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psychiatry > Feb. 19 > Flashcards

Feb. 19 Flashcards

1
Q

Anxiety Disorders

A
  • overwhelming, unduly persistent, inappropriate, or misunderstood arousal compromises effective adaptation
  • persistent bouts of fear (emotional response to real or perceived imminent threat) and anxiety (anticipation of future threat) and related behavioral disturbances
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2
Q

Anticipatory fear

A

“fear of fear”

  • if continuously reinforced by avoidance behaviors. bring on the feared panic attacks
  • happens in individuals who are naive with regard to normal functions of arousal or who lack experience in coping with anxiety-provoking situations
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3
Q

Panic

A

-triggers an amygdala response that is generally unmodulated by limbic system/cortical regulations

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4
Q

What are the symptom clusters defining anxiety disorders?

A

1) arousal that may be tonic, paroxysmal, or mixed
2) negative expectation & interpretation of situations as ominous or overwhelming
3) avoidance of situations perceived as dangerous

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5
Q

Panic Disorders

A
  • characterized by recurrent panic attacks, occurring over at least 1 month, involving anticipatory anxiety
  • avoidance of situations where panic is likely to occur or help is unavailable
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6
Q

Panic Attack

A
  • discrete period of intense fear or discomfort during which at least 4 happen abruptly and reach peak in 10 min?
  • palpitations, pounding heart
  • sweating
  • trembling, shaking
  • dyspnea, feeling smothered
  • choking sensation
  • chest pain, tightness
  • nausea, abdominal distress
  • dizziness, fainting
  • paresthesias
  • chills, hot flashes
  • fear of dying/going crazy
  • depersonalization/derealization
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7
Q

Social Phobia

A
  • fear (or panic) often with blushing, of anticipated humiliation or rejection by others in social situations
  • desires social activities & relationships, the dread of embarrassment leads to avoidance
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8
Q

Avoidant Personality Disorder

A

-ranging from familial modeling of social avoidance to more adverse experiences such as being subjected to humiliation as a form of discipline, being isolated or bullied, especially as an adolescent or disfiguring lesions that provoke disgust or rejection

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9
Q

Performance Anxiety

A
  • stage fright

- common and responds to more limited treatment

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10
Q

Simple Phobias

A
  • characterized by fear responses to specific cues, encountered during a particularly frightening experience, environment, situation
  • only require treatment when they inhibit some necessary activities (air travel, health care, excessive distress)
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11
Q

PTSD

A

-person must experience, witness, or be confronted with event that involved actual threatened death or serious injury

1) intrusion
2) arousal
3) avoidance

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12
Q

Acute Stress Disorder

A

-immediate reaction to the trauma involves dissociation followed by all 3 types of PTSD symptoms and lasts up to 1 month

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13
Q

Obsessive Compulsive Disorder

A

-intrusive, arousal, & avoidance symptoms

Examples: checking, washing, counting, confessing, symmetry/precision, hoarding, >50% have multiple

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14
Q

Generalized Anxiety Disorder

A
  • persistent (>6 months) pattern of uncontrollable worries about health, safety, access to resources, & threats to other people
  • shows multiple signs of arousal & autonomic dysfunction
  • generalized fearfulness leads to constriction of behavior, avoidance of risk or novelty, and inhibition of normal curiosity
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15
Q

Interoceptive Exposure

A

-purposefully inducing feared bodily sensations and recognizing that you can experience them without panic

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16
Q

Benzodiazepines

A

-effective in reducing anticipatory or generalized anxiety but only the most potent quickly & directly relieve panic

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17
Q

Beta-adrenergic Blocking Agents

A

-good for performance anxiety (drug is lipophilic ex: propanolol)

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18
Q

Dissociation

A

-disruption, loss, or absence of the usual integration of memory, consciousness, & personal identity

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19
Q

Hypnosis

A

-dissociation induced by intense concentration

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20
Q

psychodynamic psychotherapy

A

-explores emotional memories of triggering events and their meaning (used in dissociation disorder)

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21
Q

Mood

A

-persistent subjective states (expressed in thought, emotion, behavior, and bodily functions)

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22
Q

Mood Disorder (Affective disorder)

