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Psychiatry Flashcards

1
Q

What are the mature defense mechanisms?

A

Altruism, humor, sublimation (channeling impulses into socially acceptable behaviors), suppression

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2
Q

Reaction formation?

A

Doing opposite of what they truly feel or desire (excessive opposite)

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3
Q

Tx of narcolepsy

A

Stimulants; 1st - modafinil (non-amphetamine stimulant); 2nd - amphetamines (SE’s of HTN, arrhythmia, psychosis and risk for dependency)

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4
Q

Projection vs. displacement

A

Attributing own feelings for someone else vs. redirect emotions toward a more acceptable but still inappropriate person or object. “I think that SHE/HE thinks…”

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5
Q

Pica is associated with what lab finding?

A

Iron-deficiency anemia

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6
Q

Buspirone?

A

Selective agonist of 5HT1a receptor for GAD. Not muscle relaxant, or anticonvulsant. Few side-effects. But takes 1-2 weeks.

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7
Q

Passive-aggressive vs acting out

A

P-A: expression of hostile feelings in non-confrontational manner. Acting out is confrontational (temper tantrum. Expressing unconscious wishes or impulses through actions)

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8
Q

Serotonin syndrome vs. Neuroleptic malignant syndrome

A

Serotonin syndrome 2/2 to inc. serotonin (e.g. SSRIs + MAOIs) leading to MYOclonus, hyperreflexia, autonomic stimulation, AMS. NMS has rigidity and NO myoclonus, hyperthermia, AMS, autonomic instability. NMS 2/2 to antagonism of D2 receptor (e.g. haloperidol)

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9
Q

Suppression vs. repression

A

Suppression is the INTENTIONAL withholding of distressing unconscious material. Repression is the unconscious removal.

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10
Q

Schizoid vs. Schizotypical

A

Schizotypical is more schizophrenia-type. Paranoid. Strange superstitions. Schizoid - self-absorbed, isolated loners, restricted range of emotion. Avoidant-types desire relationship but feel inadequate, timid, and fear rejection

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11
Q

Classical vs. operant conditioning

A

Classical - involuntary responses. Operant - voluntary responses (punishment or reward)

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12
Q

Extinction

A

Discontinuation of reinforcement (whether positive or negative) eventually eliminates behavior (both classical and operant)

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13
Q

Transferance vs. countertransferance

A

What patient feels about physician vs. what physician feels about patient

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14
Q

Dissociation vs. Displacement?

A

Temporary drastic change in personality, memory, consciousness, or motor behavior vs. transferring avoided ideas and feelings to some neutral person/object

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15
Q

Infant deprivation effects

A

4 W’s = Weak, Wordless, Wanting, Wary. Deprivation for >6 mo can lead to irreversible changes

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16
Q

Evidence of physical abuse?

A

Healed fractures on X-ray, burns, subdural hematomas, pattern marks, rib fractures, retinal hemorrhage or detachment. Usu. biological mother and in kids <3 y/o

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17
Q

Conduct disorder vs. oppositional defiant disorder?

A

Oppositional defiant are hostile, defiant behavior to authority figures w/o serious violations. Conduct disorder = violating BASIC rights —-> antisocial personality disorder

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18
Q

Tourette syndrome

A

Usu. onset before age 18. Sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics > ONE YEAR. Coprolalia (inv. obscene speech in 10-20%). Tx = antipsychotics and behavioral

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19
Q

Treatment for separation anxiety disorder?

A

SSRIs and relaxation techniques/behavior interventions

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20
Q

Rett disorder

A

X-linked disorder seen almost exclusively in girls (b/c boys die in utero). Ages 1-4 –> Regression w/ loss of dvpt, loss of verbal, ID, ataxia, and stereotyped hand-wringing

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21
Q

Neurotransmitter changes in Anxiety vs. Depression

A

Depression is decreased NE, 5-HT, DA. Anxiety is INCREASED NE, decreased GABA and 5-HT.

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22
Q

HD vs. Parkinsons’ neurotransmitter change

A

HD is INC DA, low GABA and ACh. Parkinsons is LOW DA and increased 5-HT and ACh. Think how do you “Parkinsonize” people?

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23
Q

Alzheimer’s neurotransmitter change?

A

Decreased ACh.

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24
Q

Order of loss of orientation

A

Time, place, person

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25
Q

Korsakoff amnesia

A

Thiamine deficiency and associated destruction of MAMMILLARY bodies. Classically anterograde, tho some retrograde. Confabulations

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26
Q

Dissociative amnesia

A

Inability to recall important personal information usu. subsequent to severe trauma or stress. Dissociative fugue (abrupt travel during period)

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27
Q

Etios of delirium

A

CNS disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention

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28
Q

Reversible causes of dementia

A

NPH, vitamin B12 deficiency, hypothyroidism, neurosyphilis, HIV (partially).

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29
Q

Delrium vs. dementia

A

Waxing and waning consciousness with abnormal EEG and often reversible VS gradual decreased cognition w/o effect on level of consciousness, EEG normal, and often irreversible

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30
Q

Hypnagogic vs. hypnopompic?

