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Year 5 Psych > Other Psych > Flashcards

Other Psych Flashcards

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1
Q

Hypothyroidism’s psychiatric effects

A

Dementia
Depression
Anxiety
Acute agitation (“myxoedema madness”)

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2
Q

Hyperthyroidism’s effect on mood

A

Anxiety, depression, apathy

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3
Q

Psych effects hypercortisolemia

A

Depression or mania

“Steroid psychosis”

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4
Q

Psych effects of hypocortisolemia (Addison’s)

A

Depression, apathy

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5
Q

Pysch effects of pheochromocytoma

A

Episodic anxiety

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6
Q

Psych effects of hyperparathyroidism

A

Depression
Apathy
Memory deficits
Psychotic symptoms

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7
Q

Psych effects of B12 deficiency

A 
Subacute combined degeneration of spinal cord'Slowing of mental processes
Confusion
Memory problems
Intellectual impairment
Paranoid delusions
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8
Q

Psych complications MS

A

Depression (>50%), stress-related
Suicidal ideation
Increased incidence BPAD
Transient psychoses and elation, related to disease progress
Early cognitive impairment and late progressive dementia

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9
Q

Psych complications SLE

A

Transient fluctuating psych disturbances, esp acute confusional states
Depressive psychoses less frequently
Steroid tx may further psych complications

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10
Q

Psych complications-Wilson’s

A

May be presenting feature in >50%
Affective and behavioral changes most commonly
Cognitive changes

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11
Q

Psych complications Acute Intermittent Porphyria

A

Delirium (50%)
Depression
Emotional lability
Schizophrenia-like psychoses (esp paranoid)

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12
Q

Simmond’s disease

A

Hypopituitarism causing depression, irritability, impaired memory

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13
Q

PMS

A

Physical and behavioral sxs that recur in 2nd half menstrual cycle and first few days menses. Sxs must be severe enough to impair social and occupational functioning

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14
Q

PMDD

A

Prominent presence of 1 or more marked affective syndromes (depression, anxiety, affective lability, anger, irritability). Related to menses

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15
Q

Menopause-psych complications

A

Increased anxiety and depression–experience itself, not hormones, OR hormones exacerbating pre-existing mood disorders

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16
Q

Ix-PMS

A

Prospective charting daily sxs for at least two menstrual cycles essential to confirm.
Rule out migraine, chronic fatigue, gynae conditions

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17
Q

Tx-PMS

A

Fluoxetine, starting in luteal phase

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18
Q

Pseudocyesis

A

Woman firmly believes herslef to be pregnant and develops objective pregnancy signs in absence pregnancy

Somatoform disorder, variant depression.
Presents as complication of post-partum depression or psychosis with amenorrhea.
Rule out ectopic, corpus luteal cyst, placenta previa, pituitary/pelvic tumor

Psych tx: supportive or insight-oriented psychotherapy

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19
Q

Postnatal depression

A

Signif depressive episode, within 6/12 postpartum.

RFs: personal or FHx depression, old age, single mother, poor relationship with own mother, ambivalence toward or unwanted pregnancy, poor support, signif other stressors, previous postpartum psychosis

Edinburgh Postnatal Depression Scale
Bio: antidepressants
Psychosocial: psychoeducation, CBT, support (health visitors, social workers)

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20
Q

Postpartum psychosis

A

Acute psychotic episode, peak at 2/52 postpartum
RF: personal/FHx major psych disorder, lack support, single parent, previous PPP

Lability of sxs, insomnia, perplexity, bewilderment, disorientation, thoughts suicide/infanticide

Bio: ECT, mood stabilizers (carbamazepine), early use antidepressants. Antipsychotics

ADMIT.

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21
Q

Sexual dysfunction

A

Persistent impairment normal patterns of sexual interest/response.

