Psycho stuff Flashcards
Type of defense? Tantrums
Acting out - Expressing unacceptable feelings and thoughts through actions.
Type of defense? patient impulsively breaks items in the doctor’s office due to the rage at his perceived abandonment
acting out
Type of defense? Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
Dissociation
Type of defense? A common reaction in newly diagnosed AIDS and cancer patients.
Denial - Avoiding the awareness of some painful reality.
Type of defense? resident yells at med student after being embarassed by his attending
Displacement - Transferring avoided ideas and feelings to some neutral person or object (vs. projection).
Type of defense? Mother yells at her child, because her husband yelled at her
Displacement - Transferring avoided ideas and feelings to some neutral person or object (vs. projection).
Type of defense? Men watching sports games for hours on end
Fixation - Partially remaining at a more childish level of development (vs. regression).
Type of defense? Abused child identifies with an abuser.
Identification - modeling behavior after another person who is more powerful (though not necessarily admired).
Type of defense? Describing murder in graphic detail with no emotional response.
Isolation (of affect) - Separating feelings from ideas and events.
Type of defense? A man who wants another woman thinks his wife is cheating on him.
Projection - Attributing an unacceptable internal impulse to an external source (vs. displacement).
Type of defense? After getting fired, claiming that the job was not important anyway.
Rationalization - Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame.
Type of defense? ex heroin user really wants to use heroin, but volunteers with narcotics anonymous
Reaction formation - Replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite (vs. sublimation).
Type of defense? A patient with libidinous thoughts enters a monastery.
Reaction formation - Replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite (vs. sublimation).
Type of defense? bedwetting in a previously toilet-trained child when hospitalized
Turning back the maturational clock and going back to earlier modes of dealing with the world (vs. fixation). Often seen in children under stress such as illness, punishment, or birth of a new sibling, etc
Type of defense? Not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconscious.
Repression - involuntary withholding an idea or feeling from conscious awareness (vs. suppression).
Type of defense? A patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly.
Splitting - believing that people are either all good or all bad at different times due to intolerance of ambiguity. Commonly seen in borderline personality disorder.
Type of defense? Mafia boss makes large donation to charity.
Altruism - Alleviating guilty feelings by unsolicited generosity toward others.
Type of defense? Nervous medical student jokes about the boards.
Humor - Appreciating the amusing nature of an anxiety- provoking or adverse situation.
Type of defense? Teenager’s who wants to kill his father suddenly can’t use his arm anymore
Sublimation - Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system (vs. reaction formation) or one that is socially acceptable
Type of defense? Teenager’s aggression toward his father is redirected to perform well in sports.
Sublimation - Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system (vs. reaction formation) or one that is socially acceptable
Type of defense? Choosing to not worry about the big game until it is time to play.
Suppression - Intentional withholding of an idea or feeling from conscious awareness (vs. repression).
Type of defense? mother says that her son with osteosarcoma is going to be a football player one day
Fantasy - substitution of an imaginary, less disturbing view of the world to avoid awareness of painful feelings (about one’s illness)
transference vs. countertransference
-
transference - unconscious shifting of emotions/desires associated with one person to another
- emotions often originate from feelings expressed toward parental relationships during childhood
- often occurs because the therapist or physician somehow reminds the patient of the person associated with the original emotion; resemblance can be physical, behavioral, or situational
- countertransference - doctors project feelings about formative or other important persons onto patient (doc sees patient as a younger sibling)
ADHD
typical age of onset?
sx?
trmt?
< 12 yo
hyperactivity, impulsiviity, inattention in multiple settings; commonly coexists w/ difficulties in school (associated with decreased frontal lobe volume/metabolism)
methylphenidate, amphetamines, atomoxetine, behavioral interventions
Conduct Disorder
typical age of onset?
sx?
trmt?
< 18 y
(after this age, it is likely to be antisocial personality d/o)
patient has behaviors that violate the basic rights of others (physical threats, destruction of properties, theft)
Tourettes
typical age of onset?
sx?
trmt?
< 18 yo
sudden, non-rhythmic motor + vocal tics that persists >1 year
trmt: antipsychotics, behavioral therapy
Separation anxiety d/o
typical age of onset?
sx?
trmt?
onset 7-9 years
overwhelming fear of separation from home or persons (may lead to factitious physical complaints to avoid going somehwere away from place of comfort)
trmt: SSRI, relaxation techniques
Autism
typical age of onset
sx?
more common in girls or boys?
early childhood
poor social interactions, communication deficits, repetitive/ritualized behaviors, and restricted interests
common in boys
Rett
typical age of onset?
sx?
trmt?
1-4 yo
symptoms of regression: loss of development, loss of verbal abilities, intellectual disabilities, ataxia, hand-wringing
X-linked d/o - seen only in girls
Orientation to person, place, and time - which one is lost first? which one is lost last?
orientation to time is lost first
orientation to person is lost last
what type of psychosis is this?
