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From Flashcardlet > First Aid Psychiatry > Flashcards

First Aid Psychiatry Flashcards

0
Q

Stanford Binet IQ Test

A

Calculates IQ as mental age/ chronoligical age X100

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1
Q

What are different ways to measure Intelligence Quotient?

What is the mean IQ defined at? Standard Deviation? Diagnosis for Mental Retardation? Severe Mental Retardation? Profound Mental Retardation

A

Stanford Binet IQ Test, Wechlser Adult Intelligence Scale (WAIS III), Wechsler Intelligence Scale for Children (WISC)

100 is mean, standard deviation is 15
IQ< 70 is one of criteria for diagnosis of mental retardation

IQ< 40 severe MR, IQ< 20 profound MR

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2
Q

Wechler Adult Intelligence Scale (WAIS III)

A

Uses 14 subtests (7 verbal, 7 performance). Can quantify intellectual decline

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3
Q

Wechsler Intelligence Scale for Children

A

Used for children between ages 6-16

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4
Q

What are the two types of simple learning? Definitions

A

Habituation- repeated stimulation leads to decreased response.

Sensitization- repeated stimulation leads to increased response.

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5
Q

Classical Conditioning

What happened in pavlov’s experiment.

A

Learning in which a natural response (Salivation) is elicited by a conditioned, or learned stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food)

Ringing the bell provoked salivation.

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6
Q

What is operant conditioning? What are the four types of operant conditioning?

A

Learning in which a particular action is elicited because it produces a reward.

Positive reinforcement- desired reward produces action (mouse pressures button to get food)

Negative Reinforcement- Removal of aversive stimulus elicits behavior (mouse presses button to avoid shock)

Punishment- application of aversive stimulus extinguishes unwanted behavior
Extinction- discontinuation of reinforcement eliminates behavior

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7
Q

What are reinforcement schedules? What are the types? Which one is rapidly extinguished/ Slowly extinguished?

A

Pattern of reinforcement determines how quickly a behavior is learned or extinguished.

Continuous- reward received after every response. Rapidly extinguished

Variable Ratio- reward received after random number of responses. Slowly extinguished.

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8
Q

Transference?

A

Patient projects feelings about formative or other important persons onto physician.

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9
Q

Countertransference?

A

Doctor projects feelings about formative or other important persons onto patient.

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10
Q

What is the central goal of Freuidian psychoanalysis?

A

Make patient aware of what is hidden in his/her unconsciousness.

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11
Q

What is Id, Ego, Superego?

A

Id- Primal Urges, food, sex, aggression. Id “drives” instict. Entirely subconcious

Ego- mediator between primal urges and behavior accepte in reality.

Superego- moral values, conscience, can lead to self-blame and attacks on ego.

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12
Q

Explain the Oedipus Complex?

A

Repressed sexual feelings of a child for opposite-sex parent, accompanied by rivalry with same-sex parent. First described by Freud.

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13
Q

Describe Shaping and Modeling in social learning

A

Shaping- behavior achieved following reward of closer and closer approximations of desired behavior

Modeling- behavior acquired by watching others and assimilating actions onto own repertoire.

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14
Q

Describe Erickson’s Stages of Psychosocial Development. Examples?

A

8 stages of normal development, each posing a new crisis. Unsuccessful completion of a stage may manifest as psychosocial maladaptation later in life.

Examples include the oral sensory sage at 0-12-18 months where trust vs. mistrust is crisis.

Adolescence stage at 12-20 years where identity vs. role confusion is crisis.

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15
Q

Ego Defenses

A

Unconscious mental processes of the ego used to resolve conflict and prevent feelings of anxiety and depression.

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16
Q

Ego Defense: Acting Out

A

Unacceptable feelings and thoughts are expressed through actions. Tantrums.

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17
Q

Ego Defense: Dissociation

A

Temporary drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress.

Extreme forms can result in dissociative identiy disorder (multiple personality disorder)

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18
Q

Ego Defense: Denial

A

Avoidance of awareness of some painful reality

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19
Q

Ego Defense:Displacement

A

Process whereby avoided ideas and feelings are transferred to some neutral person or object (vs. projection).

Mother places blame on child because she is angry with husband

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20
Q

Ego Defense: Fixation

A

Partially remaining at a more childish level of development vs. regression.

Men fixating on sports games

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21
Q

Ego Defense: Identification

A

Modeling behavior after another person who is more powerful (through not necessarily admired). Abused child identifies himself/ herself as an abuser.

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22
Q

Ego Defense: Isolation of affect

A

Separation of feelings from ideas and events.

Describing murder in graphic detail with no emotional response.

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23
Q

Ego Defense: Projection

A

An unacceptable internal impulse is attributed to an external source.

Ex. a man who wants another woman thinks his wife is cheating on him.

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24
Q

Ego Defense: Rationalization

A

Proclaiming logical regions for actions actually performed for other reasons. Usually to avoid self lame

After getting fired, claiming that the job was not important anyway.

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25
Q

Ego Defense: Reaction formation

A

Process whereby a warded-off idea or feeling is replaced by an unconscioulsy derived emphasis on its oposite.

Patient with libidinous thoughts enters a monastery.

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26
Q

Ego Defense: Regression

A

Turning back the maturational clock and going back to earlier modes of dealing with the world.