Bio causes: drugs/EtOH, med side effects, pain/discomfort, feeling tired, recent childbirth

Psych causes: relationship problems, performance anxiety, excessive monitoring self-arousal, guilt, fear preg or STIs, lack knowledge, previous rape or childhood abuse

Social: fear interruption, partner (attractiveness), disinterest, criticism, sexual inexperience, sexually incompatible

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22
Q

Sexual aversion

A

Strong negative feelings, fear, anxiety due to prospect of sexual interaction, of sufficient intensity to lead to active avoidance of sexual activity

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23
Q

Excessive sexual desire

A

Nymphomania in women, satyriasis in men.
Can be secondary to mood disorder (mania), in early dementia, associated with LD, secondary to brain injury, drug side effect

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24
Q

Erectile failure

A

Inability to develop/maintain erection.
RF: moral/religious views on sex, previous negative experiences, performance anxiety, EtOH/drugs, stress/fatigue

Physical causes: older, gradual onset, no erections, lost RFs (smoking, DM, obesity, HTN, EtOH etc)
Psych causes: younger, sudden onset, erections present at morning, on masturbation

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25
Conduct disorder
One or more of following: - Aggression/cruelty to people/animals - Destruction property - Deceitfulness - Theft - Fire-setting - Truancy - Running away from home - Severe provocative or disobedient behavior
26
Oppositional defiant disorder
Enduring pattern negative, hostile, defiant behavior No serious violation societal norms or rights of others May occur in one situation only
27
Tx conduct disorder and oppositional defiant disorder
``` Functional family therapy Behavioral management aggression Parent training (positive parenting program, incredible years program) Remedial teaching Alternative peer group activities ```
28
Separation anxiety disorder
Increased and inappropriate anxiety around separation from attachment figures or home
29
School refusal
Not a dx May have somatization Peak ages 5-6 (separation anxiety) and 10-11 (school transition), adolescents (low self-esteem, depression)
30
Most common emotional disorder in childhood
Generalized anxiety Somatization common Temperament and parental overprotection may predispose
31
Pervasive development disorder
Severe impairments social interactions and communication skills. Restricted stereotyped interests and behaviors Includes autism, asperger's, rett's, childhood disintegrative disorder
32
Autism
Abn reciprocal social interaction, communication, language impairment. Repetitive repertoire of interests and activities RFs: Downs, Fragile X, obstetric complications, toxic agents, pre or post-natal infection (rubella), neuro disorders (e.g. tuberous sclerosis) Three characteristic features within first three years life: 1. Impairment in social interaction (poor use non-verbal behaviors) 2. Impairment in communication 3. Restricted stereotyped interests and behaviors
33
Asperger's
Similar to autism but no signif abnormalities in language acquisition or cognitive development/intelligence
34
Childhood disintegrative disorder (heller's syndrome)
M>F 2 years normal development followed by loss previously acquired skills before age 10. Assoc with autism-like impairment of social interaction and repetitive stereotyped interests and mannerisms After deterioration, may resemble autism
35
Tx-autism
Antipsychotics for stereotypies SSRIs for compulsive and self-harming behavior Behavioral interventions: behavioral modification, social skills training, CBT Social therapies include educational and vocational interventions
36
Rett's syndrome
Almost all are women Initially normal development then motor deterioration and severe LD from 6/12 Progressive and destructive encephalopathy and stereotyped hand movements (midline hand-wringing) MECP2 gene on X chromo implicated
37
ADHD/Hyperkinetic disorder: RFs and sxs
80% genetically inherited. Increased risk with low birth weight, maternal substance use in pregnancy, head injury, metabolic disorders, prolonged emotional deprivation. Three core sxs: - Inattention - Hyperactivity - Impulsiveness
38
Ix-ADHD
``` Interview family and child Observe child in more than one setting Collateral information (SCHOOL REPORT) Conner's rating scale Screen for comorbidities Neuro exam ```
39
Tx-ADHD