Perceptions in the absence of external stimuli (e.g., seeing a light that is not actually present).
hallucinations
what type of d/o is this?
woman genuinely believes she is married to a celebrity when, in fact, she is not
delusional d/o
when it occurs for >1 month
what type of psychosis is this?
Unique, false beliefs about oneself or others that persist despite the facts (e.g., thinking aliens are communicating with you).
when does it become a disorder?
delusions
when it occurs for >1 month
What type of hallucination is this?
HypnaGOgic
HypnoPOMPic
HypnaGOgic = Occurs while GOing to sleep.
HypnoPOMPic = Occurs while waking from sleep (“POMPous upon awakening”).
differentiate between
Brief psychotic disorder
Schizophreniform disorder
Schizophrenia
Schizoaffective disorder
Schizophrenia - periods of psychosis, disturbed behavior and thought, and decline in functioning
- Brief psychotic disorder: <1 month
- Schizophreniform disorder: 1-6 months
-
Schizophrenia:
>6 months
** **
Schizoaffective disorder: > 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episode. 2 subtypes: bipolar or depressive
∆ btwn + and - sx of schizophrenia?
(+) = delusions, hallucinations, disorganized speech, behavior
(-) = flat affect, social withdrawal, ø motivation, lack of speech/thought
what are schizophrenics at increased risk of?
suicide
∆ btwn
dissociative d/o
derpersonalization d/o
derealization d/o
dissociative d/o = multiple personalities; think TAMU
derpersonalization d/o = feelings of detachment or estrangement from one’s body, thought,s perceptions, and actions
derealization d/o = feelings of detachment or estrangement from one’s environment
∆ btwn
manic episode
hypomanic
manic episode = sx that last >1 week
- Distractability
- Irresponsibility (no regard to consequences)
- Grandiosity (inflated self-esteem)
- Flight of ideas
- Activity/Agitation (increase)
- Sleep (decreased)
- Talkative/pressured speech
hypomanic = sx that last at least 4 days
- sx are like manic episode, but not severe enough to cause marked impairment in social/occupational functioning; ie no need to hospitalize
∆ btwn
Bipolar I d/o
Bipolar II d/o
Cyclothymic d/o
- Bipolar I d/o - 1 manic episode (w/ or w/o a hypomanic or depressive episode)
- Bipolar II d/o - hypomanic + depressive episode, with return to normal mood and functioning in btwn episodes (have not experienced a full manic episode); use of antidepressants can precipitate mania
- Cyclothymic d/o - dysthymia + hypomania; milder form of bipolar; lasts at least 2 years
how does sleep change in a person with MDD?
decrease slow-wave sleep (delta) - ie less deep sleep
decrease REM latency (ie increase REM early in sleep cycle)
increase total REM sleep
repeated nighttime awakenings
early-morning awakenings
ECT
does it hurt?
is the memory loss permanent?
produces a painless seizure
amnesia (ante/retro) occurs, but usually resolves within 6 months
∆ btwn
major depressive d/o
dysthymia
atypical depression
major depressive d/o - major depressive episodes that last 6-12 mo, with at least 5/9 of SIG E CAPS criteria that last for >2 weeks, ∆ sleep patterns
**dysthymia - **milder form of SIG E CAPS, but last >2 years
atypical depression
- mood reactivity (mood briefly improves in response to positive events)
- vegetative state (hypersomnia, weight gain)
- leaden paralysis (heavy feeling in arms/legs)
- increased sensitivity to interpersonal rejection
how is panic d/o diagnosed?
panic attack followed by _>_1 month of _>_1 of the following:
persistent concern of future attacks
worrying about consequences of attack
behavioral ∆s related to attacks
what type of phobia is this?
exaggerated fear of embarrassment in social situations
(e.g., public speaking, using public restrooms).
Social anxiety disorder
trmt: SSRI
What type of phobia is this?
exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone
Agoraphobia
what kind of anxiety d/o is this?
uncontrolled anxiety; associated with sleep ∆, fatigue, GI ∆, difficulty concentrating
**generalized anxiety d/o = >6 mo **
what kind of anxiety d/o is this?
emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, illness)
adjustment d/o
lasting < 6 months
(> 6 months in presence of chronic stressor).
what kind of d/o is this?
Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions; patient knows that something is wrong
Obsessive-compulsive disorder - Ego dystonic
Associated with Tourette disorder.
Treatment: SSRIs, clomipramine.
What kind of anxiety d/o is this?
Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions; patient thinks its perfectly fine
obsessive-compulsive personality disorder - egosyntonic
what kind of anxiety d/o is this
preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning; patients often repeatedly seek cosmetic surgery
body dysmorphic d/o
∆ btwn
Post-traumatic stress d/o
Acute stress d/o
Persistent reexperiencing of a previous traumatic event; may involve nightmares or flashbacks, intense fear, helplessness, or horror. Leads to avoidance of stimuli associated with the trauma and persistently increased arousal. Causes auses significant distress, negative cognitive alterations, and/or impaired functioning.
