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USMLE > Psychiatry Pathology > Flashcards

Psychiatry Pathology Flashcards

1
Q

What is formication?

A

The sensation of ‘creep crawlies’ across the skin

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2
Q

In whom are olfactory hallucinations most likely?

A

Individuals experiencing an ‘aura’ prior to having a seizure, e.g. epileptic individuals

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3
Q

In whom are auditory hallucinations most likely?

A

Schizophrenics

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4
Q

What type of hallucination is formication?

A

Tactile

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5
Q

In whom are tactile hallucinations most likely?

A

Those experiencing delirium tremens (i.e. those in alcohol withdrawal), or in users of cocaine

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6
Q

What are clang associations?

A

A type of thinking whereby the sound of a word, rather than its meaning, provides the impetus for subsequent associations - e.g. in mania, ‘Hey man is your name Dan? Plan fans, ban pans!’

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7
Q

What is the difference between an illusion and a hallucination?

A

Illusion = misperception of REAL external stimuli, while a hallucination is a completely FALSE sensory perception (for which there is no basis)

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8
Q

What are Axis I disorders?

A

Psychiatric disorders, other than personality disorders

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9
Q

What are Axis IV disorders?

A

Those caused by psychosocial or environmental stressors

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10
Q

What are Axis II disorders?

A

Personality disorders and mental retardation

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11
Q

What are Axis V disorders?

A

‘Global assessment of function’

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12
Q

What are Axis III disorders?

A

Pertinent medical conditions

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13
Q

What does primary gain mean, with regard to psychological motivators?

A

Refers to internal motivations. E.g. a patient unable to deal with internal psychological conflict may unconsciously convert that conflict to somatic symptoms - i.e. conversion disorder

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14
Q

What does secondary gain mean, with regard to psychological motivators?

A

Refers to external motivations. E.g. patient’s disease results in financial compensation/benefits etc.

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15
Q

What are the mature defence mechanisms?

A
  1. Altruism
  2. Humour
  3. Sublimation
  4. Suppression
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16
Q

What is the difference between suppression and repression?

A

Suppression is a mature defence mechanism, and involves an uncomfortable thought being VOLUNTARILY pushed from the conscious mind.

Repression is an immature defence mechanism, and involves an uncomfortable thought being INVOLUNTARILY excluded from one’s concious

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17
Q

What are the immature defence mechanisms?

A

1) Repression; 2) Splitting; 3) Dissociation; 4) Rationalisation; 5) Projection; 6) Isolation; 7) Identification; 8) Regression; 9) Reaction formation; 10) Fixation; 11) Displacement; 12) Denial; 13) Acting out

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18
Q

Give the name of a therapy commonly used in psychiatry, considered ‘somatic’:

A

ECT

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19
Q

In which neurological condition may diazepam be of particular use?

A

Chorea

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20
Q

What effect will be seen in barbiturate OD?

A

Respiratory depression

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21
Q

What is the mechanism of benzodiazepines?

A

Potentiate GABA-A mediated inhibition

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22
Q

What is the mechanism of barbiturates?

A

Potentiate GABA-A mediated inhibition

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23
Q

When may BZDs cause respiratory depression in OD (like barbiturates)?

A

When taken with alcohol

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24
Q

What drug is given to reverse BZD OD?

A

Flumazenil

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25
Q

What may happen if BSDs are reversed too quickly?

A

Rebound seizures

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26
Q

In what population should prescription of BZDs be avoided where possible?

A

Addicts

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27
Q

What are the +ve’s of buspirone over BZDs for anxiety?

A
  1. Less likely to be abused

2. Alcohol does not potentate its affect

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28
Q

What are the -ve’s of buspirone?

A

Slower onset of action

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29
Q

What are the classes of anxiolytics?

A
  1. BZDs; 2. Barbiturates; 3. Buspirone
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30
Q

What is the action of typical antipsychotics?

A

Antagonise dopamine D2 receptors

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31
Q

What are some examples of typical antipsychotics?

A

Haloperidol; chlorpromazine

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32
Q

What are the S/Es of typical antipsychotics?

