Second Flashcards
Cotards syndrome
Nihilistic delusional belief associated with psychotic depression and schizophrenia.
Folie a deux
Shared delusion of one person influenced by another in which the treatment is to separate the two parties.
Post partum depression time frame
Within 4 weeks of delivery
Sexual masochism
Characterized by arousal caused by psychological or physical punishment to self by others.
Sexual sadism
Arousal caused by giving punishment.
What condition is commonly comorbid with microvascular ischemia such as CVA
Depression
Time frame for GAD
6 months
Lifetime prevalence of GAD
33%
What do insufficient serotonin levels lead to in GAD
Insufficient Inhibition of the hypothalamic pituitary axis (HPA) (body’s stress response)
Methylmalonic acid blood test is more sensitive to
Vitamin B12 deficiency
Homocysteine blood test more sensitive to
Folic acid deficiency
Homocysteine is an amino acid that your body naturally breaks down into other substances with the help of vitamin B6, B12, and folic acid.
Adonis complex
Perceive muscles are inadequate
Circumstantial speech
Overly inclusive and includes a lot of unnecessary detail and digressions** but eventually reaches the point.
Tangential Speech
Speech pattern with lots of unecessary details and digressions and never reaches the point
Flight of ideas
Erratic direction changes with an identifiable connection between thoughts
Loosening of Associations
An illogical connection between thoughts, digressing in multiple directions, but sentence structure remains intact.
Somatization disorder
Characterized by multiple complaints not from specific disease states or organs. Symptoms are numerous, unrelated and difficult to measure.
Conversion disorder
sudden onset of single neurological symptom after a significant stress.
when patient presents with anxious/panic cardiac type symptoms, what must be ruled out first and why
Cocaine induced mood disorder b/c it may lead to MI and if you give a BB to reduce anxiety, in the setting of MI due to unopposed alpha beta effects on heart and potential worsening of myocardial ischemia.
What does interpersonal therapy focus on
personal relationships and how they contribute to depression
Supportive psychotherapy
Focuses on strengthening defense mechanisms to restore function and is usually reserved for those with more primitive coping mechanisms.
Koro
A korean delusion that their penis is shrinking into their abdomen
Zar
belief that spirit is posessed (North African & Middle East)
Taijin Kyofusho
Japanese - belief their body is offensive to others
Kuru
Prion disease with neurolodegenerative effects leading to death caused by ritualistic cannabilism of eating brains of deceased.
2 month old behavioral red flags
- Does not respond to loud sounds
- Does not track light or faces around the room
- Does not reciprocate smile
- No hands to mouth
- doesnt hold up head while on tummy
4 month old behavioral red flags
- Shows no affection to caregivers
- No symmetrical eye movement in all directions
- Does not push legs down when placed on a hard surface
- Difficulty bringing things to mouth
- No vowel sound production
- No ability to roll in either direction
- Excessive rigidity or laxed muscle tone
- No laughter or squeeling sounds
6-8 month red flags
- No stringing vowels or consonants together
- no interest in exploring
- No interest in reaching things
Etiology of Rett syndrome
Genetic mutation MECP 2- metabolic disorder
Stage 1 of Retts Syndrome
- 6-18 months gross developmental delay, muscle flacidity, loss of eye contact breath holding
Stage 2of Rett’s Syndrome
Ages 1-4 years - stereotypical hand movements, absence seizures, sleep disorders, irritability, irregular breathing
Stage 3 of Rett’s syndrome
Age 2-10 years, increased rigidity, bruxism, EPS head and neck, seizures, weight loss
Stage 4 Retts syndrome
Older than 10 years - loss of trunk control, plateau of deterioration and seizure activity. Unable to walk.
Demographics of ASD
Onset before age 3, Male to females 4 to 1.
