Psychology Flashcards
1
Q
2 different types of stressors in Adjustment disorder
A
- Lingering
2. Unexpectant
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
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
4
Q
3 types of depressive symptoms (3 classifications)
A
- Neurovegetative/Somatic
- ->wt loss/gain, anorexia/hyperphagia, insomnia/hypersomnolence, psychomotor retardation/agitation, low energy/fatigue, low concentration, tearfullness - Emotional
- -> anxiety, tearfulness, apathy, low sex drive, emotional flatness, irritability - Ideation
- -> worthlessness, helplessness, guilt, aggression, suicidally, homicidality
5
Q
What is the most unrecognized and undertreated condition worldwide?
A
Major Depressive Disorder
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
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
8
Q
SIG E CAPS
A
- Sleep
- Interest
- Guilt
- Energy
- Concentration
- Appetite
- Psychomotor
- Suicide
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
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
11
Q
Tx choices for MDD are based on what 3 things?
A
- Depression subtype
- Prior treatment hx and side effects
- Family hx
12
Q
1st line tx for MDD
A
SSRI + psychotherapy
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
14
Q
Older age ______ remission intervals
A
shortens
15
Q
Major life stressors in order of severity
A
- Death of spouse
- Divorce
- Marital Separation
- Incarceration
- Injury/Illness
- Marriage
- Dismissal from work/eviction
- Marital reconciliation
- Retirement
- Change in health of family member
16
Q
Psychological d/o that has the highest suicide rate in men? In women?
A
Men = Bipolar depression Women = Schizophrenia
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
18
Q
Tx for dysthymia
A
Psychotherapy
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
20
Q
Hypomania:
A
- Does not affect functionality
- Does not present w/ psychosis
- No need for hospitalization
21
Q
Women or men affected more in BPD? Higher SES or lower SES?
A
Women
Higher SES
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
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)
24
Q
What Rx should not be given in BPD I (but can be considered for BPD II and Cyclothymia)
A
Antidepressants
25
Is rapid cycling more common in BPD I or BPD II?
BPD II
26
Criteria for Cyclothymia
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
27
Tx for Cyclothymia
Lithium + psychotherapy
--> Antidepressants can shift to hypomania but can be used unlike in BP I
28
All personality disorders generally have these 3 things
1. ) Maladaptive thoughts (misinterpretations)
2. ) Distorted worldview (intra or interpersonal)
3. ) Atypical behavior/lifestyle
29
When do personality disorders usually start to appear?
Adolescent or early adulthood
30
Personality disorders more common in males
```
Anti-social
Paranoid
Schizoid and Schizotypal
Narcissistic
Obessive Compulsive
```
31
Personality disorders more common in females
Borderline
Histrionic
Dependent
32
Personality Disorder Clusters:
A-
B-
C-
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
33
Cluster A personality disorder tx
Psychotherapy (individual or group)
34
Cluster B personality disorder tx
Psychotherapy
Borderline type = lithium, CBZ, VPA, atypicals, SSRIs + psychotherapy
35
Avoidant Personality D/O tx
Psychopharm (SSRI, MAOI, buspirone, BBs) and psychotherapy
36
Dependent personality type tx
SSRI, TCA short term and psychotherapy
37
OCD tx
Psychotherapy is the most effective
SSRI may help to dec. perfectionism and ritualizing
38
Suggestive symptoms of somatic symptom disorder
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
39
Duration of symptoms needed in order to classify Somatic Symptom Disorder
6 months
40
How many symptoms does one w/ SSD usually present with?
At least 8
- -> at least 4 are from pain
- -> 2 from GI
- -> 1 Sexual/reproductive
- -> 1 Pseudonuerological
41
Most common pain complaints in SSD
Lower back
Head
Pelvis
Temporomandibular joint
42
Duration needed to classify someone as Illness anxiety disorder
6 months
43
Mental disorders can affect other medical conditions. How would you classify this? (mild, moderate, severe, extreme)
```
Mild = factor increases medical risk
Moderate = factor worsens medical condition
Severe = It causes an ER visit/hospitalization
Extreme = Results in severe, life-endangering risk
```
44
What is the main difference between factitious disorder and the other somatic symptom disorders?
Patient't know their pain is fake
45
How many symptoms are needed to dx a child w/ conduct disorder?
3/15
4 categories:
1. Aggression
2. Destruction
3. Lying and theft
4. Rule violation
46
Two types of Conduct Disorder w/ limited prosocial emotions
1. Anger and Hostility
| 2. Lack of empathy and guilt
47
When can you start seeing oppositional defiant disorder? conduct disorder?
ODD as young as age 3 or 4...usually dx'd a few yrs later
CD as young as 2 yo
48
Duration of oppositional defiant disorder
At least 6 months...if younger than 5 symptoms are daily, if older than they occur at least once a week
49
Mild ODD
Moderate ODD
Severe ODD
```
Mild = symptoms occur in only 1 location
Moderate = symptoms occur in 2 locations
Severe = symptoms occur in 3+ locations
```
50
1st line tx for conduct disorder. 2nd line?