Post-traumatic stress d/o = >1 month
Acute stress d/o = 3 days = 1 month
∆ btwn factitious d/o and malingering d/o?
both are conscious attempts to create symptoms
factitious d/o = 1˚ gain = get medical attention for self
malingering d/o = 2˚ gain = get $$, Rx, avoid work; complaints cease after gain
type of d/o
Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to avoid work, obtain compensation; complaints cease after gain
malingering
type of d/o
Patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention
Factitious disorders
type of factitious d/o
history of multiple hospital admissions and willingness to receive invasive procedures
Munchausen syndrome
type of factitious d/o
When illness in a child or elderly patient is caused by the caregiver
Munchausen syndrome by proxy
conscious or unconscious?
factitious d/o
malingering d/o
somatoform d/o
factitious d/o + malingering d/o = CONSCIOUS
somatoform d/o = UNCONSCIOUS
type of somatic d/o?
Variety of complaints in one or more organ systems lasting for months to years. Associated with excessive, persistent thoughts and anxiety about symptoms.
Somatic symptom disorder
type of somatic d/o
Sudden loss of sensory or motor function (e.g., paralysis, blindness, mutism), often following an acute stressor;
conversion d/o
type of somatic d/o
Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance.
hypochondriasis
∆ btwn personality trat vs disorder?
trait = repetiive pattern of perceiving, relating, and thinking about the environment and onself
disorder = Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/ or impaired functioning; person is usually not aware of problem
what kind of personality d/o is this?
Pervasive distrust and suspiciousness; projection is the major defense mechanism.
paranoid, cluster A
what kind of personality d/o is this?
Voluntary social withdrawal, limited emotional expression, content with social isolation (vs. avoidant).
Schizoid, Cluster A
what kind of personality d/o is this?
Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness.
Schizotypal, Cluster A
what kind of personality d/o is this?
Disregard for and violation of rights of others, criminality, impulsivity
Antisocial d/o, Cluster B
M>F; must be > 18 years old and have history of conduct disorder before age 15
(Conduct disorder if < 18 years old)
what kind of personality d/o is this?
Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, boredom, sense of emptiness
Borderline, Cluster B
females > males
splitting is a major defense mechanism
what kind of personality d/o is this?
Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance.
Histronic, Cluster B
what kind of personality d/o is this?
Grandiosity, sense of entitlement; lacks empathy and requires excessive admiration; often demands the “best” and reacts to criticism with rage.
Narcissistic, Cluster B
what kind of personality d/o is this?
Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others
Avoidant, Cluster C
what kind of personality d/o is this?
Preoccupation with order, perfectionism, and control; person thinks behavior consistent with one’s own beliefs and attitudes (vs. OCD).
Obsessive compulsive personality disorder - egosyntonic
what kind of personality d/o is this?
Submissive and clinging, excessive need to be taken care of, low self-confidence.
Dependent, Cluster C
2 major ∆s btwn anorexia and bulimia nervosa
anorexia nervosa: BMI <17, amenorrhea
bulimia nervosa: BMI normal; irregular menses
children often wake up screaming in the middle of the night in terror.
what part of sleep does this occur?
how does this compare to nightmares?
slow-wave sleep (delta waves); ie it occurs during non-REM -> children will have no memory of arousal
nightmares occur during REM sleep -> children will remember the scary dream
narcolepsy
pathophysiology?
what part of sleep does it occur?
what is it associated with? 2
trmt?
decreased orexin aka hypocretin
starts off with REM sleep!!
hypnagogic (going to sleep) or hypnopompic (post sleep) hallucinations
cataplexy (loss of all muscle tone)
daytime stimulants: amphetamines
nighttime: sodium oxybate (GHB)
(produced in the lateral hypothalamus)
Type of defense?
adult who was sexually abused as a child and has no awareness of this until he sees a movie involving sexual abuse
repression
type of defense?
combat veterans describes friends dying in cold and distant tones
isolation (of affect)
type of defense?
war profiteer giving money to numerous charities
altruism
type of defense?
joking about the boards prior to the exam
deciding not to think about the results until the scores are released
humor
suppression
type of defense?
surgeon who avoids his feelings of failure after a patient dies by thinking about every step of the surgery in meticulous detail
intellectualization
type of defense?
worker accusing his boss of having sexual desires for him when in doubt the worker has desires for his boss
projection
type of defense?
a patient w/ sexually explicit thoughts become a sex therapist
sublimation
patient presents w/ a fixed, dilated pupil
consider uncle herniation - leads to compression of ispilateral CN 3 and posterior cerebral artery
nasal ulceration, sinusitis, and hemoptysis w/ rapidly progressing glomerulonephritis
Wegener’s polyangiitis
c-ANCA - neutrophil proteinase 3