Characteristics of DMDD
- Disruptive Mood dysregulation disorder
- temper outbursts three times per week for at least 12 months with at least a 3 month period that is asymptomatic
- Persistent angy, irritable mood nearly every day between outbursts
- Verbal or physical aggression towards people grossly out of proportion to provocation
Reactive attachment disorder characteristics
severely disturbed relationships usually beginning before age 5
Which symptom is more commonly associated with children and not adolescence with MDD
psychomotor agitation, anxious, irritable, selective mute, flat affect
Examples of tasks a 3 year old can complete
ride a tricycle, know age and gender differences
Which age can chidren copy a circle, square
- circle - 24 months
- square - 5 years old
What is the differentiation stage and what disorder can arise if this stage is not successfully accomplished
Starting at age 6 months, child goes from checking in to playing nearby. Child may use a transitional object to soothe themselves. Difficulties in this stage may lead to borderline personality disorder.
What is the practicing stage and what disorder can arise due to difficulties in accomplishing this stage.
Overlaps from age 6 months to 18 months of age, developing a sense of autonomy, walkng and exploring the world. Engages in games that reassurance of caregiver and independence of child. Issues during this stage can give rise to narccistic personality disorder.
What is the stage of rapproachment and what can arise with difficulties during this stage. (Mahler)
Overlaps from age 15 months to 24 months. Characterized by child realizing their limits. Pulling away from aggression and running towards caregivers. Child attempts to reconcile autonomy with need for others. Issues in this stage can lead to borderline personality traits of splitting and projection.
What is object constancy stage and which disorder can arise.
Age 24-36 months. The child can hold a picture of the caregiver in mind while differentiating self and others. Consolidates dependency and consistency of caregivers. Problems may give rise to schizoid personality disorder.
Cluster A personality disorders
- Characterized by unusual thoughts or eccentric behaviors
- Includes paranoid personality disorder, schizoid, and schizotypical.
Paranoid personality disorder
Pervasive, persistent, and consistent mistrust of people.
Schizoid personality disorder
Pervasive detachment from social relationships and restricted range of expression of emotions in interpersonal settings.
Schizotypal personality disorder
Persistent pattern of social deficits characterized by acute discomfort and reduced capacity for close relationships complicated by cognitive and perceptual distortions and eccentric behaviors.
Cluster B personality disorders
Dramatic expression of fluctuating emotions, affective instability.
* Borderline personality disorder
* Narccistic personality disorder
* Antisocial personality disorder
* Histrionic
Antisocial personality disorder and ages for dx
A consistent disregard for the rights of others since the age of 15. Cannot be diagnosed until age 18.
Borderline personality disorder
Unstable sense of self, unstable interpersonal relationships, chronic feelings of emptiness, exacerbated by extreme separation anxiety, inability to be alone and persistent concern for the availability of others to help reduce the internal distress.
Histrionic personality disorder
Pervasive, persistent pattern of excessive emotionality and other attention-seeking behaviors.
Narcisstic Personality Disorder
Peristent inferiority complex overcompensated by the overinflated sense of importance and being perceived as special. Feel entitled yet depended on other with whom they often lack empathy and concern. The grandiosoty serves as a defense against not feeling valued while defensively putting off their need for others, despite craving constant admiriation and reassurance.
Cluster C personality Disorders
Consistent and persistent pattern of fear and anxiety with maladaptive coping mechanisms (avoidance, procrastination, difficulty in following through, difficulty unwinding) motivated by fear of rejection or criticism.
OCD, Dependent, avoidant
Avoidant personality disorder
Cluster C - pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to perceived criticism or real.
Dependent personality disorder
Cluster C - consistent and pervasive pattern of maladaptive behaviors from an excessive need to be cared for leading to submissive and clinging behaviors. Hoping to reduce the chance of separation.
What is psychoanalysis best suited for
People in late adolescence and early adulthood to examine unconcious motivations of past and present situations which takes place over the course of several years.
Failing to master what stage inhibits the development of purpose and, virtue leading to children remain followers, lack self-initiative, and can feel like they are a bother to others.
Failure to master initiative versus guilt.
What developmental stage are middle school children in?
Industry versus inferiority and moving toward identity versus role confusion.