Seen in children under stress (bedwetting) and in patients on dialysis (crying)

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27
Q

Ego Defense: Repression

A

Involuntary witholding an idea or feeling from consciousness awareness

Not remembering a conflictual or traumatic experience. Pressing bad thoughts into the unconscious

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28
Q

Ego Defense: Splitting

A

Belief that people are either all good or all bad at different times due to intolerance of ambiguity. Seen in borderline personality disorder.

Patient that says all nurses are cold and insensitive but that the doctors are warm and friendly.

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29
Q

What are the mature/ less primitive ego defenses?

A

Sublimation, Altruism, Suppression, Humor

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30
Q

Ego Defense: Sublimation

A

Process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system.

Actress uses experience of abuse to enhance her acting. Sublimation in chemistry: substance changes from a solid to a gas

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31
Q

Ego Defense: Altruism

A

Guilty feeling alleviated by unsolicited generosity towards others.

Mafia boss makes large donation to charity

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32
Q

Ego Defense: Suppression

A

Voluntary withholding of an idea or feeling from conscious awareness (vs. repression).

Choosing not to think about hte USMLE until the week of the exam.

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33
Q

Ego Defense: Humor

A

Appreciating hte amusing nature of an anxiety- provoking or adverse situation.

Nervous medical student jokes about the boards.

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34
Q

What are effects of long-term deprivation of affection in infants?

A

Decreased muscle tone, poor language skills, poor socialization skills, Lack of basic trust, Anaclitic depression (hospitalism), weight loss, physical illness

Severe deprivation can result in infant death. Deprivation for > 6 months can lead to irreversible changes.

4 W’s: weak, wordless, wanting, wary

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35
Q

Physical Abuse Evidence, Abuser, Epidemiology

A

Evidence- healed fractures on x-ray, cigarette burnes, subdural hematomas, multiple bruises, retinal hemorrhage or detachment

Abuser- Usually female and the primary caregiver

3000 deaths/ year in the United States

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36
Q

Sexual Abuse Evidence, Abuser, Epidemiology

A

Evidence- Genital/ Anal Trauma, STDs, UTIs

Abuser- known to victim, usually male

Peak incidence 9-12 years of age.

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37
Q

Child Neglect

A

Failure to provide a child with adequate food, shelter, supervision, education, and/or affection. Most common form of child maltreatment.

Evidence: poor hygiene, malnutrition, withdrawal, impaired social/ emotional development, failure to thrive.

As with child abuse, child neglect must be reported to local child protective services.

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38
Q

Anaclitic Depression (Hospitalism)

A

Depression in an infant attributable to continued separation from caregiver.

Infant becomesw withdrawn and unresponsive.

Reversible, but prolonged separation can result in failure to thrive or otehr developmental disturbances (Delayed speech)

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39
Q

Regression in Children

A

Children regress to younger patterns of behavior under conditions of stress such as a physical illness, punishment, birth of a new sibling, or fatigue (bedwetting in a previously toilet-trained child when hospitalized).

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40
Q

What are the Childhood and Early Onset Disorders?

A

ADHD, Conduct Disorder, Oppositional Defiant Disorder, Tourette’s Syndrome, Separation Anxiety Disorder

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41
Q

What happens in ADHD? Associated with? Treatment

A

Limited attention span and poor impulse control. Onset before age 7.

Characterized by hyperactivity, motor impairment, and emotional lability. Normal intelligence but commonly coexists with difficulty in school.
May continue into adulthood in as many as 50% of individuals.

Associated with decreased frontal lobe volumes.

Treat with methylphenidate (Ritalin), amphetamines (Dexedrine), atomoxetine (nonstimulant SNRI)

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42
Q

Conduct Disorder? After 18 years, what is this diagnosed as?

A

Repetitive and pervasive behavior violating social norms (physical aggression, destruction of property, theft).

Diagnosed as antisocial personality disorder after 18

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43
Q

Oppositional Defiant Disorder

A

Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms.

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44
Q

Tourette’s Syndrome. Lifetime prevalence? Associated with? Onset at? Treatment

A

Characterized by sudden, rapid, recurrent nonrhythmic stereotyped motor movements or vocalizations (tics) that persist for greater than 1 year. Lifetime prevalence of 0.1-1.0% in the general population.

Coprolalia (obscence speech) found in only 20% of patients.

Associated with OCD. Onset at < 18 years of age.

Treatment: antipsychotics.(haloperidol)

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45
Q

Separation Anxiety Disorder. Common onset?

A

Overwhelming fear of separation form home or loss of attachment figure. May lead to factitious physical complaints to avoid going to school. Common onset from 7-9 years of age.

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46
Q

What are the pervasive developmental disorders?

A

Autistic Disorders, Aspergers, Rette’s disorder, Childhood disintegrative disorder

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47
Q

Autistic Disorder, More common in? Treatment?

A

Severe language impairment and poor social interactions. Greater focus on objects than on people. Characterized by repetitive behavior and usually below-normal intelligence. Rarely, may have unusual abilities (savants). More common in boys. Treatment: behavioral and supportive therapy to improve communication and social skills.

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48
Q

Asperger’s Disorder

A

A milder form of autism. Characterized by all-absorbing interests, repetitive behaviors, and problems with social relationships. Children are of normal intelligence and lack verbal or cognitive deficits. No language impairement.

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49
Q

Rette’s Disorder? Most commonly affects?

A

X-linked disorder seen almost exclusively in girls (affected males die in utero or shortly after birth).

