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STEP 1 (3) > Psychiatry- Pathology (2) > Flashcards

Psychiatry- Pathology (2) Flashcards

1
Q

What is a personality trait?

A

an enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself

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2
Q

What is a personality disorder?

A

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

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3
Q

Describe Cluster A personality disorders

A

Odd or eccentric; inaility to develop meaningful social relationships

no psychosis

genetic association with schizophrenia

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4
Q

What are the three main types of Cluster A personality disorders

A

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

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5
Q

Describe Cluster B personality disorders

A

Dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse

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6
Q

What are the main types of Cluster B personality disorders

A
  • Antisocial
  • Borderline
  • Histrionic

Narcissitic

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7
Q

Describe Antisocial PD

A

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

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8
Q

Describe Borderline PD

A

Unstable mood and interpersonal relationships, impulsivity

self-mutilation, boredom, and a sense of emptiness

females more common

splitting is a major defense mechanism

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9
Q

Describe Histrionic PD

A

Excessive emotionality and excitability, attention seeking, sexually provacative, overly concerned with appearance

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10
Q

Describe Cluster C personality disorders

A

Anxious or fearful; genetic association with anxiety disorders

Includes: Avoidant, Obsessive-compulsive, and Dependent subtypes

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11
Q

Describe Avoidant PD

A

hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid)

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12
Q

Describe Obsessive-Compulsive PD

A

Preoccupation with order, and control; ego-syntonic (behavior consistent with one’s one beliefs and attitudes (vs. OCD))

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13
Q

Describe Dependent PD

A

Submissiv and clincy, excessive needs to be taken car of, low self-confidence

these pts often get stuck in abusive relationships

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14
Q

“Schizo-“

A

Schzoid < Schizotypical (Schzoid + odd thinking) < Schizophrenic (greater odd thinking than schizotypical) < Schizoaffective (schizophrenic symptoms + bipolar or depressive mood disorder)

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15
Q

Schizophrenia time course:

A

<1 mo- brief psychotic disorder, usually stress related

1-6 mo- schizophreniform disorder

6+ mo- schizophrenia

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16
Q

Describe anorexia nervosa

A

Excessive dieting +/- purging; intense fear of gaining weight and body image distortion

BMI <18.5

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17
Q

What are some associations of anorexia nervosa

A

osteopenia, metatarsal stress fractures

amenorrhea

lanugo

anemia

electrolyte problems

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18
Q

Describe bulimia nervosa

A

Binge eating with recurrent compensatory behavior (e.g. vomiting, laxatives, fasting, excessive exercise) occurring weekly for 3+ months

Body weight often within normal range

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19
Q

What are some associations of bulimia nervosa

A

parotitis

enamel erosion

alkalosis (vomiting)

dorsal hand calluses from vomiting (Russell sign)

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20
Q

What is general dysphoria?

A

Strong, persistent cross-gender identification characterized by persistent discomfort with one’s sex assigned at birth, causing significant distress (aka transgender0

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21
Q

What is transsexualism?

A

desire to live as the opposite sex, often through surgery or hormone tx

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22
Q

What is transvestism?

A

paraphilia (aka cross-dressing), not gender dysphoria

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23
Q

Describe sleep terrors

A

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

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24
Q

What is nacrolepsy?

A

dysregulation of sleep-wake cycles with excessive day time sleepiness caused by decreased hypocretin (orexin) production in the lateral hypothalamus

25
Q

What are some associations of nacrolepsy?

A

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

26
Q

How is narcolepsy tx?

A

daytime stimulants (e.g. amphetamines, modafinil)

and nighttime sodium oxybate (GHB)

27
Q

What are the major stages in overcoming substance addiction?

A
  1. Precontemplation (not yet acknowledging the problem)
  2. Contemplation (acknowledgin that there is a problem, but not ready to make a change)
  3. Preparation/determination- getting ready to change behaviors
  4. Action/willpower- changing behaviors
  5. Maintenance
  6. Relapse
28
Q

What are the major depressant drugs?

A

Alcohol

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

Barbiturates

Benzodiazepines

29
Q

What are some indications of intoxication with a depressant?

A

nonspecific: mood elevation, decreased anxiety, sedation, respiratory depression

30
Q

What are some indications of withdrawal with a depressant?