Dysdiadochokinesia and what part of brain is effected
Inability to perform rapidly alternating hand movements, cerebellum
Astereognosis
Unable to discriminate between objects based on touching
Reaction formation
When a person reacts in the opposite way of how they feel or they want to feel in order to hide their true feelings.
Sublimation
Substituting a socially acceptable constructive activity for a robust contrasting impulse. “A woman puts negative energy into a home improvement project after a breakup”
Name most common tricyclics
End in tryptaline, pramine, franil
“at the pramiere, fran tryped”
1. amitriptyline (elavil)
2. nortriptyline (Pamelor)
3. imipramine (tofranil)
4. clomipramine (anafranil)
5. desipramine (norpramin)
6. doxepin (silenor)
MAOI - most common
- tranylcypromine (parnate)
- isocarboxazid (marplan)
- phenelzine (nardil)
- slegeline
“TIPS”
Name a purpose of a defense mechanism
resolve conflict associated with ego-dystonic stimuli
Primary prevention
Reduce incidence of disease or condition
Secondary prevention
aims to detect a condition early and prevent it from getting worse
Tertiary prevention
Enhance the quality of life after the disease or condition occurs
What does medicare part B cover
durable medical equipment, outpatient appointments, and ambulance services
DBT involvrd reconciling the tension to find the truth between
Radical acceptance and change
Strategic therapy
uses the paradoxical directive to effect a change in behavior
Just Culture
ANA’s statement on promoting open and fair interprofessional collaboration aimed at reducing human error.
What teratogenic effect does depakote have and when
1st trimester- Neural tube defect - spina bifida most common (also heart defect, cleft lip and palate.)
Lithium causes what type of teratogenic effect and when
Cardiac malformations first trimester (ebstein anomaly - tricuspid valve)
Clozapine and ANC requirements
- Must be stopped for an ANC less than 1000.
- Prior to starting the ANC should be greater than 1500
cluster B personality disorders
The dramatic type - antisocial, narcisstic, borderline, histrionic
How do BB cause depression
they are believed to cross the blood-brain barrier and lead to symptoms associated with depression (especially lipophilic BB)
Undoing defense mechanism
when a person tries to cancel out a threatening thought or emotion by engaging in a contrary behavior
Manager being extra nice after disciplining employee.
What is an example of legal ruling trends over the last 30 years
Juries have been encouraged to find defendants not guilty
what elements of CBT inform DBT
mindfulness, meditation, and emotional regulation
what developmental stage does abstract thinking develop
formal operations stage age 11-15 years
What type of prevention is a suicide hotline?
Secondary prevention because a specific condition with specific interventions is aimed at reducing a specific risk outcome.
A person with a low self esteem, poor self-control, self-doubt requiring a high degree of reassurance failed to master what developmental stage.
Industry versus inferiority where the child learns skills, takes pride in their accomplishments and develop self-esteem from being valued by peers for their competencies
High specificity tests identify
True positives and rules it in.
SPin.
Type I error
When null hypothesis is rejected when in fact it is true
In OCD, which symptom is consistent with the obsession
anxiety (ruminations, checking gas, hand washing are compulsions)
Cluster A personality disorders
odd/eccentric type - paranoid, schizoid, schizotypal
Sinclair method of treating ETOH abuse
taking naltrexone 1 hour before intended alcohol use
Quality Improvement
Aims to review current practices and outcomes
Strategic Therapy
short-term problem focused on an interventional approach to treatment
Experiential therapy
technique that uses expressive tools and activities to recreate emotional situations from the past or present so they can be resolved in a less threatening manor.
Structural therapy
addresses patterns of interaction that cause conflict within a family system
Solution focused therapy
enhances individual strengths, and past successes are used to build communal self-efficacy within the family system. Tools include the miracle question, scaling questions, and coping questions
Which class of medications is used to treat nightmares in PTSD
Alpha 1 blockers (prazosin)
What treatment is indicated for treating HIV neurocognitive deficits (HAND) and dementia
antiretroviral therapy
Repression
a defense mechanism where a person expresses pleasurable emotions accompanied by amnesia or lack or awareness of an ego-dystonic event. An unconcious defense mechanism deployed by the ego to keep disturbing or threatening thoughts from the concious.
