psychiatry Flashcards
1
Q
learning in which a particular action is elicited bc it produces a punishment or reward
usually deals with VOLUNTARY responses
A
operant conditioning
2
Q
discontinuation of reinforcement (positive or negative) eventually elimantes behavior. can occur in operant or classical conditioning
A
extinction
3
Q
doctor projects feelings about formative or other important persons onto pt
A
countertransference
4
Q
pt projects feelings about formative or other important persons onto physician
A
transference
5
Q
expressing unacceptable feelings and thoughts through actions
tantrums
A
acting out
6
Q
mother yells at her child bc her husband yelled at her
A
displacement
7
Q
temporary drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
A
dissociation
8
Q
partially remaining at a more childish level of development (vs regression)
A
fixation
adults fixating on video games
9
Q
expressing extremely positive thoughts of self and others while ignoring negative thoughts
A
idealization
10
Q
modeling behavior after another person who is more powerful
abused child later becomes a child abuser
A
identification
11
Q
describing murder in graphic detail with no emotional response
A
isolation of affect
12
Q
disgruntled employee is repeatedly late to work
A
passive aggression
13
Q
a man who wants to cheat on his wife accuses his wife of being unfaithful
A
projection
14
Q
proclaiming logical resaons for actions actually performed for other reasons, usually to avoid self blame
after getting fired: guy says job wan’t importnant anyways
A
rationalization
15
Q
a pt says that all nurses are cold but doctors are warm and friendly
A
splitting
16
Q
mafia boss makes large donation to charity to make himself feel better about negative feelings
A
altruism
17
Q
choosing to not worry about the big game until it is time to play
A
suppression
18
Q
mature forms of defense
A
SASH
suppression, altruism, sublimation, humor
19
Q
infant deprivation effects
A
weak, wordless, wanting (socially), and wary
deprivation for >6 months can lead to irreversible changes
20
Q
vulnerable child syndrome
A
parents perceive child as especially susceptible to illness or injury
usually follows serious illness or life threatening event
21
Q
ADHD
A
onset before age 12, multiple settings
continues into adulthood for 50% individuals
22
Q
autism spectrum disorder associated with
A
increased head and brain size
must be in childhood
23
Q
x linked dominant disorder in girls
symptoms at age 1-4
regression with loss of development, verbal abilities, intellectual disability, ataxia, stereotyped hand wringing
A
rett syndrome
24
Q
conduct disorder
A
like antisocial personality but less than 18
25
enduring pattern of hostile, defiant behavior toward authroity figures in absence of serious violations of social norms
oppositional defiant disorder
26
common onset is 7-9
fear of separation from home or loss of attachment figure
factitious physical complaints to avoid going to or staying at school
treatment?
separation anxiety disorder
treat: CBT, play, therapy, family therapy
27
tourette syndrome
before 18, sudden tics that persists for over 1 YEAR
treat with psychoeducation, behavioral therapy
28
NTs alzheimers
increased glutamate
| decreased Ach
29
NTs anxiety
increased norep
| decreased, gaba and serotonin
30
depression NTs
decreased norep, serotonin, dopamine
31
huntingtons NTs
decreased GABA and ach
| increased dopamine
32
parkinsons NTs
decreased dopamine
| increased Ach
33
schizophrenia NTs
increased dopamine
34
orientation loss order
time, place, person
35
korsakoff syndrome
amnesia (anterograde over retro) caused by B1 deficiency
| destruction mamillary bodies
36
inability to recall important info, usually subsequent to severe trauma or stress
dissociative amnesia
37
abrupt travel or wandering during period of disociative amnesia with traumatic circumstance
dissociative fugue
38
mutliple personalitiy disodered
dissociative identify disorder
39
delerium
eeg
drug to use
caused by
wax and wane level of consciousness
disorganized thinking, hallucinations
illusions, misperceptions, disturbance in sleep wake cycle
secondary to other illness often
diffuse slowing EEG
haloperidol as needed
can be caused by anticholinergics in elderly
reversible
40
dementia is or isn't reversible
is not
41
hypnaGOgic hallucination
Occurs while GOing to sleep
| Sometimes seen in narcolepsy
42
Hypnopompic hallucination
Occurs while waking from sleep
Pompous upon awakening
Sometimes seen in narcolepsy
43
Reversible causes of dementia
Hypothyroidism, depression, vitamin B12 deficiency, normal pressure hydrocephalus, neurosyphilis
44
In elderly people ____ and ____ may present like dementia (pseudodementia)
Screen for what
Depression and hypothyroidism
TSH and B12 levels
45
What would you see on brain image of schizophrenic
Venticulomegaly
46
How long do symptoms have to be going on for it to be schizophrenia
Brief psychotic disorder?
