Psychiatry - Pathology Part 1 Flashcards
What are the seven effects of long-term affection deprivation on infants?
Decreased muscle tone, poor language skills, poor socialization skills, lack of basic trust, anaclitic depression, weight loss, and physical illness
True or False? Severe long-term affection deprivation can result in infant death.
True
What are the “four W’s” that result from long-term affection deprivation of infants?
Weakness, Wordlessness, Wanting (social), and Wariness
In cases of physical abuse in children, is the abuser most frequently female or male?
Female
True or False? In cases of physical abuse in children, the abuser is usually the primary caregiver.
True
In cases of sexual abuse in children, is the abuser more frequently male or female?
Male
True or False? In cases of sexual abuse in children, the abuser is usually a stranger to the victim.
False; the abuser is usually known to the victim
Approximately how many deaths per year result from the physical abuse of children in the United States?
Approximately 3000
The peak incidence of sexual abuse in children occurs in what age range?
9 to 12 years
A diagnosis of a sexually transmitted disease in a young child may be evidence of what?
Child abuse
A young girl with a history of urinary tract infections presents with multiple bruises and decreased vision in the right eye; ophthalmic evaluation revealed retinal detachment; imaging studies revealed healed fractures and subdural hematoma; these findings may be evidence of which condition?
Child abuse
Name the most common form of child maltreatment.
Child neglect
True or False? Child abuse must be reported to local child protective services but child neglect does not.
False; both must be reported to local child protective services
Child neglect is characterized by failure to provide what support for the child?
Adequate food, shelter, supervision, education, affection
What signs and symptoms can be indicative of child neglect?
Withdrawal, malnutrition, poor hygiene, failure to thrive
What is anaclitic depression?
Depression in an infant as a result of continued separation from the caregiver
What is a major consequence of anaclitic depression in infants?
Failure to thrive or other developmental disturbances
What is the response of an infant with anaclitic depression to human contact?
Infants can become withdrawn and unresponsive to people when suffering from anaclitic depression
Name four stressors that can lead to regression in children.
Physical illness, punishment, birth of a new sibling, or fatigue
Bedwetting in a previously toilet-trained child during hospitalization is an example of what type of behavior?
Regression as a result of a stressor
What psychiatric disorder is characterized by poor impulse control and an inability to pay attention?
Attention-deficit hyperactivity disorder
What is the average intelligent quotient of a child with attention-deficit hyperactivity disorder?
Patients with attention-deficit hyperactivity disorder have a normal intelligence quotient
Which drugs are used to treat attention-deficit hyperactivity disorder?
Methylphenidate (Ritalin), amphetamines, atomoxetine
Attention-deficit hyperactivity disorder is characterized by what three traits?
Hyperactivity, motor impairment, emotional lability
What brain region has been found to be smaller in patients with attention-deficit hyperactivity disorder?
Frontal lobe
True or False? Attention-deficit hyperactivity disorder is exclusively a disorder of childhood.
False, as many as 50% of children will carry the disorder into adulthood
A mother brings her nine-year-old son in for evaluation for attention-deficit hyperactivity disorder because his teacher has noticed distractibility, restlessness, and inattention at school, which has never been present before now. Does her child have attention-deficit hyperactivity disorder?
No, the onset of symptoms must begin before 7 years of age
An 14-year-old boy is brought to the clinic after he set the neighbor’s cat on fire; this patient has many arrests and school expulsions in his background; what is the most likely diagnosis?
Conduct disorder
After reaching the age of 18 years, patients with conduct disorder are commonly rediagnosed with what psychiatric diagnosis?
Antisocial personality disorder
A boy has been defying authority; he commonly makes rude remarks to his parents, teachers, and other adults; he has no history of violence toward people or animals; what is the most likely diagnosis?
Oppositional defiant disorder
What differentiates conduct disorder from oppositional defiant disorder?
Criminal behavior; children with oppositional defiant disorder are noncompliant but stop short of criminal acts whereas conduct disorder is characterized by behaviors that include criminal acts
A 10-year-old boy has multiple tics, makes random grunting sounds, and often has involuntary outbursts of profanity; what is the most likely diagnosis?
