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First Aid > Psychiatry - Pathology (2) > Flashcards

Psychiatry - Pathology (2) Flashcards

1
Q

Specific phobia

  • Definition
  • Treatment
  • Social anxiety disorder
    • Definition
    • Treatment
  • Agoraphobia
A
  • Definition
    • Fear that is excessive or unreasonable and interferes with normal function.
    • Cued by presence or anticipation of a specific object or situation.
    • Person recognizes fear is excessive.
  • Treatment
    • Can treat with systematic desensitization.
  • Social anxiety disorder
    • Definition
      • Exaggerated fear of embarrassment in social situations (e.g., public speaking, using public restrooms).
    • Treatment
      • SSRIs.
  • Agoraphobia
    • Exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone.
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2
Q

Generalized anxiety disorder

  • Definition
  • Treatment
  • Adjustment disorder
A
  • Definition
    • Pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event.
    • Associated with sleep disturbance, fatigue, GI disturbance, and difficulty concentrating.
  • Treatment
    • SSRIs, SNRIs, buspirone, cognitive behavioral therapy.
  • Adjustment disorder
    • Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, illness) and lasting < 6 months (> 6 months in presence of chronic stressor).
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3
Q

Obsessive-compulsive disorder

  • Definition
  • Treatment
  • Ego dystonic
  • Body dysmorphic disorder
A
  • Definition
    • Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress
    • Associated with Tourette disorder.
  • Treatment
    • Relieved in part by the performance of repetitive actions (compulsions)
    • SSRIs, clomipramine.
  • Ego dystonic
    • Behavior inconsistent with one’s own beliefs and attitudes (vs. obsessive-compulsive personality disorder)
  • Body dysmorphic disorder
    • Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning
    • Patients often repeatedly seek cosmetic surgery.
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4
Q

Post-traumatic stress disorder

  • Definition
  • Treatment
  • Acute stress disorder
A
  • Definition
    • Persistent reexperiencing of a previous traumatic event (e.g., war, rape, robbery, serious accident, fire).
    • May involve nightmares or flashbacks, intense fear, helplessness, or horror.
    • Leads to avoidance of stimuli associated with the trauma and persistently increased arousal.
    • Disturbance lasts > 1 month, with onset of symptoms beginning anytime after event, and causes significant distress, negative cognitive alterations, and/or impaired functioning.
  • Treatment
    • Psychotherapy, SSRIs.
  • Acute stress disorder
    • Lasts between 3 days and 1 month.
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5
Q

Malingering

A
  • Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific 2° (external) gain (e.g., avoiding work, obtaining compensation).
  • Poor compliance with treatment or follow-up of diagnostic tests.
  • Complaints cease after gain (vs. factitious disorder).
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6
Q

Factitious disorders

  • Definition
  • Munchausen syndrome
  • Munchausen syndrome by proxy
A
  • Definition
    • Patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (1° [internal] gain).
  • Munchausen syndrome
    • Chronic factitious disorder with predominantly physical signs and symptoms.
    • Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures.
  • Munchausen syndrome by proxy
    • When illness in a child or elderly patient is caused by the caregiver.
    • Motivation is to assume a sick role by proxy.
    • Form of child/elder abuse.
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7
Q

Somatic symptom and related disorders

  • Definition
  • Somatic symptom disorder
  • Conversion disorder
  • Illness anxiety disorder (hypochondriasis)
A
  • Definition
    • Category of disorders characterized by physical symptoms with no identifiable physical cause.
    • Both illness production and motivation are unconscious drives.
    • Symptoms not intentionally produced or feigned.
    • More common in women.
  • Somatic symptom disorder
    • Variety of complaints in one or more organ systems lasting for months to years.
    • Associated with excessive, persistent thoughts and anxiety about symptoms.
    • May co-occur with medical illness.
  • Conversion disorder
    • Sudden loss of sensory or motor function (e.g., paralysis, blindness, mutism), often following an acute stressor
    • Patient is aware of but sometimes indifferent toward symptoms (“la belle indifférence”)
    • More common in females, adolescents, and young adults.
  • Illness anxiety disorder (hypochondriasis)
    • Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance.
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8
Q

