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Pathology Flashcards

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1
Q

Psych genetics

A

Combination of genetics and environmental influences

Genes seem to play a big role with schizophrenia and bipolar disorder

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2
Q

Infant deprivation effects

A

Weak
Wordless
Wanting
Wary

Be sure to distinguish failure to thrive causes: can be deprivation, malnutrition, malabsorption, or glycogen storage disease

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3
Q

Child abuse- physical

A

Fractures- spiral; in different stages of healing
Subdural hematomas and retinal hemorrhages
Lack of eye contact
Often mother (biological)

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4
Q

Child abuse- sexual

A

genital, anal, oral trauma; STIs, UTIs

Usually male perpetrator
Peak incidence in 9-12 year olds

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5
Q

Child neglect

A

Failure to provide kid with adequate food, shelter, supervision, education, affection

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6
Q

Vulnerable child syndrome

A

Parents think kid is extremely susceptible to injury
Often as a result of a serious or life-threatening event
Signs: missed school or overuse of medical services

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7
Q

ADHD

A

Onset before 12
Limited attention span and poor impulse control

Often continues into adulthood (50%)- tx with methylphenidate +/- CBT

Other treatments: atomoxetine, guanfacine, clonidine

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8
Q

Autism spectrum disorder

A

Poor social interactions, repetitive/ ritualized behaviors, restricted interests

May be assoc. with intellectual disability, savants (unusual abilities), more common in boys

Assoc with increased head/ brain size and tuberous sclerosis

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9
Q

Rett syndrome

A

X-linked dominant disorder (seen almost exclusively in girls- boys die)

Regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and HAND WRINGING

Think of this when you see a GIRL with HAND-WRINGING

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10
Q

Conduct disorder

A

Repetitive and pervasive behavior –> violates social norms (stealing, destruction of property)

Often progresses to antisocial disorder (dx at 18)

Tx: CBT

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11
Q

Oppositional defiant disorder

A

Enduring pattern of hostile and defiant behavior in the ABSENCE of serious violations of social norms

Kid saying no all the time

Oppositional defiant disorder –> Conduct disorder –> Antisocial

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12
Q

Separation anxiety disorder

A

7-9 years
Overwhelming fear of separation from home or loss of family figure
Factitious complaints/ Avoids going to school
Tx: family therapy, play therapy, CBT

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13
Q

Tourette syndrome

A

Onset before age 18
Sudden, rapid, recurrent, non-rhythmic motor and vocal tics that persist for > 1yr (Motor&raquo_space; Vocal)
Assoc with OCD and ADHD

Tx: psychoeducation, CBT
High potency anti-psychotics (fluphenazine, pimozide), tetrabenazine, guanfacine, and clonidine

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14
Q

NT changes- Alzheimers

A

Decreased ACh

Increased glutamate

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15
Q

Anxiety

A

Decreased GABA and 5-HT

increased NE

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16
Q

Depression

A

Decreased NE, 5HT, and dopamine

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17
Q

Huntington

A

Decreased GABA, ACh

Increased dopamine

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18
Q

Parkinson

A

Decreased dopamine

Increased ACh

Opposite (essentially) of Huntington (HT also affects GABA)

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19
Q

Schizophrenia

A

Increased dopamine (just like HT)

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20
Q

Orientation

A

Ability for a person to know who he or she is

General order of loss: 1. time, 2. place, 3. person

Causes of loss: alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, infection, nutritional deficiencies

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21
Q

Amnesia

A

Retrograde- can’t remember what happened BEFORE a CNS injury
Anterograde- can’t make new memories (AFTER a CNS injury)
Korsakoff- confabulations, anterograde amnesia, personality change, and memory loss (permanent)

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22
Q

Dissociative amnesia

A

Can’t recall important PERSONAL information after a severe trauma

Kind of sounds like repression??