A

Gogic is going to sleep. Pompic is upon awakening.

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31
Q

Diagnostic criteria for schizophrenia?

A

> SIX MONTHS, 2/5: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech or thought.”

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32
Q

Brief pyschotic vs. schizophreniform vs. schizoaffective disorder?

A

< 1 mo vs. 1-6 mo vs. at least 2 weeks of sable mood WITH psych + MDD, Manic, or mixed

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33
Q

Delusional disorder

A

Fixed, persistent, untrue belief system lasting > 1 MONTH

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34
Q

Dissociative identity disorder vs. Depersonalization/derealization disorder

A

Dissociative = presence of 2 or more distinct identities/personality states. Most common in women - sexual abuse, PTSD, depression, substance, borderline, somatoform. Depersonalization = persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, actions, or environment

35
Q

Manic episode criteria

A

> 1 week. At least three of DIG FAST = Distractibility, irresponsibility, grandiosity, flight of ideas, Activities and agitation, Sleep down, talkativenes/pressured speech

36
Q

Hypomanic criteria

A

No marked impairment in functioning. At least 4 consc. days. No psychosis.

37
Q

Bipolar I vs. II

A

II is hypomanic + depressive.

38
Q

Cyclothymic

A

Dysthymia and hypomania. At least TWO YEARS.

39
Q

Major depressive disorder criteria

A

At least 5/9 for TWO WEEKS. SIG E CAPS - Sleep disturbance, loss of Interest, Guilt/feelings of worthlessness, Energy loss/fatigue, Concentration problems, Appetite/wt changes, Pyschomotor retardation or agitation, Suicidal ideations.

40
Q

Depression –> what sleep changes?

A

Decreased slow-wave, decreased REM latency, increased REM early in sleep, increased overall REM, repeated nighttime awakenings, EARLY-MORNING wakening

41
Q

Dysthymia

A

TWO YEARS

42
Q

Atypical depression

A

Mood reactivity, reversed vegetative symptoms (hypersomnia and weight gain), leaden paralysis, long-standing interpersonal rejection sensitivity

43
Q

Three types of postpartum mood

A

Within 4 weeks of delivery. “Blues” (50-85% incidence) characterized by depressed affect, tearfulness, fatigue starting 2-3 days after. Usually resolves in TEN DAYS. Tx = supportive. Postpartum depression (10-15% inc.), depressed, anxiety, poor concentration lasting TWO WEEKS to a YEAR. Pyschosis usually lasting 4-6 weeks..

44
Q

Pathologic grief

A

Longer than SIX-TWELVE months. Normal grief - shock, denial, guilt, somatic, simple hallucinations.

45
Q

Adverse effects of ECT?

A

Disorientation, temporary HA, partial anterograde /retrograde amnesia usu. fully resolving in 6 months

46
Q

Panic disorder

A

Intense fear and discomfort peaking in 10 minutes w/ at least four: Palps, Parasthesias, And distress, Nausea, Intense fear of dying/loss of control, light headedness, CP, Chills, Choking, disconnectedness, Sweating, Shaking, SOB. Tx = CBT, SSRI, venlafaxine, Benzos. Dx requires an attack AND FEAR of attack for 1 month

47
Q

GAD criteria

A

At least SIX MONTHS. Associated with sleep disturbance, fatigue, GI, difficulty concentration. Tx = SSRIs, SNRIs, buspirone, CBT

48
Q

Adjustment disorder

A

LESS than SIX months.

49
Q

OCD vs. OCPD

A

OCD is “Ego-dystonic” meaning that obsessions are INCONSISTENT with beliefs. Whereas OCPD are ego-tonic. Tx OCD with SSRIs and clomipramine

50
Q

PTSD

A

Persistent re-experiencing > ONE MONTH. Tx = psych, SSRIs. Acute stress disorder is 3 days to 1 month.

51
Q

Unexplained symptoms or complaints with a conscious attempt to deceive

A

If for SECONDARY gain = malingering. If chief goal is psychological (PRIMARY) = factitious disorder (where complaints continue even after gain)

52
Q

Munchausen syndrome

A

CHRONIC factitious disorder w/ predominantly physical signs and symptoms. Multiple admission, willingness to undergo procedures.

53
Q

Somatic symptom disorder vs. conversion disorder

A

Somatic symptom - varied complaints lasting months to years usu. associated with excessive thought and anxiety. Conversion - SUDDEN loss of sensory or motor function often following stress; pt aware but indifferent (la belle indifference)

54
Q

Personality disorder vs. trait

A

Disorder is inflexible, maladaptive, rigid pattern of behavior causing distress and impaired f(x). Pt usually NOT aware.

55
Q

Avoidant vs. dependent vs schizoid personality disorder

A

Avoidants are sensitive to rejection, desire relationships, feel inadequate. Dependents are submissive, CLINGY, need to be taken care of. Schizoids are VOLUNTARY social withdrawal and content with isolation.

56
Q

Histrionic vs narcissitic personality disorder

A

Histrionic - excessive emotionality and excitability, attention seeking, sexually provocative, appearance. Narcissitic = sense of ENTITLEMENT, lacks empathy, demands “the best.”

