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ESUN MS2Unit3 > Psychiatry III > Flashcards

Psychiatry III Flashcards

1
Q

Diagnostic criteria for obesity?

A

More than 20% ideal weight/BMI>30

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2
Q

Block which 3 receptors would cause weigh gain?

A

H1/M receptor/5HT2c/also block D2 increase prolactin cause weight gain in women

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3
Q

What are some drugs for obesity?

A

Amphetamine/Orlistat (lipase inhibitor)/topiramate and zonisamide (anti-convulsants)

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4
Q

DSM 5 criteria for anorexia?

A

Refuse to maintain normal weight/don’t eat/fear of gaining/body image dysmorphism (self restricted)/restricting (don’t purge) and binge type

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5
Q

Highest mortality rate of psych disorder?

A

Anorexia

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6
Q

What characteristics does anorexia pt usually have?

A

Rigid/type A personality/high endogenous opiate/Lanugo hair

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7
Q

Treatment for anorexia?

A

If severe enough—>force feeding tube/have to be firm with them

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8
Q

DSM 5 criteria for bulimia

A

eating an atypically large amount of food (compulsion)—>1 time a week for 3 month/purging (compensatory behavior) and non purging type/no anorexia symptoms/

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9
Q

Which is more prevalent, anorexia or bulimia?

A

Bulimia

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10
Q

Which has better prognosis, anorexia or bulimia?

A

Bulimia

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11
Q

What are some medical signs of bulimia?

A

Poor dentition/low phosphate and magnesium/salivary enlargement/normal to obese weight/Russel’s sign

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12
Q

Treatment for bulimia?

A

Psychotherapy/SSRI/TCA

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13
Q

What is the mild anorexia disorder called

A

Avoidant/restrictive food intake disorder

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14
Q

What is the mild bulimia disorder called

A

Binge eating disorder

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15
Q

Diagnostic criteria for delusional disorder?

A

Single focused delusion/no hallucination/normal lives

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16
Q

What is Capgras delusion?

A

Delusion where pt feels someone has been replaced by an imposter

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17
Q

What is Fregoli delusion?

A

Delusional disorder that the pt thinks different people are actually the same person that change appearance or in disguise/paranoid—>you are following me….

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18
Q

What is vampirism?

A

Delusion that one is a vampire

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19
Q

What is lycanthropy?

A

Delusion that one is a werewolf

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20
Q

What other disorder do pyschopathic cannibalism pts have?

A

Antisocial/psychopathy/and delusion about eating people

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21
Q

What is folie a deux or shared delusion disorder?

A

Symptoms of a delusional belief are transmitted from one person to another (voodoo zombie)

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22
Q

What is cotard’s delusion?

A

Delusion that the pt believe that he/she is dead

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23
Q

What is the heroin like drug that rot flesh?

A

Krokodil

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24
Q

What is Morgellons/delusional parasitosis?

A

Delusion that you are infested with parasite and they are underneath your skin/might actually find some bacteria or parasite (self induced)

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25
Q

What is erotomanic delusion?

A

Pt think another person (stranger/famous people) is in love with him/her

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26
Q

What part of the brain is hyperactive in delusional disorder?

A

Mesolimbic system with high DA like schizo

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27
Q

Treatment for delusional disorders?

A

Psychotherapy help to cope/antipsychotic doesn’t work that well—>hard to treat

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28
Q

Progression of Alzheimer’s disease?

A

Normal—>mild cognitive impairment (mild memory lost) —>dementia

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29
Q

DSM 5 criteria for Azheimer’s?

A

Mild or major (can’t live alone) neurocognitive disorder. Focus on decline of function/cognition/behaviors

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30
Q

What are early and late onset AD?

A

Early onset—>30-60/rare/single gene mutation (presenilin 1/2)
Late onset—->over 60 but usually around 80

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31
Q

Some risk factors for AD?

