Psychiatry Flashcards
disordered thought content and thought processes, perceptual disturbances, illusions or hallucinations, delusions, impaired reality orientation
psychotic disorders
-memory and consciousness not impaired
hallucinations, bizarre behavior, delusions
positive symptoms
flat affect, poor grooming, social withdrawal, anhedonia, poor eye contact
negative symptoms
persecutory or grandiose delusions or auditory hallucinations; MOST COMMON
paranoid schizo
disorganized speech or behavior, flat or inappropriate affect
disorganized schizo
delusions and hallucinations; ABSENT: paranoid, disorganized, catatonic symptoms
undifferentiated schizo
no longer have prominent psychotic symptoms but have blunted affect/odd behavior
residual schizo
schizo phases:
- subtle behavior changes, functional decline, social withdrawal, irritability
- delusions, hallucinations, disorganized speech, bizarre behavior
- blunted affect, other negative symptoms
- prodromal
- psychotic
- residual
rare type of schizo- needs two of following: motor immobility, excess motor activity w/o purpose, extreme negativism or mutism, echolalia, echopraxia
catatonic schizo
schizo- two of the five following symptoms present for a 1 month pd, persisting for 6 months ?
delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms
DOC for schizo?
dopamine and serotonin antagonists- atypical antipsychotics
schizo:
best Tx for positive Sx?
negative Sx?
typical antipsychotics
atypical antipsychotics
mixture of psychotic and mood symptoms i.e. depressive/manic/mixed episode during which criteria for schizo also met
schizo affective d/o
char. by non-bizarre delusions (realistic) that occur for at least 1 month
delusional d/o
common after catastrophic event, sx for 1 day to 1 month
brief psychotic d/o
same sx as schizophrenia but sx last 1-6 months
schizophreniform d/o
physical complaints involving many organ systems, no medical explanation
somatization d/o
most common concerns are facial flaws, imagined defect in physical appearance or exaggeration of minor flaw? Tx?
body dysmorphic d/o, SSRI
one or more neuro complaints that can’t be explained clinically; MC sx: shifting paralysis, blindness, and mutism
conversion d/o
fake signs and Sx, assume the sick role
factitious d/o
production of physical/psych sx for external gain
malingering
pain in one or more area w/o identifiable cause, significant distress and impaired functioning; 1st line?
pain d/o; SSRI/TCAs
major depressive episode- five or more depressive signs and sx during the same ?; at least one of Sx must be ? or ?
2 week period; depressed mood or anhedonia
manic episode- lasts at least? needs at least three manic sx
one week
SAD treatment?
light therapy, buproprion, SSRIs
char. by anhedonia, psychomotor retardation/agitation, anorexia, weight loss, depressed mood, feelings of guilt, sleep disturbance, may have suicidal ideation
melancholia
char. by overeating/weight gain, oversleeping, reactive mood, leaden paralysis, oversensitivity to interpersonal rejection
atypical depression
char. by motor immobility or stupor, blurred affect, purposeless motor activity, extreme withdrawal, negativism, bizarre mannerisms or posturing, echolalia, echopraxia, or ‘waxy flexibility’
catatonic depression
PP depression occurs within ? Tx ?
4 weeks of delivery, SSRIs
side effects include GI upset, headache, sexual dysfunction
SSRIs s/e
s/e include weight gain, OH, antichol. effects, somnolence
TCAs
MAOIs and SSRIs can results in?
serotonin syndrome (acute MS changes, restlessness, diaphoresis, tremor, hyperthermia, seizures, muscle rigidity, coma/death (rare)
ECT safe in preggo and elderly; biggest concern?
memory loss
lithium- narrow therapeutic window- check levels ?
every 4-8 weeks
char. by 1+ major depressive episodes and at least one hypomanic episode
BPII
chronic mild depression; no psychotic or manic/hypomanic features
dysthymic d/o
less severe version of BPII, mild depressive and hypomanic episodes
cyclothymic d/o
maladaptive behavioral or emotional Sx that develop w/i 3 months and end within 6 months
adjustment d/o
schizoid, schizotypal, and paranoid personality d/o; weird/peculiar, associated with PSYCHOTIC d/o
Cluster A (mad)
antisocial, borderline, histrionic, narcissistic personality d/o; emotional, inconsistent, associated with MOOD d/o
Cluster B (bad)
avoidant, dependent, OCD personality d/o; fearful, anxious, associated with ANXIETY d/o
Cluster C (sad)
pervasive distrust and suspicion of other beginning by early adulthood; hostile and angry
paranoid personality d/o (PDO)
voluntary social withdrawal; eccentric and reclusive; no desire for close relationships
schizoid PDO
pervasive and eccentric behavior; most likely to progress to schizo
schizotypal PDO
magical thinking, special personal significance, belief in clairvoyance or telepathy, belief in superstitions or the occult
schizotypal PDO
inability to conform to social norms, strong tendency to commit unlawful acts
antisocial PDO
manipulative, deceitful, impulsive, and totally lacking empathy/remorse
antisocial PDO
may begin in childhood as conduct d/o, child may have Hx of physical and/or sexual abuse, starting fires, harming animals
antisocial PDO
poorly set self-image, mood swings, impulsivity, self-mutilation and manipulative suicide attempts
borderline PDO
Tx for borderline PDO includes?