Methylphenidate (Ritalin) Atomoxetine Psychoeducation Behavioral interventions School interventions
40
Elective mutism
Selectivity in vocal communication depending on social circumstances Small percentage have speech/articulation problem Psycho-social: psych stress, social anxiety, oppositional behavior
41
Tic disorders
Sudden, repetitive, non-rhythmic movements or vocalizations Involuntary but can be suppressed for brief periods More prominent during times stress Simple motor tics, e.g. blinking, neck jerking Simple vocal tics, e.g. grunting, coughing Complex motor tics, e.g. jumping Complex vocal tics, e.g. senseless repetition of words
42
Gilles de la Tourette's syndrome
Multiple motor and one or more vocal tics At least one year Causes distress and impaired function Usu develops by age 7 Tx with antipsychs, alpha adrenergics if severe and impairing Treat comorbid conditions (OCD, ADHD) Psychoeducation Awareness and relaxation training, habit reversal traning School liaison
43
Non-organic enuresis
Involuntary voiding of urine in children who have established bladder control according to devel age. Primary: never established urinary continence Secondary: continence achieved in past
44
Causes non-organic enuresis
Genetics (75% have 1st degree relative with same problem) Devel delay Stress Inadequate toilet training
45
Tx-non-organic enuresis
Medication is last resort: desmopressin, imipramine Psych: enuresis alarms, STAR CHART! for good behavior (e.g. using bathroom before bed), not outcomes Social: parental education, educate about toilet training esp if primary
46
Non-organic encoparesis
Deposition feces in inappropriate places in children who should have established consistent bowel control Primary-when bowel control never been achieved Secondary-after period normal bowel control
47
Non-organic encoparesis: causes
``` Devel delay Coercive or punitive potty training Emotional, physical, or sexual abuse Disturbed parent-child relationship Parental marital conflict Other psych disturbance, e.g. autism ```
48
Non-organic encoparesis: tx
``` Medical management if appropriate e.g. laxatives Change in diet if appropriate Education child and family STAR CHARTS Sneaky Poo therapy ```
49
Learning Disability-definition
Devel condition characterized by global impairment intelligence and signif difficulties in socially adaptive functioning
50
impairment-definition
Loss or abnormality of psych, physiological, or anatomical structure or function
51
Disability-definition
Restriction or lack (from impairment) of ability to perform an activity in manner and range considered normal
52
handicap-definition
Disadvantage for given individual, resulting from impairment or disability that limits or prevents the fulfilment of role that is normal to that individual
53
Mild learning disabilities
Language alright but delayed Live independently Struggle academically Variable emotional/social immaturity
54
Moderate learning disabilities
Speech delayed; deficits in speech and comprehension Few have numeracy/literacy Can do simple, supervised work Reduced self-care and limited motor skills Majority have identifiable organic cause
55
Severe learning disabilities
Marked impairment motor fn Little/no speech in childhood--may develop some later 24hr care
56
Profound learning disabilities
Severely limited language, communication, self-care and mobility Significant associated medical problems, higher level support Organic etiology clear in most cases
57
Down's syndrome
Trisomy 21 Intell impairment, characteristic facies and habitus Dx'd at birth but intell disability evident end 1st year life Delayed milestones Many associated physical problems Psychiatric comorbidities common--depression, BPAD, Tourette's, schizophrenia, autism, DEMENTIA--early onset
58
Genetic conditions causing LD
``` Prader-Wili Angelman ("Happy Puppet syndrome") Cri du chat DiGeorge Noonan's Tuberous sclerosis Neurofibromatosis Sturge-Weber PKU Fragile XTurners Trisomy X Klinefleters XYY male Autism ```
59
Non-genetic causes LD
``` FAS Iodine deficiency and congenital hypothyroidism Toxins infective agents (TORCH infections) Hypoxic damage CNS and skull devel abnormalities ```
60
Biological causes dementia
Parenchymal degeneration intracranial mass Infection (vCJD, syph) Endo-hypothyroid, hyperparathyroid, Cushings, addisons Metabolic-uremia, hepatic encephalopathy, hypoglycemia, Mg derangement, electrolyte imbalance, B12 defic Toxins-heavy metal, EtOH
61
Sxs dementia