A

Age/female/fewer year of education/psych illness/alcohol abuse

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32
Q

Distinguish depression from dementia?

A

On test dementia pt would try to impress but depression pt would not want to participate

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33
Q

Is brain imaging helpful for AD pts?

A

Not really—>nonspecific findings

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34
Q

What would you see on a PET scan for AD pt?

A

More blue tone/enlarged ventricles—>less blood flow

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35
Q

The most common frontotemporal dementia is?

A

Pick’s disease—>decline in social interpersonal conduct (behavioral)—>memory problems come later

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36
Q

What to give frontotemporal dementia pt?

A

Divalproex for behavioral/SSRI for irritability. depression and impulsive behaviors/don’t use SGA

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37
Q

What’s the brain of an AD pt like?

A

Cerebral atrophy/hippocampus atrophy

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38
Q

What kind of stain do you use to stain neuritic and neurofibrillary tangles?

A

Silver stain

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39
Q

What stain is used to confirm the presence of amyloid plaques?

A

Congo red

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40
Q

Familiar onset AD has higher Abeta40 or 42?

A

Abeta 42

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41
Q

Where are presenilins located?

A

Gamma-secretase

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42
Q

What caused the earlier onset of AD?

A

Down syndrome

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43
Q

What are the 2 types of plaques do you see in AD pt?

A

Diffuse and neuritic plaques (dark center)

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44
Q

What’s in neurofibrillary tangles?

A

Hyperphosphorylated Tau proteins

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45
Q

What is granulovacuolar degeneration (GVD) and hirano bodies and where do you see them?

A

GVD—>granulocyte in a vacuole in a neuron/AD pts or old ppl

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46
Q

Two subtypes of frontotemploral degeneration?

A

FTLD-tau (Pick’s) and FTLD-TDP

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47
Q

Is senile and memory lost as one ages a normal phenomena?

A

No

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48
Q

What are the 2 kinds of drugs used for AD?

A

AChE inhibitor and NMDA receptor antagonists

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49
Q

HTN causes ___ infarct of the ____ and causes ____ dementia?

A

Lacunar infarcts/lenticulostriate/vascular dementia

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50
Q

Clinically, vascular dementia presents as a ___ progression

A

Step wise—>decline, level off, decline, level off and repeat/emotionally lability

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51
Q

What other risk factors do vascular dementia pt has?

A

Cardiovascular

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52
Q

Treatment for vascular dementia

A

Control cardiovascular risk factors/AD drugs

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53
Q

End stage Parkinson’s show ___ loss

A

severe neuronal loss

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54
Q

What are other symptoms do you see with lewy body dementia that you don’t see with AD?

A

Vivid hallucination and delusions/memory less affected/nigral pallor/atrophy of the limbic system/REM sleep disorder (act out dreams)/high neuroleptic sensitivity

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55
Q

What is the appearance difference between the lewy body in substantial nigra and cortical?

A

SN—->round and dark in the middle

Cortical—>acentral nucleus

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56
Q

Treatment for lewy body dementia?

A

AChE inhibitor/levodopa for movement disorder/NO antipsychotic drugs

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57
Q

What is mini metal status examination (MMSE)?

A

Screening tool for dementia (non specific for types)—>out of 30 (higher the better)

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58
Q

What are the 5 areas of MMSE?

A

Orientation/registration/attention and calculation/recall/language

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59
Q

What is montreal cognitive assessment (MoCA)?

A

Screening tool for dementia (out of 30)—>more comprehensive than MMSE

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60
Q

What is DEATH for ADL and SHAFT for IADL?

A

DEATH—>dressing/eating/ambulating/toileting/hygiene

SHAFT—>shopping/housekeeping/accounting/food preparation/transportation

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61
Q

What is the difference between adult home/assisted living facilities and nursing facilities?