Normal to age 4, followed by regression characterized by loss of development, mental retardation, loss of verbal abilities, ataxia, and stereotyped hand-wrining. Symptoms can begin anytime after 1 year.

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50
Q

Childhood disintegrative disorder? Common onset?

A

Marked regression in multiple areas of functioning after at least 2 years of apparently normal development. Significant loss of expressive or receptive language skills, social skills, or adaptive behavior, bowel or bladder control, play, or motor skills.

Common onset between 3 and 4 years of age. More common in boys.

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51
Q

What neurotransmitter changes will you see with anxiety?

A

Increased NE, Decreased GABA, Decreased Serotonin

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52
Q

What neurotransmitter changes will you see with depression?

A

Decreased NE, Decreased SE, Decreased dopamine

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53
Q

What neurotransmitter changes will you see with Alzheimer’s?

A

Decreased ACH

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54
Q

What neurotransmitter changes will you see with Huntington’s?

A

Decreased GABA, Decreased ACH

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55
Q

What neurotransmitter changes will you see with schizophrenia?

A

Increase dopamine

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56
Q

What neurotransmitter changes will you see with Parkinson’s

A

Decreased dopamine, Increased ACH

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57
Q

Orientation, what is the order of loss? Common causes of loss of orientation

A

Person’s ability to know who he or she is, what date and time it is, and what his or her present circumstances are.

Common causes of loss of orientation include: alcohol, drugs, fluids/ electrolyte imbalance, head trauma, hypoglycemia, nutritional deficiencies.

Order of loss: 1st- time, 2nd- place, last- person.

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58
Q

What are the four types of amnesia?

A

Retrograde, Anterograde, Korsakoff’s Amnesia, Dissociative Amnesia

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59
Q

Retrograde Amnesia-

A

Inability to remember things that occurred before a CNS insult

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60
Q

Anterograde Amnesia

A

Inability to remember things that occurred after a CNS insult (no new memories)

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61
Q

Korsakoff’s Amnesia. Seen in what populations? Associated with?

A

Classic anterograde amnesia caused by thiamine deficiency. Leads to bilateral destruction of mamilary bodies. May also lead to some retrograde amnesia.

Seen in alcoholics and associated with confabulations

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62
Q

Dissociative amnesia

A

Inability to recall important personal information, usually subsequent to severe trauma or stress.

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63
Q

Delirium. What do you want to check for? Hows the EEG look?

A

Waxing and Waning Level of consciousness with acute onset. Rapid decrease in attention span and level of arousal.

Characterized by acute changes in mental status, disorganized thinking, hallucinations (often visual), illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction.

Most common psychiatric illness on medical and surgical floors. Abnormal EEG

Check for drugs with anticholinergic effects. Often reversible.

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64
Q

Dementia. Hows the EEG look? Causes?

A

Gradual decrease in cognition with no change in level of consciousness. Characterized by memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/ personality changes, impaired judgment.

Patient is alert.
Increased incidence with age. More often gradual onset. Normal EEG.
Caused by alzheimer’s disease, vascular thrombosis, hemmorhage ( may have acute/subacute onset), HIV, pick’s disease, substance abuse, CJD

USUALLY IRREVERSIBLE.

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65
Q

Pseudodementia

A

In Elderly patients, depression may present like dementia.

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66
Q

Hallucination

A

Perceptions in the absence of external sitmuli

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67
Q

Illusion

A

Misinterpretation of actual external stimuli

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68
Q

Delusions

A

False beliefs not shared with otehr members of a culture/ subculture that are firmly maintained in spite of obvious proof to the contrary.

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69
Q

Loose associations

A

Disorders in the form of thought (the way ideas are tied together)

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70
Q

Schizophrenia. Associated with? How long? Risk Factors

A

Periods of psychosis and disturbed behavior with a decline in functioning lasting > 6 months.

Associated with increased dopaminergic activity and decreased dendritic branching

Marijuana Use is a risk factor for schizophrenia in teenagers.

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71
Q

What does diagnosis of Schizophrenia require?

A

2 or more of the following:

  1. Delusions
  2. Hallucinations.
  3. Disorganized speech (loose associations)
  4. Disorganized or catatonic behavior.
  5. Negative symptoms- flat affect, social withdrawal, lack of motivation, lack of speech of thought
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72
Q

How long does brief psychotic disorder last?

A

<1 month, usually stress related

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73
Q

Schizophreniform Disorder

A

1-6 months

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74
Q

Schizoaffective Disorder

A

at least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episode. 2 subtypes: bipolar or depressive.

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75
Q

What are the five types of schizophrenia?

A 
Paranoid (delusions)
Disorganized (With regard to speech, behavior, and affect)
Catatonic (Automatisms)
Undifferentiate (elements of all types)
Residual
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76
Q

Which plays more of a role in schizophrenia: genetic or environmental factors? Lifetime prevalence? How does it present?

A

Genetics factors

Lifetime prevalence of 1.5%. Males= females, blacks= whites.

Presents earlier in men (late teens to early 20s vs. late 20s to early 30s in women).

Patients are at increased risk of suicide.

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77
Q

Delusional Disorder

A

Fixed, persistant nonbizarre belief system lasting greater than 1 month. Functioning otherwise not impaired. Often self-limited.

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78
Q

Shared Psychotic Disorder (Folie a Deux)

A

Development of delusions in a person in a close relationship with someone with delusional disorder. Often results upon separation.

