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Clinical Medicine > Psychology > Flashcards

Psychology Flashcards

1
Q

2 different types of stressors in Adjustment disorder

A
  1. Lingering

2. Unexpectant

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2
Q

To dx adjustment disorder:

A

History of stressor

Diagnosis of exclusion

Degree of emotional reactions is disproportionate to stressor

Marked impairment of occupational, academic, interpersonal function

Symptoms are not part of normal bereavement

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3
Q

Treatment of Adjustment d/o

A

Psychotherapy is first choice (individual, family, behavioral)

–> SSRI if pt cant undergo psychotherapy or symptoms are unmanagable

–> BDZ if anxiety is overwhelming, poor sleep…temporary

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4
Q

3 types of depressive symptoms (3 classifications)

A
  1. Neurovegetative/Somatic
    - ->wt loss/gain, anorexia/hyperphagia, insomnia/hypersomnolence, psychomotor retardation/agitation, low energy/fatigue, low concentration, tearfullness
  2. Emotional
    - -> anxiety, tearfulness, apathy, low sex drive, emotional flatness, irritability
  3. Ideation
    - -> worthlessness, helplessness, guilt, aggression, suicidally, homicidality
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5
Q

What is the most unrecognized and undertreated condition worldwide?

A

Major Depressive Disorder

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6
Q

Diagnosing Depression…criteria

A

1 or more major depressive episode lasting at least 2 weeks: Either depressed mood or loss of interest + at least 4 additional symptoms

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7
Q

PHQ-9 (what classifies mild, moderate, and severe, when to admit?)

A

Mild: 5-9
Moderate: 10-14
Severe: 15-19
Admit: > 20

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8
Q

SIG E CAPS

A
  • Sleep
  • Interest
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor
  • Suicide
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9
Q

Pathophysiology of Depression

A

Neurotransmitter imbalance
–NE, Serotonin, Dopamine

Excess Cortisol (its a stress hormone)

Psychosocial: past traumatic episodes, lack of social support, h/o child abuse/neglect/physical/emotional abuse

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10
Q

DDX (medical conditions and psych conditions)

A

Medical: Pancreatic CA, Bronchogenic CA, Hypothyroidism, Cushing’s Syndrome, CVA (L>R)

Psych: SAD, Schizophrenia, Dysthymia, Cyclothymia, BP, Grief

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11
Q

Tx choices for MDD are based on what 3 things?

A
  1. Depression subtype
  2. Prior treatment hx and side effects
  3. Family hx
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12
Q

1st line tx for MDD

A

SSRI + psychotherapy

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13
Q

A pt has MDD and is mainly apathetic, has low motivation, and anhedonia. What is an appropriate Rx choice

A

Dopa, NE reuptake inhibitors

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14
Q

Older age ______ remission intervals

A

shortens

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15
Q

Major life stressors in order of severity

A
  1. Death of spouse
  2. Divorce
  3. Marital Separation
  4. Incarceration
  5. Injury/Illness
  6. Marriage
  7. Dismissal from work/eviction
  8. Marital reconciliation
  9. Retirement
  10. Change in health of family member
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16
Q

Psychological d/o that has the highest suicide rate in men? In women?

A 
Men = Bipolar depression
Women = Schizophrenia
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17
Q

Dysthymia criteria

A

At least 2 years of depressed mood for more days than not. (no more than 2 mos of remission)

Less severe symptoms, not dysfunctional

No suicidality

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18
Q

Tx for dysthymia

A

Psychotherapy

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19
Q

Differences between bipolar depression type I, type II, and cyclothymic disorder

A

BPD I: Can exist w/ or w/o MDD. More severe mania

BPD II: Characterized by hypomanic, must have at least one MDD

Cyclothymic: hypomania and less severe depression

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20
Q

Hypomania:

A
  1. Does not affect functionality
  2. Does not present w/ psychosis
  3. No need for hospitalization
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21
Q

Women or men affected more in BPD? Higher SES or lower SES?