Tourette’s syndrome
What is the age of onset for Tourette’s syndrome?
Younger than 18 years of age
What psychiatric disorder has higher prevalence in patients with Tourette’s syndrome?
Obsessive-compulsive disorder
What class of medications is used to treat Tourette’s syndrome?
Antipsychotics such as haloperidol
How long do Tourette’s symptoms need to be present to qualify a patient for the diagnosis?
More than one year
What differentiates conduct disorder from antisocial personality disorder?
Age; conduct disorder is seen in patients younger than 18 years of age, whereas antisocial personality is a diagnosis of patients older than 18 years of age
A 7-year-old girl presents to the clinic with a stomach ache; she sometimes vomits to avoid going to school out of fear that her parents might not be home at the end of the day; what is the most likely diagnosis?
Separation anxiety disorder
What is the common age of onset for separation anxiety disorder?
7-8 years of age
Describe the symptoms of autistic disorder.
Severe language impairment, social deficits, and usually a low intelligence quotient
What are the treatment goals for patients with autism?
Behavioral and supportive therapy to improve communication and social interactions
What is the name given to an autistic child with an unusual specialized ability?
Savant
A four-year-old patient presents for poor school performance. When the physician enters the room, the patient is spinning the wheels of a toy truck and flapping his arms. He does not make eye contact with his mother or the physician, nor does he look at the physician when his name is called. What is a likely diagnosis?
Autistic disorder
What differentiates Asperger’s disorder and autism?
Children with Asperger’s are of normal intelligence and lack verbal or cognitive deficits
In contrast to patients with Asperger’s disorder, patients with autism have _____ (normal/below-average) _____ intelligence and _____ (more/less) severe deficits in social skills and communication.
Below-average; more
True or False? Individuals with autism express repetitive movement, but individuals with Asperger’s disorder do not.
False; both disorders are characterized by repetitive movements
What are the major issues in a patient with Asperger syndrome?
Difficulty forming relationships and all-consuming interests, although patients have normal intelligence and verbal skills
Describe Rett’s disorder.
Patients exhibit normal development until approximately age 4 years and then regress (loss of development, mental retardation, loss of verbal skills, ataxia, and stereotyped hand-wringing)
Why is Rett’s disorder seen almost exclusively in females?
Affected males generally die in utero or shortly after birth
What is the mode of inheritance of Rett’s disorder?
X-linked recessive
What is childhood disintegrative disorder?
Regression after at least 2 years of apparently normal development
A 5-year-old girl has lost receptive and expressive language skills, social skills, motor skills, and bowel and bladder control over the past two years. What is the most likely diagnosis?
Childhood disintegrative disorder
What is the typical age of onset of childhood disintegrative disorder?
Between 3 and 4 years of age
True or False? Childhood disintegrative disorder is exclusively found in girls.
False; Rett’s disorder is exclusively found in girls. Childhood disintegrative disorder is more prevalent in boys
What psychiatric disorder is characterized by increased norepinephrine levels and decreased γ-aminobutyric acid and 5-hydroxytryptamine levels?
Anxiety disorder
While Parkinson’s disease is marked by _____ (decreased/increased) levels of dopamine, the levels of dopamine in schizophrenia are _____ (decreased/increased).
Decreased; increased
While anxiety is marked by _____ (decreased/increased) levels of norepinephrine, the levels of norepinephrine in depression are _____ (decreased/increased).
Increased; decreased
What neurotransmitter level abnormalities are seen in anxiety disorder?
Elevated norepinephrine, low γ-aminobutyric acid, and low 5-hydroxytryptamine levels
What neurotransmitter abnormalities are seen in Huntington’s disease?
Decreased γ-aminobutyric acid and acetylcholine levels
What neurotransmitter abnormalities are seen in schizophrenia?
Increased dopamine levels
What neurotransmitter abnormalities are seen in depression?
Decreased norepinephrine, dopamine, and 5-hydroxytryptamine levels
What neurotransmitter abnormalities are seen in Parkisnon’s disease?
Decreased dopamine and increased acetylcholine levels
Name six common causes of delirium (or loss of orientation).
Alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional deficiencies
List the order in which a person loses his or her orientation.