A

-unusually intense & persistent mood occurs out of context, compromising self-care, adaptive functioning, and the ability to relate to others

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23
Q

Mania

A
  • mood state that is elevated, expansive, or irritable with accompanying vegetative symptoms (disruptions of homeostasis)
  • must last >/=1 week
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24
Q

Signs of Mania

A
  • excessive output of speech & thought
  • distractibility
  • racing thoughts
  • excessive pleasure seeking
  • impulsive/aggressive acts
  • delusions or hallucinations
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25
Q

Hypomania

A

-mood with some/all features of mania except psychosis

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26
Q

need 5 for Major Depressive Episode

A
  • SIG: E CAPS
  • sleep, loss of interest, guilt, decreased energy, concentration difficulty, appetite disturbance, psychomotor retardation/agitation, suicidal thoughts)
27
Q

Dysthymic disorder

Now: Persistent Depressive Disorder

A
  • individuals who persistently experience symptoms of depressed mood and at least 2 of the other characteristics of major depression
  • low mood for 2 or more years, clinically significant distress or impairment
28
Q

Psychoeducation

A

-explaining a diagnosis in terms of etiology and particular symptoms while offering ways to improve coping

29
Q

Electroconvulsive Therapy

A

-the safest & most rapidly effective treatment for mood disorders

30
Q

Vagal Nerve Stimulation

A

-FDA approved for refractory depression

31
Q

Delusions

A

-false beliefs that are no changed by reason or evidence that controvert them

32
Q

Auditory Hallucinations

A
  • most common type of hallucination
  • may be experienced as convos b/w several diff. voices that talk together about the individual, comment on their thoughts, or command them do do something
  • or perceptions that someone is controlling the thoughts, emotions, or behaviors
33
Q

Thought Disorder

A
  • absence of linear & logical connections b/w ideas

- disorganized with speech or writing (incomprehensible)

34
Q

Derailment

A

-loss of meaning due to random connections/loose associations b/w ideas

35
Q

Tangential

A

-responses to questions are only partially or remotely connected to topic

36
Q

Circumstantial

A

-excessively detailed or circuitous speech, yet still responsive to the question

37
Q

Neologism

A

-creation of words with unique meaning understood only by the individual

38
Q

Blocking

A

-losing track of the goal of speech & not being able to return to the topic

39
Q

World Salad

A

-complete disregard for conventions of word usage or gammer, incoherence

40
Q

Clanging

A

-the sounds of words, rather than meanings or conventions of speech, determine the flow of speech

41
Q

Perseveration

A

-repetition of words or phrases

42
Q

Anxiety

A

-fear (flight or flight)
-stress
(psychological & physiological symptoms)

43
Q

Major Anxiety Disorders

A
  • Panic Disorder
  • Social Anxiety Disorder
  • Simple Phobia
  • Agoraphobia
  • Generalized Anxiety Disorder
  • Substance-Induced Anxiety Disorder
  • Anxiety Disorder Due to Another Medical Condition
44
Q

Onset, Course, Epidemiology of Panic Disorder

A
  • early teens through age 40
  • chronic, relapsing (may remit)
  • Prevalence 1-3% community, 3-8% primary care
  • Female:Male 2:1
45
Q

Phobia in Medical Setting?

A
  • claustrophobia (MRI)

- vasovagal (fainting) response involving blood, needles, & injury are common occurrences

46
Q

Agoraphobia

A
  • marked, persistent fear or anxiety about 2 or more of the following (accompanied by avoidance)
  • using public transportation
  • being in open spaces (parking lots, bridges, market)
  • being in shops, theaters, cinemas
  • standing in line or being in a crowd
  • being outside of the home alone

-if panic attacks are present give both diagnosis

47
Q

Treatment of Social Phobia

A
  • rehearsal, improved competence “Toastmasters International”
  • Beta-blockers to reduce distress for public speaking
48
Q

Treatment of Simple Phobias

A

-short-term treatment with short-acting benzos for symptomatic relief (fear of flying, claustrophobia in MRI); repeated gradual exposure (systemic desensitization) to feared stimulus for lasting relief