A

Women

Higher SES

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22
Q

Pathophysiology of BPD

A

Up regulation of monoamine neurotransmission and receptor function

Changes in limbic system/prefrontal cortex

Major life stressors can trigger

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23
Q

Tx of BPD I

A

Lithium is gold standard
–>Other mood stabilizers include VPA, lamotrigine/lamictal

Can give antipsychotics especially w/ mania w/ psychosis

  • ->Acts faster than mood stabilizers
  • ->Zyprexa (Olanzapine)
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24
Q

What Rx should not be given in BPD I (but can be considered for BPD II and Cyclothymia)

A

Antidepressants

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25
Q

Is rapid cycling more common in BPD I or BPD II?

A

BPD II

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26
Q

Criteria for Cyclothymia

A

At least 2 years of numerous periods of hypomanic symptoms that do not meet criteria for a manic episode and numerous periods of depressive symptoms that do not meet criteria for a major depressive episode

Milder form of BPD II

Cycling more frequent than type I or II

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27
Q

Tx for Cyclothymia

A

Lithium + psychotherapy

–> Antidepressants can shift to hypomania but can be used unlike in BP I

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28
Q

All personality disorders generally have these 3 things

A
  1. ) Maladaptive thoughts (misinterpretations)
  2. ) Distorted worldview (intra or interpersonal)
  3. ) Atypical behavior/lifestyle
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29
Q

When do personality disorders usually start to appear?

A

Adolescent or early adulthood

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30
Q

Personality disorders more common in males

A 
Anti-social
Paranoid
Schizoid and Schizotypal
Narcissistic
Obessive Compulsive
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31
Q

Personality disorders more common in females

A

Borderline
Histrionic
Dependent

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32
Q

Personality Disorder Clusters:
A-
B-
C-

A

A- odd or eccentric behavior, cognitive distortions
–> Paranoid, Schizoid, Schizotypal

B- Overly emotional, dramatic, unpredictable
–> Antisocial, Borderline, Histrionic, Narcissistic

C- Anxious or fearful behavior, avoids confrontation, withdrawn
–> Avoidant, Dependent, Obsessive Compulsive

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33
Q

Cluster A personality disorder tx

A

Psychotherapy (individual or group)

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34
Q

Cluster B personality disorder tx

A

Psychotherapy

Borderline type = lithium, CBZ, VPA, atypicals, SSRIs + psychotherapy

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35
Q

Avoidant Personality D/O tx

A

Psychopharm (SSRI, MAOI, buspirone, BBs) and psychotherapy

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36
Q

Dependent personality type tx

A

SSRI, TCA short term and psychotherapy

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37
Q

OCD tx

A

Psychotherapy is the most effective

SSRI may help to dec. perfectionism and ritualizing

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38
Q

Suggestive symptoms of somatic symptom disorder

A
  1. Pain that is excessive or chronic (unchanging)
  2. Conversion symptoms (abdominal MC)
  3. Chronic, multiple symptoms that lack an explanation
  4. Complaints that don’t improve
  5. Excessive concern w/ health or body appearance
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39
Q

Duration of symptoms needed in order to classify Somatic Symptom Disorder

A

6 months

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40
Q

How many symptoms does one w/ SSD usually present with?

A

At least 8

  • -> at least 4 are from pain
  • -> 2 from GI
  • -> 1 Sexual/reproductive
  • -> 1 Pseudonuerological
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41
Q

Most common pain complaints in SSD

A

Lower back
Head
Pelvis
Temporomandibular joint

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42
Q

Duration needed to classify someone as Illness anxiety disorder

A

6 months

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43
Q

Mental disorders can affect other medical conditions. How would you classify this? (mild, moderate, severe, extreme)

A 
Mild = factor increases medical risk
Moderate = factor worsens medical condition
Severe = It causes an ER visit/hospitalization
Extreme = Results in severe, life-endangering risk
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44
Q

What is the main difference between factitious disorder and the other somatic symptom disorders?

A

Patient’t know their pain is fake

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45
Q

How many symptoms are needed to dx a child w/ conduct disorder?

A

3/15

4 categories:

  1. Aggression
  2. Destruction
  3. Lying and theft
  4. Rule violation
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46
Q

Two types of Conduct Disorder w/ limited prosocial emotions

A
  1. Anger and Hostility

2. Lack of empathy and guilt

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47
Q

When can you start seeing oppositional defiant disorder? conduct disorder?