A

EPSEs
Anti-cholinergic symptoms
NMS

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33
Q

What are the anticholinergic S/Es? + their mneumonic?

A

DRY as a bone, FULL as a flask, HOT as a hare, RED as a beet, MAD as a hatter, BLIND as a bat, the HEART runs alone, BLOATED as a toad

i.e. dry mm; urinary retention; heat intolerance, flushing, delirium, mitosis, tachy, ileus

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34
Q

What drug can be given for anticholinergic poisoning?

A

Physostigmine

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35
Q

What are the EPSE’s?

A

Parkinsonian symptoms
Tardive dyskinesia
Akasthesia
Torticollis

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36
Q

What drugs can be given for EPSE’s?

A

Benztropine

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37
Q

What is the mnemonic for NMS?

A 
FEVER:
Fever
Enzyme (CK) elevated
Vital fluctuating
Encephalopathy
Rigidity/renal failure
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38
Q

What drug can be given for NMS, and how does it work?

A

Dantrolene - prevents the release of Ca2+ from the ER

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39
Q

What is the action of atypical antipsychotics?

A

Antagonize dopamine D2 + serotonin 5-HT2 receptors

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40
Q

What are some commonly used atypical antipsychotics?

A

Risperidone; olanziprine; aripiprazole; clozapine

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41
Q

What are the S/Es of atypical antipsychotics?

A

Weight gain
Sedation
Anti-cholinergic symptoms
MILD EPSE’s

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42
Q

What is retrograde amnesia?

A

Inability to recall old memories

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43
Q

For how long must a patient have symptoms in order for them to be diagnosed?

A

> 6/12

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44
Q

What is the mechanism of action of SSRIs?

A

Increase synaptic serotonin levels by inhibiting presynaptic uptake

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45
Q

When is serotonin syndrome most likely to occur?

A

When SSRIs are taken WITH MAO inhibitors

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46
Q

What are the common S/Es of SSRIs?

A

Sexual dysfunction
GI upset
(Serotonin syndrome)

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47
Q

What is the mechanism of action of SNRIs?

A

Inhibit serotonin reuptake and norepinephrine reuptake at the synapse

48
Q

What are the common S/Es of SNRIs?

A 
HTN
Sweating
WL
GI upset
Blurred vision
Sexual dysfunction
NMS
49
Q

What is the mechanism of action of TCAs?

A

Inhibit serotonin and norepinephrine reuptake

50
Q

What are the common S/Es of TCAs?

A 
Heart block
Constipation
Urinary retention
Dizziness
Daytime sleepiness
51
Q

What is the mechanism of action of MAO inhibitors?

A

Increase serotonin and norepinephrine levels in presynaptic neutrons and synopsis by inhibiting their breakdown

52
Q

What is an example of a MAO inhibitor?

A

Iproniazid

53
Q

What are the common S/E’s of MAO inhibitors?

A 
'Cheese reaction'/tyramine toxicity
Dizziness
Daytime sleepiness (somnolence)
Orthostatic (postural) hypotension
WG
54
Q

What psychiatric condition is associated with grandiosity?

55
Q

How would a major depressive episode be diagnosed?

A

5 or more SIG E CAPS symptoms, including either depressed mood or anhedonia, for a period longer than 2 weeks

56
Q

What are the SIG E CAPS symptoms of a major depressive episode?

A 
Sleeping difficulty
loss of Interests
Guilt
loss of Energy
loss of Concentration
Appetite changes
Psychomotor retardation
Suicidal ideation
57
Q

What is leaden paralysis?

A

Limbs feel ‘weighed down’

58
Q

What are the symptoms of atypical depression?

A
  1. Hypersomnia
  2. Weight gain
  3. Leaden paralysis
59
Q

How would a major depressive episode be diagnosed?

A

5 or more SIG E CAPS symptoms, including either depressed mood or anhedonia, for a period longer than 2 weeks, in which there are 2 or more episodes with a symptom-free period lasting at least 2 months

60
Q

How is dysthymia diagnosed?

A

A mild depression most of the time >2 years, but not meeting the criteria for major depressive disorder (MDD). Patients = frequent criers

61
Q

What are the features of seasonal affective disorder?

