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STEP 1 (3) > Psychiatry- Pathology (1) > Flashcards

Psychiatry- Pathology (1) Flashcards

1
Q

What are the results of long-term deprivation of affection in infants?

A
  • failure to thrive
  • poor language/socialization
  • lack of basic trust
  • anaclitic depression

deprivation for 6+ months can lead to irreversible changes

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2
Q

What are some common signs of physical child abuse?

A

spiral fractures (or multiple fractures at different stages of healing)

burns

subdural hematomas

posterior rib fractures

retinal detachment

Usually from the biological MOTHER (represent 40% of deaths under 1 yo)

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3
Q

What are some common signs of sexual child abuse?

A

genital, anal, or oral trauma

abuser usually known to victim, usually male (peak incidence around 9-12 yo)

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4
Q

What is child neglect defined as?

A

failure to provide a child with adequate food, shelter, supervision, education, and/or affection(most common form of child mistreatment)

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5
Q

What are some common childhood and early-onset disorders?

A

attention-deficity hyperactivity disorder (ADHD)

conduct disorder

oppositional defiant disorder

separation anxiety disorder

Tourette syndrome

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6
Q

Describe attention-deficity hyperactivity disorder (ADHD)

A

Onset is commonly before 12, presenting with children with limited attention spans and poor impulse control and characterized by hyperactivity.

Intelligence is normal but commonly affects school performance

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7
Q

How common is attention-deficity hyperactivity disorder (ADHD) in adulthood?

A

persists in up to 50%

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8
Q

What anatomic changes are seen in attention-deficity hyperactivity disorder (ADHD)?

A

decreased frontal lobe volume/metabolism

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9
Q

How is attention-deficity hyperactivity disorder (ADHD) tx?

A

stimulants (e.g. methylphenidate) +/- cognitive behavioral therapy

atomoxetine may be an alternative to stimulants in selected pts.

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10
Q

What is a conduct disorder?

A

repetitive and pervasive behavior violating the basic rights of others (e.g. physical aggression, destruction of property, theft).

After age 18, most of these pts will meet the criteria for antisocial personality disorder

tx with CBT

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11
Q

What is oppositional defiant disorder?

A

enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms

tx with CBT

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12
Q

What is seperation anxiety disorder?

A

common onset at 7-9 yo, presenting with overwhelming fear of seperation from home or loss of attachment figure. May lead to factitious physical complaints to avoid going to or staying at school.

tx with CBT, play therapy, and fam therapy

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13
Q

Describe Tourette syndrome

A

Onset before 18 yo, characterized by sudden, rapid, recurreny, nonrhythmic, motor and vocal tics that persist for 1+ yr.

Associated with OCD and ADHD

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14
Q

_______ is found in 10-20% of all Tourette pts.

A

Coprolalia (involuntary obscene speech)

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15
Q

How is Tourettes tx?

A

psychoeducation, behavioral therapy

for intractable tics, low-dose high-potency antipsychotics (e.g. fluphenazine, pimozide), tetrabenazine, and clonidine may be used

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16
Q

What are pervasive developmental disorders?

A

characterized by difficulties with language and failure to acquire or early loss of social skills

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17
Q

What are some common pervasive developmental disorders?

A

Autism spectrum disorder

Rett syndrome

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18
Q

Describe Autism spectrum disorder

A

characterized by poor social interaction, communication deficits, repetitive behaviors, and restricted interests. MUST present in early childhood.

more common in boys

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19
Q

T or F. Autism spectrum disorder may or may not present with intellectual disability

A

T. Rarely accompanied by unusual by unusual abilities (sevants)

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20
Q

Describe Rett syndrome

A

X-linked disorder seen almost exclusively in GIRLS (affected males die in utero or shortly after birth)

Symptoms usually become apparent around ages 1-4, including regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and sterotyped hand-wringing

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21
Q

What neurotransmitter changes are seen in Alzheimer disease?

A

decreased ACh

increased glutamate

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22
Q

What neurotransmitter changes are seen in Anxiety disorders?

A

increased nor

decreased GABA, 5-HT

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23
Q

What neurotransmitter changes are seen in depression?

A

decreased nor, 5-HT, AND dopamine

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24
Q

What neurotransmitter changes are seen in Huntington disease?

A

decreased GABA, ACh

increased dopamine

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25
Q

What neurotransmitter changes are seen in Parkinson disease?

A

decreased dopamine

increased ACh

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26
Q

What neurotransmitter changes are seen in Schizophrenia?