Short to long term memory impairment Personality change: forgetful, social withdrawal, mood lability, disinhibition, silliness, reduced self-care, apathy, fatigue, deteriorating executive fn Dysphagia, agnosia, apraxia Anxiety and/or depression
62
Ddx-depression
``` Delirium Depression (pseudodementia) Amnestic disorders LD Psychosis Normal aging ```
63
Reversible causes dementia
``` Hematomas SOL NPH Endocrine causes Vitamin deficiencies ```
64
Ix-dementia
Bloods: FBC, LFT, U&Es, gluc, ESR, TSH, Ca, Mg, PO4, VDRL, HIV, B12, folate, CRP, blood culture, LP, EEG, CXR, ECG, CT, MRI, SPECT Let's just do all the tests Assess with MMSE, ACE-III Assess functionality and social functioning
65
Tx-dementia
Anticholinesterase inhibitors (tacrine, donepezil, rivastigmine) Antioxidants (selegiline, Vit E) Treat comorbidities
66
Alzheimers: pathology and cause
MCC dementia (2/3) Amyloid plaques in hippocampus, cortex, substantia nigra Neurofibrillary tangles (phosphorylated tau) Loss neurons and synapses Causes: genetics: APP, apoE4 Age
67
Alzheimer's-sxs
Four A's: amnesia, aphasia, agnosia, apraxia Early: failing memory, muddled efficiency with ADLs, spacial dysfn, wandering, irritability Middle: intell and personality changes. Dysphasia, aphasia, apraxia, agnosia, impaired visospatial skills and executive fn Late: fully dependent, physical deterioration, incontinecne, gait abnormalities, spasticity, seizures, tremor, weight loss, primitive reflects, EPS Psych delusions and hallucinatins in a few Depression comon
68
Lewy body dementia
15-20% senile dementia Progressive cognitive decline of sufficient magnitude to interfere with normal functions Lewy bodies: eosinophilic neuronal inclusions with alpha-synuclein and ubiquitin in brainstem nuclei, BG, paralimbic structures
69
Lewy body dementia-sxs
Fluctuating cognition with pronounced variations in attention and alertness Recurrent visual hallucinations: well-formed and detailed Spontaneous motor features parkinsonism
70
Lewy body dementia-tx
Don't give with antipsychs (at least at our level)--neuroleptic malignant syndrome risk
71
Fronto-temporal dementia (Pick's disease)
Early onset. Atrophy fronto-temporal regions | Associated with mutations in tua gene
72
Fronto-temporal dementia: sxs
insidious onset and gradual progression, early decline in social/interpersonal conduct. Emotional blunting, loss insight All sorts of other signs too long to list but are exactly what you imagine they are.
73
vascular dementia
``` Infarcts caused by thromboemboli or arteriosclerosis (causing HTN) RFs are RFs for atherosclerosis STEP-WISE decline. May follow CVA. More acute than Alzheimer's Emotional and personality changes early. ``` Manage causative factors Daily aspirin especially--delays progression
74
Delusional misidentification syndrome
Delusional belief that someone you know has been replaced by an imposter who is their exact double Delusions that strangers or ppl pt meets are pt's persecutors in disguise
75
Delusional parasitosis
Believe that insects are colonizing their bodies
76
Folie a deux
Shared delusion, usu within family
77
De Clerambault's syndrome
Delusion that someone (usu man of higher status) is in love with her Inappropriate advances. Can become angry and violent when rejected
78
Cotard's syndrome
Nihilistic delusion where pt thinks parts of body are rotting and they've stopped existing Believe themselves to be dead/unable to die, therefore eternally alive
79
Munchausens/Factitious disorder
Feigned illness | Can have munchausen's by proxy
80
Couvade syndrome
Experience symptoms resembling pregnancy in expectant fathers
81
Ganser's syndrome
Approximate, absurd, inconsistent answer to simple questions Dissociative reaction against intolerable stress Overrepresented in prison populations
82
Idealization
Part of splitting | Another individual has more positive traits/qualities than actually possesses
83
Sublimation
Transforms negative emotion into socially acceptable ones. E.g. art, sport
84
Projective identification
Self-fulfilling prophecy | Projected emotions/feelings alter behavior
85
Systemic therapy
Aka family therapy | Explores relationships between individuals (i.e. in systems).
86
Dialectical behavior therapy
Intended for borderline | CBT + distress tolerance + mindfulness
87
Arbitrary inference
Cognitive distortion where individual jumps to conclusion without evidence

Year 5 Psych (5 decks)

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