Psychiatry - Pathology (1) Flashcards
1
Q
Infant deprivation effects
- Long-term deprivation of affection results in:
- Deprivation for > 6 months
- Severe deprivation
A
- Long-term deprivation of affection results in:
- Decreased muscle tone
- Poor language skills
- Poor socialization skills
- Lack of basic trust
- Anaclitic depression (infant withdrawn / unresponsive)
- Weight loss
- Physical illness
-
The 4 W’s:
- Weak
- Wordless
- Wanting (socially)
- Wary
- Deprivation for > 6 months
- Can lead to irreversible changes.
- Severe deprivation
- Can result in infant death.
2
Q
Child abuse
- For each
- Evidence
- Abuser
- Epidemiology
- Physical abuse
- Sexual abuse
A
- Physical abuse
- Evidence: Healed fractures on x-ray (e.g., spiral fractures are highly suggestive of abuse), burns (e.g., cigarette, scalding), subdural hematomas, pattern marks/bruising (e.g., belts, electrical cords), rib fractures, retinal hemorrhage or detachment
- Abuser: Usually biological mother
- Epidemiology: ~3000 deaths/yr in U.S., 80% < 3 yr old
- Sexual abuse
- Evidence: Genital, anal, or oral trauma; STDs; UTIs
- Abuser: Known to victim, usually male
- Epidemiology: Peak incidence 9–12 years old
3
Q
Child neglect
- Definition
- Evidence
A
- Definition
- Failure to provide a child with adequate food, shelter, supervision, education, and/or affection.
- Most common form of child maltreatment.
- As with child abuse, child neglect must be reported to local child protective services.
- Evidence
- Poor hygiene, malnutrition, withdrawal, impaired social/emotional development, failure to thrive.
4
Q
Attention-deficit hyperactivity disorder
- Definition
- Findings
- Treatment
A
- Definition
- Childhood and early-onset disorder
- Onset before age 12.
- Limited attention span and poor impulse control.
- Normal intelligence, but commonly coexists with difficulties in school.
- Continues into adulthood in as many as 50% of individuals.
- Findings
- Characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.)
- Associated with decreased frontal lobe volume/metabolism.
- Treatment
- Methylphenidate, amphetamines, atomoxetine, behavioral interventions (reinforcement, reward).
5
Q
Conduct disorder
A
- Childhood and early-onset disorder
- Repetitive and pervasive behavior violating the basic rights of others (e.g., physical aggression, destruction of property, theft).
- After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder.
6
Q
Oppositional defiant disorder
A
- Childhood and early-onset disorder
- Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms.
7
Q
Tourette syndrome
- Definition
- Findings
- Treatment
A
- Definition
- Childhood and early-onset disorder
- Onset before age 18.
- Lifetime prevalence of 0.1–1.0% in the general population
- Associated with OCD and ADHD
- Findings
- Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for > 1 year.
- Coprolalia (involuntary obscene speech) found in only 10–20% of patients.
- Treatment
- Antipsychotics and behavioral therapy.
8
Q
Separation anxiety disorder
- Definition
- Treatment
A
- Definition
- Childhood and early-onset disorder
- Common onset at 7–9 years.
- Overwhelming fear of separation from home or loss of attachment figure.
- May lead to factitious physical complaints to avoid going to or staying at school.
- Treatment
- SSRIs and relaxation techniques/behavioral interventions.
9
Q
Pervasive developmental disorders
- Definition
- Examples
A
- Definition
- Characterized by difficulties with language and failure to acquire or early loss of social skills.
- Examples
- Autism spectrum disorder
- Rett disorder
10
Q
Autism spectrum disorder
- Definition
- Findings
A
- Definition
- Pervasive developmental disorder
- Must present in early childhood
- More common in boys
- Findings
- Characterized by poor social interactions, communication deficits, repetitive/ritualized behaviors, and restricted interests.
- May or may not be accompanied by intellectual disability
- Rarely accompanied by unusual abilities (savants).
11
Q
Rett disorder
- Definition
- Findings
A
- Definition
- Pervasive developmental disorder
- X-linked disorder seen almost exclusively in girls (affected males die in utero or shortly after birth).
- Findings
- Symptoms usually become apparent around ages 1–4, including regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing.
12
Q
Neurotransmitter changes with these diseases
- Alzheimer disease
- Anxiety
- Depression
- Huntington disease
- Parkinson disease
- Schizophrenia
A
- Alzheimer disease
- Decreased ACh
- Anxiety
- Increased norepinephrine
- Decreased GABA
- Decreased 5-HT
- Depression
- Decreased norepinephrine
- Decreased 5-HT
- Decreased dopamine
- Huntington disease
- Decreased GABA
- Decreased ACh
- Increased dopamine
- Parkinson disease
- Decreased dopamine
- Increased 5-HT
- Increased ACh
- Schizophrenia
- Increased dopamine
13
Q
Orientation
- Definition
- Common causes of loss of orientation
- Order of loss
A
- Definition
- Patient’s ability to know who he or she is, where he or she is, and the date and time.
- Often abbreviated in the medical chart as “alert and oriented × 3” (AO×3)
- Common causes of loss of orientation
- Alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, infection, nutritional deficiencies.
- Order of loss
- 1st—time
- 2nd—place
- Last— person
14
Q
Amnesias
- Retrograde amnesia
- Anterograde amnesia
- Korsakoff amnesia
- Dissociative amnesia
A
- Retrograde amnesia
- Inability to remember things that occurred before a CNS insult.
- Anterograde amnesia
- Inability to remember things that occurred after a CNS insult (no new memory).
- Korsakoff amnesia
- Classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies.
- May also include some retrograde amnesia.
- Seen in alcoholics, and associated with confabulations.
- Dissociative amnesia
- Inability to recall important personal information, usually subsequent to severe trauma or stress.
- May be accompanied by dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances).
15
Q
Cognitive disorder
A
- Significant change in cognition (memory, attention, language, judgment) from previous level of functioning.
- Associated with abnormalities in CNS, a general medical condition, medications, or substance use.
- Includes delirium and dementia.