Stimulants
2nd line = anticonvulsants (for nonspecific aggression)
51
Dx Schizophrenia criteria
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
52
What is the most common schizophrenia subtype?
Paranoid
53
What are the different subtypes of schizophrenia (even though DSM-V got rid of them)
1. Paranoid
2. Disorganized
3. Catatonic
4. Undifferentiated
5. Residual
54
Etiology of Schizophrenia
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
55
What are the 4 A's in Schizophrenia presentation?
Autism
Ambivalence
Affectivity
Association
56
Positive vs. Negative symptoms in schizophrenia: Region in the brain, what are the symptoms, and how are they managed?
```
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
Which subtype of schizophrenia has the best prognosis?
Paranoid
58
How does schizophreniform differ from schizophrenia?
In duration: lasts 1-6 mos and is usually carries a better prognosis
59
How does schizoaffective disorder differ from schizophrenia?
Mood disorder develops alongside schizophrenia (major depression and/or mania)
60
Distinguish brief psychotic d/o from schizophrenia.
Brief psychotic d/o lasts 1 mo or less w/ better prognosis and clearly identifiable stressor
61
3 phases of schizophrenia treatment
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
What is the 1st line pharmacological tx of schizophrenia?
Atypical Antipsychotics
--Risperdal, Zyprexa, Seroquel, Clozapine, Ziprasidone
**Can give benzo temporarily as "bridging" if needed
**Psychotherapy is useful in higher functioning pts (CBT)
63
What co-morbidity is most commonly associated w/ schizophrenia?
Substance use
- -50% ETOH
- -75% smoke tobacco
64
Besides substance use, what other co-morbidities are associated w/ schizophrenia?
Social anxiety
PTSD
OCD
Depression --> 10-15% commit suicide (paranoid has highest risk)
65
Neuropsychopathology of Psychosis: What areas are affected? (4)
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
_____ is the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli assoc. w/ the trauma
PTSD
67
Are women or men more affected by PTSD?
Women
68
How long must symptoms persist to dx someone w/ PTSD?
1 month w/ significant clinical, occupational, personal disruption
69
Acute PTSD, Chronic PTSD, Delayed onset PTSD
Acute PTSD: < 3 mos
Chronic PTSD: > 3 mos
Delayed onset: > 6 mos from stressor
70
Differentiate PTSD and Acute Reaction to Stress
PTSD > 1 month
| ARS < 1 month and has full recovery
71
PTSD and ARS are associated w/ ________.
Dissociative Disorder
72
3 co-morbid conditions associated w/ PTSD
Major Depression
Panic Disorder
Substance Abuse
73
4 types of Dissociation Disorder that can be associated w/ PTSD
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
First line tx for PTSD
Psychotherapy and Exposure therapy
75
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?
SSRI (Zoloft)
76
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?
Prazosin
77
Do benzos or debriefing help w/ PTSD?
NO!
78
What is the most common psychiatric disorder in the general population? What is the percentage?
Anxiety D/O...15%
79
Does panic disorder have a trigger/stimulus associated with it?
NO
80
What is the criteria for diagnosing one w/ panic disorder
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
Age of onset of panic disorders and are they more frequent in females or males?
Median 20-24 yo and more common in females.
82
Tx of choice for panic disorder
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
Criteria for panic disorder w/ agoraphobia
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
Most common phobia
Insects
85
How long must one have a fear (phobia) to be diagnosed
6+ months
86
1st line tx for phobias
Behavior/CBT therapy
87
Difference between social anxiety disorder and avoidant personality disorder
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
Criteria for generalized anxiety disorder
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
GAD epidemiology: When does it begin and peak? Males or females more common? Co-morbidities?
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
Tx for GAD
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
_____ is done in response to obsession.
Compulsion
92
Fears/phobias compared to OCD
Fears or phobias are less complex than those of OCDs
..OCD Fears= unwanted violent images, fear of contamination, making mistakes, etc.
93
Males and Females present w/ OCD at different times in life. Explain when.
Males = childhood, early adulthood
Females = adulthood
94
Which type of OCD is the most common?
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
What is the criteria for dx OCD
Obsession or compulsion or both must be present
Time consuming... > 1 hr/day or causing significant distress
96
Co-morbidities of OCD
```
Anxiety disorder (76%)
Depression/BP (63%)
Tic disorder (30%)
```
97
What scale is used to determine severity of OCD?
Yale-Brown Obsessive Compulsive Scale
98
Best tx for OCD pts
Behavioral therapy + pharmacologic rx (SSRIs and clomipramine preferable)
99
Difference between substance abuse and substance dependence
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
Are physical dependence and addition the same thing?