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79
Q

What are the dissociative disorders

A

Dissociative identitiy disorder, depersonalization disorder, dissociative fugue

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80
Q

Dissociative identity disorder. More common in? Associated with a history of?

A

Formerly known as multiple personality disorder. Presence of 2 or more distinct identities or personality states. More common in women. Associated with history of sexual abuse.

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81
Q

Depersonalization Disorder

A

Persistent feelings of detachment or estrangment from oneself

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82
Q

Dissociative Fugue

A

Abrupt change in geographic location with inability to recall past, confusion about personal identity or assumption of a new identity. Associate with traumatic circumstances (natural disasters, wartime, trauma). Leads to significant distress or impairment. Not the result of substance abuse or general medical conditions.

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83
Q

Types of hallucinations and what they are common in?

A

Visual Hallucinations- common in delirium
Auditory Hallucinations- common in schizophrenia
Olfactory Hallucinations- often occurs as an aura of psychomotor epilsepy

Gustatory- Rare

Tactile Hallucination- Common in alchol withdrawal (formication- the sensation of ants crawling on one’s skin). Also seen in cocaine abusers (cocaine bugs)

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84
Q

Hypnagogic hallucinations

A

Occurs while going to sleep

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85
Q

Hypnopompic hallucinations

A

Occur while waking from sleep (Pompous upon awakening)

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86
Q

Manic Episode

A

Distinct period of abnormally and persistently elevate, expansive, or irritable mood lasting at least one week. Often disturbing to patients.

Diagnosis requires 3 or more of the following: Distractilbility, Irresponsibility, Grandiosity, Flight of Ideas, Increase in goal-directed activity/ psychomotor agitation, decreased need for sleep, talkativeness or pressured speech

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87
Q

Hypomanic Episode

A

Like manic disorder except mood disturbance is not severe enough to cause marked impairment in social/ and or occupational funcitoning or to neccessitate hospitalization. No psychotic features.

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88
Q

Bipolar Disorder. Treatment

A

Defined by presence of at least 1 manic (Bipolar 1) or hypomanic (bipolar II) episode. Depressive symptoms always occur eventually. Use of antidepressants can lead to increased mania. Patients mood and functoning usually return to normal between episodes.

Engagement in pleasurable activities with painful consequences can be seen.

High suicide risk.

Treatment: high mood stabilizers (lithium, valproic acid, carbamazepine, atypical antipsychotics)

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89
Q

Cyclothymic Disorder-

A

Milder form of bipolar disorder lasting at least 2 years

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90
Q

Major Depressive Episode

A

Characterized by atleast 5 of the folowing 9 symptoms for 2 weeks (symptoms must include patient-reported depressed mood or anhedonia.

Sleep Disturbance, Loss of Interest, Guilt or feelings of worthlessness, Loss of Energy, Loss of concentration, Appetite/ weight changes, Psychomotor ertardation or agitation, suicidal ideations, depressed mood

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91
Q

Major Depressive Disorder

A

Recurrent- requires 2 or more major depressive episodes with a symptom free interval of 2 months

92
Q

Lifetime prevalence of major depressive episode?

A

5-10% ion males, 10-25% females

93
Q

Dysthymia-

A

milder form of depression lasting at least two years.

94
Q

Seasonal Affective Disorder

A

Associated with winter season, improves in response to full-spectrum light exposure.

95
Q

What does the sleep pattern of depressed patients look like?

A

Decreased slow-wave sleep, Decreased REM latency, Increased REM early in sleep cycle, Increased total REM, Repeated nighttime awakenings, Early morning awakening (important screening question)

96
Q

Atypical Depression? Treatment?

A

Differs from classical forms of depression. Characterized by hypersomnia, overeating and mood reactivity (the ability ot experience improved in response to positive events vs. persistent sadness.

Associated with weight gain and sensitivity to rejection.

Most common subtype of depression.

Treatment: MAOIs/ SSRI

97
Q

Electroconvulsive Therapy? Adverse effects?

A

Treatment option for major depressive disorder refractory to other treatment. Produces a painless seizure in an anesthesized patient. Major adverse effects are disorientation and anterograde/ retrograde amnesia (can be minimized when ECT is performed unilaterally)

98
Q

Risk Factors for Suicide

A

Sex (Male), Age (Teenager or Elderly), Depression, Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness), 3 or more prescription medications, Organized plan, No spouse (divorced, widowed, or single especially if childless). Social support lacking.

Women try more often. Men succeed more often.

99
Q

Panic Disorder? Treatment

A

Defined by the presence of recurrent periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following. Described in context of occurence. Associated with persistent fear of having another attack.

Palpitations, Paresthesias, Abdominal Distress, Nausea, Intense Fear of dying or losing control. Chest Pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of breath.

Treatment: Cognitive behavioral therapy, SSRIs, TCAs, benzodiazepines.

100
Q

Specific Phobia

A

Fear that is excessive or unreasonable and interferes with normal function. Cued by presence or anticipation of a specific object or situation. Person recognizes fear is excessive. Can treat with systematic desensitization.

101
Q

Social Phobia (Social Anxiety Disorder). Treat with?

A

Exaggerated fear of embarassment in social situations (public speaking, using public restrooms). Treatment: SSRIs.

102
Q

Obsessive Compulsive Disorder? Treatment? Associated with?