Labs in hypothyroidism
High TSH (normal 0.4-4.5) and low T4 (normal 0.7-1.9)
Kindling
a metaphorical theory that small neurobiological reactions lead to full blown disorders.
Example of qualifications for Medicare part A
- age 65 or older
- Disability entitled to social security disability benefits for at least 24 months
- Have ESRD and be on dialysis or kidney transplant
Psychic determinism
psychodynamic principal that determines all behavior has purpose
Ego development principle
one understands that others have needs and that impulsive acts and causes self-harm
Id principle
seeks immediate gratification and pleasure
Superego
Ethical restraint and moral framework
Hashimotos thyroiditis
autoimmune, goiter, antibodies cause inflammation in thyroid gland, have trouble make enough thyroid hormone - symptoms of hypothyroidism
Pharmacokinetics
The bodys affect on the drug, distribution, metabolism, excretion, absorption
pharmacodynamics
The affect of the drug on the body, antagonist, agonist
Defense mechanisms is people with cluster c personality disorders
Reinforcing isolation and intellectualization
Cluster B personality disorder defense mechanisms
Projective identification, regression, somatization, denial,externalization, dissociation
Cluster A personality disorders defense mechanisms
Projections, avoidance, procrastination and fantasy based
How do benzodiazepines affect TBI
Can cause memory problems and confusion
Core concepts of Transactional analysis
Experience feelings out of the blue. Transference and countertransferance describes how memories from past relationships can impact current relationships more specifically how perception can impact how one conducts current relationships and life scripts
Side effects of THC
Heightened sensitivity, including paradoxical anxiety, impairs motor skills and cognition, and decreased motivation.
Late symptom > 6 months of microcytic hypochromic anemia
Pica
MMSE scores
9 or less - severe
10-18- moderate
19-23- mild
MMSE scores
9 or less - severe
10-18- moderate
19-23- mild
Which eating disorder affects individuals of average height and weight, especially in sports with target weights
Bulimia
Screening for depression is what type of prevention
Secondary
What type of cognitive decline is often comorbid in Down’s syndrome
Alzheimer’s
How can lithium effect thyroid
Hypothyroid
Two Biomarkers of heavy drinking
Elevated MCV and triglycerides
Which is a legal determination competence or capacity to refuse care
Competence
who is considered to be the founder of psychiatric nursing
Hildegard Peplau - developed theory of interpersonal relationships in the 1950’s
What does PICO stand for
guides clinicians in practicing evidence based interventions
* P - who is the patient population
* I- what is the potential intervention
* C - Is there a comparison or control group
* O- what is the desired outcome
steps in evidenced based practice process
- ask a question - start with patient’s situation and formulate clear answerable question (PICO can be used)
- Find evidence
- appraise evidence
- apply evidence
- evaluate outcome
resilence
ability to transform a disastrous situation into a growth experience in an effort to move forward
Concordance
.a way of working together with people. may be seen as developing a mutually agreed upon treatment plan
adaptation
ability of person to adjust to changes or new experiences
What is serotonin derived from and where is it synthesized
the amino acid tryptophan, raphe nuclei in the brain stem
Examples of catecholamines, what are they derived from and where are they synthesized
dopamine, norepinephrine, epinephrine. they are derived from the amino acid tyrosine and syntheisized in the brain, adrenal medulla and by some sympathetic fibers
What do catecholamines play a role in
nutrient metabolism, thermogenesis, glycogenolysis and hormone secretion
Examples of high potency antipsychotics (1st generation)
Haldol, fluphenazine (prolixin)
Examples of moderate potency antipsychotics (1st generation)
Loxapine and perphenazine (trilafon)
Examples of low potency antipsychotics (1st generation)
chlorpromazine (thorazine) and thioridazine (mellaril)
What is the antidote for serotonin syndrome
cryptohetadine (periactin) histamine-1 receptor antagonist
3 of the following criteria are needed for a diagnosis of catatonia
stupor, catalepsy (marked loss of voluntary movement causing body to appear rigid and inflexible), wavy flexibility, mutism, negativisim, posturing, mannerisms, stereotypy, agitation, excessive motor activity, grimacing, echolalia, echopraxia (involuntary repeat or imitate actions of someone else)
Lithium therapeutic range
0.8-1.2
Identity vs role confusion
Adolescence (12-20 years) development of stable and coherent sense of self including one’s vallues, beliefs. Characterized by exploration of different roles and identities which can lead to a period of identity confusion.