A

Adult home—>rent a room/provides meal/not much medical problem/elderly is independent
Assisted living—>assist with IADLs/no medical nor nursing care
Nursing facilities—>pt is dependent of all ADLs (like incontinence)

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62
Q

The lower the score on Geriatric Depression Scale the ___?

A

Better

63
Q

What is the score range for normal/mild/moderate/severe of MoCA and MMSE?

A

Normal >26
Moderate 20-26
Mild 10-20
Severe

64
Q

Fundamental hypothesis of psychoanalytic theory: every event and symptom has ___?

A

Meaning

65
Q

___ is the reservoir of the reasons of why you do certain thing that can not be explained by consciousness

A

Unconsciousness

66
Q

What is unconscious?

A

Repressed thoughts and feelings

67
Q

What is libido in psychosexual stages of development?

A

Anything that makes you want to do things

68
Q

When and what is the oral phase of psychosexual stages?

A

birth - 1 year and half—>baby sucking and putting things in their mouth/dependency

69
Q

What is adult oral traits?

A

Ppl who enjoy food/drink/smoke to the excess—>become passive and dependent

70
Q

When and what is the anal phase?

A

1 and half to 3 years—>emphasis on control (parents tell the kids “no”/potty training/crawling and exploring

71
Q

What is adult anal traits?

A

Being too controlled/neat/correct/careful with money/organized

72
Q

What is fixation and regression regarding psychosexual stages?

A

Fixation—>extra investment of libido in one phase

Regression—>reverse back to earlier phase (under stress like being sick)

73
Q

When and what is the phallic phase?

A

3-5/6—>curious about sex differences/close to parent of opposite sex

74
Q

When and what is latency phase?

A

6 to teens—>boys and girls learn how to be boys and girls/they don’t like each other

75
Q

When and what is genital phase?

A

Teen to adult—>true intimacy

76
Q

What are the 3 structural model of the mind?

A

ID—>”child”/goal is to get the most pleasure (fun and bad)
Superego—>”parent”/from age 5/what’s right and wrong (follow the rule)/learned from mentors and models in life
Ego—>”adult”/it is who we are (personality)/evolving—>balancing between superego and ID

77
Q

When ego is under stress (don’t know what to do know)—>stress—>we utilize ____?

A

Defense mechanism—>decrease stress

78
Q

What is the level I defense mechanism?

A

Psychotic—>change reality/common for ppl before age 5 and adult dreams and fantasy (real bad)

79
Q

What are the 3 level I defense mechanisms?

A

Delusional projection—>putting down somebody else to make you feel better (lead to paranoid)
Psychotic denial—>denying reality
Distortion—>reshape reality to suit your need

80
Q

What is level II defense mechanism?

A

immature mechanisms/common for ppl from 3-15/trying to be close to people but its not working—>what can i do to make you care about me?

81
Q

What are the 4 level II defense mechanisms?

A

Projection—>project one’s own bad feeling onto you (being paranoid (paranoid personality) that everybody is out to get you and in a way everyone is connected to you—>make you felt connected)
Somatization—>turn one’s own bad feeling into physical illness or pain then seek attentions from others
Acting out—>antisocial behaviors (I don’t like my feeling so i would do something (punch ppl) instead of feeling something)
Splitting—>See ppl or event as completely good or bad (black or white)—>borderline personality disorder

82
Q

What is level III defense mechanism?

A

common in ppl from 3-90/seems odd or quirky/in acute distress from healthy people (high functioning)

83
Q

What are the first 4 level III defense mechanism?

A

Denial—>just don’t wanna deal with it right now (cancer pt)
Displacement—>lash out to a safer target (can’t yell at dean, yell at med students)—>phobias (afraid of something—>transfer to something i can deal with like a spider)
Dissociation—>after a traumatic event—>dissociate and forget your identity (long term is Multiple personality disorder)
Identification—>unconsciously joining the more powerful person or aggressor (Stockholm Syndrome)—>helpless person in an abusive situation

84
Q

What are intellectualization/isolation of affect/rationalization of level III defense mechanism?