A

increased dopamine

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27
Q

Orientation is a pts. ability to know where they are, the date, etc. Common causes of loss of orientation include:

A

alcohol, drugs

fluid/electrolyte imbalance

head trauma

hypoglycemia

infetion

malnutrition

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28
Q

What things are lost first with disorientation?

A

1st-time

2nd-place

3rd- person

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29
Q

What are the major types of amnesias?

A

retrograde (cant remember old memories)

anterograde (cant make new memories)

Korsakoff syndrome

Dissociative amnesia

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30
Q

What is Korsakoff syndrome?

A

amnesia (anterograde > retrograde) caused by vitamin B1 deficiency and associated destruction of mammillary bodies. Seen in alcoholics.

Confabulations are characteristic

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31
Q

What is dissociative amnesia?

A

inability to recall important personal info, 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)

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32
Q

What is delirium?

A

‘waxing and waning’ level of consciousness with acute onset marked by rapid decrease in attention span and level of arousal.

characterized by disorganized thinking, hallucinations (often visual), illusions, misperceptions, cognitive dysfunction

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33
Q

_____ is the most common presentation of altered mental status in inpatient setting

A

Delirium

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34
Q

When does delirium commonly occur?

A

2ndry to other illness (e.g. CNS disease, infection, trauma, substance abuse/withdrawal, hemorrhage, urinary/fecal retention)

may be due to meds (e.g. anticholinergics, especially in the elderly)

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35
Q

How is delirium tx?

A

tx is aimed at IDing and addressing udnerlying condition

Haloperidol may be used as needed

Use benzodiazepines for alcohol withdrawal

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36
Q

What is dementia?

A

Decrease in intellectual function with affecting level of consciousness, characterized by memory deficits, apraxia, aphasia, agnosia, loss of abstract thought, and/or impaired judgement

NOTE: A pt with dementia can develop delirium (e.g. a pt with Alzheimer who develops pneumonia is at risk of delirium)

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37
Q

What are some irreversible causes of dementia?

A

Alzheimer disease

Lewy body dementia

Huntington disease

Pick disease

cerebral infarct

Creutzfeldt-Jakob disease

chronic substance abuse

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38
Q

What are some reversible causes of dementia?

A

hypothyroidism

depression

vitamin B12 deficiency

normal pressure hydrocephalus

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39
Q

EEG is usually normal in ____ while abnormal in ______

A

normal in dementia; abnormal in delirium

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40
Q

In the elderly, depression and hypothyroidism can present like dementia (pseudodementia). How should this be handled?

A

screen for depression and measure TSH, B12 levels

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41
Q

What is psychosis?

A

a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking. Can occur in pts with medical illness, psychiatric illness, or both.

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42
Q

What are the types of hallucination?

A

visual, auditory, olfactory,

gustatory,

tactile

hypnagogic

hypnopompic

43
Q

Visual hallucinations are most commonly a feature of what?

A

medical illness (e.g. drug intoxication) over psych illness

44
Q

Auditory hallucinations are most commonly a feature of what?

A

psych illness over medical illness

45
Q

Olfactory hallucinations are most commonly a feature of what?

A

often occur as an aura of psychomotor epilepsy and in brain tumors

46
Q

Gustatory hallucinations are most commonly a feature of what?

A

epilepsy

47
Q

Tactile hallucinations are most commonly a feature of what?

A

alcohol withdrawal (e.g. formication- the sensation of bugs crawling on the skin). Also seen in cocaine abuse (‘cocaine crawlies’)

48
Q

When does hypnagogic hallucination occur?

A

when going to sleep (sometimes seen in narcolepsy), whereas hypnopompic hallucinations are seen when waking from sleep

49
Q

How is Schizophrenia defined?

A

chronic mental illness with periods of psychosis, disturbed behavior and thought, and decline in functioning lasting 6+ months.

Associated with increased dopamine activity and decreased dendritic branching

50
Q

How is schizophrenia diagnosed?

A

2+ of the following:

delusions

hallucinations- often auditory

disorganized speech (loose associations)

disorganized or catatonic behavior

“Negative symptoms”- flat affect, social withdrawal, lack of motivation, lack of speech or thought

51
Q

T or F. Genetics and environment contribute to the etiology of schizophrenia

A

T. As does frequent cannabis use in teens

52
Q

The lifetime prevelance of schizophrenia is ____

A

1.5% (white=black, male-female). presents earlier in men (late teens to early 20s vs late 20s to early 30s in women on avg.)

53
Q

What is the first line tx of schizophrenia?

