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Psychiatry Flashcards

1
Q

acting out

A

unacceptable feelings and thoughts are expressed through actions, ie tantrums

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2
Q

dissociation

A

temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress “extremem forms can result in dissociative identity disorder”

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3
Q

denial

A

avoidance of awareness of some painful reality, with newly diagnosed AIDS and cancer pts

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4
Q

displacement

A

process whereby avoided ideas and feelings are transferred to some neutral person or object (vs. projection), ie mother places blame on child because she is angry at her husband

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5
Q

fixation

A

partially remaining at a more childish level of development (vs. regression), ie men fixating on sports game

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6
Q

identification

A

modeling behavior after another person who is more powerful, ie abused child IDs himself as an abuser

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7
Q

isolation of affect

A

separation of feelings from ideas and events, ie describing murder in graphic detail with no emotional response

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8
Q

projection

A

an unacceptable internal impulse is attributed to an external source, a man who wants another woman thinks his wife is cheating on him

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9
Q

rationalization

A

proclaiming logical reasons for actions actually performed for other reasons usually to to avoid self-blame, after getting fired, claiming that the job was not important anyways

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10
Q

reaction formation

A

process whereby a warded off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite, ie pt with libidinous thoughts enteres a monastery

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11
Q

regression

A

turning back the maturational clock and going back to early modes of dealing with the world, ie seen in children under stress (bedwetting) and in patients with dialysis (crying)

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12
Q

repression

A

involuntary witholding of an idea or feeling from conscious awareness, ie not remembering a conflictual or traumatic experience or pressing bad thoughts into the unconscious

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13
Q

splitting

A

belief that people are either all good or all bad at different times due to intolerance of ambiguity, seen in borderline personality disorder

ex. a pt says that all the nurses are cold and insensitive but that the doctors are warm and friendly

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14
Q

altruism

A

guilty feelings alleviated by unsolicited generosity toward others, ie mafia boss makes large donation to charity

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15
Q

humor

A

appreciating the amusing nature of an anxiety-provoking or adverse situation, ie a nervous medical student jokes about the boards

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16
Q

sublimation

A

process whereby one replaces an unacceptable wish with an course of action that is similar to the wish but does not conflict with one’s value system, ie actress uses experience of abuse to enhance her acting

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17
Q

suppression

A

voluntary witholding of an idea or feeling from conscious awareness (vs repression), ie choosing not to think about the USMLE until the week of the exam

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18
Q

What are the four mature ego defenses?

A

Mature women wear a SASH: sublimation, altruism, suppression, humor

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19
Q

Rett’s disorder

A

X-linked disorder seen only in girls; symptoms start at age 1-4, followed by regression with loss of development, mental retardation, loss of verbal abilities, ataxia, and stereotyped hand wringing

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20
Q

Childhood disintegrative disorder

A

marked regression after 2 years of apparently normal development

significant loss of expressive or receptive language skills, social skills or adaptive behavior, bowel or bladder control, play or motor skills

common onset 3-4 years old, more in boys

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21
Q

dissociative amnesia

A

inability to recall important personal information, usually after severe trauma or stress

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22
Q

depersonalization disorder

A

persistent feelings of detachment or estrangement from one’s own body, a social situation, or the environment

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23
Q

dissociative fugue

A

abrupt change in geographic location with inability to recall past, confusion about personal identity or assumption of a new identity; associated with traumatic circumstances

24
Q

What are the diagnostic criteria for a manic episode?

A

Three or more of the following:

Maniacs DIG FAST

  1. Distractibility
  2. Irresponsibility
  3. Grandiosity
  4. Flight of ideas
  5. increased in goal directed Activity/psychomotor Agitation
  6. decreased need for Sleep
  7. Talkativeness or pressured spech
25
What are the diagnostic criteria for major depressive disorder?
``` 5/9 symptoms for at least 2 more weeks: SIGECAPS 1. Sleep disturbance 2. Loss of Interest 3. Guilt or feelings of wrothlessness 4. loss of Energy 5. loss of Concentration 6. Appetite/weight changes 7. Psychomotor retardation or agitation 8. Suicidal ideations 9. Depressed mood ```
26
What are the symptoms of atypical depression?
hypersomnia, overeating, mood reactivity associated with weight gain and sensitivity to rejection, most common subtye of depression tx: MAOis, SSRIs
27
What are the risk factors for suicide completion?
SAD PERSONS ``` Sex (male) Age (teens or elderly) Depression Previous attempts Ethanol Rational thinking Sickness Organized plan No spouse Social support lacking ```
28
What are the diagnostic criteria for panic disorder?
recurrent periods of intense fear and discomfort peaking in 10 minutes with 4 of the following: PANICS ``` Palpitations Paresthesias Abdominal distress Nausea Intense fear of dying or losing control lIght headedness Chest pain Chills Choking disConnectedness Sweating Shaking Shortness of breath ``` Tx: CBT, SSRIs, TCAs, benzos
29
Tx for alcohol withdrawal
Benzos
30
Tx for anorexia/bulimia
SSRIs
31
Tx for anxiety
Benzos Buspirione SSRIs
32
Tx fo ADHD
Methylphenidate (ritalin) | Amphetamines (dexadrine)
33
Tx for atypical depression
MAOIs | SSRIs
34
Tx for Bipolar disorder
``` Lithium Valproic acid Carbamazepine Lamotrigine Atypical antipsychotics ```
35
Tx for depression
SSRIs SNRIs TCAs
36
Tx for Depression with insomnia
Mirtazapine (5HT antagonist and sedative)
37
Tx for OCD
SSRIs | Clomipramine
38
Tx for Panic disorder
SSRIs TCAs Benzos
39
Tx for PTSD
SSRIs
40
Tx for Schizophrenia
Antipsychotics
41
Tx for Tourette's
Antipsychotics (haloperidol)
42
Tx for Social phobias
SSRIs
43
Antipsychotics
Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine --> all block D2 receptors Uses: schizophrenia, psychosis, acute mania, Tourette's can cause extrapyramidal system side effects and neuroleptic malignant syndrome
44
neuroleptic malignant syndrome
FEVER ``` Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles ```
45
Atypical antipsychotics
Olanzapine, clozapine, quetiapine, risperiodne, aripiprazole, ziprasidone --> block 5HT2, dopamine, alpha, H1 receptors Use: schizophrenia (better than typical for negative symptoms), olanzapine is also used for OCD, anxiety disorder, depression, mania, Tourette's fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics Clozapine can cause angranulocytosis
46
What are the toxicities of lithium?
LMNOP ``` Lithium side effects Movement (tremor) Nephrogenic diabetes insipidus hypOthyroidism Pregnancy problems ```
47
Buspirone
Stimulates 5HT1A receptors for generalized anxiety disorder doesnt cause sedation, addiction or tolerance --> doesnt interact with alcohol
48
TCAs
imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine --> block reuptake of NE and 5HT, block muscarinic cholinergic, alpha and H1 receptors use: depression, bedwetting (imipramine), OCD (clomipramine), fibromyalgia Toxicity: Convulsions, Coma, and Cardiotoxicity; also respiratory depression and hyperpyrexia
49
SSRIs
fluoxetine, paroxetine, sertraline, citalopram uses: depression, OCD, bulimia, social phobias AE: Gi distress, sexual dysfunction, "serotonin syndrome" --> hyperthermia, myoclonus, CV collapse, flushing, diarrhea, seizures
50
SNRIs
venlafaxine, duloxetine --> inhibit 5HT and NE reuptake Use: depression. Venlafaxine --> GAD, duloxetine for diabetic peripheral neuropathy AE: increased BP, sedation, nausea
51
MAOis
phenelzine, tranylcypromine, isocarboxazid, selegiline --> increase amine transmitters (NE, 5HT, DA_ use: atypical depression, anxiety, hypocondriasis Toxicity: hypertensive crisis with tyramine ingestion and B-agonists
52
Buproprion
smoking cessation; increases NE and DA toxicity: stimulant effects (tachy, insomnia), headache, seizure in bulimic patients, but NO sexual side effets atypical antidepressant
53
Mirtazapine
atypical antidepressant alpha 2 antagonist (increases release of NE and 5HT) and potent 5HT2 and 5HT3 antagonist toxicity: sedation, increased appetite, weight gain, dry mouth
54
Maprotiline
atypical antidepressant blocks NE reuptake Toxicity: sedation, orthostatic hypotension
55
Trazodone
atypical antidepressant primarily inhibits 5HT reuptake Use: insomnia, as high doses are needed for antidepressant effects Toxicity: sedation, nausea, priapism, postural hypotension

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