A

ODD as young as age 3 or 4…usually dx’d a few yrs later

CD as young as 2 yo

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48
Q

Duration of oppositional defiant disorder

A

At least 6 months…if younger than 5 symptoms are daily, if older than they occur at least once a week

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49
Q

Mild ODD
Moderate ODD
Severe ODD

A 
Mild = symptoms occur in only 1 location
Moderate = symptoms occur in 2 locations
Severe = symptoms occur in 3+ locations
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50
Q

1st line tx for conduct disorder. 2nd line?

A

Stimulants

2nd line = anticonvulsants (for nonspecific aggression)

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51
Q

Dx Schizophrenia criteria

A

Continuous disturbances persisting for at least 6 months with at least 1 month of active phase symptoms which need to be at least 2 of the following:

  • -Delusions
  • -Hallucinations
  • -Disorganized speech
  • -Catatonic Behavior
  • -Negative Symptoms
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52
Q

What is the most common schizophrenia subtype?

A

Paranoid

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53
Q

What are the different subtypes of schizophrenia (even though DSM-V got rid of them)

A
  1. Paranoid
  2. Disorganized
  3. Catatonic
  4. Undifferentiated
  5. Residual
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54
Q

Etiology of Schizophrenia

A

No one cause!

  • -Genetics
  • -Advanced paternal age
  • -Viral infection of mother (1st or 2nd trimester)
  • -Toxoplasmosis in utero
  • -Infant starvation or maternal deprivation
  • -Toxic exposure
  • -Anorexia
  • -Birth trauma
  • -Smaller brains
  • -Psychoactive drugs
  • -DOB in late winter/early spring
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55
Q

What are the 4 A’s in Schizophrenia presentation?

A

Autism
Ambivalence
Affectivity
Association

56
Q

Positive vs. Negative symptoms in schizophrenia: Region in the brain, what are the symptoms, and how are they managed?

A 
Positive = increased D2 in mesolimbic
Negative = decreased D2 in mesocortical; can see brain abnormalities on CT (enlarged lateral/3rd ventricle, reduced volume in amygdala, basal ganglia, cerebellum, prefrontal cortex and reduced symmetry of frontal, temporal, and occipital parts of brain)

Positive s/s: Hallucinations, delusions, disorganized thought, cognitive impairment

Negative s/s: Social withdrawal, flat/blunted affect, poverty of speech, avolition

Positive symptoms respond best to neuroleptics, negative symptoms have a poor prognosis

57
Q

Which subtype of schizophrenia has the best prognosis?

A

Paranoid

58
Q

How does schizophreniform differ from schizophrenia?

A

In duration: lasts 1-6 mos and is usually carries a better prognosis

59
Q

How does schizoaffective disorder differ from schizophrenia?

A

Mood disorder develops alongside schizophrenia (major depression and/or mania)

60
Q

Distinguish brief psychotic d/o from schizophrenia.

A

Brief psychotic d/o lasts 1 mo or less w/ better prognosis and clearly identifiable stressor

61
Q

3 phases of schizophrenia treatment

A
  1. ) Acute phase = hospitalization and reduction of harmful sx (haldolol and benzo to stabilize PRN)
  2. Behavior Stabilization = Get pt back to community
  3. Stable phase = Minimize relapse and monitor drug adherence, SE, DI
62
Q

What is the 1st line pharmacological tx of schizophrenia?

A

Atypical Antipsychotics
–Risperdal, Zyprexa, Seroquel, Clozapine, Ziprasidone

**Can give benzo temporarily as “bridging” if needed

**Psychotherapy is useful in higher functioning pts (CBT)

63
Q

What co-morbidity is most commonly associated w/ schizophrenia?

A

Substance use

  • -50% ETOH
  • -75% smoke tobacco
64
Q

Besides substance use, what other co-morbidities are associated w/ schizophrenia?