A

Intellectualization—>in acute distress you do something or explain with words (like when your spouse just passed away)—>the feelings are not there—>OCD
Rationalization—>explain away negative feelings (it’s not my fault)
Isolation of affect—>when you understand the situation but not feeling it (numb)

85
Q

What are reaction formation/regression/undoing of level III defense mechanism?

A

Reaction formation—>do the opposite of how you feel (hate somebody you really like)
Regression—>child like behaviors during stress
Undoing—>do something in hope that something in the past can be corrected (superstition)

86
Q

What is level IV defense mechanism?

A

mature/good for you and the society (virtues)

87
Q

What are the 5 level IV defense mechanism?

A

Altruism—>do things for others to make you feel good
Sublimation—>really want to do something but can’t so im gonna do something else instead (like beating ppl up, can’t do that, take boxing lessons)
Anticipation—>plan ahead for something that might be anxiety provoking
Suppression—>suppress the anxiety for a brief period of time—>come back to it later
Humor—>express yourself in a humorous fashion that other people might accept it

88
Q

What is transference and counter transference?

A

Transference—>pt use past to judge or reply the current relationship with the physician (e.g. prejudice)—>see physician as a father figure—>use past relationship with father to interact or expect from the physician
Countertransference—>the opposite goes from the physician to the pt

89
Q

Pain (nociception) is detected what kind of nerve?

A

Free nerve endings

90
Q

Difference between A delta and C fiber for nociception

A 
A delta (highly myelinated)--->reflex 
C fiber--->long lasting dull pain
91
Q

What is mechanical hyperalgesia?

A

The area around the injury is tender and painful as well

92
Q

When the pain and temp comes into the spinal cord, it ___?

A

Crosses over to the other side and go up through the spinothalamic tract

93
Q

Descending ___ system modulate pain and can be manipulated by opioid?

A

Descending pain modulatory system (contain opioid receptors)

94
Q

__ receptor is the most important opioid receptor for pain relieve?

A

Mu

95
Q

Endogenous opioid can be released ____ and ____ with ACTH

A

centrally and peripherally with ACTH

96
Q

Opioid can cause hyper__? and how to stop this from developing?

A

Hyperalgesia (causing pain response)/block the GLU system

97
Q

Which has a more sustained activity, NSAIDs or opioids?

A

NSAIDS

98
Q

Inflammatory pain use? horrible pain, use __ for short time?

A

NSAID/opioid

99
Q

Progression of neuropathic pain?

A

Ca influx (sub-threshold pain response)—>Ca and Na influx (full pain response)—>wires got crossed (excess GLU)—>more rapid firing (central sensitization—>chronic pain)

100
Q

What are the 3 “bus stops” of pain perception?

A

Spinal reflex (reflex pain—>curse/throw stuff)—>thalamus—>cortex and limbic (conscious pain)

101
Q

Clinical management: if a pt in pain doesn’t response too much to Ca channel drugs, what other kind of drugs can you give?

A

Na channel blockers

102
Q

Weak ascending NE to cortex/descending NE to spinal cord causes?

A

Depression, anxiety and many other psychiatry disorder/pain (that’s why depressed/anxious people has more pain—>they travel together)

103
Q

How do antidepressant treat problems related to ascending and descending NE?

A

Antidepressant with NE reuptake inhibitors strengthen ascending and descending NE—>remit psychiatric disorders and decrease pain (NE stimulates GABA—>downregulate pain fiber—>pain relieve)

104
Q

How you perceive pain is highly depends on your ___ and ___?

A

How you were raised and your personality/level of education (higher educated people don’t use opioid for pain)

105
Q

When a pt who’s on opioid for years for pain management broke his leg–>he experience more or less pain than a pt that has not been on opioid?

