Psychiatry: UWorld Flashcards
Physical signs of PCP intoxication
-nystagmus -hypertension -tachycardia -ataxia -dysarthria -m. rigidity
Physical signs of LSD intoxication
-sweating -tachycardia -pupillary dilatation -palpitations -tremors -poor coordination
Cocaine intoxication
-anxiety, aggression, agitation -psychosis or delirium -feeling of bugs crawling on skin -high or low BP -tachycardia or bradycardia -sweating -pupil dilation -N/V -insomnia -OD ==> cardiac arrhythmias, MI, seizures stroke
Reaction formation
defense mechanism in which person does the opposite of an expressed thought or emotion
Conversion d/o dx
-sx of altered neurologic fxn (motor or sensory) -precipitated by psych stressor -not feigned or intentionally produced -no medical/organic cause -sx cause significant social or occupational
Dissociative identity vs. Dissociative amnesia vs. Dissociative fugue
-DID = multiple distinct identities -DA = memory disturbance usually w/traumatic event -DF = memory disturbance w/travel away from home
Model of psychosis
-mesolimbic pathway = (excess) dopamine ==> psychotic sx -mesocortical = (less) dopamine ==> negative sx -tuberoinfundibular = prolactin control -nigrostriatial = voluntary movement ==> SEs of anti-psychotic meds (tardive dyskinesia, EPS, akithisia)
MDD dx criteria
- >2 weks - at least 5/9 criteria (SIGECAPS) - significant impairment
GAD criteria
-excessive worry/anxiety about multiple event + -6 months of 3+ sx: -impaired sleep -poor concentration -easy fatigability -irritability -m. tension -restlessness
Typical patient/focus for interpersonal psychotherapy
-relationship conflicts -life role transitions -grief -focus: current relationships/conflicts
Typical patient/focus for supportive psychotherapy
-pt: lower fxning, in crisis, psychotic, cognitively impaire -focus: coping skills, foster understanding, build adaptive defense mechanisms
Typical patient/focus for psychodynamic psychotherapy
-pt: higher functioning, persistent patterns of dysfunction, more neurotic -focus: unconscious conflicts, past relationships/conflicts, break down defense mechanisms
Typical patient/focus for CBT
-pt: persistent maladaptive thoughts, avoidance -focus: identify and challenge maladaptive thoughts, behavioral techniques (breathing, goal setting)
Typical patient/focus for dialectical behavioral therapy
-pt: borderline personality d/o, self injury -focus: acceptance & change, improve emotion regulation, manage self harm
Typical patient/focus for biofeedback
-pt: prominent physical responses accompany psych sx -focus: improve awareness/control over physiologic rxns, lower stress, integrate mind/body
Avg. risk of bipolar and impact of family history
-avg = 1% -1st degree relative = 5-10%
Rationalization vs. Intellectualization
-rationalization = justify behavior to avoid difficult truth/protect self esteem -intellectualization = using intellect to avoid uncomfortable feelings
Tx for co-morbid depression with chronic/serious illness
-SSRIs
Depression vs. Adjustment d/o
-Depression criteria=5/9 SIGECAPS; must have anhedonia or low mood; may occur in response to stressors; >2wks; social or occupational dysfunction -Adjustment d/o = w/in 3 mo. of stressor, lasts no more than 6 mo. after stressor ends, does not meet full criteria for depression
Circumstantiality = Tangential = Loose associations =
**characteristics of disorganized thinking -circumstantial = very detailed answers that deviate from topic but eventually return to topic/question -tangential = abrupt deviations that is minimally relevant w/out return to original subject -loose associations = little logical connection/association between phrases/thoughts
Manic vs. Hypomanic episode
-Bipolar = elevated/irritable mood, increased energy, + 3-4 or DIGFAST -Manic = severe sx, 1 week+, marked impairment, +/- psychosis -hypomanic = less severe sx, >=4 days, no hospitalization, no psychosis
Delirium vs. Psychosis
-Delirium = fluctuating consciousness w/abnormal cognitive exam -Psychosis = hallucinations/delusions w/normal cognitive exam
Common cause of medication-induced psychosis
-glucocorticoids: particularly @ high doses or in elderly pts.
Tx of adjustment d/o
- psychotherapy 2. SSRIs if needed as adjunct