A

Depression for 2 consecutive years during the same season, periods of depression are followed by non-depressed symptoms

62
Q

Which antidepressant may be best for patients with atypical depression?

A

MAO inhibitors

63
Q

What is bipolar I?

A

Mania + depression

64
Q

What is bipolar II?

A

Hypomania + depression

65
Q

What is cyclothymia?

A

Cyclic shift between dysthymia and hypomania for at least 2 years

66
Q

How is mania defined?

A

A period of elevated or irritable mood lasting at least one week + three symptoms described in DIG FAST - Distractibility; Insomnia; Grandiosity; Flight of ideas; increased Activity; pressured Speech; Thoughtlessness

67
Q

What is the biological basis of anxiety?

A

Involves the amygdala + is associated with increased activity of norepinephrine and decreased activity of GABA and serotonin

68
Q

In addition to anxiety what other symptoms are required for 6/12 in order to be diagnosed with GAD?

A
  1. Feeling of being on edge
  2. Fatigue
  3. Difficulty concentrating
  4. Irritability
  5. Sleep disturbance
  6. Muscle tension
69
Q

How should GAD be treated? And why should it be treated this way?

A

Start with BZD, then switch to buspirone to avoid dependency

70
Q

What does ‘FRANCISE’ stand for in PTSD?

A 
F = flashbacks/flat affect
R = reminders
A = avoidance
N = numb
C = concentrating difficulty
I = irritability 
S = sleep disturbance
E = edgy
71
Q

How does acute stress disorder differ from PTSD?

A

Acute stress disorder comes on within 1 month of the traumatic event, but resolves within 1 month of onset

72
Q

What does ‘HARD’ stand for in PTSD?

A 
H = hyperarousal/hypervigilence
A = avoidance of triggers
R = re-live
D = distress that interferes with daily functioning
73
Q

What is the USA treatment for PTSD?

A

Exposure therapy

74
Q

What are the ‘PANIC’ criteria for panic attacks?

A 
P = palpitations
A = abdominal distress
N = numbness/nausea
I = intense fear of death
C = choking/chills/chest pain
75
Q

How many times must panic attacks occur before it may be defined as panic disorder?

A

> 2x per week

76
Q

What are the most common types of social phobias?

A

Public speaking

Public washroom use

77
Q

What are the 3 different types of specific phobia?

A
  1. Situational (e.g. closed spaces)
  2. Animal/insect/environmental (e.g. cats, spiders, heights)
  3. Other (e.g. injections, blood)
78
Q

1st degree relatives of what type of patients are more likely to develop OCD?

A

Tourette’s

79
Q

What other factors contribute to OCD?

A

Genetic factors
Psychosocial factors
Imbalance of serotonin

80
Q

What does ego-dystonic mean?

A

A response that is exaggerated

81
Q

Which types of antidepressant might be used in OCD?

A

SSRI + TCA

82
Q

What organ system tends to be affected in conversion disorder?

A

Neurological system

83
Q

What are the diagnostic criteria for somatisation disorder?

A
  1. At least 2 GI symptoms
  2. At least 1 neurological symptom
  3. At least 1 symptoms that is sexual or reproductive-system related?
  4. At least 4 pain symptoms
  5. Onset pre-30
  6. No organic cause of the symptoms
84
Q

What is condition associated with ‘la belle indifference’?

A

Conversion disorder

85
Q

What neurological conditions may a person with conversion disorder complain of?

A
  1. Blindness
  2. Paralysis
  3. Parathesia
  4. Pseudo-seizures
  5. Mutism
  6. Globus hystericus
86
Q

How may one differentiate between a seizure and a pseudo-seizure?

A

Serum lactate - will be elevated after a true seizure, but not a pseudo-seizure

87
Q

How do hypochondrias differ from OCD?

A

Hypochondriacs constantly worry they HAVE a serious illness, whereas those with OCD constantly they will CATCH an illness

88
Q

How do hypochondrias, BDD and body image disturbance differ?

A

Hypochondrias feel they have a SPECIFIC DISEASE, whereas in BDD, patients will feel they have an abnormal BODY PART. And then in body image distortion patients will feel their WHOLD BODY is abnormal

89
Q

How does factitious disorder differ from somatisation?