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23
Q

Dissociative identity disorder

A

AKA multiple personality disoder

2 or more distinct identities or personality states (more common in women)

Associated with hx of sexual abuse, PTSD, depression, substance abuse, borderline personality, somatoform conditions

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24
Q

Depersonalization/ derealization disorder

A

Detachment or estrangement from body, through, perceptions, and actions (DEPERSONALIZATION)

Or from one’s environment (DEREALIZATION)

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25
Delirium
REVERSIBLE (hrs to days) "waxing and waning"-- remember what else is?? Follicular B cell lymphoma Either ways, waxing and waning level of consciousness with acute onset Disorganized thinking, hallucinations (visual), illusions Generally secondary to other illness (CNS disease, infection, trauma, substance abuse/withdrawal, metabolic and electrolyte disturbances, hemorrhage, fecal retention) Can be caused by anticholinergics in the elderly
26
Dementia
DeMEMtia is characterized by MEMory loss; usually IRREVERSIBLE Decrease in intellectual function WITHOUT affecting consciousness Memory deficits, apraxia, aphasia, agnosia, loss of abstract thought, behavioral/ personality changes, impaired judgment **NOTE: In the elderly, depression and hypothyroidism (which causes decreased energy/ depression) can present like dementia; therefore check TSH levels, B12 levels, and screen for depression before diagnosing them with dementia
27
Psychosis
Distorted perception of reality --> characterized by hallucinations (auditory), and disorganized thinking
28
Delusions
Unique false beliefs that persist despite the facts (thinking aliens are communicated with you)
29
Disorganized thought
Speech may be incoherent, tangential, or derailed
30
Hallucinations
Perceptions in the absence of external stimuli Visual- assoc. with MEDICAL illness Auditory- assoc. with psych illness (SCHIZOPHRENIA) Olfactory- can be seen with temporal lobe epilepsy and brain tumors Gustatory- rare, seen in epilepsy Tactile- seen with alcohol WITHDRAWAL and stimulant USE (cocaine crawlies) HypnaGOgic- while GOing to sleep (seen in narcolepsy) HypnoPOMPic- when waking from sleep (also seen in narcolepsy)
31
Schizophrenia
S&S > 6 MONTHS Chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning 1. Delusions 2. Hallucinations (auditory) 3. Disorganized speech 4. Disorganized behavior 5. Negative symptoms (affective flattening, avolution (lack of motivation), anhedonia- can't feel pleasure, asociality, alogia- lack of speech) Can be precipitated by cannabis use; ventriculomegaly seen in brain imaging Tx: ATYPICAL antipsychotics (e.g. risperidone)
32
Brief psychotic disorder
If schizophrenic symptoms last for <1mo Assoc with stress
33
Schizophreniform disorder
If lasting 1-6 months
34
Schizoaffective disorder
If > 2 weeks of hallucinations or delusions, but NO MOOD DISORDER (depression or mania)
35
Delusional disorder
False beliefs lasting >1month Can be shared by individuals in close relationship Ex: Man is convinced that his wife is cheating on him (involves one person --> not pervasive like paranoid personality disorder)
36
Mood disorder
Abnormal range of moods or internal emotional states and loss of control over them Episodic psychotic features may be present
37
Manic episode
Lasts AT LEAST 1 week ``` DIGFAST Distractibility Irritability Grandiosity Flight of ideas Agitation Sleep is less Talkativeness ```
38
Hypomanic
Similar to manic, but LESS THAN 4 days
39
Bipolar
Bipolar I- at least one manic episode +/- depressive/hypomania Bipolar II- hypomanic + depressive episode Think that Type II has TWO types of moods Tx: mood stabilizers (lithium, valproic acid, carbamazepine), ATYPICAL antipsychotics
40
Major depressive disorder
Lasts 6-12 months ``` SIGECAPS + depressed mood Sleep disturbance Interest is lost (anhedonia) Guilt/ worthlessness Energy loss and fatigue Concentration probs Appetite/ weight changes Psychomotor retardation or agitation Suicidal ideation ``` Episodes: at least 5/9 symptoms for 2 or more weeks Tx: 1st line- CBT and SSRIs SNRIs, mirtazapine (alpha2 blocker), buproprion (increases NE and dopamine)
41
Persistant depressive disorder (dythymia)
milder depression, lasts > 2years
42
Depression (with atypical features)