A

Social anxiety
PTSD
OCD
Depression –> 10-15% commit suicide (paranoid has highest risk)

65
Q

Neuropsychopathology of Psychosis: What areas are affected? (4)

A
  1. ) Mesolimbic –> positive sx
  2. ) Mesocortical –> negative sx
  3. ) Glutamate (NMDA) is dysregulated resulting in negative, positive, and cognitive sx
  4. ) Gama-Aminobutyric Acid (GABA) is decreased
66
Q

_____ is the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli assoc. w/ the trauma

A

PTSD

67
Q

Are women or men more affected by PTSD?

A

Women

68
Q

How long must symptoms persist to dx someone w/ PTSD?

A

1 month w/ significant clinical, occupational, personal disruption

69
Q

Acute PTSD, Chronic PTSD, Delayed onset PTSD

A

Acute PTSD: < 3 mos
Chronic PTSD: > 3 mos
Delayed onset: > 6 mos from stressor

70
Q

Differentiate PTSD and Acute Reaction to Stress

A

PTSD > 1 month

ARS < 1 month and has full recovery

71
Q

PTSD and ARS are associated w/ ________.

A

Dissociative Disorder

72
Q

3 co-morbid conditions associated w/ PTSD

A

Major Depression
Panic Disorder
Substance Abuse

73
Q

4 types of Dissociation Disorder that can be associated w/ PTSD

A
  1. ) Dissociative Amnesia - pt can’t recall traumatic event
  2. ) Dissociative fugue - pt assumes new identity w/ impulsive relocation away from home…no memory of prior identity
  3. ) Dissociative Identity Disorder - multiple personality d/o…associated w/ severe childhood abuse
  4. ) Depersonalization Disorder - detachment from oneself (dreamlike) and sense of strangeness of external world (derealization)
74
Q

First line tx for PTSD

A

Psychotherapy and Exposure therapy

75
Q

A person dx’d w/ PTSD is undergoing psychotherapy and exposure therapy but seems to still have high levels of anxiety. What pharmacotherapy could you use to solve this?

A

SSRI (Zoloft)

76
Q

A person dx’d w/ PTSD is undergoing psychotherapy and exposure therapy but still seems to be suffering from nightmares. What pharmacotherapy could you use to solve this?

A

Prazosin

77
Q

Do benzos or debriefing help w/ PTSD?

A

NO!

78
Q

What is the most common psychiatric disorder in the general population? What is the percentage?

A

Anxiety D/O…15%

79
Q

Does panic disorder have a trigger/stimulus associated with it?

A

NO

80
Q

What is the criteria for diagnosing one w/ panic disorder

A

More than 1 unexpected full symptom attack and at least one of those attacks is accompanied by >1 month of persistent concern or worry about consecutive panic attacks or their consequences

These “full symptom” attacks require at least 4 of the following:

  • -Palpations
  • -Sweating
  • -Trembling
  • -SOB
  • -CP
  • -Choking
  • -N/V
  • -Dizziness
  • -Chills/Heat
  • -Paresthesia
  • -Derealization
  • -Depersonalization
  • -Fear of loosing control/dying
81
Q

Age of onset of panic disorders and are they more frequent in females or males?

A

Median 20-24 yo and more common in females.

82
Q

Tx of choice for panic disorder

A

Psychotherapy…CBT or Exposure tx

If functionally impaired can give SSRI 1st line…BZD are used but cautiously in pts w/ hx of ETOH/Drug abuse

83
Q

Criteria for panic disorder w/ agoraphobia

A

Same criteria as panic disorder but agoraphobia must have a fear or avoidance of places/situations from which escape might be difficult…these people are usually housebound and need accompaniment

84
Q

Most common phobia

A

Insects

85
Q

How long must one have a fear (phobia) to be diagnosed

A

6+ months

86
Q

1st line tx for phobias

A

Behavior/CBT therapy

87
Q

Difference between social anxiety disorder and avoidant personality disorder

A

Same s/s but they are worse in avoidant personality disorder.

