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Psychiatry > Trivia and Psychotherapy > Flashcards

Trivia and Psychotherapy Flashcards

1
Q

Drug toxicity that causes nystagmus

A

PCP (and lithium)

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2
Q

EtOH dependence tx

A

Naltrexone, Disulfuram, Acamprosate

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3
Q

Sensitive tests for Delirium

A

Serial 7’s, orientation, 3 item recall

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4
Q

Benefit of IV haldol (over PO, etc.)

A

No EPS

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5
Q

Term for when you move a patient and they stay in that position

A

Waxy flexibility (seen in catalepsy)

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6
Q

Drugs that increase lamotrigine level

A

VPA (via glycuronidation?) and sertraline

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7
Q

ADHD in children is difficult to distinguish from what?

A

Bipolar disorder (mania)

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8
Q

PTSD criterion categories

A
  1. Intrusive symptoms
  2. Avoidance
  3. Hyperarousal
  4. Negative mood or Cognitive change
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9
Q

Atomoxetine BBW

A

SI (and hepatotoxicity)

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10
Q

Main symptom of childhood MDD

A

Irritability

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11
Q

TD risk

A

5% per year, highest in women with affective disorder

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12
Q

Dystonia risk is highest in whom

A

Young males

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13
Q

Violence risk is 30x higher in what demographic?

A

Substance use disorder

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14
Q

Venlafaxine

A
  • Short half-life, fast renal clearance (no build-up, good for old people)
  • Minimal DDI and minimal P450 activity
  • Dose dependence DBP increase up to 10-15mm Hg
  • QT prolongation
  • Sexual SE in 30%
  • Bad DC syndrome
  • Nausea, especially with IR tabs
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15
Q

Resistance

A

Ideas unacceptable to conscious; prevents therapy from proceeding

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16
Q

Free association

A

Patient says what comes to mind uncensored. Clues to unconscious

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17
Q

Mature defense mechanisms

A

Suppression; Altruism; Anticipation; Affiliation; Sublimation; Humor

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18
Q

Neurotic defense mechanisms

A

RRIDE: Repression (expel from consciousness); Reaction formation (do opposite); Intellectualization (details to distance from emotions); Displacement; Externalization (blame on another)

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19
Q

Primitive defense mechanisms

A

PPPAADS: Projection (falsely attribute unacceptable feelings to another); Projective identification (falsely attribute to another who projects back); Passive-aggressive (indirectly express aggressive feelings); Autistic fantasy (day-dreaming); Acting out (inappropriate beh without consideration of consequences); Denial (refusing to acknowledge reality); Splitting (compartmentalize opposite affective states)

20
Q

Lambert and Tallman in psychotherapy

A
  • Quality of relationship affects outcome more than specific therapy
  • Lambert: 40% motivation or severity of problem; 30% relationship; 15% expectancy (placebo); 15% techniques
  • Tallman: Outside therapy people rarely have friends to listen >20 minutes; People close are often involved in problem and cannot provide safe impartial perspective
21
Q

Two conditions associated with decreased density/volume of hippocampus

A

MDD and PTSD

22
Q

Mindfulness based stress reduction (MBSR) program for 8 weeks -> brain changes

A

Changes in grey matter concentration in brain regions involved in learning and memory processes, emotional regulation. Self-referential processing and perspective taking.
* Left hippocampus increase

23
Q

Psychotherapist versus therapist

A

Psychotherapist: Psychiatrist, Psychologist, SW, NP, PA, Minister/Priest
Therapist: anyone!

24
Q

Psychotherapy continuum

A

Psychoanalytic Behavioral

25
Q

Psychoanalysis (Freud, Jung)

A
  • Focus on unconscious, insight by interpretation of unconscious conflict
  • Most rigorous: 3-5/week, years, $$
  • Patient on couch, analyst unseen
  • Patient must be stable, highly motivated, verbal, psychologically minded, able to tolerate stress without overly regression/distraught/impulsive
  • Analyst neutral
  • Goal is STRUCTURAL REORGANIZATION OF PERSONALITY
  • Techniques: Interpretation, clarification, working through, dream interpretation
26
Q

Psychoanalysis terms

A

Transference, Countertransference, Therapeutic alliance, Resistance, Free association