A

atypical antipsychotics (e.g. risperidone)

54
Q

What are some variants of schizophrenia?

A
  • brief psychotic disorder (lasting less than 1 month, usually stress related)
  • Schizophreniform disorder (lasting 1-6 months)
  • Schizoaffective disorder (lasting 2+ weeks and presenting with psychotic symptoms with episodic superimposed major depression or mania)
55
Q

What is delusional disorder?

A

fixed, persistent false belief system lasting 1+ month. Functioning otherwise not impaired (ex. a women who genuinely believes she is married to a celebrity when she isnt)

56
Q

What are the dissociative disorders?

A
  • Dissociative identity disorder
  • Depersonalization/derealization disorder
57
Q

Describe Dissociative identity disorder

A

formerly known as multiple personality disorder. Presence of 2 or more distinct identities or personality states.

More common in women

Associated with a hx of sexual abuse, PTSD, depression, borderline personality

58
Q

Describe depersonalization disorder

A

persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions (depersonalization) or one’s environment (derealization)

59
Q

What is a Mood disorder?

A

characterized by an abnormal range of moods or internal emotional states amd loss of control over them. Severity of moods causes distress and impairment in social and occupational functioning.

Includes major depressive disorder, bipolar disorder, dysthymic disorder, and cyclothymic disorder.

60
Q

What is a manic episode?

A

distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased actiivty or energy lasting at least a week.

61
Q

Diagnosis of a manic episode requires hospitalization or at least 3 of the following:

A

Distractibility

Irresponsibility (seeks pleasure with regard to consequences (hedonistic))

Grandiosity (inflated self-esteen)

Flight of Ideas

Increase in goal-directed activity

decreased sleep

62
Q

What is a hypomanic episode?

A

like manic episode except mood disturbance is not severe enough to caused marked impairment in social and/or occupational functioning or to necessitate hospitalization

Lasts at least 4 consecutive days

63
Q

What is Bipolar I disorder defined as?

A

the presence of at least 1 manic episode with or without a hypomanic or depressive episode

64
Q

What is Bipolar II disorder defined as?

A

presence of a hypomanic and a depressive episode

65
Q

More on Bipolar disorder

A

pts. mood and functioning usually returns to normal in between episodes.

High suicide risk

use of antidepressants can precipitate mania

66
Q

How is bipolar disorder tx?

A

mood stabilizers (e.g. lithium, valproic acid, carbamazepine), atypical antipsychotics

67
Q

What is a cyclothymic disorder?

A

dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 yrs

68
Q

Major depressive disorder

A

may be a self-limited disorder, with episodes usually lasting 6-12 months.

Episodes marked by at least 5 of the 9 major symptoms for 2+ weeks

69
Q

What are the major symptoms of major depressive disorder?

A

SIG E CAPS

Sleep disturbance

Loss of interest (anhedonia)

Guilt or feelings of worthlessness

Energy loss and fatigue

Concentration problems

Appetite/weight changes

Psychomotor retardation

Sucidial ideations

70
Q

How is depressive disorder tx?

A

CBT and SSRIs are first line

SNRIs, mirtazapine, and bupropion can also be used

and electroconvulsive therapy in select pts.

71
Q

Pts. with depression typically have what change sin their sleep stages?

A

decreased slow-wave sleep, REM latency

Increased REM early in sleep cycle, and total REM sleep

repeated nighttime awakenings

Early-morning wakening (terminal insomnia)

72
Q

What is persistent depressant disorder (dysthymia)?

A

depression, often milder, lasting at least 2 yrs

73
Q

What is atypical depression?

A

differs from classical forms and marked by mood reactivity (being able to experience improved mood in response to positive events, albiet brief), ‘reversed’ vegetative symptoms (hypersomnia, hyperphagia), leadn paralysis (heavy feelings in arms and legs), and long-standing interpersonal rejection sensitivity.

74
Q

How is atypical depression tx?

A

CBT and SSRIs are first line

MAO inhibitors are effective also

75
Q

Postpartum mood disturbances occur by definition within 4 weeks of delivery and include:

A

Maternal (postpartum) “blues”

Postpartum depression

Postpartum psychosis

76
Q

Describe postpartum blues

A

50-85% incidence rate. Characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery and usually resolving after 10 days.

Tx is supportive and follow up appropriate

77
Q

Describe postpartum depression

A

10-15% incidence rate characterized by depressed affect, anxiety, and poor concentration starting within 4 weeks of delivery.

