Psychiatry Flashcards
Describe acting out
Expressing unacceptable feelings and thoughts through actions (tantrums)
Describe dissociation
Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
Describe denial
Avoiding the awareness of some painful reality
Describe displacement
Transferring avoided ideas and feelings to some neutral person or object
Describe fixation
Partially remaining at a more childish level of development
Describe identification
Modeling behavior after another person who is more powerful (though not necessarily admired)
Describe isolation (of affect)
Separating feelings from ideas and events
Describe projection
Attributing an unacceptable internal impulse to an external source (a man who wants another woman thinks his wife is cheating on him)
Describe rationalization
Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame
Describe reaction formation
Replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on the opposite
Describe regression
Turning back the maturational clock and going back to earlier modes of dealing with the world
Describe repression
Involuntarily withholding an idea or feeling from conscious awareness
Describe splitting
Believing that people are either all good or all bad at different times due to intolerance of ambiguity. Commonly seen in borderline personality disorder.
Describe altruism
Alleviating guilty feelings by unsolicited generosity toward others
Describe humor
Appreciating the amusing nature of an anxiety-provoking or adverse situation
Describe sublimation
Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system
Describe suppression
Intentional withholding of an idea or feeling from conscious awareness
Conduct disorder in children often leads to what disorder in adults?
Antisocial personality disorder
What is coprolalia?
Involuntary obscene speech found in 10-20% of Tourette syndrome patients
Describe Rett disorder
X linked disorder (seen in girls). Symptoms become apparent at 1-4 YO and include regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing.
Anxiety is associated with what neurotransmitter changes?
High NE, low GABA and serotonin
Huntington disease is associated with what neurotransmitter changes?
Low ACh and GABA, high DA
Parkinson is associated with what neurotransmitter changes?
Low DA, high ACh and serotonin
Schizophrenia is associated with what neurotransmitter changes?
High DA
What is the most common presentation of altered mental status in inpatient settings?
Delirium
What are hypnagogic hallucinations?
Hallucinations that occur while going to sleep
What are hypnopompic hallucinations?
Hallucinations that occur upon awakening
What are the ‘positive symptoms’ of schizophrenia?
Hallucinations, delusions, disorganized speech, and disorganized or catatonic behavior
What are the ‘negative symptoms’ of schizophrenia?
Flat affect, social withdrawal, lack of motivation, lack of speech or thought
A diagnosis of schizophrenia requires symptoms lasting more than what?
6 mo
What is brief psychotic disorder?
Symptoms lasting less than 1 month
What is schizophreniform disorder?
Symptoms lasting 1-6 months
What is schizoaffective disorder?
At least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episode. Bipolar or depressive subtype.
Describe dissociative identity disorder
Presence of 2+ distinct identities or personality states. More common in women.
Describe depersonalization/derealization disorder
Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions (depersonalization) or one’s environment (derealization)
Describe mood disorder
Characterized by an abnormal range of moods or internal emotional states and loss of control over them. Includes major depressive disorder, bipolar disorder, dysthymic disorder, and cyclothymic disorder. Psychotic features may be present.
What is the difference between manic episode and hypomanic episode?
Manic episodes last at least 1 week and disturb patient and their functioning. Hypomanic episodes last at least 4 days and are not severe enough to cause marked impairment in social and/or occupational functioning.
What is bipolar I?
At least 1 manic episode with or without a hypomanic or depressive episdode
What is bipolar II?
Hypomanic and a depressive episode
What are treatment options for bipolar disorders?
Mood stabilizers (lithium, valproic acid, carbamezepine), atypical antipsychotics
What is cyclothymic disorder?
Dysthymia and hypomania; milder form of bipolar lasting at least 2 years
Describe atypical depression
Differs from classical forms of depression. Characterized by mood reactivity (being able to experience improved mood in response to positive events), “reversed” vegetative symptoms (hypersomnia and weight gain), leaden paralysis, and long-standing interpersonal rejection sensitivity. Most common subtype of depression.
The diagnosis of panic disorder requires what?
Panic attack followed by 1 month (or more) of 1 (or more) of the following: persistent concern of additional attacks, worrying about consequences of the attack, or behavioral change related to attacks. Symptoms are the systemic manifestations of fear.
What is malingering disorder?
Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary external gain (avoiding work, compensation, etc). Poor compliance with tx or follow-up of diagnostic tests. Complaints cease after gain.
What is factitious disorder?
Patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and get medical attention (primary internal gain)
What is Munchausen syndrome?
A form of factitious disorder - chronic. Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures.
What is somatic symptom disorder?
Physical symptoms with no identifiable physical cause. Both illness production and motivation are unconscious drives. Variety of complaints in 1+ organ systems lasting for months to years. Associated with excessive, persistent thoughts and anxiety about symptoms. May co-occur with medical illness.
What is conversion disorder?
Physical symptoms with no identifiable physical cause. Both illness production and motivation are unconscious drives. Sudden loss of sensory or motor function often following an acute stressor.
What is illness anxiety disorder (hypochondriasis)?
Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance.
The cluster A personality disorders are characterized by what?
“Weird.” Odd or eccentric; inability to develop meaningful social relationships. No psychosis; genetic association with schizophrenia.