The patient will become disoriented to time, place, then person
What type of amnesia is characterized by the inability to remember things that occurred after a central nervous system insult (ie, no new memories)?
Anterograde amnesia
What type of amnesia is typically caused by thiamine deficiency as a result of alcoholism?
Korsakoff amnesia
What type of amnesia is associated with confabulations?
Korsakoff amnesia
Thiamine deficiency can lead to damage to what brain structures?
Mammillary bodies bilaterally
What type of amnesia is associated with the inability to remember things that occurred before a central nervous system insult?
Retrograde amnesia
Is Korsakoff amnesia anterograde or retrograde?
Largely anterograde, but with some retrograde memory loss
What type of amnesia causes the inability to recall important personal information after a severe trauma or stress?
Dissociative amnesia
Define delirium.
Acute-onset waxing and waning level of orientation and perception
You are paged for an agitated patient who is confused, visually hallucinating, and intermittently combative. Her vital signs are stable, labs are normal, and the only medication she is administered is a sleep aid. What is the likely diagnosis?
She is likely experiencing medication-induced delirium
What diagnostic test may be helpful in diagnosing delirium?
Delirium is associated with an abnormal electroencephalographic recordings
What type of hallucinations are common in delirium?
Visual; auditory hallucinations are more common in schizophrenia
What category of medications are known to cause delirium in elderly patients?
Drugs with anticholinergic effects
Define dementia.
Gradual decline in cognitive function with no change in level of consciousness.
An 80-year-old patient presents with weight loss, sleep disturbances, anhedonia, and fatigue. In addition to dementia, what common psychiatric diagnosis should be investigated?
Depression (pseudodementia)
Dementia is _____ (reversible/irreversible) whereas delirium is _____ (reversible/irreversible).
Irreversible; reversible
True or False? Individuals with dementia have changes in their level of consciousness and are not usually alert.
False; individuals with dementia do not have changes in consciousness and are usually alert
What changes are seen in patients suffering from dementia?
Memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, and impaired judgment
Electroencephalographic recordings in individuals with dementia are _____ (normal/abnormal).
Normal
What is the primary characteristic of dementia?
Memory loss
Name six possible etiologies of dementia.
Alzheimer’s disease, vascular thrombosis, HIV, Pick’s disease, substance abuse, Creutzfeldt-Jakob disease
_____ (Delusions/Hallucinations/Illusions) are perceptions in the absence of external stimuli.
Hallucinations
_____ (Delusions/Hallucinations/Illusions) are misinterpretations of actual external stimuli.
Illusions
_____ (Delusions/Hallucinations/Illusions) are false beliefs that are not shared with other members of one’s culture/subculture.
Delusions
Define loose associations.
They are a sequence of ideas that are only remotely related to each other, if at all. In conversation, the frame of reference usually changes with each sentence
Visual hallucinations are more common in _____ (delirium/schizophrenia) while auditory hallucinations are more common in _____ (delirium/schizophrenia).
Delirium; schizophrenia
Olfactory hallucinations may precede what clinical event?
Psychomotor epilepsy
_____ is the sensation of ants crawling on one’s skin.
Formication
Formication is typically seen among patient who abuse what substance?
Cocaine
True or False? Gustatory hallucinations are common in patients with psychomotor epilepsy.
False; olfactory hallucinations are more common in these patients. Gustatory hallucinations are rare
Name two situations in which tactile hallucinations are common.
Delirium tremens secondary to alcohol withdrawal and cocaine abuse
What type of hallucination occurs while going to sleep, hypnagogic or hypnopompic?
Hypnagogic
What type of hallucination occurs while waking from sleep, hypnagogic or hypnopompic?
Hypnopompic
For a diagnosis of schizophrenia, periods of psychosis and disturbed behavior leading to a decline in functioning must be present for how long?
For 6 months or longer
What psychotic disorder is characterized by symptoms that are consistent with schizophrenia but that last for less than 6 months?
Schizophreniform disorder
An 18-year-old man presents with hallucinations, delusions, and social withdrawal. These symptoms lasted for 2 weeks with onset during final exams and then spontaneously resolved. What is the diagnosis?