A

Factitious disorder - patients are aware, and desire primary psychological gain
Somatisation - patients are unaware, but may have primary or secondary gain

90
Q

How does factitious disorder differ from malingering?

A

Although the patients are aware in both factitious and malingering, in factitious there is primary gain, but in malingering there is secondary gain

91
Q

How does Munchausen’s differ from factitious disorder?

A

= a specific type of factitious disorder whereby the symptoms are not real, or are real but are intentionally induced

92
Q

What is a dissociative disorder, and in whom is it most likely to occur?

A

A sudden, temporary loss of identity or memory for personal events. A high proportion of patients with dissociative disorder have a history of trauma or child abuse

93
Q

What is the minimum age for the diagnosis of a personality disorder?

94
Q

What is the mnemonic for the difference between schizoid vs. schizotypal personality disorder?

A

SchizOIDS AVOID reality, may day-dream and may be cold and introverted. SchizoTYPALS are odd, magical TYPES

95
Q

What is the general difference between cluster B and cluster A + C disorders?

A

Cluster B generally involves the outward expression of traits, whilst cluster A + C tend to be inwardly directed

96
Q

What are the Cluster A disorders?

A

Paranoid PD; schizoid PD; Schizotypal PD

97
Q

What are the Cluster B disorders?

A

Borderline PD; Antisocial PD; Narcissistic PD; Histrionic PD

98
Q

What are the Cluster C disorders?

A

Avoidant PD; Dependant PD; OCPD (anankastic)

99
Q

What are the mnemonics to remember the general traits of each cluster?

A

Accusatory, Aloof, Avoidant
Bad to the Bone
Cowardly, Compulsive, Clingy

100
Q

What is the lifetime suicide rate in an individual with schizotypal PD?

101
Q

What factors predispose to borderline PD?

A
  1. 5x more likely in 1st degree relatives (e.g. in children with parents who have it)
  2. Increased risk in patients whom have alcoholic relatives, or relatives with mood disorders
  3. Sexual/physical abuse
  4. Childhood neglect/abuse
102
Q

What is the mnemonic ‘PRAISE’ with regard to borderline PD?

A 
P = paranoid
R = relationship instability
A = angry outburst/abandonment fear
I = impulsiveness
S = suicidal threats
E = emptiness
103
Q

What factors predispose to antisocial PD?

A

Violent, criminal environments increase the risk of a patient developing an antisocial PD

104
Q

What are the 4 types of dissociative disorder?

A
  1. Dissociative amnesia
  2. Depersonalisation disorder
  3. Dissociative fugae
  4. Dissociative identity disorder - patient exhibits >/= 2 distinct identities
105
Q

What is the mortality of anorexia nervosa?

106
Q

What is the weight of patients diagnosed with anorexia nervosa?

A

> 15% below normal

107
Q

What is the weight of bulimia nervosa patients?

A

Normal (usually)

108
Q

What is classically seen in patients that abuse laxatives?

A

Melanosis coli

109
Q

What are the medical conditions associated with anorexia nervosa?

A
  1. Arrhythmia
  2. MI
  3. Amenorrhoea
  4. Hyperkalaemia
  5. Hypercholestraemia
  6. Melanosis coli
  7. Osteoporosis
110
Q

What are the signs associated with bulimia?

A
  1. Dental erosions
  2. Russell’s sign
  3. Hypertrophy of the salivary glands
  4. Metabolic alkalosis
111
Q

What drug is contraindicated in bulimia and anorexia nervosa?

A

Bupropion - it increases the incidence of seizures

112
Q

What are dyssomnias?

A

Primary sleep disorders characterised by impairment in the amount, quality, or timing of sleep

113
Q

What are parasomnias?

A

Primary sleep disorders characterised by abnormal behaviour during the sleep cycle

114
Q

What is the most common cause of insomnia?

115
Q

What drug may be used in restless legs syndrome?

A

Ropinirole

116
Q

What are the features of narcolepsy?

A 
Hypnagogic hallucinations
Hypnopompic hallucinations (during waking hours)
Short REM latency
Cataplexy
Sleep paralysis

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