A

Recurring, intrussive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by performance of repetitive actions (compulsions). Ego dystonic; behavior inconsistent with one’s own beliefs and attitudes (vs. obsessive compulsive personality disorder). Associated with Tourette’s disorder.

Treatment: SSRIs, clomipramine

103
Q

Post Traumatic Stress Disorder (PTSD) vs. Acute Stress Disorder? Treatement for PTSD

A

Persistent reexperiencing of a previous traumatic event. May involve nightmares or flashbacks, intense fear, helplessness, or horror. Leads to avoidance of stimuli associate with the trauma and persistently increased arousal.

Disturbance lasts greater than a month with onset greater than 1 month after event and causes significant distress and/or impaired functioning.

Treatment: psychotherapy, SSRIs
Acute Stress Disorder- lasts between 2 days/ 1 month

104
Q

Generalized anxiety disorder? Treatment?

A

Pattern of uncontrollable anxiety for atleast 6 months that is unrelated to a specific person, situation, or event. Associated with sleep disturbance, fatigue, and difficulty concentrating.

Treatment: Benzodiazepines, buspirone, SSRIs.

105
Q

Adjustment Disorder

A 
Emotional Symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (Divorce, illness) and lasting less than 6 months. 
Greater than 6 months in presence of a chronic stressor.
106
Q

Malingering

A

Patient consciously fakes of claims to have a disorder in order to attain a specific secondary gain (avoiding work, obtaining drugs). Avoids treatment by medical personnel. Complaints cease after gain (vs. factitious disorder)

107
Q

Factitious Disorder?

A

Patient consciously creates physical and/or psychological symptoms in order to assume sick role and to get medical attention (primary gain).

108
Q

Manchausens Syndrome

A

Chronic Factitious Disorder with predominantly physical signs and symptoms. Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures.

109
Q

Munchausen’s Syndrome By Proxy

A

When illness in a child is caused by the caregiver. Motivation is to assume a sick role by proxy. Form of child abuse.

110
Q

Somatoform Disorders. More common in?

A

Category of disorders characterized by physical symptoms with no identifiable physical cause. Both illness production and motivation are unconscious drives. Symptoms not intentionally produced or feigned.
More common in women.

111
Q

What are the somatoform disorders?

A

Somatization Disorder, Conversion, Hypochondriasis, Body Dysmorphic Disorder, Pain Disorder

112
Q

Somatization Disorder

A

Variety of complaints in multiple organ systems (Atleast 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over a period of years

113
Q

Conversion

A

motor or sensory symptoms, often following an acute stressor. Patient is aware but indifferent toward symptoms.

114
Q

Hypochondriasis

A

Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance

115
Q

Body Dysmorphic Disorder

A

Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning. Patients often repeatedly seek cosmetic surgery.

116
Q

Pain Disorder

A

Prolonged pain with no physiologic findings.

117
Q

Personality Trait

A

An enduring repetitive pattern or perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts.

118
Q

Personality Disorder

A

Inflexible, Maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and or impaired functioning. Person is usually not aware of problem. Stably by early adulthood and not usually diagnosed in children.

119
Q

Describe the Cluster A Personality Disorders. What are the different types? Genetic Association with?

A

Odd or eccentric, inability to develop meaningful social relationships. No psychosis. Genetic Association with schizophrenia.

Paranoid, Schizoid, Schizotypal
“Weird”= Accusatory, Aloof, Awkward

120
Q

Paranoid

A

Cluster A, Pervasive Distrust and Suspiciousness, projection is major defense mechanism

121
Q

Schizoid

A

Cluster A, Voluntary social withdrawal, limited emotional expression, content with social isolation (vs. avoidant).

SchizoiD= distant

122
Q

Schizotypal

A

Cluster A, Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness. Schizotypal= magical thinking

123
Q

Describe Cluster B personality disorders. What are the different types?

A

Dramatic, emotional, erratic, genetic association with mood disorders and substance abuse.

“Wild” (Bad to the Bone)
Types are antisocial, borderline, histrionic, narcissistic.

124
Q

Antisocial, more common in?

A

Cluster B, disregard for and violation of rights of others, criminality, males> females, conduct disorder if less than 18

125
Q

Histrionic

A

Cluster B, excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance

126
Q

Narcissistic

A

Cluster B, Grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demands the “best” and reacts to criticism with range.

127
Q

Cluster C description?

A

Anxious or fearful; genetic association with anxiety disorders

“Worried” (Cowardly, Compulsive, Clingy”

Avoidant, obsessive compulsive, and dependent

128
Q

Avoidant

A

Cluster C, Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid)

129
Q

Obsessive Compulsive

A

Cluster C, Obsessive Compulsive- preoccupation with order, perfectionism, and control. Ego syntonic; behavior consistent with one’s own beliefs and attitudes (vs. OCD)

130
Q

Dependent

A

Cluster C, Submissive and clinging, excessive need to be taken care of, low self-confidence

131
Q

What is the schizophrenia time course?

A

<1 month- brief psychotic disorder, usually stress related

1-6 months- schizophreniform disorder

> 6 months schizophrenia

132
Q

What is the progression of schizophrenia?