Industry vs inferiority
Middle childhood (6-12). children who struggle with this stage may feels a sense of inferiority and incompetence. They may have difficulty interacting with peers and seek adult reassurance.
logotherapy
Approach within existential therapy focusing on individuals find meaning and purpose in their life “finding healing through finding meaning ”
family homeostasis
Tendency of family members to resist change and maintain familar roles and dynamics even when they are dysfunctional
Self differentiation
In systemic family therapy refers to an individuals ability to maintain a sense of self while remaining emotionally connected to others. Encourages members to maintain emotional autonomy and not react impulsively during conflicts, Instead, they should engage in open non-reactive communication
Triangulation
when a 3rd party is brought into a conflict between two individuals or family members. It can involve the formation of alliances or coalitions within the family often leading to increased conflicts and difficulties resolving issues.
structual family family therapy
involves identifying and reorganizing family roles, boundaries, and hierarchies to improve family functioning
multisystemic family therapy (MST)
In cases where youth is involved in delinquet behavior, such as substance abuse, and coflicts with the law. MST targets various systems that influences the youth’s behavior, including family dynamics, peer relationships, school, and the community, . Its a comprehensive approach that addresses the complex factors that contribute to delinquent behavior and provides strategies for change.
Scaling questions
Used in solution-focused therapy to help family members evaluate their current situation on a scale and explore what would make it one point better. Encourages small steps of improvement and sets a positive and solution oriented tone alllowing them to identify realistic goals and solutions for their challenges.
Paradoxical directives
A key technique in strategic family therapies. Involves prescribing the symptom or problematic behavior as asolution to disrupt dysfunctional patterns. This higlights the unworkability of the behavior or provoke resistance from the family, ultimately leading to a shift in the famly dynamics and the creation of change (example- person with crippling fear of making a mistake, may be asked to make a small mistake to see how it feels)
Straightforward directives
In strategic family therapy, provides clear and specific instructions for changing specific behaviors and interactions within the family. Designed to create immediate change and address the identified issues directly. Particularly useful when the goal is to interrupt existing patterns and proved a clear path for behavior change within the family. “Example, telling family for the next 24 hours to ignore child’s tantrum in order to not reinforce negative behavior.”
The best medication for withdrawal symptoms for a patient with liver disease
Ativan (lorazepam) due to shorter half-life and less hepatic metabolism
How long should someone refrain from alcohol use after stopping antabuse (disulfiram)
up to 2 weeks
Which medication is recommended for ADHD and Tics
Guanfacine (Intuniv) alpha 2 blocker
What type of therapy is reccomended for ASD
Aplied Behavioral analysis therapy (ABA)
1st line medication for bipolar I with acute depression
Atypical antipsychotic (e.g., Latuda)
An increase in Na levels causes Lithium levels to
Decrease
Which medications increase Lithium levels
NSAIDs, thiazide diuretics, ACEI, metronidazole, tetracycline
Which medications decrease lithium levels
potassium sparing diuretics, theophylline
How does psychotherapy effect the corticolimbic pathway
Enhances function of the prefrontal cortex down to the limbic system
How does pharmacotherapy effect corticolimbic pathway - direction
First targets limbic system and then works it way up
How does omega fish oils work to help those with mood disorders
Increasing serotonin levels, altering dopamine function and regulating corticotrophin-releasing factor
Which cranial nerve is associated with anticholinergic side effects of face, dry mouth, decreased respiratory secretions, decreased tearing
Cranial Nerve VII
Which medication is the only FDA approved medication for Bulimia Nervosa
Fluoxetine
Characteristics of refeeding syndrome
hypophasphatemia, hypomagnesmia, hypokalemia, glucose intolerance, thiamine deficiency, and fluid overload
What clinical features are more commonly seen in bipolar major depression
hypersomnia, hyperphagia, leaden paralysis, delusions and hallucinations
Geriatric bipolar disorder differences
lower instances of comorbid anxiety and substance abuse, lower instance of increased sexual interest, during hypo/manic episodes
Examples of some medications that induce psychosis
analgesics, antidepressants, antivirals, anticholinergics, corticosteroids, antieleptics, interferons.