``` Mood reactivity (+ mood --> but brief) Hypersomnia, hyperphagia Leaden paralysis (heaviness in arms and legs) Interpersonal rejection sensitivity Tx: CBT and SSRIs ```
43
Postpartum mood disturbances
Onset within 4 wks of delivery "Blues": resolves within 10 DAYS Depression: More than 10 days --> SIGECAPS Psychosis: delusions, hallucinations, and thoughts of harming the baby or self --> Tx: hospitalization, atypical antipsychotic, ECT
44
Grief
Usually less than 6 months Characterized by shock, denial, guilt, sadness, anxiety, yearning and somatic symptoms May have hallucinations of the deceased person; duration varies widely NO SUICIDAL IDEATION
45
Pathologic grief
Generally after more than 6 months; persistent and can cause functional impairment
46
Electroconvulsive therapy
Used for tx refractory depression (or deep with psychotic symptoms) Produces grand mal seizure in patient Can lead to disorientation, temporary headache, amnesia (that generally resolves in 6 months)
47
Suicide completion risk (SADPERSONS)
SADPERSONS ``` Sex (male) Age (young adult or elderly) Depression Previous attempt Ethanol or drug use Rational thinking loss (psychosis) Sickness (medical illness) Organized plan No spouse or social support Stated future intent ``` Most common method of success is firearms
48
Anxiety disorder
Inappropriate experience of fear/worry and its physical manifestations Interfere with daily functioning Includes panic disorder, phobias, generalized anxiety disorder, and selective mutism Tx: CBT, SSRIs, and SNRIs
49
Panic disorder
Recurrent panic attacks Requires 1 MONTH or more of: - Persistent concern of additional attacks - Worrying about the consequences of attack - Behavioral change related to attack Periods of intense fear (peaking in 10 minutes, with at least 4 of the following) Palpitations, paresthesias, dePersonalizations/ derealization Abdominal distress Nausea Intense fear of dying, intense fear of losing control or going crazy, lIghtheadedness Chest pain, chills, choking Sweating, shaking, shortness of breath Tx: CBTs, SSRIs, and venlafaxine (SNRI) --> same as anxiety disorder
50
Specific phobia
Fear or anxiety about a specific object or situation Social anxiety- fear of social situations (public speaking, public restrooms) Agoraphobia- fear of open or enclosed places (e.g. public txportation, leaving home alone, lines, crowds) Tx: Same as with panic disorder (CBT, SSRI, SNRI) + beta blocker or benzo for acute attacks (social) OR MAOIs for agoraphobia
51
Generalized anxiety disorder
Anxiety for > 6 MONTHS UNRELATED to a specific person, situation, or event Same tx as anxiety disorder (CBT, SSRIs, SNRIs)
52
Adjustment disorder
Anxiety about an identifiable psychosocial stressor lasting < 6 MONTHS (can be greater is the stressor is chronic) Tx: CBTs, SSRIs
53
OCD
Reccuring obsession that cause sever distress; relieved by partaking in the compulsion Associated with Tourettes Tx: CBT, SSRI and clomipramine (TCAD)
54
Body dysmorphic disorder
Preoccupation with minor or imagined defect in appearance Pts seek repeated cosmetic treatment Tx: CBT
55
PTSD
Disturbance last > 1 month after prior trauma | Tx: CBT, SSRIs, and venlafaxine (just like with panic disorder)
56
Acute stress disorder
Similar symptoms as PTSD but lasts between 3 days and 1 month Tx: CBT, pharm generally not needed
57
Malingering
Patient fakes or exaggerates to get a secondary (external) gain (e.g. avoid work) Complaints CEASE after gain, as opposed to factitious disorder
58
Factitious disorder
Patient CONSCIOUSLY creates a physical/ psychological symptom in order get primary (internal gain)--> attention HOWEVER these people do not have a variety of bodily complaints --> that is more characteristic of somatic symptom disorder
59
Subclasses of factitious disorder
Imposed on self (Munchausen): chronic, physical signs and symptoms; multiple hospital admissions an willingness to undergo invasive procedures imposed on another (Munchausen by proxy): illness in a child or elderly patient is caused or fabricated by caregiver --> THIS IS ELDER/CHILD abuse
60
Somatic symptom and related disorders
Physical symptoms causing significant distress and impairment Illness production and motivation are UNCONSCIOUS drives --> not intentionally produced or feigned
61
Somatic symptom disorder
