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Psychiatry Flashcards

0
Q

What is acting out?

A

Immature ego defense in which a patient expresses unacceptable thoughts/feelings through action

Ex: Tantrum

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1
Q

What are the mature ego defenses?

A

SASH

Suppression
Altruism
Sublimation
Humor

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2
Q

What is Dissociation?

A

Immature ego defense in which a patient temporarily drastically changes personality, memory, or behavior to avoid emotional stress.

Extreme form is dissociative identity disorder (split personalities).

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3
Q

What is denial?

A

Immature ego defense in which the patient avoids the awareness of some painful reality.

Ex: AIDS and cancer patients commonly react this way

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4
Q

What is Displacement?

A

Immature ego defense in which the takes emotions toward one thing and directs them toward another.

Ex: My boss yells at me, I’m mad at my boss, I yell at my wife.

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5
Q

What is Projection?

A

Attributing an unacceptable INTERNAL impulse to an external source.

Ex: Patient wants another women, accuses his wife of cheating.

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6
Q

What is Fixation?

A

Immature ego defense in which a patient remains partially at a more childish level of development.

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7
Q

What is Identification?

A

Immature ego defense in which a person will model behavior after another person who is more powerful (even if not admired).

Ex: Abused child identifies with an abuser

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8
Q

What is Isolation?

A

Isolation of affect is an immature ego defense in which a person separates feelings from ideas & events.

Ex: Describes a murder in gory detail without an emotional response.

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9
Q

What is Rationalization?

A

Proclaiming logical reasons for actions performed for other reasons. Usually to avoid self-blame.

Ex: After getting fired, claiming that you didn’t want the job anyway.

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10
Q

What is Reaction Formation?

A

Immature ego defense in which a person replaces a feeling with an emphasis on its opposite.

Ex: A very sexual person joins a monastery.

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11
Q

What is Regression?

A

Immature ego defense in which a person reverses their maturation to go back to an earlier mode of dealing with the world. Seen in children under new stressors (birth of a sibling, hospitalization).

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12
Q

What is Repression?

A

Immature ego defense in which a person INVOLUNTARILY withholds a feeling/idea from conscious thought.

Ex: Not remembering that a traumatic experience happened.

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13
Q

What is Splitting?

A

Immature ego defense in which patients believe that people are either all good or all bad at different times. Commonly seen in borderline personality disorder.

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14
Q

What is Altruism?

A

A mature ego defense in which people alleviate guilty feelings by generosity toward others.

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15
Q

What is Humor?

A

A mature ego defense in which a person can laugh about an adverse or anxious situation.

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16
Q

What is Sublimation?

A

A mature ego defense in which a person replaces an unacceptable wish with an action that is similar but acceptable.

Ex: A teen’s aggression toward his father is channeled into sports

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17
Q

What is Suppression?

A

A mature ego defense in which a person intentionally withholds an idea/feeling from conscious awareness.

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18
Q

What is the treatment for separation anxiety disorder?

A

SSRI’s & behavioral interventions

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19
Q

When must ADHD present to be diagnosable?

A

Before age 12

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20
Q

What is seen with autism spectrum disorder?

A

Poor social interactions
Communication deficits
Repetitive behaviors
Restricted interests

Seen more in boys

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21
Q

What is seen with Rett disorder?

A

X-linked seen only in females (males die in utero)

Symptoms at age 1-4
Regression/loss of development
Loss of speech
Ataxia
Stereotyped hand wringing
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22
Q

What NT changes are seen in Huntinton’s disease?

A

Decreased GABA & ACh

Increased Dopamine

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23
Q

What NT changes are seen in Parkinson’s disease?