Tx: CBT and SSRIs

78
Q

Describe postpartum psychosis

A

0.1-0.2% incidence rate characterized by delusions, thoughts of harming the baby or self

Risk factors include hx of bipolar or psychotic disorder, fist pregnancy, fam hx

79
Q

How is postpartum psychosis tx?

A

hospitalization and initiation of atypical antipsychotics, if insufficient, ECT may be used

80
Q

What is pathologic grief?

A

NOTE: normal bereavement is characterized by shock, denial, guilt, and somatic symptoms. Duration varies widely.

Pathologic grief lasts 6+ months, and satisfies major depressive criteria (e.g. weight loss, anhedonia, etc.)

81
Q

What are the main uses of electroconvulsive therapy?

A

used mainly for treatment-refractory depression, depression wit psychotic symptoms, and acutely suicidal patients.

82
Q

How does electroconvulsive therapy work?

A

produces grand mal seizures in an anesthetized pt.

83
Q

What are the major risk factors for suicide completion?

A

SAD PERSONS

Sex (male)

Age (teenager or elderly)

Depression

Previous attempt

Ethanol or drug use

loss of Rational thinking

Sickness

Organized plan

No spouse (divorced, widowed, single, especially if childless)

Social network lacking

84
Q

T or F. Women try to commit suicide more often

A

T. But men succeed more often

85
Q

What is a panic disorder?

A

defined by recurrent panic attacks with symptoms of palpitations, paresthesias, abdominal distress, naisea, light-headedness, chest pain, chills, choking, sweating, shaking, and/or SOB.

STRONG genetic component

86
Q

How is panic disorder tx?

A

CBT, SSRIs, and venlafaxine are first line

benzodiazepines occasionally used in acute settings.

87
Q

What is agoraphobia?

A

fear of open or enclosed spaces, using public transport, being in a line or crowds, or leaving home alone

Tx: CBT, SSRIs, and MAOIs

88
Q

What is generalized anxiety disorder?

A

anxiety lasting 6+ months unrelated to a specific person, situation, or event. Associated with sleep disturbance, fatigue, GI disturbance, and/or difficulty concentration

89
Q

How should generalized anxiety disorder be tx?

A

CBT, SSRIs, SNRIs are first line

Buspirone, TCAs, and benzodiapepines are second line

90
Q

What is an adjustment disorder?

A

emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g. divorce, illness) and lasting less than 6 months

Tx: CBT, SSRIs

91
Q

T or F. Often in OCD, the behavior is inconsistent with one’s own beliefs and attitudes (aka ego-dystonic) but they are performed anyways

A

T.

92
Q

How is OCD tx?

A

CBT, SSRIs, and clomipramine are first line

93
Q

What is body dysmorphic disorder?

A

preoccuption with minor or imagined defects in one’s appearance causing significant emotional distress or impaired functioning; pts often repeatedly seek cosmetic surgery.

Tx: CBT

94
Q

How is PTSD tx?

A

CBT, SSRIs, and venlafaxine are first line

95
Q

How long does acute stress disorder last?

A

between 3 days and 1 month

Tx: CBT; pharmacotherapy is usually not indicated

96
Q

What is malingering?

A

When a pt consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary (external) gain (e.g. avoiding work, obtaining compensation).

Poor compliance with tx or follow-up common

Complaints cease after gain (vs. factitious disorder)

97
Q

What is a factitious disorder?

A

When a patient consciously creates a physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (primary (internal) gain)

98
Q

What is Munchausen syndrome?

A

chronic factitious disorder with predominantly physical signs and symptoms. Characterized by a hx of multiple hospital admission and willingness to undergo invasive procedures

99
Q

What is Munchausen syndrome by proxy?

A

Illness in a child or elderly pt. caused or fabricated by the caregiver. Form of abuse

100
Q

What are somatic symptoms/disorders?

A

a caetgory of disorders characterized by physical symptoms with no identifiable physical cause. Both illness production and motivation are unconscious drives. Symptoms are not intentionally produced or feigned.

More common in women

101
Q

What is conversion disorder?

A

loss of sensory or motor function (e.g. paralysis, blindness, mutism), often following an acute stressor; pt is aware of but sometimes indifferent toward symptoms

more common in women, teenagers, and young adults

102
Q

What is illness anxiety disorder (hypocondriasis)?

A

preoccupation with an fear of having a serious illness despite medical health

103
Q

What is a somatic symptom disorder?

A

variety of complaints in 1+ organ system lasting months to years associated with excessive, persistent thoughts and anxiety about symptoms

May co-occur with medical illness

104
Q
A

STEP 1 (3) (16 decks)

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