A

More pain (opioid hyperalgesia)

106
Q

What is anterior cingulate and orbital/ventralmedial prefrontal cortex’s roles in pain perception?

A

Anterior cingulate—>hypervigilance on where the next pain is gonna be from
Orbital and ventralmedial prefrontal cortex—>think of all the things that might cause pain (i hurt my ankle, i shouldn’t go out tonight)

107
Q

How do you tell if a pt has opioid hyperalgesia?

A

Opioid level is going up and up and more pain/short cold pressure time (stick your arm into a huge pot of ice)—>low pain tolerance

108
Q

What is analogue visual scale (AVS)?

A

Used to assess pain with pictures of faces

109
Q

What are the 3 common factors for all the psychotherapy?

A

Alliance (importance varies among different therapies)/expectation/Hawthorne effect (you do better when you are watched)

110
Q

What is the base and aim of psychoanalysis and psychodynamic?

A

Unconscious conflicts are repressed and causes difficulty/making unconscious conscious—>understanding conflict

111
Q

What are the 4 techniques of psychoanalysis and psychodynamic?

A

Free association/analysis of transference and resistance/dream interpretation

112
Q

How long is psychoanalysis and psychodynamic/interpersonal?

A

Long term therapy—>sometimes years/short term

113
Q

What is the base and aim of interpersonal psychotherapy?

A

Problematic attachment early in life cause later interpersonal problem/correct the problems

114
Q

What are the 4 techniques of interpersonal psychotherapy?

A

Loss and grief/role disputes/role transition (from med school to residency)/interpersonal deficits (social skills)

115
Q

What do interpersonal treat?

A

Depression and eating disorder

116
Q

What is family system psychotherapy/what are the 2 techniques/what does it treat?

A

The whole family is the patient/normalizing boundaries and redefining blame/child behaviors

117
Q

What is group therapy?

A

Treat people with common experiences

118
Q

What is the aim of behavioral psychotherapy and what does it treat?

A

Relieve symptoms by unlearning maladaptive behaviors/phobias, depression, autism, psychotic disorder and ODD and ADHD

119
Q

Which psychotherapy is based on classical and operant conditioning?

A

Behavioral

120
Q

What is classical conditioning?

A

unconditioned stimulant (natural, e.g. meat—>salivation) combine with neutral stimulant (tone)—->neutral stimulant become conditioned stimulant—>tone causes salivation

121
Q

what is the change over time of the strength of the conditioned response (classical conditioning)?

A

Acquisition (pairing stimulants)—>extinction (neutral stimulant stop working)—>time delay—>hear tone, drool again but then decline without UCS

122
Q

What is stimulus generalization and discrimination?

A

Stimulus is being generalized (when phobia pt develop agoraphobia)/pt learn to differentiate among similar stimuli (goal of the therapy)

123
Q

What is systemic desensitization?

A

Derived from classical conditioning/aim to unlearn the association of a fear or addiction with certain object/e.g. phobia of clown—>start with a pic of a normal clown—>learn to relax when looking at it—>and then move up to real and more scary clowns

124
Q

What is positive and negative reinforcer of operant conditioning?

A

Positive—>add something to strengthen the response (give gold start to children)
Negative—>remove a bad stimulant to strengthen the response (anxious pt avoid something that makes them anxious)

125
Q

How is the size and timing of the reinforcer affect the behaviors?

A

The bigger/and sooner you give the reinforcer after the response—>the better

126
Q

What is the 4 kinds of partial reinforcement schedules (unlike continuous—>give every time after a response)?

A

Fixed ratio (like every 3 responses)/variable ratio (like 3 times a month)/fixed interval (like get paid every month)/variable interval (like get paid sometime per week some time per month)

127
Q

What kind of schedule of reinforcement is most consistent across the longest time?

A

Interval

128
Q

Difference between reinforcement and punishment regarding response of operant conditioning?