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
____% 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 _____.
6% population uses illicit substances
40% have tried it in lifetime
51% >12yo use ETOH
Binge drinking occurs mostly btw 18-25yo
102
Most commonly abused illegal drugs in order
1. Marihuana
2. Amphetamines
3. Cocaine
4. Opiates
103
3 addicting agent characteristics to consider
1. Degree of Euphoria
2. Reinforcement of agent
3. Rapidity of onset
104
What is the reward center of the brain and what is release (a neurotransmitter) that is addictive/reinforcing
Nucleus Accumbens = reward system
Dopamine
105
2 host variables for addiction
1. Genetics
| 2. Underlying psych d/o
106
Symptoms substances produce:
--Depression/anxiety, fear of intimacy and inhibitions =
--Low self-esteem =
--Uncontrolled anger =
Alcohol
Cocaine
Heroin and Opiates
107
Most common way to drug screen
Urine
| **Does not measure impairment
108
Chronic alcoholics consume ______ of hard liquor
> 1 liter/day
109
CAGE Questions
Cut down
Annoyed
Guilty
Eye-opener
+1 suggests an alcohol problem, 2+ indicates a problem
110
What is the CIWA and when is it used?
Clinical Institute Withdrawal Assessment
Used on any pt admitted to hospital w/ potential for symptoms of alcohol withdrawal
111
What do the scores mean on CIWA?
15: severe withdrawal
112
CIWA categories
```
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
You work in an alcohol detox center. When should you call a physician (HR, BP)
HR > 110 bpm
SBP > 180
DBP > 120
114
What is always given to pts who come in w/ alcohol intox?
Thiamine 100mg IM immediately and then 100mg BID for 3 days post
115
How often should CIWA be performed? Vital signs?
CIWA q 8 hrs for 24 hrs and vitals q4 hrs = < 8 on initial CIWA score
116
In the tx of alcohol what do the following pharm tx's do:
- -Disulfiram
- -Naltrexone
- -Acamprosate
Disulfiram: used to temproarily help establish sobriety
Naltrexone: blocks endogenous opioid release decreasing ETOH craving
Acamprosate: For abstinent pts only
117
A person comes into the ER w/ hallucinations, HTN, tachycardia, nystagmus and numbness and is very agitated. Tx?
Seclude them in a quiet area and restrain if necessary. Since agitated w/ psychosis give Haldol.
This is PCP tx
118
What is heroin prevalence? Does it occur more often in women or men? What ages?
2% use in USA
Men > Women
Ages 30-40
119
Heroine combined w/ cocaine IV is _____
Speedball
120
Life threatening effects of opioids
- -Respiratory Depression
- -Decreased mental status
- -Decreased tidal wave
- -Hypoglycemia
- -Pupillary miosis (constriction)
121
Tx for opioid overdose
IV Naloxone (Narcan)
Hydration
ICU admission of vital support
122
Medical sequelae of cocaine use
```
CVA
MI
Seizures
Cardiac arrhythmias
Pupillary dilation (mydriasis)
Cardiomyopathies
Sudden cardiac death
```
123
What does cocaine withdrawal look like?
Intense cravings are most prominent sign
Fatigue, guilt, anxiety, feeling helpless, hopeless, worthless, suicidal
124
Tx for cocaine withdrawal
Lorazepam (Ativan) if harmful to self/others
Haldol if psychosis involved
125
What is the antidote to treating depressant overdose (diazepam or alprazolam)
Flumazenil
126
Tx for overdose on Ketamine
ABCs
| Supportive care...IV hydration
127
Types of amphetamines
Amphetamine, dextroamphetamine
Meth-amphetamine
MDMA (ecstasy)
Bath Salts
128
Are the pupils constricted or dilated when intoxicated on amphetamines?
Dilated
129
Tx for acute intox of amphetamines and maintenace tx
Acute: Short acting benzo's for agitation
Maintenance:
Antidepressants and drug counseling
130
TWEAK Questions
Who is it recommended for?
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
Most common age of onset in anorexia nervosa
14-18 yo (rare before puberty or after 40yo)
132
4 different etiologies that combine to cause anorexia nervosa
1. Biological
2. Cultural
3. Genetic
4. Psychological
133
Biggest co-morbidity associated w/ anorexia nervosa?
Anxiety (60-65%)
Mood disorders, substance abuse, and personality disorders are other co-morbidities
134
Medical illnesses that can present like anorexia nervosa
```
Hyperthyroidism
IBD
Malignancies
AIDS
Tuberculosis
```
135
Anorexia Nervosa weekly weight gain goals in hospital setting and out-patient setting
2-3 lbs/wk for hospitalized pts
0.5-1 lbs/wk for outpatient programs
136
What function must come back to consider anorexics at "target weight"
Females - when normal menstruation returns
Males - when testicular function returns