Schizophreniform
6 months
Less than 1 month
1-6 months
47
What is schizoaffective disorder (SAD)
Over 2 weeks of hallucinationts or delusions without major mood episode + periods of concurrent major mood episode with schizo symptoms
Both schizo without mani and shizo with mania
48
Delusional disorder last for
Has to be false belief for 1 month or more
49
Manic episode must last how long
At least 1 week
50
Hypomanic episode
Like manic episode except mood disturbance is not sevrere enough to cause marked impairment in social and or occupational functioning or to necessitate hospitalization
No psychotic features
Last 4 consecutive days
51
Bipolar 1
At least 1 mani episode +/- a hypomanic or depressive episode
Ian shameless
52
Bipolar II
Presence of hypomanic and depressive episode
BP 2 HD
53
Milder form of bipolar disorder lasting AT LEAST 2 years
| Fluctuating btwn mild depression and hypomanic symptoms
Cyclothymic disoerder
I lived in CT for 2 years and was a little depressed and hypomanic
54
Major depressive disorder
Episodes last 6-12 months
5 of 9 SIGECAPS for 2 weeks
Must have depressed mood or anhedonia
55
Pts with depression typically have the following changes in sleep stages
Decreased slow wave sleep and REM latency
Increased REM early in sleep cycle and increased in total REM
Repeated nighttime awakenings
Early morning wakenings
56
Depression with atypical features
Differs from classical forms of depression
Characterized by mood reactivity (being able to experience improved mood in response to positive events, albeit briefly)
Reversed vegetative symptoms (hypersomnia, hyperphagia)
Leaden parlysis (heavy arms and legs)
57
Maternal postpartum blues occurs ____ days after delivary and resolves when
Treatment?
2-3 days after birth, 10 days resolves
| Treat = supportive
58
Postpartum depression
Treat?
10-15% incidencee rate
Depressed affect, anxiety, poor concentration
CBT and SSRI
59
Characterized by mood congruent delusions, hallucinagtions, and thoughts of harming the baby or self. Risk factor is history of bipolar, or psychotic disorder, first preg, fam histroy, recent stop of psych meds
Treatment?
Pospartum psychosis
Treat with hospitalization and atypical antipsychotic then ECT if needed
60
How long does grief usually last
Under 6 months
61
What is ECT used for
Produces what
AE
Treatment refractory depression, depresssion with psychotic symptoms, and acutely suicidal pts
Produces grand mal seizure in anesthetized pt
Ae = diorientation, HA, anterograde/retrograde amnesia usually resolving in 6 months
Safe in pregnancy
62
Risk factors for suicide completion
SAD PERSONS
Sex (male), age (young adult or elderly), depression, previous attempt, ethanol or drug use, rational thinking loss, sickness, organixed plan, no spouse or social support, stated future intent
63
Suicide: ___ try more often _____ succeed more
What object
Women try more, men succeed more often
Guns
64
Treatment panic disorder
CBT, SSRI and venlafaxine first line
Benzo in acute setting
65
Exaggerated fear of open or enclosed places, using public tranit, being in line or crowds, or leaving home alone
Treat?
Agoraphobia
CBT, SSRI, MAO inhibitor
66
Treatment of social anxiety disorder
CBT SSRI, venlafaxine
67
Generalized anxiety disorder lasts how long
Anxiety lasting over 6 months
Restless, irritable, sleep disturbance, fatigue
68
Treatment of GAD
CBT, SSRI, SNRI, buspirone, TCAs
| Benzos are second line
69
Adjustment disorder
Emotional symptoms causing impairment following an identifiable psychosocial stressor and lasting less than 6 MONTHS, over 6 months with chronic stressor
70
Treatment for obsessive compulsive disorder
CBT, SSRI, clomipramine are first line
71
Treatment for body dysmorphic disorder
CBT
72
How long does disturbance of post traumatic stress disorder have to last
Treatment?