A

Response goes up for reinforcement and down for punishment (need to know the response afterwards to determine)

129
Q

What is positive and negative punishment?

A

Positive—>add something bad (get hit by parents for stealing)
Negative—>lose something good (run with ice cream–>ice cream fall—>stop running with ice cream)

130
Q

What are some drawbacks of punishment?

A

Does not erase a bad habit/need to do it every time after the response/the people who’s giving punishment can be angry and abusive/doesn’t tell you what is right

131
Q

What is conversion disorder?

A

Triggered by trauma or stress—>sudden loss of 1 or more motor or sensory function (protecting you from experiencing the trauma again?)—>neurologic symptoms does not follow how the nervous system works
Unconscious and no 2nd gain

132
Q

What are the 6 techniques of behavioral psychotherapy?

A

Systemic desensitization/flooding/aversive conditioning (punish when bad)/token economy (positive reinforcement)/self monitoring/stimulus control (change behavior to avoid punishment)

133
Q

What is the aim of cognitive therapy?

A

to be mindful of their thoughts/challenge the thought/get rid of bad thoughts and replace it with good thoughts/correct errors in thinking

134
Q

What are the 2 techniques for cognitive therapy?

A

Psychoeducation (recognize thoughts) and cognitive restructuring (challenge them)

135
Q

How long and what does cognitive therapy treat?

A

short term/depression, anxiety and eating disorder

136
Q

What are the 3 fundamental proposition of CBT?

A

Cognition affect behaviors (mediational model)/cognition can be monitored and altered/change cognition, change behaviors

137
Q

What are the 3 classes of CBT?

A

Coping skill therapy—>manage stress
Cognitive restructuring method—>change how to think
Problem solving—>combination of the other two

138
Q

Common things like homework that CBT does?

A

Homework/focus on future/give pt lots of info

139
Q

What is the structure of a CBT session?

A

10-30-10/first 10 mins for yesterday’s hw/30 mins for actual work/last 10 assigning hw

140
Q

What are the conscious and unconscious disorders of somatoform disorder?

A

Conscious—>on purpose (Factitious/malingering)

Unconscious—>not aware (conversion/somatization)

141
Q

What are primary and secondary gain regarding somatofrom disorders?

A

Primary—>unconscious (my parents are like this so i’m like this)
Secondary—>external motivations (drugs/need housing)

142
Q

Increasing number of somatoform symptoms increase the chance of ?

A

depression and anxiety

143
Q

What is somatic symptom disorder?

A

Collection of medical problems that has no causes (2 GI/1 GU/1 neurological)—>accumulating symptoms
Unconscious/no 2nd gain

144
Q

What is illness anxiety disorder?

A

Hypochondriasis—>unconscious and no 2nd gain

145
Q

What is body dysmorphic disorder?

A

preoccupy by your appearance—>unconscious and no 2nd gain

146
Q

What is pain disorder (DSM IV)?

A

Just one symptom that is painful (don’t meet somatization disorder—>milder version)

147
Q

What is factitious disorder?

A

Known as Munchausen syndrome—>consciously faking medical problems for yourself (by proxy is what parents do to kids)
It is on purpose but the purpose might not be conscious

148
Q

What is malingering?

A

Consciously faking it to gain something (criminal)

149
Q

What are 2 drugs for anorexia?

A

Mirtazapine and olanzapine

150
Q

Pain management for injury

A

Give opiate for acute injury/give NISAD and send him home/come back with neutropathic pain—>give AED or SSRI or SNRI

151
Q

Aim of motivational interview?

A

work through ambivalence and help the pt to reach a decision

152
Q

What are the 5 principles of MI?

A

DARES—>discrepancy/avoid confrontation/roll with resistance/empathy/support self efficacy

153
Q

5 steps of MI (SBIRT)?

A

rapport—>pro and con—>personalized feedback—?assess readiness (readiness ruler)—>create action plan

ESUN MS2Unit3 (11 decks)

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