A

nonspecific: anxiety, tremor, seizures, insomnia

31
Q

What are some indications of intoxication with alcohol?

A

emotional lability, slurred speech, ataxia, coma, blackouts

Serum y-glutamyltransferase elevated

AST 2x as high as ALT

32
Q

What are some indications of withdrawal with alcohol?

A

several withdrawal may cause autonomic hyperactivity and DTs (5-15% mortality rate)

Tx DTs with benzodiazepines

33
Q

What are some indications of intoxication with opiods?

A

euphora, respiratory and CNS depression, decreased gag reflex

pupillary constriction

seizures

Tx: naloxone, naltrexone

34
Q

What are some indications of withdrawal of opiods?

A

sweating, dilated pupils, piloerection (‘cold turkey”)

fever, rhinorrhea

yawning, nausea, stomach cramps

diarrhea

Tx: long term support, methadone, and buprenorphine

35
Q

What are some indications of intoxication with barbiturates?

A

low saftey margin, marked respiratory depression

tx: symptom management (e.g. assist respiration, and increase BP)

36
Q

What are some indications of withdrawal with barbiturates?

A

delirium, CV collapse

37
Q

What are some indications of intoxication with benzodiazepines?

A

greater safety margin; ataxia, minor respiratory depression

tx: flumazenil (benzodiazepine receptor antagonist, but rarely used as it can precipitate seizures)

38
Q

What are some indications of withdrawal from benzodiazepines?

A

sleep disturbance, depression, rebound anxiety, seizure

39
Q

What are the major stimulant drugs?

A

Amphetamines

Occiane

Caffeine

Nicotine

40
Q

What are some indications of intoxication with stimulants?

A

mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety

41
Q

What are some indications of withdrawal with stimulants?

A

post-use crash, including depression, lethargy, weight gain, and HA

42
Q

What are some indications of intoxication with amphetamines?

A

euphoria, grandiosity,

pupillary dilation

HTN, tachycardia

anorexia, paranoisa, fever

cardiac arrest, seizure if severe

43
Q

What are some indications of withdrawal from amphetamines?

A

anhedonia, increased appetitie, hypersomnolence, existential crises

44
Q

What are some indications of intoxication with cocaine?

A

impaired judgment, pupillary dilation, halucinations (including tactile), paranoid ideations,

angina, sudden cardiac death

45
Q

How is cocaine OD tx?

A

a-blockers, benzodiazepines (BBs not recommended)

46
Q

What are some indications of withdrawal from cocaine?

A

hypersomnolence, malaise, severe craving, depression

47
Q

What are the main hallucinogens?

A

PCP, LSD, and marijuana

48
Q

What are some indications of intoxication with PCP?

A

belligerence, impulsivity, fever, analgesia

vertical and horizontal nystagmus

tachycarida

homicidality

Tx: benzodiazepines, rapid-acting antipsychotic

49
Q

What are some indications of withdrawal from PCP?

A

depression, anxiety

irritability

restlessness

anergia

disturbance of thought and sleep

50
Q

What are some indications of intoxication with LSD?

A

perceptual distortion (visual, auditory)

depersonalization

anxiety, paranoia

psychosis

flashbacks

51
Q

What is the pharmaceutical form of marijuana?

A

dronabinol (tetrahydrocannabinol): used as an antiemetic (chemo) and appetitie stimulant (in AIDS)

52
Q

Heroin addiction places users at increased risk of:

A

hepatitis, HIV, abscesses, bacteremia, right-heart endocarditis

53
Q

How is heroin addiction tx?

A

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)

54
Q

What are the main complications of alcoholism?

A

alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy

testicular atrophy

55
Q

How is alcoholism tx?

A

disulfram

acamprosate

naltreone

supportive care

56
Q

What is Wernicke-Korsakoff syndrome?

A

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

57
Q

What are Delirium tremens (DTs)?

A

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

58
Q

How are Delirium tremens (DTs) tx?

A

benzodiazepines

59
Q

What is alcoholic hallucinosis?

A

condition marked by visual hallucinations 12-48 hrs after last drink

tx: long-acting benzodiazepines (e.g. lorazepam, diazepam, and chlordiazepoxide)

STEP 1 (3) (16 decks)

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