A

Decreased Dopamine

Increased 5-HT & ACh

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24
What NT changes are seen in schizophrenia?
Increased Dopamine
25
What is lost first with regard to orientation in a confused patient?
1) Time 2) Place 3) Person
26
What is the treatment for delirium?
Identify & address underlying cause Optimize brain function (O2, etc.) Haloperidol
27
What is pseudodementia?
Depression in the elderly may present like dementia
28
What type of hallucinations are usually medical in etiology & what type are psychiatric?
Auditory --> psychiatric Visual --> medical
29
What are the time cutoffs on the spectrum of schizophrenic disorders?
Brief psychotic disorder (stress) 1-6 months --> Schizophreniform disorder >6 months --> Schizophrenia
30
What is seen in schizoaffective disorder?
1) At least 2 weeks of psychotic symptoms with stable mood | 2) At least 1 episode of major depression or mania or mixed
31
When does schizophrenia present?
~20 in males ~30 in females
32
What is seen in delusional disorder?
Fixed untrue belief for > 1 month Functioning is otherwise not impaired
33
What is seen during a manic episode?
Lasts > 1 wk. Hospitalization or 3+ of the following (DIG FAST): ``` Distractibility Irresponsibility (hedonistic) Grandiosity Flight of ideas Agitation/Activity Sleep (decreased need) Talkativeness (pressured speech) ```
34
What constitutes bipolar disorder?
Bipolar I: 1+ manic episode with or without depression Bipolar II: 1+ hypomanic & 1+ depressive episode
35
What is seen with cyclothymic disorder?
Dysthymia & hypomania. Milder form of bipolar disorder lasting at least 2 years.
36
What are the criteria for Major depressive disorder?
Depressed mood & 5 of the 9 symptoms for 2+ weeks (SIG E CAPS) ``` Sleep Disturbance Interest (loss of) Guilt or feelings of worthlessness Energy loss & fatigue Concentration problems Appetite & weight changes Psychomotor retardation or agitation Suicidal ideation ```
37
What is the criteria for persistent depressive disorder?
aka Dysthymia Depression, often mild, lasting at least 2 years
38
What is seen in atypical depression?
``` Mood reactivity (mood improvement in response to positive events) Hypersomnia Weight gain Leaden paralysis Sensitivity to interpersonal rejection ```
39
How long do postpartum blues last? Postpartum depression? Postpartum psychosis?
Blues: begin 2-3 weeks postpartum; last <10 days Depression: Begin within 1 month; lasts 2 weeks to over a year Psychosis: Lasts a few days to 4-6 weeks
40
What is electroconvulsive therapy used for?
Refractory major depression Major depression in a pregnant patient Depression with psychotic features Catatonia
41
What are the risk factors for completion of suicide?
SAD PERSONS ``` Sex (male) Age (teens or elderly) Depression Previous attempt EtOH or drug use Rational thinking (loss of) Sickness (medical illness; 3+ meds) Organized plan No spouse Social support lacking ```
42
What is seen with agoraphobia?
Exaggerated fear of open or enclosed places, public transportation, lines or crowds, or leaving home alone.
43
What is the minimum cutoff in time for generalized anxiety disorder?
>6 months Must be unrelated to a specific person, situation, or event.
44
What is seen in adjustment disorder?
Emotional symptoms causing impairment that follow an identifiable stressor for <6 months.
45
What is the time cutoff for PTSD?
> 1 month --> PTSD < 1 month --> Acute stress disorder
46
What is malingering? Factitious disorders? Somatoform disorders?
Malingering --> Pt consciously lies to get an external (secondary) gain Factitious --> Pt consciously lies to get psychological (primary) gain Somatiform --> Illness production is unconscious drive
47
What are the somatoform disorders?
Somatic symptom disorder: Many complaints in multiple organ systems Conversion disorder: Sudden loss of sensory or motor function following acute stressor Illness anxiety disorder (hypochondriasis)
48
What are the Cluster A personality disorders? | Describe them
Paranoid - distrust Schizoid - voluntary social withdrawal, content with isolation Schizotypal - eccentric, odd beliefs, awkwardness
49
What are the cluster B personality disorders?
Antisocial Borderline Histrionic Narcissistic
50
What is seen in antisocial PD?
Disregard for rights of others Criminality Males > Females Must be >18 & have Hx of conduct disorder before 15
51
What are the Cluster C personality disorders? | Describe them
Avoidant - Sensitive to rejection, desires relationships w/ others Obsessive-Compulsive - needs order, perfectionist Dependent - submissive & clingy, low sel-confidence
52
What is seen with anorexia nervosa?
Excessive dieting +/- purging Body image distortion Osteoporosis Amenorrhea
53
What is seen with bulimia nervosa?
``` Binge eating +/- purging Normal body weight Parotitis Dorsal hand calluses Enamel erosions Mallory-Weiss tears ```
54
What is the treatment for narcolepsy?
Daytime stimulants | Nighttime sodium oxybate
55
What are the stages of change in overcoming substance addiction?
1) Precontemplation 2) Contemplation 3) Planning 4) Action 5) Maintenance 6) Relapse
56
What is seen with opioid withdrawal?
``` Sweating Dilated pupils Rhinorrhea Yawning Stomach cramps Diarrhea ```