Brief psychotic disorder
Name the five subtypes of schizophrenia.
Disorganized, catatonic, paranoid, undifferentiated, and residual
Name the four positive symptoms of schizophrenia.
Delusions, hallucinations, disorganized thought, and disorganized/catatonic behavior
What is schizoaffective disorder?
The presence of psychotic symptoms for two weeks without symptoms of mood disorder, followed by the addition of symptoms of mood disorder
What “negative symptoms” are seen in patients with schizophrenia?
Lack of motivation, speech, and thought are other negative symptoms
What patterns of symptoms are seen in male and female sufferers of schizophrenia?
While the prevalence is equal, the disease presents at a younger age in men
True or False? The lifetime prevalence of schizophrenia is 1.5%.
True
Name the two subtypes of schizoaffective disorder.
Bipolar and depressive
True or False: Patients with schizophrenia are at an increased risk of suicide.
True
What neurotransmitter abnormality is associated with schizophrenia?
Increased dopaminergic activity; antipsychotic drugs are dopamine blockers
What neuronal abnormality is associated with schizophrenia?
Decreased dendritic branching
What is delusional disorder?
A fixed, persistent, nonbizarre belief system lasting > one month
In delusional disorder, functioning (is/is not) impaired.
Functioning is not impaired and the disorder is often self-limited
A husband believes he was abducted by aliens and subjected to tests; his wife subscribes to the same belief; name the disorder.
Shared psychotic disorder or folie à deux
What is the treatment for shared psychotic disorder?
Separation of the affected patients
A woman with a history of sexual abuse and two distinct identities with different names and personalities presents to your office; from what disorder does she suffer?
Dissociative identity disorder
Define depersonalization disorder.
This is a disorder where are person is unattached to his reality as if having an “out-of-body” experience
A middle-age man has just moved into town and is seeking a primary care provider, but cannot recall elements of personal information or past history. What is the most likely diagnosis?
Dissociative fugue
A patient presents with racing thought, pressured speech, and a decreased need for sleep that has lasted 2 weeks. What is the diagnosis in this patient?
Manic episode
How long do manic symptoms need to last to qualify as a manic episode?
At least one week
A patient presents with increased distractibility, rapid speech, and insomnia that has lasted for 2 weeks. He believes that he is an agent of God and that he needs to speak with the President to give him special instructions. What is this patient’s diagnosis?
Manic episode
Diagnosis of mania requires the presence three of which seven symptoms?
Distractibility, Irresponsibility, Grandiosity, Flight of ideas, increase in goal-directed Activity/psychomotor Agitation, decreased need for Sleep, Talkativeness or pressured speech (remember: DIG FAST)
True or False? Hypomanic episodes require hospitalization.
False; hypomanic episodes are usually less intense than manic episodes and do not require hospitalization
How do hypomanic episodes differ from manic episodes?
Hypomanic episodes do not have psychotic features
Can a patient with a history of manic episodes but no history of depressive episodes be diagnosed with bipolar disorder?
Yes; a patient may have bipolar disorder and never experience a depressive episode
How does bipolar I differ from bipolar II disorder?
Bipolar I is characterized by manic episodes
A patient with bipolar disorder presents with increased manic symptoms after being started on a new medication; what medication was likely started?
An antidepressant, which can cause increased mania in bipolar patients
What drugs are most commonly used to treat bipolar disorder?
Lithium, valproic acid, carbamazepine and atypical antipsychotics
Unlike bipolar I, bipolar II involves _____ (hypomanic/manic) episodes that are possibly mixed with depressed episodes.
Hypomanic
What disorder is a milder form of bipolar disorder that lasts for at least 2 years?
Cyclothymic disorder
How many depressive criteria must be endorsed (in addition to depressed mood or anhedonia) to qualify for major depressive episode?
Five
For a diagnosis of major depressive episode, the symptoms must occur over what time frame?
Must occur for at least 2 weeks
True or False: Sleep disturbances are commonly seen in major depressive episodes.
True
What is the psychiatric term for the loss of interest in doing something that one once liked to do?
Anhedonia
What milder form of depression lasts for >2 years?
Dysthymia
What specific type of depression responds to full-spectrum light exposure and is more common in winter months?