Manic episode with mixed features must include 3 of the following
depressed mood, low energy, diminshed interest in most activities, psychomotor retardation, excessive guilt or thoughts of worthlessness, recurrent thoughts of suicide or death
Is it common for mania with mixed features to transition to mania
no, but it can transition to depression
Projection
lower adaptive defense mechanism defined as reacting to unacceptable thoughts or impulses as if outside of ones self
Failure to thrive infants are below what percentile on body charts
3rd percentile
Deficit schizoprehnia
Patients who primarily experience negative symptoms of schizophrenia. Less likely to experience delusions with a high emotional content, less likely to have a substance use disorder, less likely to have a depressive disorder and are less likely to show improvement or recover
Interaction between lamictal and birth control
Estrogen can make lamictal less effective, lamictal levels can increase (double) during pill free week.
Characteristics of schizophrenia in neurological system
- inadequate synapse formation and excessive pruning of synapses
- low glutamate
- High dopamine in mesolimbic pathway (positive sx)
- Low dopamine mesocortical pathway prefrontal cortex (negative sx)
- Brain structures small except enlargened ventricles
Risks of developing schizophrenia
- first degree relative (parents, siblings, children)
- age of onset male 18-25 and females 25-35
Mesolimbic pathway
- originates in VTA to the nucleus accumbens, amygdala, hippocampus, stria terminalis
Mesocotrical pathway
originates in VTA and proects primarily to prefrontal cotrex
Neurotransmitters alzheimers
- Acetylcholine - role in memory, learning, attention, arrousal, involuntary muscle movement
- Decreased in alzehimers
- Glutamate - memory and cognition
- Decreased in alzheimers
- ? Dopamine may be low*
neurotransmitters in addiction
- substances increase dopamine
- GABA decreased in prefrontal cortex addiction characteristics - poor impulse control and disinhibition
- Alcohol can reduce GABA production leading to GABA withdrawal
{GABA - helps body feel relaxed and feel calm)
neurotransmitters ADHD
Decreased serotonin, dopamine and norepinephrine
Autism neurotransmitters
- Low serotonin in brain may increase repetitive behaviors
- hypothesis elevated serotonin in blood
- GABA - decreased - implicated in social processing, sensorimotor areas may be associated with altered tactile function(may have some increase in certain areas of brain)
- imbalance of glutamate and gaba
- Glumtamate may be increased - overstimulation of neurons associated with neurological disorders
Neurotransmitters in antisocial personality disorder
serotonin and dopamine
Low serotonin, more release of dopamine in the nucleus accumbens (reward system)
labs for hyperthyroidism
Elevated T3 and T4, low TSH
Low T3 and T4, high TSH
hypothyroidism
Normal TSH levels
0.5 - 5.0
What medication for acute panic attack
hydroxyzine
Time frame for adjustment disorder
emotional or behavioral symptoms begin within 3 months of experiencing a significant stressor
Prazosin
alpha1-adrenergic antagonist. Preferred in treatment of nightmares associated with PTSD.
Tourette disorder
presence of both motor and vocal tics that are sudden, repetitive, and involuntary