Personality

  • Personality trait
  • Personality disorder
A
  • Personality trait
    • An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself.
  • Personality disorder
    • Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/ or impaired functioning
    • Person is usually not aware of problem.
    • Usually presents by early adulthood.
    • Three clusters, A, B, and C
      • Remember as Weird, Wild, and Worried based on symptoms.
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9
Q

Cluster A personality disorders

  • Definition
  • Disorders
A
  • Definition
    • Odd or eccentric
    • Inability to develop meaningful social relationships.
    • No psychosis
    • Genetic association with schizophrenia.
    • “Weird” (Accusatory, Aloof, Awkward).
  • Disorders
    • Paranoid
    • Schizoid
    • Schizotypal
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10
Q

Cluster A personality disorders

  • Paranoid
  • Schizoid
  • Schizotypal
A
  • Paranoid
    • Pervasive distrust and suspiciousness
    • Projection is the major defense mechanism.
  • Schizoid
    • Voluntary social withdrawal, limited emotional expression, content with social isolation (vs. avoidant).
    • Schizoid** = distant.**
  • Schizotypal
    • Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness.
    • Schizotypal = magical thinking.
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11
Q

Cluster B personality disorders

  • Definition
  • Disorders
A
  • Definition
    • Dramatic, emotional, or erratic
    • Genetic association with mood disorders and substance abuse.
    • “Wild” (Bad to the Bone).
  • Disorders
    • Antisocial
    • Borderline
    • Histrionic
    • Narcissistic
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12
Q

Cluster B personality disorders

  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
A
  • Antisocial
    • Disregard for and violation of rights of others, criminality, impulsivity
    • Males > females
    • Must be > 18 years old and have history of conduct disorder before age 15.
    • Conduct disorder if < 18 years old.
    • Antisocial = sociopath.
  • Borderline
    • Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, boredom, sense of emptiness
    • Females > males
    • Splitting is a major defense mechanism.
  • Histrionic
    • Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance.
  • Narcissistic
    • Grandiosity, sense of entitlement
    • Lacks empathy and requires excessive admiration
    • Often demands the “best” and reacts to criticism with rage.
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13
Q

Cluster C personality disorders

  • Definition
  • Disorders
A
  • Definition
    • Anxious or fearful
    • Genetic association with anxiety disorders.
    • “Worried” (Cowardly, Compulsive, Clingy).
  • Disorders
    • Avoidant
    • Obsessive-compulsive
    • Dependent
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14
Q

Cluster C personality disorders

  • Avoidant
  • Obsessive-compulsive
  • Dependent
A
  • Avoidant
    • Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid).
  • Obsessive-compulsive
    • Preoccupation with order, perfectionism, and control
    • Ego-syntonic: behavior consistent with one’s own beliefs and attitudes (vs. OCD).
  • Dependent
    • Submissive and clinging, excessive need to be taken care of, low self-confidence.
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15
Q

Schizo-

  • -id vs. -typal vs. -phrenic vs. -affective
  • Schizophrenia time course
A
  • Schizoid < Schizotypal < Schizophrenic < Schizoaffective
    • Schizotypal = schizoid + odd thinking
    • Schizophrenic = greater odd thinking than schizotypal
    • Schizoaffective = schizophrenic psychotic symptoms + bipolar or depressive mood disorder
  • Schizophrenia time course
    • < 1 mo—brief psychotic disorder, usually stress related
    • 1–6 mo—schizophreniform disorder
    • > 6 mo—schizophrenia
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16
Q