57
Q

Anorexia nervosa vs. Bulimia nervosa

A

Anorexia - Excessive dieting +/- purging, intense fear of gaining weight, body image distortion, and increase exercise (BMI < 18.5). Dec. bone density - metatarsal stress fx, amenorrhea, lanugo, anemia, electrolyte disturbances. Bulimia has BINGE eating +/- purging. Parotitis, enamel erosion, electrolyte distruabcnes, alkalosis, dorsal hand calluses (Russel)

58
Q

Sleep terror

A

Terror w/ screaming at night. non-REM (so no memory of arousal). slow-wave sleep

59
Q

Narcolepsy cause

A

Caused by decrease OREXIN production in lateral hypothalamus.

60
Q

Substance use disorder criteria

A

Two or more in ONE year: tolerance, withdrawal, larger amounts than desired, persistent dire to cut down, sig energy, important f(x) down, continued use, craving, recurrent use in physically dangerous situations, failure to fulfill obligations, conflicts

61
Q

Six stages of overcoming addiction

A

Pre-contemplation, contemplation, preparation/determination, action/willpower, maintenance, relapse

62
Q

Opioid intoxication vs. withdrawal

A

Intox - Pinpoint pupils, CNS depression, dec. gag, sz (Tx = naloxone or naltrexone). Withdrawal - sweating, dilation, piloerection, fever, thinorrhea, yawning, nausea, stomach cramps, diarrhea (Tx = support, methadone, buprenorphine)

63
Q

Amphetamine withdrawal vs. cocaine withdrawal

A

Amph - anhedonia, increased appetite, hyper-somnolence, existential crisis. Cocaine - hyper somnolence, malaise, severe craving, depression/suicidality

64
Q

Cocaine intox

A

Impaired judgment, pupils BIG, hallucinations, paranoid, angina, SCD. Tx = benzos

65
Q

PCP tx

A

Benzos and rapid-acting anti-psychotic

66
Q

Marijuana intoxication

A

Euphoria, anxiety, paranoid, perception of slowed time, impaired judgment, social withdrawal, inc. appetite, dry mouth, conjuctival inn, hallucinations

67
Q

Treatments for heroin addiction

A

Methadone - long-acting oral opiate. Naloxone + buprenorphine - partial agonist. Naltrexone is a long-acting opioid antagonist used for relapse prevention once detox’d

68
Q

DT’s time

A

2-5 days after last drink. Autonomic -> psychotic -> confusion. Tx = benzos

69
Q

Neuroleptic malignant syndrome

A

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Tx = dantrolene (binds ryanodine receptor to decrease intracellular Ca2+ = muscle relaxant), bromocriptine (DA agonist)

70
Q

Chlorpromazine side effects?

A

Corneal deposits

71
Q

Thioridazine side effects?

A

reTINAL deposits

72
Q

Clozapine

A

May cause agranulocytosis (weekly WBC) and seizures

73
Q

Risperidone side effects

A

Increased prolactin -> decreased GnRH, LH, and FSH (lactation, gynecomastia, irregular menstruation, fertility)

74
Q

Ziprasidone side effects

A

Prolonged QT

75
Q

Lithium side effects

A

Tremor, nephrogenic DI, hypothyroidism, pregnancy problems (Ebstein). Most is reabsorbed at PCT of kidney

76
Q

Serotonin syndrome

A

Hyperthermia, confusion, MYOCLONUS, CV collapse, flushing, diarrhea, sz. Tx = cyproheptadine (5-HT2 receptor antagonist)

77
Q

SNRIs

A

Venlafaxine and duloxetine. Inhibit 5-HT and NE reuptake. Venla used also for GAD and panic while duloxetine for diabetic peripheral neuropathy. Tox = HTN, stimulant, sedation nausea

78
Q

TCA toxicities

A

Alpha-1 blocking (hypotension), antichol (tachy, urinary retntion, dry mouth, seen more in amitriptyline over nortriptyline). Cardiotoxicity (Tx = NaHCO3)

79
Q

MAOi names

A

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B)

80
Q

MAOi

A

Increase NE, 5-HT, and DA. Tox = HTN, CNS stim, serotonin syndrome. Thought to be more useful for atypical depression (phenelzine and tranylcypromine; leaden, mood reactivity, rejection sensitivity, inc. sleep + appetite)

81
Q

Bupropion

A

Antidepressant also used for smoking cessation. Increases NE and DA by unknown. SE - SEIZURE, stimulant, HA. No sexual side effects

82
Q

Mirtazapine

A

alpha-2 antagonist (increased release of NE and 5-HT) and 5-HT2/3 antagonist. Tox = sedation, increased appetite and weight gain, dry mouth

83
Q

Trazodone

A

Blocks 5-HT2 and alpha-1 adrenergic. Tox - priapism, sedation, nausea, postural hypotension

84
Q

Globus pharyngis/hysteriucs

A

Feeling of lump in one’s throat. 45% of pop. gets at one point. Commonly triggered by emotions/stress.

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