Psychiatry- Pathology (2) Flashcards
What is a personality trait?
an enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself
What is a personality disorder?
Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning (person is usually not aware of the problem).
usually presents in early adulthood.
Three clusters: A, B, and C
Describe Cluster A personality disorders
Odd or eccentric; inaility to develop meaningful social relationships
no psychosis
genetic association with schizophrenia
What are the three main types of Cluster A personality disorders
Paranoid (projection is the major self defense)
Schizoid (voluntary social withdrawal, limited emotional expression, and content with social isolation (vs. avoidant)
Schizotypical (eccentric appearnace, odd beliefs or magical thinking, interpersonal awkwardness
Describe Cluster B personality disorders
Dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse
What are the main types of Cluster B personality disorders
- Antisocial
- Borderline
- Histrionic
Narcissitic
Describe Antisocial PD
Disregard for and violation of rights of others, criminality, impulsivity; males more than females
must be 18+ yo and have a hx of conduct disorder before 15
Describe Borderline PD
Unstable mood and interpersonal relationships, impulsivity
self-mutilation, boredom, and a sense of emptiness
females more common
splitting is a major defense mechanism
Describe Histrionic PD
Excessive emotionality and excitability, attention seeking, sexually provacative, overly concerned with appearance
Describe Cluster C personality disorders
Anxious or fearful; genetic association with anxiety disorders
Includes: Avoidant, Obsessive-compulsive, and Dependent subtypes
Describe Avoidant PD
hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid)
Describe Obsessive-Compulsive PD
Preoccupation with order, and control; ego-syntonic (behavior consistent with one’s one beliefs and attitudes (vs. OCD))
Describe Dependent PD
Submissiv and clincy, excessive needs to be taken car of, low self-confidence
these pts often get stuck in abusive relationships
“Schizo-“
Schzoid < Schizotypical (Schzoid + odd thinking) < Schizophrenic (greater odd thinking than schizotypical) < Schizoaffective (schizophrenic 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
Describe anorexia nervosa
Excessive dieting +/- purging; intense fear of gaining weight and body image distortion
BMI <18.5
What are some associations of anorexia nervosa
osteopenia, metatarsal stress fractures
amenorrhea
lanugo
anemia
electrolyte problems
Describe bulimia nervosa
Binge eating with recurrent compensatory behavior (e.g. vomiting, laxatives, fasting, excessive exercise) occurring weekly for 3+ months
Body weight often within normal range
What are some associations of bulimia nervosa
parotitis
enamel erosion
alkalosis (vomiting)
dorsal hand calluses from vomiting (Russell sign)
What is general dysphoria?
Strong, persistent cross-gender identification characterized by persistent discomfort with one’s sex assigned at birth, causing significant distress (aka transgender0
What is transsexualism?
desire to live as the opposite sex, often through surgery or hormone tx
What is transvestism?
paraphilia (aka cross-dressing), not gender dysphoria
Describe sleep terrors
Periods of terror with screaming in the middle of the night occurring during slow-wave sleep (non-REM sleep- no memory of arousal) (as opposed to nightmares that occur during REM sleep)
usually self-limited
What is nacrolepsy?
dysregulation of sleep-wake cycles with excessive day time sleepiness caused by decreased hypocretin (orexin) production in the lateral hypothalamus
What are some associations of nacrolepsy?
hypagogic (just before sleep) or hypnopompic (just before awakening) hallucinations
nocturnal and narcoleptic sleep episodes that start with REM sleep
Cataplexy (loss of all muscle tone following strong emotional stimulus, such as laughter) in some pts.
strong genetic component
How is narcolepsy tx?
daytime stimulants (e.g. amphetamines, modafinil)
and nighttime sodium oxybate (GHB)
What are the major stages in overcoming substance addiction?
- Precontemplation (not yet acknowledging the problem)
- Contemplation (acknowledgin that there is a problem, but not ready to make a change)
- Preparation/determination- getting ready to change behaviors
- Action/willpower- changing behaviors
- Maintenance
- Relapse
What are the major depressant drugs?