49
Q

Treatment for Agoraphobia

A

-gradual exposure (systematic desensitization) plus SSRIs

50
Q

Substance/Medication-Induced Anxiety Disorder (Panic Attacks Predominate)

A
  • Stimulates: cocaine, meth, ADHD meds, caffeine
  • Alcohol (mini-withdrawals)
  • Over-the-counter decongestants & cough syrup
51
Q

Anxiety Disorder Due to Another Medical Condition

A

-Endocrinopathies (pheochromocyoma, hyperthyrodism, hypoglycemia)
-Metabolic Problems
-Neurological Problems (vestibular dysfunction)
(diagnosis is made if a patient’s medical condition is known to induce anxiety, & preceded the onset of the anxiety)

52
Q

Premenstrual Dysphoric Disorder

A
  • in the week before onset of menses, patients suffer from a combo of symptoms which include:
  • marked affective lability, irritability, anger, interpersonal conflicts, feeling on edge, anxiety, depression, over-eating, food cravings, sleep problems, feeling overwhelmed & out of control
  • symptoms must have lasted for better part of 2 years and must be documented prospectively for at least 2 menstrual cycles
  • symptoms must disappear shortly after onset of menses & are not just an exacerbation of ongoing interpersonal conflicts
53
Q

Cyclothymic Disorder

A
  • rapidly alternating mood states, occurring for at least 2 years, but never meeting criteria for Major Depression, Mania, or Hypomaina
  • looks like borderline personality disorder, many may have both (border line has more chaotic life circumstances, self-injurious behavior & history of abuse)
54
Q

Bipolar Disorders

A

-seen as bridge b/w psychotic disorders & depressive disorders in terms of symptomatology, family history, & genetics

55
Q

Bipolar 1 Disorder

A
  • distinct period of abnormally & persistently elevated mood, lasting at least 1 week
  • classic “manic depression”
  • full-blown mania is a psychotic disorder (patient loses contact with reality, severely impaired judgement)
  • vast majority of bipolar patients experience at least one major depressive episode in their life in addition to mania
56
Q

Bipolar 2 Disorder

A
  • distinct period of abnormally & persistently elevated, expansive, or irritable mood & abnormal & persistently inc. activity or energy, lasting at least 4 consecutive days, & present most of the day, nearly every day
  • in addition, patient must have a history of major depression that lasted at least 2 weeks
  • patients “up” episodes rarely are as disruptive as in BP1, but combo with recurrent depression causes sig. impairment & distress
57
Q

Hippocampus

A
  • short term memory
  • symptom/signs: cognitive inefficiency, recollection bias (depressed people cannot access happy memory; manic makes sad memory inaccessible)
58
Q

Thalamus

A
  • Individual thalamic nuclei are part of three distinct circuits that link cortical areas with sensory cortices & subcortical structures, these regulate emotion, motivation, arousal, & attention
  • symptom/signs: erratic arousal, subjective distress, compromised attention/concentration
  • loss of pleasurable responses to sensation in depression
  • sometimes associated with hypersensitivity to sensory input in mania
59
Q

Dorsolateral Prefrontal Cortex

A

-conscious thought, executive functions (selection among alternatives, anticipation, inhibition of impulses, sequencing)
symptom/signs: helplessness, indecisiveness, hopelessness, distorted sense of time (slowed in depression, accelerated in mania)

60
Q

Orbitofrontal Cortex

A

-assess rick in pursuit of reward, relate new into to cortex (memory & environment)
symptom/signs: overestimation of risk & reduced reward in depression, underestimation of risk in mania

61
Q

Anterior Cingulate Gyrus

A

-Integration of emotion & cognition

symptom/signs: abnormal motivation (apathy in depression), dysregulation of arousal

62
Q

Amygdala

A

-fear, rage, selective attention

symptom/signs: anxiety, irritability, vigilance, hypersentitivity to neg. environmental cues

63
Q

Nucleus Accumbens

A
  • reward

- lack of pleasure (depression), decreased or increased motivation

64
Q

HPA axis

A

-sleep, appetite, sexual behavior, metabolic rate, adaptation to acute or chronic env./social stress
symptom/signs: insomnia/hypersomina, lack or inc. sexual interest, hyperphagia or anorexia

psychiatry (7 decks)

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