27
Q

Psychodynamic psychotherapy

A
  • AKA “expressive,” “insight-oriented”
  • Based on modified psychoanalysis
  • No couch, less focus on transference and dynamics
  • Interpretation, encouragement to elaborate, affirmation and empathy important
  • 1-2/week, open-ended duration
  • Limited goals
28
Q

Supportive Psychotherapy

A
  • Support of authority figure during period of illness/turmoil/decompensation
  • Warm, friendly, non-judgmental, leadership
  • Supports ultimate DEVELOPMENT INDEPENDENCE
  • Expression emotion encouraged
29
Q

Types of psychotherapy

A
  1. Psychoanalysis
  2. Psychodynamic
  3. Supportive
  4. CBT (IPT, CBT, DBT, behavioral)
  5. Other: Group, Family, Couples
30
Q

CBT

A
  • Manualized, time limited, coach-like, homework

* IPT, CBT, DBT, behavioral therapy

31
Q

IPT

A

(CBT)

  • Time-limited tx for MDD developed in the 70’s, for a variety of populations (old, young, HIV, marital)
  • Assumes connection b/t onset mood d/o and interpersonal context in which they occur
  • 12-16 weeks
  • RCTs: IPT v. venlafaxine showed increased bloodflow to R. basal ganglia. IPT group also increased posterior cingulate. Underscored importance of limbic/paralimbic recruitment in psychotherapy-medication changes
32
Q

CBT

A
  • Derived from theories of normal/abnormal development and of emotion/psychopathology
  • Utilizes cognitive model, operant conditioning, classical conditioning
  • Approach focuses on here and now
  • Tx is empowering-gaining psychological and practical skills
  • Homework
  • Techniques: identify cognitive distortions, test automatic thoughts, identify maladaptive assumptions
  • Therapist takes active, problem oriented, directive stance
  • Used for wide range problems: depression, anxiety, bulimia, anger, adjustment to illness, phobias, chronic pain
33
Q

Psychotherapy in which techniques include: identify cognitive distortions, test automatic thoughts, identify maladaptive assumptions

A

CBT

34
Q

Psychotherapy derived from theories of normal/abnormal development and of emotion/psychopathology

A

CBT

35
Q

CBT and IPT in Major Depression

A

16-20 sessions as effective as imipramine for less severely depressed patients

36
Q

Glucose metabolism with CBT and venlafaxine

A

Decrease everywhere, Increase in Lateral inferior occipital

37
Q

CBT in panic disorder

A

16x = medication

Better tolerated and more durable

38
Q

CBT in OCD

A

Cue exposure and response prevention

As effective as medication

39
Q

DBT

A

Developed to tx BPD

  • Based on behaviorist theory w/cognitive therapy elements
  • Incorporated “mindfulness” (from Zen) as central component
  • Therapist specially trained
  • Individual and group sessions
  • Focuses on self-destructive behaviors, esp suicidality
  • Learn core mindfulness, emotion regulation, interpersonal effectiveness, distress tolerance
40
Q

Psychotherapy using Zen mindfulness as central component

A

DBT

41
Q

Psychotherapy teaching core mindfulness, emotion regulation, interpersonal effectiveness, distress tolerance

A

DBT

42
Q

CBT (DBT) in BPD

A

Superior to “tx as usual” for reducing parasuicide, medical severity of parasuicide, treatment drop-out, number of inpatient hospitalization days

43
Q

Group psychotherapy

A
  • Carefully selected patients, trained leader, immediate feedback
  • Self-help groups enable members to give up patterns of unwanted behavior; Therapy groups help patients understand why
  • Encompasses theoretical spectrum of therapies: supportive, time-limited, CB, psychodynamic, IP, family, client-centered based on nonjudgmental expression of feelings
44
Q

Family therapy

A
  • Interrupt rigid patterns causing distress
  • Family systems theory: family unit acts as though homeostasis must be maintained
  • Therapy: discover hidden patterns and help understand behaviors
  • Many treatment models, schedule and duration flexible
45
Q

Couples therapy

A
  • Different than “marriage counseling,” because more limited in scope
  • Couple or in group
  • Indicated when individual tx fails to resolve relationship difficulty
  • Geared toward enabling each to see other realistically

Psychiatry (5 decks)

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