Seasonal affective disorder
A patient presents with depressed mood, anhedonia, feelings of guilt, loss of concentration, increased appetite, loss of energy, and suicidal ideation. What additional information needs to be obtained to make the diagnosis of major depressive episode?
The time course (ie, symptoms were present for most days during the past 2 weeks)
Which mnemonic can be used to remember the symptoms of depression?
SIG E CAPS: Sleep disturbance, loss of Interest (anhedonia), Guilt or feelings of worthlessness, loss of Energy, loss of Concentraion, Appetite/weight changes, Psychomotor retardation or agitation, Suicidal ideation, depressede mood
The lifetime prevalence of major depressive episode is higher for which sex?
The lifetime prevalence is higher in women (10% to 25%) than in men (5% to 12%)
What change in slow-wave sleep is seen in patients with depression?
A decrease in slow-wave sleep
What changes in rapid eye movement sleep are seen in patients with depression?
Decreased rapid eye movement sleep latency and increased total rapid eye movement sleep
What is the most important sleep-related question to ask when screening for depression?
Does the patient experience increased early-morning awakenings
What symptoms differentiate atypical depression from classical depression?
Hypersomnia, overeating, and ability to react positively to positive events (depressed patients are usually always sad)
What disorders is electric convulsive therapy used to treat?
Depression refractory to other treatment modalities
Name the adverse effects of electric convulsive therapy.
Disorientation, anterograde and retrograde amnesia
True or False? Electroconvulsive therapy renders a person unconscious.
False; electroconvulsive therapy induces a seizure in an already anesthetized patient
_____ (Unilateral/Bilateral) treatment can lower the risk of posttreatment amnesia.
Unilateral
Which sex is at greater risk of suicide completion?
Men; although women attempt suicide more frequently
What are the 10 factors that increase a person’s risk of suicide completion (remember the mnemonic SAD PERSONS)?
Sex (male), Aage (teenage, elderly), Depression, Previous attempt, Ethanol or drug use, loss of Rational thinking, Sickness, having an Organized plan, having No spouse, and lacking Social support
Who attempts suicide more often, males or females?
Females
A patient presents with discrete episodes of intense fear and discomfort that peak within 10 minutes, with symptoms of palpitations, sweating, paresthesias, chest pain, chills, and shortness of breath. His symptoms resolve spontaneously after each episode. What disorder might this patient have?
Panic disorder
What therapies are used in treatment of panic disorders?
Cognitive behavioral therapy, selective serotonin reuptake inhibitors, tricyclic antidepressants, benzodiazepines
What mnemonic describes the symptoms a patient may experience during a panic attack?
PANICS: Palpitations, Paresthesias, Abdominal distress, Nausea, Intense fear of dying or losing control, lIghtheadedness, Chest pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of breath
A medical student worries constantly about exams, organizes his study time immediately after the last test, and stays up at night fretting about bills, putting gas in his car before school, and his girlfriend. Does he have panic disorder?
No, more likely he has general anxiety disorder or a personality disorder; a patient with panic disorder must suffer at least four physical symptoms of a panic attack in discreet episodes
Name a treatment option for specific phobias.
Systematic desensitization; repeated exposure to the stimulus until the fear reaction abates
True or False? Individuals with a specific phobia lack insight into their condition.
False; patients typically realize that their fear is excessive
How do pathological specific phobias differ from normal fears?
Pathological specific phobias interfere with normal functioning and are triggered by presence of the stimulus
A person who suffers from a fear of public speaking has what specific phobia?
Social phobia; an excessive fear of embarrassment
What drugs can be used to treat social phobias?
Selective serotonin reuptake inhibitors
Describe the symptoms of obsessive-compulsive disorder.
Recurring and intrusive thoughts causing severe anxiety (obsessions) that are relieved by performance of repetitive actions (compulsions)
Name the common medical therapy used in obsessive-compulsive disorder.
Selective serotonin reuptake inhibitors and clomipramine (a tricyclic antidepressant)
Obsessive-compulsive disorder is considered ego dystonic; define ego dystonic.
Behavior inconsistent with one’s own beliefs and attitudes, distressing to the patient