Alcohol
Opiods (e.g. morphine, heroin, methadone)
Barbiturates
Benzodiazepines
What are some indications of intoxication with a depressant?
nonspecific: mood elevation, decreased anxiety, sedation, respiratory depression
What are some indications of withdrawal with a depressant?
nonspecific: anxiety, tremor, seizures, insomnia
What are some indications of intoxication with alcohol?
emotional lability, slurred speech, ataxia, coma, blackouts
Serum y-glutamyltransferase elevated
AST 2x as high as ALT
What are some indications of withdrawal with alcohol?
several withdrawal may cause autonomic hyperactivity and DTs (5-15% mortality rate)
Tx DTs with benzodiazepines
What are some indications of intoxication with opiods?
euphora, respiratory and CNS depression, decreased gag reflex
pupillary constriction
seizures
Tx: naloxone, naltrexone
What are some indications of withdrawal of opiods?
sweating, dilated pupils, piloerection (‘cold turkey”)
fever, rhinorrhea
yawning, nausea, stomach cramps
diarrhea
Tx: long term support, methadone, and buprenorphine
What are some indications of intoxication with barbiturates?
low saftey margin, marked respiratory depression
tx: symptom management (e.g. assist respiration, and increase BP)
What are some indications of withdrawal with barbiturates?
delirium, CV collapse
What are some indications of intoxication with benzodiazepines?
greater safety margin; ataxia, minor respiratory depression
tx: flumazenil (benzodiazepine receptor antagonist, but rarely used as it can precipitate seizures)
What are some indications of withdrawal from benzodiazepines?
sleep disturbance, depression, rebound anxiety, seizure
What are the major stimulant drugs?
Amphetamines
Occiane
Caffeine
Nicotine
What are some indications of intoxication with stimulants?
mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
What are some indications of withdrawal with stimulants?
post-use crash, including depression, lethargy, weight gain, and HA
What are some indications of intoxication with amphetamines?
euphoria, grandiosity,
pupillary dilation
HTN, tachycardia
anorexia, paranoisa, fever
cardiac arrest, seizure if severe
What are some indications of withdrawal from amphetamines?
anhedonia, increased appetitie, hypersomnolence, existential crises
What are some indications of intoxication with cocaine?
impaired judgment, pupillary dilation, halucinations (including tactile), paranoid ideations,
angina, sudden cardiac death
How is cocaine OD tx?
a-blockers, benzodiazepines (BBs not recommended)
What are some indications of withdrawal from cocaine?
hypersomnolence, malaise, severe craving, depression
What are the main hallucinogens?
PCP, LSD, and marijuana
What are some indications of intoxication with PCP?
belligerence, impulsivity, fever, analgesia
vertical and horizontal nystagmus
tachycarida
homicidality
Tx: benzodiazepines, rapid-acting antipsychotic
What are some indications of withdrawal from PCP?
depression, anxiety
irritability
restlessness
anergia
disturbance of thought and sleep
What are some indications of intoxication with LSD?
perceptual distortion (visual, auditory)
depersonalization
anxiety, paranoia
psychosis
flashbacks
What is the pharmaceutical form of marijuana?
dronabinol (tetrahydrocannabinol): used as an antiemetic (chemo) and appetitie stimulant (in AIDS)
Heroin addiction places users at increased risk of:
hepatitis, HIV, abscesses, bacteremia, right-heart endocarditis
How is heroin addiction tx?
Methadone (long acting oral opiate for heroin detox or maintenance)
Naloxone + buprenorphine (antagonist + partial agonist. Naloxone is not PO bioavailable, so withdrawal symptoms occur only if injected)
Naltrexone (long acting opiod antagonist used for relapse prevention once detox is complete)
What are the main complications of alcoholism?
alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy
testicular atrophy
How is alcoholism tx?
disulfram
acamprosate
naltreone
supportive care
What is Wernicke-Korsakoff syndrome?
caused by vit B1 deficiency, and marked by a triad of confusion ophthalmoplegia, and ataxia with many progressing to irreveersible memory loss, confabulation, and personality change
Associated with periventricular hemorrhage/necrosis of mammilary bodies
What are Delirium tremens (DTs)?
life-threatening alcohol withdrawal symptoms that peak 2-4 days after last drink and marked by autonomic hyperactivity (.e.g tachycardia, tremor, anxiety, seizures)
Classically occurs in hospital settings postsurgery in alcoholics that dont get a drink
How are Delirium tremens (DTs) tx?
benzodiazepines
What is alcoholic hallucinosis?
condition marked by visual hallucinations 12-48 hrs after last drink
tx: long-acting benzodiazepines (e.g. lorazepam, diazepam, and chlordiazepoxide)