Eating disorders

  • Anorexia nervosa
    • Definition
    • Findings
  • Bulimia nervosa
    • Definition
    • Findings
A
  • Anorexia nervosa
    • Definition
      • Excessive dieting +/− purging
      • Intense fear of gaining weight, body image distortion, and increased exercise, leading to a body weight well below ideal (≈ BMI < 17 kg/m2).
      • Seen primarily in adolescent girls
    • Findings
      • Associated with decreased bone density.
      • Severe weight loss, metatarsal stress fractures, amenorrhea, lanugo (fine body hair), anemia, and electrolyte disturbances.
      • Osteoporosis caused in part by decreased estrogen over time.
      • Commonly coexists with depression.
  • Bulimia nervosa
    • Definition
      • Binge eating +/− purging
      • Often followed by self-induced vomiting or use of laxatives, diuretics, or emetics.
      • Body weight often maintained within normal range.
      • Seen predominantly in adolescent girls
    • Findings
      • Associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from induced vomiting (Russell sign).
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17
Q

Gender dysphoria

  • Definition
  • Transsexualism
  • Transvestism
A
  • Definition
    • Strong, persistent cross-gender identification.
    • Characterized by persistent discomfort with one’s sex assigned at birth, causing significant distress and/or impaired functioning.
    • Affected individuals are often referred to as transgender.
  • Transsexualism
    • Desire to live as the opposite sex, often through surgery or hormone treatment.
  • Transvestism
    • Paraphilia, not gender dysphoria.
    • Wearing clothes (e.g., vest) of the opposite sex (cross-dressing)
18
Q

Sexual dysfunction

  • Includes:
  • Differential diagnosis includes:
A
  • Includes:
    • Sexual desire disorders (hypoactive sexual desire or sexual aversion)
    • Sexual arousal disorders (erectile dysfunction)
    • Orgasmic disorders (anorgasmia and premature ejaculation)
    • Sexual pain disorders (dyspareunia and vaginismus).
  • Differential diagnosis includes:
    • ƒƒDrugs (e.g., antihypertensives, neuroleptics, SSRIs, ethanol)
    • ƒƒDiseases (e.g., depression, diabetes, STDs)
    • Psychological (e.g., performance anxiety)
19
Q

Sleep terror disorder

A
  • Periods of terror with screaming in the middle of the night
  • Most common in children.
  • Occurs during slow-wave sleep.
    • Occurs during non-REM sleep (no memory of arousal) as opposed to nightmares that occur during REM sleep (memory of a scary dream).
  • Cause unknown, but triggers may include emotional stress, fever, or lack of sleep.
  • Usually self limited.
20
Q

Narcolepsy

  • Definition
  • Also associated with:
  • Treatment
A
  • Definition
    • Disordered regulation of sleep-wake cycles
    • 1° characteristic is excessive daytime sleepiness.
    • Caused by decreased orexin production in lateral hypothalamus.
    • Strong genetic component.
  • Also associated with:
    • ƒƒHypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations.
      • Hypnagogic—going to sleep
      • Hypnopompic—post-sleep
    • ƒƒNocturnal and narcoleptic sleep episodes that start off with REM sleep.
    • Cataplexy (loss of all muscle tone following a strong emotional stimulus, such as laughter) in some patients.
  • Treatment
    • Daytime stimulants (e.g., amphetamines, modafinil) and nighttime sodium oxybate (GHB).
21
Q

Substance use disorder

A
  • Maladaptive pattern of substance use defined as 2 or more of the following signs in 1 year:
    • Tolerance—need more to achieve same effect
    • ƒƒWithdrawal
    • Substance taken in larger amounts, or over longer time, than desired
    • Persistent desire or unsuccessful attempts to cut down
    • Significant energy spent obtaining, using, or recovering from substance
    • Important social, occupational, or recreational activities reduced because of substance use
    • Continued use in spite of knowing the problems that it causes
    • Craving
    • Recurrent use in physically dangerous situations
    • Failure to fulfill major obligations at work, school, or home due to use
    • Social or interpersonal conflicts related to substance use
22
Q