57
What is the treatment for cocaine intoxication?
Benzodiazepines Do NOT use beta blockers (unopposed alpha --> malignant HTN)
58
What is seen with delirium tremens?
1) Autonomic hyperactivity (tachycardia, tremors, anxiety) 2) Seizures 3) Psychotic symptoms 4) Confusion
59
What is the treatment for Tourette syndrome?
Antipsychotics
60
What are the high potency neuroleptics? | What toxicities are seen?
Neuroleptics = 1st generation antipsychotics "Try Flying High" Trifluoperazine Fluphenazine Haloperidol Toxicities: EPS Galactorrhea Neuroleptic malignant syndrome
61
What is the evolution of extrapyramidal side effects of the neuroleptics?
4 hour dystonia (stiffness, spasm) 4 day akithisia (restlessness) 4 week bradykinesia (parkinsonism) 4 month tardive dyskinesia (oral-facial movements; can be permanent)
62
What is seen with neuroleptic malignant syndrome?
``` FEVER: Fever Encephalopathy Vitals unstable Enzymes^ (CPK) Rigidity ```
63
What are the low potency neuroleptics?
"LOWlife Cheating Thieves" Chlorpromazine Thioridazine
64
What side effects are seen with low-potency neuroleptics?
``` All: Dry mouth (M) Constipation (M) Hypotension (alpha-1) Sedation (Histamine) ``` Chlorpromazine - Corneal deposits Thioridazine - reTinal deposits
65
What is the mechanism of neuroleptics?
Block D2 dopamine receptors in the mesolimbic pathway
66
What are the atypical antipsychotics?
"atypical for Old Closets to Quietly Risper from A to Z" ``` Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone ```
67
What toxicities are seen with Clozapine?
Agranulocytosis (weekly WBC counts) Weight gain Seizure
68
What toxicities are seen with Risperidone?
^Prolactin Can cause irregular menstruation ^ fertility issues
69
What toxicities are seen with Ziprasidone?
Atypical antipsychotic QT prolongation
70
What are the uses for Lithium? | What toxicities are seen?
Mood stabilizer for bipolar disorder SIADH ``` Toxicities (STENT): Sedation Thyroid dysfunction Ebstein anomaly Nephrogenic diabetes insipidus Tremor ```
71
What is the mechanism of Buspirone?
Stimulates 5-HT(1a) receptors Used for GAD
72
What side effects are seen with SSRI's?
GI upset Sexual dysfunction Serotonin syndrome w/ other drugs that ^5-HT Suicide during 4-8 wk lag time
73
What is seen in serotonin syndrome? | What is the treatment?
``` Hyperthermia Confusion Diarrhea Flushing CV collapse ``` Tx: Cyproheptadine (5-HT2 antagonist)
74
What are the SNRI's? | What are their uses?
Venlafaxine - Depression & GAD Duloxetine - Depression & diabetic neuropathy
75
What toxicities are seen with TCA's?
Sedation Anti-adrenergic --> postural hypotension Anticholinergic --> dry mouth, tachycardia, urinary retention
76
What are the MAOI's?
"MAO Takes Pride In Shanghai" Tranylcupromine Phenelzine Isocarboxazid Selegiline (MAO-B only)
77
What are the uses of MAOI's? | What toxicities are seen?
Used for: Atypical depression, Anxiety, Hypochondriasis ``` Toxicities: Hypertensive crisis (tyramine found in wine & cheese) Many drug interactions (SSRI's, TCA's, St. John's wart, meperidine, dextromethorphan) ```
78
What is bupropion used for? | What side effects are seen?
Atypical antidepressant; Smoking cessation Toxicities: Stimulant effects Seizure in bulemic pts No sexual side effects
79
What is the mechanism of Trazadone? | What toxicities are seen?
Blocks 5-HT2 & alpha-1 adrenergic receptors Toxicities: Priapism Postural hypotension Sedation
80
What drugs are used in the treatment of bipolar disorder?
Mood stabilizers: Lithium, Valproic acid, Carbamazepine | Atypical antipsychotics
81
What is seen with serum sickness?
``` 5-10 days after a drug exposure Fever Urticaria Proteinuria LAD Vasculitis - fibrinoid necrosis w/ PMN infiltration ``` It is a Type III hypersensitivity reaction
82
How is acyclovir activated?
Viral thymidine kinase Only present in HSV & VZV
83
What is seen with systemic mastocytosis?
``` Mast cells in the bone marrow & other organs --> ^^Histamine Gastric acid secretion --> diarrhea Syncope Flushing Hypotension Bronchospasm Urticaria ```
84
Can Turner syndrome patients become pregnant?
Yes, usually only with in vitro fertilization & hormone supplementation.
85
Where in the bone does hematogenous osteomyelitis commonly occur?
The metaphysis of long bones The hematogenous route is seen primarily in children
86
What are the pharmacologic methods of preventing sickle cell crisis?
1) Hydroxyurea --> ^HbF | 2) Ca2+-dependent K+ channel blockers --> prevent RBC dehydration
87
What is a germinoma? | What is seen?
It is a pineal gland germ-cell tumor. ``` Symptoms: Precocious puberty (hCG secretion) Obstructive hydrocephalus Parinaud syndrome (impaired upward gaze) ```
88
What antipsychotics can affect the eyes?
Chlorpromazine - Corneal deposits Thioridazine - Retinal deposits ("Thioretazine")
89
What stain can be used to stain the liver for A1AT deficiency?
PAS stain It shows the A1AT deposits in the liver.
90
What drugs cause gallstones?
Bile acid-binding resins (loss of bile acids) Fibrates (inhibit 7-alpha-hydroxylase) Octreotide Ceftriaxone
91
What anti-MTB drug should be used if a patient is on protease inhibitors?
Rifabutin

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