Variety of bodily complaints (pain, fatigue) --> lasts months to years Associated with anxiety about symptoms Tx: CBT and SSRIs
62
Conversion (functional neurological symptom) disorder
Loss of sensory or motor function (paralysis, blindness, mutism) --> often following an acute stressor
63
Illness anxiety disorder
Excessive preoccupation with acquiring or having a serious illness (despite medical evaluation) Hypochondriacs
64
Pseudocyesis
False, non delusional belief of being pregnant
65
Eating disorders- anorexia
Anorexia- excessive dieting or binging/purging with BMI < 18.5 Associated with decreased bone density, severe weight loss, stress fractures, and amenorrhea (due to loss of hypothalamic GnRH signal) Tx: psychotherapy and nutritional rehabilitation (NOTE: SSRIs are not first line! -vs. Bulimia) BEWARE of refeeding syndrome: increased insulin --> hypophosphatemia & hypokalemia --> cardiac complications
66
Bulimia nervosa
NOT associated with low BMI Binge eating with purging/fasting/laxatives occurring weekly for at least 3 months & overvaluation of body image Associated with parotitis, enamel erosion, electrolyte disturbances, alkalois, dorsal hand calluses Tx: psychotherapy, nutritional rehab, and antidepressants
67
Binge eating disorder
Regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors) Increased risk of diabetes Tx: psychotherapy such as CBT, SSRIs
68
Gender dysphoria
People not identifying with their gender | E.g. people who are transgender may have gender dysphoric disorder
69
TransSEXualism
Desire to live as the opposite sex (often through surgery)
70
TrasVESTism
Paraphilia, not gender dysphoria; wearing CLOTHES (e.g. VEST) of the opposite gender (cross-dressing)
71
Sexual dysfunction
Sexual desire disorders Sexual arousal disorders Orgasmic disorders Sexual pain disorders DDx: drugs (antiHTN, anti depressants, neuroleptics), diseases (depression, diabetes, and STIs), and psychological (performance anxiety)
72
Sleep terror syndrome
Terror with screaming in the middle of the night Occurs during slow-wave/ deep (N3) sleep Triggers: emotional stress, fever, lack of sleep Usually self-limited
73
Restless leg syndrome
Uncomfortable sensation in legs --> accompanied by urge to move them (worse at rest and falling asleep) Tx: dopamine agonists (pramiprexole)
74
Narcolepsy
Disordered regulation of sleep-wake cycle --> excessive daytime sleepiness, though they awaken feeling rested Caused by decreased OREXIN (HYPOCRETIN) production in the lateral hypothalamus Associated with: 1. Hypnogogic/ hypnopompic hallucinations 2. nocturnal and narcoleptic sleep episodes that start with REM sleep 3. Cataplexy: loss of all muscle tone following strong emotional stimulus (e.g. laughter) Strong genetic association Tx: daytime stimulants (amphetamines, modafinil), nighttime (sodium oxybate- GHB)
75
Substance use disorder
Two or more of the following signs Tolerance Withdrawal Taken in larger amounts or over a larger time than desired Persistant desire or unsuccessful attempts to cut down Significant energy spent obtaining or using (or recovering) Impacts other activities Craving Continued use despite physical/psych effects
76
Stages of overcoming
1. Precontemplation- no acknowledgment of prob 2. Contemplation- acknowledges prob, but doesn't want to do anything about it 3. Preparation/ determination- getting ready to make a change 4. Action/ willpower- changes behavior 5. Maintenance- maintains changed behavior 6. Relapse- goes back to old habits, abandons new changes
77
Pica
Consistent consumption of non-food or non-staple food for > 1 month (e.g. ice, soil, flour, etc)
78
Short acting vs. long acting benzos
Short: MOT- midazolam, oxazepam, and triazolam Mid (6-24 hrs): ALT- alprazolam, lorazepam, and temazepam Long: Diazepam, chlordiazepoxide, flurazepam Use short/ mid acting ones to minimize undesirable daytime lethargy
79
Benzos that are not metabolized in the liver
LOT- lorazepam, oxazepam, temazepam
80
Lithium
Used for bipolar SE: hypothyroidism (constipation, fatigue, etc.) and nephrogenic DI
81
Valproate
Used to tx absence, tonic-clonic, and myoclonic seizures SE: Hepatotoxicity, NTDs
82
Carbamazepine
Used for trigeminal neuralgia SE: agranulocytosis, SIADH, NTDs
83
Lamotrigine
Used to tx depressive episodes and focal seizures SE: rash, SJS

Psychiatry (4 decks)

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