Stages of change in overcoming substance addiction

A
  1. Precontemplation
    • Not yet acknowledging that there is a problem
  2. Contemplation
    • Acknowledging that there is a problem, but not yet ready or willing to make a change
  3. Preparation/determination
    • Getting ready to change behavior
  4. Action/willpower
    • Changing behaviors
  5. Maintenance
    • Maintaining the behavior change
  6. Relapse
    • Returning to old behaviors and abandoning new changes
23
Q

Nonspecific depressants

  • Type of drug
  • Intoxication symptoms
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drugs: depressants
  • Intoxication symptoms
    • Nonspecific: mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression.
  • Withdrawal symptoms
    • Nonspecific: anxiety, tremor, seizures, insomnia.
24
Q

Alcohol

  • Type of drug
  • Intoxication
    • Symptoms
    • Labs
  • Withdrawal
    • Symptoms
    • Treatment
A
  • Type of drug
    • Psychoactive drug: depressant
  • Intoxication
    • Emotional lability, slurred speech, ataxia, coma, blackouts.
    • Labs
      • Serum γ-glutamyltransferase (GGT)—sensitive indicator of alcohol use.
      • Lab AST value is twice ALT value.
  • Withdrawal
    • Symptoms
      • Mild alcohol withdrawal: symptoms similar to other depressants.
      • Severe alcohol withdrawal can cause autonomic hyperactivity and DTs (5–15% mortality rate).
    • Treatment for DTs: benzodiazepines.
25
Q

Opioids (e.g., morphine, heroin, methadone)

  • Type of drug
  • Intoxication
    • Symptoms
    • Treatment
  • Withdrawal
    • Symptoms
    • Treatment
A
  • Type of drug
    • Psychoactive drugs: depressants
  • Intoxication
    • Euphoria, respiratory and CNS depression, decreased gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose).
    • Treatment: naloxone, naltrexone.
  • Withdrawal
    • Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” symptoms).
    • Treatment: long-term support, methadone, buprenorphine.
26
Q

Barbiturates

  • Type of drug
  • Intoxication
    • Symptoms
    • Treatment
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drugs: depressants
  • Intoxication
    • Low safety margin, marked respiratory depression.
    • Treatment: symptom management (assist respiration, increase BP).
  • Withdrawal symptoms
    • Delirium, life-threatening cardiovascular collapse.
27
Q

Benzodiazepines

  • Type of drug
  • Intoxication
    • Symptoms
    • Treatment
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drugs: depressants
  • Intoxication
    • Symptoms
      • Greater safety margin.
      • Ataxia, minor respiratory depression.
    • Treatment: supportive care; consider flumazenil (competitive benzodiazepine antagonist).
  • Withdrawal symptoms
    • Sleep disturbance, depression, rebound anxiety, seizure (can be triggered by reversal with flumazenil).
28
Q

Nonspecific stimulants

  • Type of drug
  • Intoxication symptoms
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drugs: stimulants
  • Intoxication symptoms
    • Nonspecific: mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety.
  • Withdrawal symptoms
    • Nonspecific: post-use “crash,” including depression, lethargy, weight gain, headache.
29
Q

Amphetamines

  • Type of drug
  • Intoxication symptoms
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drugs: stimulants
  • Intoxication symptoms
    • Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever.
    • Severe: cardiac arrest, seizure.
  • Withdrawal symptoms
    • Anhedonia, increased appetite, hypersomnolence, existential crisis.
30
Q

Cocaine

  • Type of drug
  • Intoxication
    • Symptoms
    • Treatment
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drug: stimulant
  • Intoxication
    • Impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death.
    • Treatment: benzodiazepines.
  • Withdrawal symptoms
    • Hypersomnolence, malaise, severe psychological craving, depression/suicidality.
31
Q

Caffeine

  • Type of drug
  • Intoxication symptoms
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drug: stimulant
  • Intoxication symptoms
    • Restlessness, increased diuresis, muscle twitching.
  • Withdrawal symptoms
    • Lack of concentration, headache.
32
Q