A

Schizoid< Schizotypal (Schizoid+ odd thinking)< Schizophrenic (Greater odd thinking than schizotypal)< schizoaffective (schizophrenic psychotic symptoms + bipolar or depressive mood disorder)

133
Q

Anorexia Nervosa

A

Excessive Dieting +/- purging. Intense fear of gaining weight, body image distortion, and increase exercise leading to body weight less than 85% below ideal body weight. Associated with decreased bone density. Severe weight loss, metatarsal stress fractures, amenorrhea, anemia, and electrolyte disturbances. Seen primarily in adolescent girls. Commonly coexists with depression.

134
Q

Bulimia Nervosa

A

Binge Eating +/- purging followed by self-induced vomiting or use of laxatives, diuretics, or emetics. Body weight often maintained within normal range.

Associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting (Russell’s sign)

135
Q

Gender Identity Disorder

A

Strong persistent cross-gender identification. Characterized by persistent discomfort with one’s sex causing significant distress and/or impaired functioning.

136
Q

Substance Dependence

A

Maladaptive Patterns of substance use defined as 3 or more of the following signs in 1 year:

  1. Tolerance- need more to achieve same effect
  2. Withdrawal
  3. Substance taken in larger amounts or over longer time than desired
  4. Persistent Desire or unsuccessful attempts to cut down
  5. Significant energy spent obtaining, using, or recovering from substance.
  6. Important social, occupational, or recreational activities reduced because of substance abuse.
  7. Continued use in spite of knowing hte problems it causes
137
Q

Substance Abuse

A

Maladaptive pattern leading ot clinically significant impairment or distress. Symptoms have never met criteria for substance dependence.

  1. Recurrent use resulting in failure to fulfill major obligations at work, school, or home.
  2. Recurrent use in physically hazardous situations.
  3. Recurrent substance-related legal problems
  4. Continued use in spite of persistent problems caused by use
138
Q

Substance Withdrawal

A

Behavioral, physiologic, and cognitive state caused by cessation or reduction of heavy and prolonged substance use. Signs and symptoms often opposite to those seen in intoxication.

139
Q

What happens in Alcohol intoxication? Treatment

A

Disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts, serum gamma-glutamyltransferase- sensitive indicator of alcohol use.

Treatment: naltrexone, disulfuram

140
Q

What happens in alcohol withdrawal?

A

Tremors, tachycardia, hypertension, malaise, nausea, seizures, delirium tremens (DTs), tremulousness, agitation, hallucinations (including tactile)
Treatment for DT: Benzodiazepine

141
Q

Opiods (morphine, heroin, methadone) withdrawal. Treatment?

A

CNS depression, nausea, vomiting, constipation, pupillary constriction (pinpoint pupils), seizures (overdose is life threatening).

Treatment: naloxone, naltrexone

142
Q

Opiod withdrawal

A

Anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (cold turkey), fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike symptoms), yawning.

Treatment: symptomatic, naloxone+ buprenorphine (suboxone), methadone

143
Q

Barbiturates Intoxication? Treatment?

A

Low safety margin, respiratory depression.

Treatment: symptom management (Assist respiration), Increased BP.

144
Q

Barbituate Withdrawal

A

Anxiety, seizures, delirium, life treatening cardiovascular collapse

145
Q

Benzodiazepine Intoxication. Treatment: flumazenil

A

Greater safety margin, amnesia, ataxia, somnolence, minor respiratory depression. Additive effects with alcohol. Treatment: Flumazenil (Competive GABA antagonist)

146
Q

Benzodiazepine Withdrawal

A

Rebound anxiety, seizures, tremor, insomnia

147
Q

What drugs are depressants?

A

Alcohol, Opiods, Barbituates, Benzodiazepines

148
Q

What drugs are stimulants

A

Amphetamines, Cocaine, Caffeine, Nicotine

149
Q

What drugs are hallucinogens

A

PCP, LSD, Marijuana

150
Q

What does amphetamine intoxication cause?

A

Psychomotor agitation, impaired judgment, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever

151
Q

What does amphetamine withdrawal cause?

A

Post-use crash including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence

152
Q

Cocaine Intoxication, Treatment?

A

Euphoria, psychomotor agitation, impaired jugment, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), aranoid ideations, angina, sudden cardiac death.

Treat with a benzodiazepines

153
Q

Cocaine Withdrawal

A

Post-use crash including severe depression and suicidality, hypersomnolence, fatigue, malaise, severe psychological craving

154
Q

Caffeine Intoxication

A

Restlessness, insomnia, Increased diuresis, muscle twitching, cardiac arrhythmias

155
Q

Caffeine withdrawal

A

Headache, lethargy, depression, weight gain

156
Q

Nicotine Intoxication

A

Restlessness, insomnia, anxiety, arrhythmias

157
Q

Nicotine Withdrawal. Treatment?

A

Irritability, headache, anxiety, weight grain, craving.

Treatment: Buproprion, Varenicline

158
Q

PCP Intoxication

A

Belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirium

159
Q

PCP withdrawal

A

Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

160
Q

LSD Intoxication (No withdrawal symptoms)

A

Marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation

161
Q

Marijuana Intoxication

A

Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, hallucinations

162
Q

Marijuana Withdrawal

A

Irritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hours and last 5-7 days. Can be detected in urine up to 1 month after use.