dialectal behavior therapy (DBT)
overly emotional, dramatic, and seductive, excitable, attention seeking behavior
histrionic PDO
inflated self-image, pattern of grandiosity, arrogant, haughty attitude, self-esteem is fragile
narcissistic PDO
extreme sensitivity to rejection (inferiority complex), see themselves as unappealing, feelings of inadequacy, social phobia? Tx?
avoidant PDO; BB or SSRIs
submissive behavior, cannot make their own decisions, dislike being alone
dependent PDO
orderliness, perfectionism, and inflexibility, rigid, stubborn, and emotionally constricted; may develop MDD or schizo
O-C PDO
these pts have awareness of their PDO; egoSYNtonic
O-C PDO
pts who don’t meet the full criteria for a specific PDO but have traits from many diff ones
personality d/o NOS (not otherwise specified)
excessive amounts of heightened arousal that impede daily function and interpersonal relationships
anxiety
physiologic sx include dizziness, palpitations, perspiration, loss of appetite, nausea, trembling
anxiety
anxiety DOC
SSRIs, SNRIs, or buspirone
recurrent thoughts, images, or impulses, no realistic connection to the events the patient avoids, egoDYStonic
OCD
MC obsessive compulsion
contamination
1st line for OCD?
SSRIs
sensations of helplessness, fear, and horror from a traumatic even that is out of range of normal human experience; Sx persist for more than 1 mo.; DOC?
PTSD; SSRIs
sx occuring w/i one month of an event lasting 2 days to 4 weeks, including sense of numbing or detachment, reduced awareness of surrounding, derealization, depersonalization, or dissociative amnesia, excessive anxiety or arousal
acute stress d/o
most common mental d/o in US
phobias
? phobias more common than social phobias
specific
fear of situations where embarrassment or humiliation in front of other people may occur
social phobia i.e. public speaking, using pubic BR, eating in public
fear of being in public places where escape may be difficult, may be unwilling/unable to leave home? 50-70% have coexisting ?
agoraphobia, panic d/o
anorexia less than ? expected weight for height; BMI?
85%, 17.5kg/m2
? CI in ED because it lowers the seizure threshold
Bupropion
electrolyte abnormalities in bulimia
hypomagnesemia, hypochloremic hypokalemic metabolic alkalosis
first treatment in ED?
restore nutritional state
obesity (binge eating d/o) ? over ideal body weight or BMI greater than ?; recurrent episodes at least ?
20%, 30; 2days/week x 6 months
Tx for BED- MC? appetite suppressant? pancreatic lipase inhibitor?
SSRIs, sympathomimetics, Orlistat (Xenical)
craving or desire for substance independent of physiologic w/drawal Sx
psychological dependence
substance use that has not met criteria for dependence but resulted in impairment w/in a 12-month period
substance abuse
elevated ? is a early sign of alc abuse
gamma glutamyl transpeptidase
w/drawal Sx include lacrimation, rhinorrhea, sweating, yawning, anxiety, hypertension, tachycardia, N/V, abdominal cramps, and muscle/joint pain
opioid use/abuse
constricted pupils w/ ? use
opioid
disruptive behavior may result in peer rejection and deflated self image; requests can become explosive and irritable; MC in firstborn son
ADD/ADHD
ADD/ADHD diagnosed w/ ? scales
Conners’
s/e of stimulants i.e. amphetamine/dextroamphetamine used to treat ADD/ADHD include?
growth retardation, weight loss
violation of the basic right of others or of social norms with at least three acts
conduct d/o
may progress to conduct d/o; at least 6 mo of negativistic, hostile, and defiant behavior
oppositional defiant d/o
impaired social interaction and restricted or stereotyped behavior, interests, or activities
asperger d/o
decreasing head circumference, loss of previously learned behaviors, social interactions, and motor and language development; almost exclusively seen in girls
Rett d/o
multiple motor and one or more vocal tics greater than 1 year
Tourette d/o
onset of Tourette syndrome after group A streptococcal infx ?
pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS)
retinal hemorrhages or hyphema in an infant?
shaken baby syndrome
abuse perpetrated by the mother; symptoms fabricated or clinical signs induced in child to receive attention as being an attentive or suffering mother
Munchausen syndrome by proxy
includes w/holding of food, meds, clothing, health care, etc. in elderly
neglect
forced acts of fellatio and anal penetration are considered?
sodomy
normal response to a major loss? Tx?
uncomplicated bereavement; social contact & reassurance
normal grief Sx resolve w/i ?
1 year