Nicotine

  • Type of drug
  • Intoxication symptoms
  • Withdrawal
    • Symptoms
    • Treatment
A
  • Type of drug
    • Psychoactive drugs: stimulants
  • Intoxication symptoms
    • Restlessness.
  • Withdrawal
    • Irritability, anxiety, craving.
    • Treatment: nicotine patch, gum, or lozenges; bupropion/ varenicline.
33
Q

PCP

  • Type of drug
  • Intoxication
    • Symptoms
    • Treatment
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drug: hallucinogen
  • Intoxication
    • Belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures.
    • Treatment: benzodiazepines, rapid-acting antipsychotic.
  • Withdrawal symptoms
    • Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep.
34
Q

LSD

  • Type of drug
  • Intoxication symptoms
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drug: hallucinogen
  • Intoxication symptoms
    • Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks.
  • Withdrawal symptoms
    • None
35
Q

Marijuana (cannabinoid)

  • Type of drug
  • Intoxication symptoms
  • Withdrawal symptoms
A
  • Type of drug
    • Psychoactive drug: hallucinogen
  • Intoxication symptoms
    • Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations.
    • Prescription form is dronabinol (tetrahydrocannabinol isomer): used as antiemetic (chemotherapy) and appetite stimulant (in AIDS).
  • Withdrawal symptoms
    • Irritability, depression, insomnia, nausea, anorexia.
    • Most symptoms peak in 48 hours and last for 5–7 days.
    • Generally detectable in urine for 4–10 days.
36
Q

Heroin addiction

  • Definition
  • Treatments
    • Methadone
    • Naloxone + buprenorphine
    • Naltrexone
A
  • Definition
    • Users at increased risk for hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis.
    • Look for track marks (needle sticks in veins).
  • Treatments
    • Methadone
      • Long-acting oral opiate
      • Used for heroin detoxification or long-term maintenance.
    • Naloxone + buprenorphine
      • Partial agonist
      • Long acting with fewer withdrawal symptoms than methadone.
      • Naloxone is not active when taken orally, so withdrawal symptoms occur only if injected (lower abuse potential).
    • Naltrexone
      • Long-acting opioid antagonist used for relapse prevention once detoxified.
37
Q

Alcoholism

  • Definition
  • Complications
  • Treatment
A
  • Definition
    • Physiologic tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs) when intake is interrupted.
  • Complications
    • Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy.
  • Treatment
    • Disulfiram (to condition the patient to abstain from alcohol use), naltrexone, supportive care.
    • Alcoholics Anonymous and other peer support groups are helpful in sustaining abstinence.
38
Q

Wernicke-Korsakoff syndrome

  • Definition
  • Findings
  • Treatment
A
  • Definition
    • Alcoholism
    • Caused by thiamine deficiency.
  • Findings
    • Triad of confusion, ophthalmoplegia, and ataxia (Wernicke encephalopathy).
    • May progress to irreversible memory loss, confabulation, personality change (Korsakoff psychosis).
    • Associated with periventricular hemorrhage/necrosis of mammillary bodies.
  • Treatment
    • IV vitamin B1 (thiamine).
39
Q

Mallory-Weiss syndrome

  • Definition
  • Findings
A
  • Definition
    • Alcoholism
    • Longitudinal partial thickness tear at the gastroesophageal junction caused by excessive vomiting.
  • Findings
    • Often presents with hematemesis.
    • Associated with pain (vs. esophageal varices).
40
Q

Delirium tremens (DTs)

  • Definition
  • Findings
  • Treatment
A
  • Definition
    • Life-threatening alcohol withdrawal syndrome that peaks 2–5 days after last drink.
  • Symptoms in order of appearance
    • Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures)
    • Psychotic symptoms (hallucinations, delusions)
    • Confusion
  • Treatment
    • Benzodiazepines.

First Aid (92 decks)

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