
tremor
insomnia
irritability
tachycardia
anorexia
hyperreflexia
fever
seizures
hypotension
hallucinations (tactile and visual)
delirium
```
earliest symptoms: 6-24 hrs after last drink
76
management of alcohol withdrawal
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
delirium tremens
MEDICAL EMERGENCY
seizures with altered mental status
high mortality (15-20%)
occurs ~72 hours after last drink
78
treatment for chronic alcohol dependence
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
benzodiazepines are used to treat?
anxiety disorders
seizures
they are readily available and thus commonly abused
80
barbiturates are used to treat?
epilepsy treatment
| anesthetics
81
barbiturate and benzodiapine intoxication symptoms
```
drowsiness
impaired coordination and judgment
ataxia
mood lability (frequent mood changes)
nystagmus
```
severe intoxication
- respiratory depression
- coma
- death
82
treatment for barbiturate and benzodiapine intoxication
sodium bicarbonate (to increase renal excretion of barbiturate)
flumazenil (benzodiazepine antagonist)
83
cocaine
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
cocaine overdose treatment
alpha-adrenergic antagonist for cardiac symptoms
benzos for agitations
sodium bicarb if prolonged QRS
haloperidol to treat psychosis
85
types of amphetamines
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
caffeine
adenosine antagonist
stimulant on dopaminergic stimulant
intoxication symptoms: insomnia, anxiety, restlessness, twitching, rambling speech, flushed face, diuresis, GI disturbances
87
>1 g caffeine leads to the following symptoms
tinnitus
severe agitation
cardiac arrhythmia
88
caffeine withdrawal symptoms
headache
anxiety
depression
drowsiness
89
examples of opiates?
| mechanism of action?
morphine
heroin
methadone (synthetic)
stimulate mu-opioid receptors and effect sedation and analgesia
also effect dopaminergic system -> addictive and rewarding effects
90
phencyclidine (PCP) "angel dust" mechanism
hallucinogen
anesthic and stimulant effects
acts on NMDA glutamate receptors and activates dopaminergic neurons
does not produce withdrawal symptoms
91
lsergic acid diethylamide (LSD) mechanism
acts on serotonin receptors
does not produce withdrawal symptoms
92
opiate overdose classic triad
respiratory depression
altered mental status
miosis (pinpoint pupils)
93
when does anxiety become pathologic?
1) reaction is out of proportion to the severity of the threat
2) interferes with daily living
94
anxiety Ddx
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
general anxiety disorder
| diagnostic criteria
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
general anxiety disorder
| treatment
1) cognitive behavioral therapy
2) pharmacotherapy
- benzos (short term and low dose)
- buspirone
- SSRIs
- SNRIs: venlafaxine (extended release)
97
defining feature of panic disorder
unexpected and recurrent episodes (twice or more per week) of panic attacks that develop abruptly and last ~30minutes
98
presentation of panic disorder
```
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
agoraphobia
extreme fear of being in a place where escape is difficult
100
panic disorder treatment
1) psychosocial therapy
2) pharmacotherapy
- antidepressants: SSRI, TCA, MAOi
- benzos
101
social phobia
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
specific phobia
extreme or irrational fear of a specific object or situation
- situational
- animal/insect/environmental
- other (injections, blood)
103
obsessions
persistent and recurrent thoughts that cause great anxiety
104
compulsions
repetitive and inflexible actions that are done by the patient in an attempt to eliminate anxiety