1 month
CBT, SSRI
73
Acute stress disorder
| Treatment
Lasts between 3 days and 1 month
CBT
74
Pt consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain an external gain (avoiding work, obtaining compensation)
Complaints cease after gains
Malingering
75
Pt consciously creates physical and or psychological symptoms in order to assume sick role and to get medical attention (internal gain)
Factitious disorders
76
Chronic factitiious disorder with predominantly physical signs and symptoms characterized by history of multiple hospital admissions and willingness to undergo invaasive proceudres
Factitious disorder imposed on self (munchausen syndrome)
77
Illness in a child or elderly pt is caused or fabricated by caregiver. Motivation is to assume sick role by another. Form of child/elder abuse
Factitious disorder imposed on antoerh
Munchausen syndrome by proxy
78
Variety of bodily complaints like pain and fatigue lasting for months to years. Associated with excessive, persistent thoughts and anxiety about symptoms
Somatic symptom disorder
79
Loss of sensory or motor function (paralysis, blindness, mutism) often following an acute stressor. Pt is aware of but sometimes indifferent toward symptoms, more common in females, adolescents and young adults
Conversion disorder (functional neurologic symptom disorder)
80
Excessive preoccupation with acquiring or having a seroius illness, often despite medical evaluation and reassurance. Minimal somatic symptoms
Illness anxiety disorder
81
False, nondelusional belief of being pregnant. May have signs and symptoms of pregnancy but is not pregnant
Pseudocyesis
82
Cluster A personality disorders
Paranoid, schizoid, schizotypal
83
Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
Schizotypal
84
Voluntary social withdrawal, limited emotional expression, content with social isolation
Schizoid
85
Pervassive distrust and suspiciousness, projection is the major defense mechanism
Paranoid
86
Type B personality disorders
Antisocial, borderline, histrionic, narcissistic
87
Unstable mood and interpersonal relationshiops, impulsivity, self-mutilation, suicidality, sense of emptiness, females > males
Treatment
Borderline
Dialectical behavorior therapy
88
Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance
Histrionic
89
Cluster C personality disorders
Avoidant
Obsessive compulsive
Dependent
90
Submissive and clingy, excessive need to be taken care of, low self confidence
Dependent
Pts in abusive relationships
91
BMI and associations with with anorexia
Treatment and problem with treatment
BMI under 18.5
Decreased bone density, severe weight loss, metatarsal stress fractures, amenorrhea (due to loss of pulsatile GnRH) lanugo anemia, electrolyte disturbances
```
Treat: pyschotherapy nutritional rehab are first line
Refeeding syndrome (increase insulin--> hypophosphatemia-->cardiac complications) with really malnourished pts
```
92
Bulemia is binging and purging for how long
Weekly for at least 3 months
BMI may be normal
Russel sign which is dorsal hand calluses from induced vomiting
93
Binge eating disorder increases risk for what
| First line treatment
Diabetes
Psychotherapy like CBT
SSRI
94
Desire to live as the opposite sex, often through surgery or hormone treatment
Transexualism
95
Paraphilia, not gender dysphoria, wearing clothes of opposite sex
Transvestism
96
Sleep terror disorder occurs what stage of sleep
N3 (no memory of arousal)
| nightmares are in REM sleep
97
Narcolepsy
Sleep wake cycle
Physiology
Associated with what symptoms
Disordered regulation of sleep-wake cycles
Excessive daytime sleepiness
Caused by hypocretin (orexin) production in lateral hypothalamus
Associated with: hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations
Nocturnal and narcoleptic sleep eipsodes
Cataplexy (loss of all muscle tone following strong emotional stimulus like laughter)
Strong genetic component
98
Treatment for narcolepsy
Daytime stimulants (amphetamines, modafinil) and nighttime sodium oxybate (GHB)
99
Stage of change in overcoming substance addiction
PC PAMR
| Precontemplation, Contemplation, Prep/determination, Action/willpower, Maintenance, Relapse
100
Withdrawal: sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea
Treatment
Opioids
Methadone, buprenorphine
101
Withdrawal: delirium, life threatening cardiovascular collapse
Barbs
102
When does delirium tremens usually occur
2-4 days after last drink during alcohol withdrawal
Treatm with benzos
103
High potency antipsychotics and side effects
Try to fly high
Trifluoperazine, fluphenazine, haloperidol
AE: (EPS)
104
Low potency antipsychotics first gen and AE
Chlorpromazine, thioridazine
Anticholinergic, antihistamine, a1 blockade
C hlorpromazine = Corneal deposits
T hioridazine = reTinal deposits
105
Onset of EPS with antipsychotics
ADAPT
Hours to days: Acute dystonia (muscle spasm, stiffness, ouclogyric crisis)
Days to months: akathisia (restlessness) and parkinsonism
Months to years = tardive dyskinesia (orofacial chorea)
106
Side effects of lithium
LMNOP
```
Lithium side effects
Movement (tremor)
Nephrogenic DI
HypOthyroidism
Pregnancy problems
```
Ebstein anomaly in newborn
Thiazide use in lithium toxicity in bipolar pts
107
Buspirone MOA
Stimulates 5 HT1A (buspir ONE)
Sarah on the anxiety bus
Takes 1-2 weeks to work
Does not interact with alcohol
108
What is epstein anomaly. Found in what and what is it
Lithium use while pregnant
Tricuspid leaflets displace inferior
RV hypoplasia
Tricuspid regurgitation or stensosis
Patent foramen ovale
109
Most common and fastest AE with lithium
Tremor
110
First line treatment drug for anorexia
Fluoxetine
111
First line treat binge eating disorder
Lis dexamphetamine
112
Treatment for bulemia nervosa drug
Fluoxitine