  • *Both start in early adulthood
  • *Avoidant will have greater isolation and dysfunction in everyday life
  • *Tx is the same…behavioral therapy/CBT + possible pharm tx to control symptoms (Benzo, BB, SSRI)
88
Q

Criteria for generalized anxiety disorder

A

6+ months (more days than not) of excessive anxiety/worry associated w/ 3+ of the following symptoms:

  • -Restlessness/On edge
  • -Easily fatigued
  • -Difficulty concentrating
  • -Irritable
  • -Muscle tension
  • -Sleep disturbance

Anxiety regards multiple events or activities and cause clinically significant distress in different areas of functioning

89
Q

GAD epidemiology: When does it begin and peak? Males or females more common? Co-morbidities?

A

Begins in early adulthood, peaks in middle age and then declines later in life

Females more common

High rate of co-morbidity w/ MDD

90
Q

Tx for GAD

A

Chronic tx is needed (symptoms return if stopped)

Buspirone w/ Benzo to bridge since buspirone takes about 3 weeks to work.
–> Don’t use benzo if hx of drug or ETOH use d/t its abuse potential

91
Q

_____ is done in response to obsession.

A

Compulsion

92
Q

Fears/phobias compared to OCD

A

Fears or phobias are less complex than those of OCDs

..OCD Fears= unwanted violent images, fear of contamination, making mistakes, etc.

93
Q

Males and Females present w/ OCD at different times in life. Explain when.

A

Males = childhood, early adulthood

Females = adulthood

94
Q

Which type of OCD is the most common?

A

Checking and decontamination rituals (50-60%)

  • ->Males are more likely to make sure everything is symmetrical/in its place
  • -> females more likely to have cleanliness rituals
95
Q

What is the criteria for dx OCD

A

Obsession or compulsion or both must be present

Time consuming… > 1 hr/day or causing significant distress

96
Q

Co-morbidities of OCD

A 
Anxiety disorder (76%)
Depression/BP (63%)
Tic disorder (30%)
97
Q

What scale is used to determine severity of OCD?

A

Yale-Brown Obsessive Compulsive Scale

98
Q

Best tx for OCD pts

A

Behavioral therapy + pharmacologic rx (SSRIs and clomipramine preferable)

99
Q

Difference between substance abuse and substance dependence

A

Substance abuse is the use of any drug outside of social precepts

Substance dependence is the repeated use of a drug w/ or w/o physical dependence

100
Q

Are physical dependence and addition the same thing?

A

NO!

Many pts are physically dependent but are not addicts or drug seeking…many have true pain and can be tapered off pain meds

101
Q

____% of population uses illicit substances and ____% have tried illicit substance in lifetime. ___% above age 12 use ETOH and the age range for binge drinking is _____.

A

6% population uses illicit substances
40% have tried it in lifetime
51% >12yo use ETOH
Binge drinking occurs mostly btw 18-25yo

102
Q

Most commonly abused illegal drugs in order

A
  1. Marihuana
  2. Amphetamines
  3. Cocaine
  4. Opiates
103
Q

3 addicting agent characteristics to consider

A
  1. Degree of Euphoria
  2. Reinforcement of agent
  3. Rapidity of onset
104
Q

What is the reward center of the brain and what is release (a neurotransmitter) that is addictive/reinforcing

A

Nucleus Accumbens = reward system

Dopamine

105
Q

2 host variables for addiction

A
  1. Genetics

2. Underlying psych d/o

106
Q

Symptoms substances produce:
–Depression/anxiety, fear of intimacy and inhibitions =

–Low self-esteem =

–Uncontrolled anger =

A

Alcohol

Cocaine

Heroin and Opiates

107
Q

Most common way to drug screen

A

Urine

**Does not measure impairment

108
Q

Chronic alcoholics consume ______ of hard liquor

A

> 1 liter/day

109
Q

CAGE Questions

A

Cut down
Annoyed
Guilty
Eye-opener

+1 suggests an alcohol problem, 2+ indicates a problem

110
Q

What is the CIWA and when is it used?

A

Clinical Institute Withdrawal Assessment

Used on any pt admitted to hospital w/ potential for symptoms of alcohol withdrawal

111
Q

What do the scores mean on CIWA?