The cluster B personality disorders are characterized by what?
“Wild.” Dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse.
The cluster C personality disorders are characterized by what?
“Worried.” Anxious or fearful; genetic association with anxiety disorders.
Describe schizoid personality disorder.
Cluster A: Patient has voluntary social withdrawal, limited emotional expression, and is content with social isolation
Describe schizotypal personality disorder.
Cluster A: Patient has eccentric appearance, odd beliefs or magical thinking, and interpersonal awkwardness
Describe borderline personality disorder
Cluster B: Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, boredom, sense of emptiness - splitting is a major defense mechanism
Describe histrionic personality disorder
Cluster B: Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance
Describe narcissistic personality disorder
Cluster B: Grandiosity, sense of entitlement; lacks empathy and requires excessive admiration; often demands the “best” and reacts to criticism with rage
Describe avoidant personality disorder
Cluster C: Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others
Describe dependent personality disorder
Cluster C: Submissive and clinging, excessive need to be taken care of, low self-confidence
Describe obsessive-compulsive disorder
Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions. Ego dystonic: behavior inconsistent with one’s own beliefs and attitudes
Describe obsessive-compulsive personality disorder
Cluster C: Preoccupation with order, perfectionism, and control; ego-syntonic: behavior consistent with one’s own beliefs and attitudes (vs. OCD)
Do sleep terrors occur during REM or non-REM sleep?
non-REM; no memory of trigger
Narcolepsy is caused by what?
Decreased orexin production in lateral hypothalamus
What is the treatment of narcolepsy/
Daytime stimulants and nighttime sodium oxybate
What are the 6 stages of change in overcoming substance addiction?
- Precontemplation
- Contemplation
- Preparation/determination
- Action/willpower
- Maintenance
- Relapse
What is a sensitive indicator of alcohol use?
GGT
What is the treatment for PCP intoxication?
Benzodiazepines or a rapid-acting antipsychotic
What is delirium tremens?
Life-threatening EtOH withdrawal syndrome that peaks 2-5 days after last drink. Symptoms in order of appearance: autonomic system hyperactivity, psychotic symptoms, confusion. Tx: Benzos
What is the MOA of typical antipsychotics (neuroleptics)?
Block dopamine D2 receptors (increase cAMP)
What are some side effects of typical antipsychotics?
Extrapyramidal side effects –> hyperprolactinemia, muscarinic blockade, alpha1 blockade
What is neuroleptic malignant syndrome (NMS)?
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia.
Which typical antipsychotics are high potency and have neurologic side effects (EPS symptoms)?
Haloperidol, trifluoperazine, fluphenazine
Which typical antipsychotics are low potency and have non-neurologic side effects (anticholinergic, antihistamine, anti alpha1)?
Chlorpromazine and thioridazine
Which typical antipsychotic can lead to corneal deposits?
Chlorpromazine
Which typical antipsychotic can lead to retinal deposits?
Thioridazine
What is the evolution of EPS side effects?
4 hour acute dystonia, 4 day akathisia (restlessness), 4 week bradykinesia (parkinsonism), 4 month tardive dyskinesia
What are the atypical antipsychotics?
Olanzapine, risperidone, clozapine, quetiapine, aripiprazole, ziprasidone
What is the MOA of atypical antipsychotics?
Not completely understood; varied effects on serotonin, DA and alpha and H1 receptors
What are the indications for atypical antipsychotics?
Schizophrenia (pos and neg symptoms), bipolar, OCD, anxiety, depression, mania, Tourette
What are major side effects of clozapine?
Agranulocytosis and seizures
What is a major side effect of risperidone?
Increased prolactin
What is a major side effect of ziprasidone?
Prolonged QT interval
What are lithium’s side effects?
Tremor, nephrogenic DI, hypothyroidism, and teratogenesis
What are the fetal cardiac defects due to lithium?
Ebstein anomaly and malformation of great vessels
How is lithium excreted?
Almost exclusively by the kidneys
What is the MOA of buspirone?
Stimulates 5-HT1A receptors
What is the clinical use of buspirone?
GAD
What are the names of the SSRIs?
Fluoxetine, paroxetine, sertraline, citalopram
SSRIs should not be taken with what to prevent serotonin syndrome?
MAO inhibitors, SNRIs, TCAs
What is the treatment of serotonin syndrome?
Cyproheptadine
What are the names of the SNRIs?
Venlafaxine, duloxetine
What are the toxicities of TCAs?
Sedation, alpha1 blocking effects, convulsions, coma, cardiotoxicity
What are the names of the MAO-Is?
Tranylcypromine, phenelzine, isocarboxazid, selegiline
What is the toxicity of MAO-Is?
Hypertensive crisis
What is the MOA of bupropion?
Increase NE and DA via unknown mechanism; also used for smoking cessation
What is the MOA of mirtazapine?
Alpha2 antagonist –> increased release of NE and 5-HT and potent 5-HT2 and 5-HT3 receptor antagonist
What is the MOA of trazodone?
Primarily blocks 5-HT2 and alpha1 adrenergic Rs. Used primarily for insomnia.
What is the treatment for extrapyramidal side effects?
Benztropine or diphenhydramine
What is the treatment for treatment-resistant schizophrenia?
Clozapine