163
Q

Heroine Addiction. Users at increased risk for what? Treatment

A

Increased risk for hepatitis, abscesses, overdoses, hemorrhoids, AIDS, and right sided endocarditis. Look for track marks (needle sticks in veins). Symptoms of opiod intoxication (pinpoint pupils, respiratory depression, coma)

Treatment: Naloxone, Naltrexone- competitively inhibits opiods, used in cases of overdose

Methadone- long acting oral opiate, used for heroine detoxification of long term maintenenance
Suboxone- naloxone+ buprenorphine (partial agonist), long acting with fewer withdrawal symptoms than methadone. Naloxone is not active when taken orally, so withdrawal symptoms occur only if injected (lower abuse potential)

164
Q

Alcoholism

A

Physiologic tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs) when intake is interrupted

165
Q

Alcoholism Complications

A

Alcohol cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy

166
Q

Wernicke Korsakoff Syndrome. Treatment?

A

Caused by thiamine deficiency. Triad of confusion, opthalmoplegia, and ataxia (wernicke’s encephalopathy). May progress to irreversible memory loss, confabulation, personality change (Korsakoff’s psychosis).

Associated with periventricular hemorrhage/ necrosis or mammilary bodies.

IV Vitamin B1 (Thiamine)

167
Q

Mallory Weiss Syndrome

A

Longitudinal Lacerations at the gastroesophageal junction caused by excessive vomiting. Often present with hematemesis. Associated with pain vs. esophageal varices

168
Q

Treatment for alcoholism

A

Disulfiram (to condition the patient to abstain from alcohol use), supportive care. Alcoholics Anonymous and other peer support groups are helpful in sustaining abstinence.

169
Q

Delirium Tremens (DTs). Treatment?

A

Life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink.

Symptoms in order of appearance: autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions), confusion.

Treatment: Benzodiazepines.

170
Q

Treatment for alcohol withdrawal

A

Benzodiazepine

171
Q

Treatment for anorexia/bullemia

A

SSRI

172
Q

Treatment for anxiety?

A

Benzodiazepines, Buspirone, SSRIs

173
Q

Treatment for ADHD

A

Methylphenidate (Ritalin), Amphetamines (Dexedrine)

174
Q

Treatment for Atypical Depression

A

MAO Inhibitors

SSRIs

175
Q

Treatment for Bipolar Disorder

A

“Mood Stabilizers” Lithium, Valproic Acid, Carbamazepine, Atypical Antipsychotics

176
Q

Treatment for Depression

A

SSRIs, SNRIs, TCAs

177
Q

Treatment for Depression with Insomnia

A

Mirtazapine

178
Q

Treatment for Obsessive Compulsive Disorder

A

SSRIs, Clomipramine

179
Q

Treatment for Panic Disorder

A

TCAs, Benzodiazepines

180
Q

Treatment for PTSD

A

SSRIs

181
Q

Treatment for schizophrenia

A

Antipsychotics

182
Q

Treatment for Tourette’s

A

Antipsychotics

183
Q

Treatment for social phobias

A

SSRIs

184
Q

Methylphenidate mechanism and clinical use

A

Increase presynaptic NE vesicular release (like amphetamines). However, the mechanism for relieving ADHD symptoms is not known.

Clinical Use for ADHD

185
Q

Name some Antipsychotics (Neuroleptics)

A

Haloperidole, Trifluoroperazine, Fluphenazine, Thioridazine, Chlorpromazine (Haloperidol+ azines)

186
Q

Antipsychotics Mechanism

A

All typical antipsychotics block dopamine D2 receptors (Increase cAMP)

187
Q

Antipsychotics Clinical Use

A

Schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette’s syndrome

188
Q

Antipsychotics toxicity

A

Highly lipid soluble and stored in body fat, thus very slow to be removed from body.

Extrapyramidal system side effects

Endocrine Side effects (dopamine receptor antagonism-> hyperprolactinemia-> galactorrhea)

Side effects arising from blocking muscarining (dry mouth, constipation), a (hypotension), and histamine (sedation) receptors

Neuroleptic Malignant Syndrome, Trdive Dyskinesia

189
Q

Neuroleptic Malignant Syndrome. Treatment

A

Rigidity, Myoglobinuria, Autonomic Instability, Hyperpyrexia, Treatment: dantroline, dopamine agonist (bromocriptine)

190
Q

Tardive Dyskinesia

A

Stereotypic oral-facial movements due to long-term antipsychotic use. Often irreversible.

191
Q

High Potency Antipsychotics

A

Haloperidol, Trifluoperazine, Fluphenazine- neurologic side effects

192
Q

Low potency

A

Thioridazine, chlorpromazine, non-neurologic side effects

193
Q

Chlopromazine side effects

A

Corneal Deposts

194
Q

Thioridazine

A

reTinal Deposits

195
Q

Evolution of EPS side effects from antipsychotics

A

4h- acute dystonia (mscle spasm, stiffness, oculogyric crisis)

4 days- akinesia (parkinsonian symptoms)

4wk (akathisia- (restlessness)

4 mo (tardive dyskinesia)

196
Q

Name the atypical antipsychotics

A

Olanzapine, clozapine, quetiapine, risperidone, ariprazole, ziprasidone

197
Q

Mechanism of antipsychotics?

A

Blocks 5Ht, A, H1, and dopamine receptors

198
Q

Clinical use of antipsychotics

A

Schizophrenia (useful for both positive and negative symptoms)

Olanzapine is used for OCD, anxiety, depression, mania, and tourettes

199
Q

Toxicity of antipsychotics

A

Fewer extrapyramidal and anticholinergic side effects than tradiational antipsychotics.
Olanzapine/ Clozapine may cause significant weight gain.