A

15: severe withdrawal

112
Q

CIWA categories

A 
Agitation (0-7)
Anxiety (0-7)
Auditory Disturbances (0-7)
Clouding of Sensorium (0-4)
Headache (0-7)
N/V (0-7)
Paroxysmal Sweats (0-7)
Tactile Disturbances (0-7)
Tremor (0-7)
Visual Disturbances (0-7)
113
Q

You work in an alcohol detox center. When should you call a physician (HR, BP)

A

HR > 110 bpm
SBP > 180
DBP > 120

114
Q

What is always given to pts who come in w/ alcohol intox?

A

Thiamine 100mg IM immediately and then 100mg BID for 3 days post

115
Q

How often should CIWA be performed? Vital signs?

A

CIWA q 8 hrs for 24 hrs and vitals q4 hrs = < 8 on initial CIWA score

116
Q

In the tx of alcohol what do the following pharm tx’s do:

  • -Disulfiram
  • -Naltrexone
  • -Acamprosate
A

Disulfiram: used to temproarily help establish sobriety

Naltrexone: blocks endogenous opioid release decreasing ETOH craving

Acamprosate: For abstinent pts only

117
Q

A person comes into the ER w/ hallucinations, HTN, tachycardia, nystagmus and numbness and is very agitated. Tx?

A

Seclude them in a quiet area and restrain if necessary. Since agitated w/ psychosis give Haldol.

This is PCP tx

118
Q

What is heroin prevalence? Does it occur more often in women or men? What ages?

A

2% use in USA
Men > Women
Ages 30-40

119
Q

Heroine combined w/ cocaine IV is _____

A

Speedball

120
Q

Life threatening effects of opioids

A
  • -Respiratory Depression
  • -Decreased mental status
  • -Decreased tidal wave
  • -Hypoglycemia
  • -Pupillary miosis (constriction)
121
Q

Tx for opioid overdose

A

IV Naloxone (Narcan)

Hydration

ICU admission of vital support

122
Q

Medical sequelae of cocaine use

A 
CVA
MI
Seizures
Cardiac arrhythmias
Pupillary dilation (mydriasis)
Cardiomyopathies
Sudden cardiac death
123
Q

What does cocaine withdrawal look like?

A

Intense cravings are most prominent sign

Fatigue, guilt, anxiety, feeling helpless, hopeless, worthless, suicidal

124
Q

Tx for cocaine withdrawal

A

Lorazepam (Ativan) if harmful to self/others

Haldol if psychosis involved

125
Q

What is the antidote to treating depressant overdose (diazepam or alprazolam)

A

Flumazenil

126
Q

Tx for overdose on Ketamine

A

ABCs

Supportive care…IV hydration

127
Q

Types of amphetamines

A

Amphetamine, dextroamphetamine
Meth-amphetamine
MDMA (ecstasy)
Bath Salts

128
Q

Are the pupils constricted or dilated when intoxicated on amphetamines?

A

Dilated

129
Q

Tx for acute intox of amphetamines and maintenace tx

A

Acute: Short acting benzo’s for agitation

Maintenance:
Antidepressants and drug counseling

130
Q

TWEAK Questions

Who is it recommended for?

A

Recommended for white females

Score of 3 or higher indicates alcohol problem

Tolerance (2 points) - 6 or more indicates tolerance
Worried (2 points)
Eye openers (1 point)
Amnesia (1 point)
K-Cut down (1 point)
131
Q

Most common age of onset in anorexia nervosa

A

14-18 yo (rare before puberty or after 40yo)

132
Q

4 different etiologies that combine to cause anorexia nervosa

A
  1. Biological
  2. Cultural
  3. Genetic
  4. Psychological
133
Q

Biggest co-morbidity associated w/ anorexia nervosa?

A

Anxiety (60-65%)

Mood disorders, substance abuse, and personality disorders are other co-morbidities

134
Q

Medical illnesses that can present like anorexia nervosa

A 
Hyperthyroidism
IBD
Malignancies
AIDS
Tuberculosis
135
Q

Anorexia Nervosa weekly weight gain goals in hospital setting and out-patient setting

A

2-3 lbs/wk for hospitalized pts

0.5-1 lbs/wk for outpatient programs

136
Q

What function must come back to consider anorexics at “target weight”

A

Females - when normal menstruation returns

Males - when testicular function returns

Clinical Medicine (4 decks)

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