Clozapine may cause agranulocytosis (requires weekly WBC monitoring)

200
Q

Lithium Mechanism of Action

A

Not established, possibly related to inhibition of phosphoinosital cascade

201
Q

Lithium Clinical Use

A

Mood stablizer for bipolar disorder; blockers relapse and acute manic events. Also SIADH

202
Q

Lithium Toxicty

A

Tremors, Sedation, Edema, Heart Block, Hypothyroidism, Polyruria (ADH antagonist causing nephrogenic diabetes insipidis), teratogenesis. Narrow therapeutic window requires close monitoring of serum levels.

203
Q

Mnemonic to remember lithium side effects

A 
Lithium Side Effects
Movement (tremors)
Nephrogenic Diabetes Insipidus
HypOthyroidism
Pregnancy Problems
204
Q

Buspirone Mechanism and Clinical Use

A

Stimulates 5HT1A receptors.

Used in generalized anxiety disorder. Does nto cause seationm, addiction, or tolerance and does not interact with alcohol (vs. barbituates, benzodiazepines)

205
Q

Name some TCA drugs

A

Imipramine, Amitriptyline, Desipramine, Nortriptyline, Clomipramine, Doxepine, Amoxapine

206
Q

TCA Mechanism of Action

A

Block reuptake of NE and serotonin

207
Q

TCA Clinical Use

A

Major depression, bedwetting (imipramine), OCD (clomipramine), fibromyalgia

208
Q

TCA Side Effects

A

Sedation, a-blocking effects, atropine-like (anticholinergic side effects), tachycardia, urinary retention)

3 TCA like amitriptyline have more anticholinergic effects than do 2 TCAs notriptyline.

Desipraminne is the least sedating and has the lower seizure threshold.

209
Q

TCA Toxicities. Treatment for what specific condition.

A

TriCs convulsions, coma, cardiotoxicity (arrhythmias), also respiratory depression, hyperpyrexia, confusion and hallucinations in elderly due ot anticholinergic side effects (use nortriptyline).

Use Na Bicarbonate for cardiovascular toxicity

210
Q

Name some SSRI drugs and mechanism of action.

A

Fluoxetine, Paroxetine, Sertraline, Citalopram

Selective Specific Reuptake Inhibitor

211
Q

SSRI clinical use

A

Depression, OCD, Bullimia, social phobias

212
Q

How long does it take for antidepressants to have an effect?

A

Takes 2-3 weeks

213
Q

SSRI toxicities

A

Fewer than TCAs, GI distress, sexual dysfunction (anorgasmia). “Serotonin Syndrome” with any drug that increases serotonin (MAOI inhibitors).

214
Q

What happens in serotonin syndrome. What do you use to treat serotonin syndrome?

A

Hyperthermia, muscle rigidity, cardiovascular collapse, flushing, diarrhea, seizures,

5Ht receptor antagonist. Cyproheptadine.

215
Q

Name some SNRIs and Mechanism of action

A

Venlafaxine, Duloxetine

inhibits serotonin and NE reuptake

216
Q

SNRI clinical use. Which SNRI has greater effect on NE

A

Depression. Venlafaxine is also used for generalized anxiety disorder, duloxetine is indicated for diabetic peripheral neuropathy.

Duloxetine has greater effect on NE.

217
Q

Toxicities associated with SNRI

A

Increase in BP is most common, also simulant effects, sedation, and nausea

218
Q

What are some names of MAOIs and mechanism of action of MAOIs?

A

Selegiline (Selective MAO-B inhibitor), Phenylzine, Isocarboxazid, Trancyclopramine

Nonselective MAO inhibition which will increase levels of amine neurotransmitters

219
Q

What are MAOI inhibitors used for?

A

Atypical depression, anxiety, hypochondriasis

220
Q

What are some toxicities of MAOIs

A

Hypertensive crisis with tyramine ingestion in many foods, such as wine and cheese and B- agonists. CNS stimulation. Contraindicated with SSRIs or meperidine to prevent serotonin syndrome

221
Q

Name some atypical antidepresants

A

Buproprion, Mirtazapine, Maprotiline, Trazadone

222
Q

Buproprion (Wellbutrin) mechanism of action and toxicity

A

Used for smoking cessation. Increases NE and dopamine via unknown mechanism

Toxicities include stimulant effects (Tachycardia, insomnia) headache, seizure in bullimic patients. No sexual side effects

223
Q

Mirtazapine mechanism of action

A

A2 antagonist (increase release of NE and serotonin) and potent 5-HT2 and 5HT3 receptor antagonist.

224
Q

Mirtazapine Toxicites

A

Sedation, increased appetite, weight gain, dry mouth

225
Q

Maprotiline Mechanism of Action and Toxicities

A

Blocks NE reuptake.

Sedation, orthostatic hypotention

226
Q

Trazodone mechanism of action and toxicities

A

Primarily inhibits serotonin reuptake. Used for insomnia as high doses are needed for antidepressant effects. Toxicity: sedation, nausea, priapism, postural hypotension.

TrazoBone due to male specific side effects

227
Q

Draw a serotonergic neuron and noradrenergic neuron acting on a postsynaptic neuron. Draw different Drugs and the effects they will have on the presynaptic receptors.

A

.

From Flashcardlet (18 decks)

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