Psych Flashcards
(154 cards)
1
Q
Two things one should cover in a psych interview that might not normally be covered?
A
- Feelings
2. Relationships
2
Q
Reasons confidentiality should not be kept in a psych interview
A
Admissions of:
- Abuse
- Suicidal ideation/homicidal ideation
3
Q
What is the term to describe a historian that’s not the patient?
A
Collateral source
4
Q
What events during early life should be asked about in a psych interview?
A
- Pregnancy and delivery
- Temparment and important family events
- Relationships
- Culture and relationships
5
Q
A list of what should be made during a psych interview?
A
Previous psychiatric issues as well as treatments; in chronological order
6
Q
A substance history in a psych interview should include what substance that might not otherwise be asked?
A
Caffeine
7
Q
What are the four pillars of communication that a interview should practice during a psych interview?
A
- Attentive silence
- Facilitation (encouraging comments)
- Summarization
- Clarification (drawing connections)
8
Q
Terms for rate of speech
A
- Rapid
- Slow
- Halting
9
Q
Terms for amount of speech
A
- Taciturn (saying little)
- Lacking spontaneity
- Grandiose
10
Q
Terms for tone of speech
A
- Monotone
- Singsong
- Slurred
11
Q
Terms for speech impairments
A
- Dysarthric (muscle speech problem)
- Stuttering
- Echolalia
12
Q
Term for not comprehending speech clearly
A
Aphasic
13
Q
Difference between mood and affect
A
- Mood-how patient describes their emotional state
* Affect-how interview describes PTs emotional state
14
Q
Labile affect
A
Sudden shifts in emotional state
15
Q
Flat affect
A
Shallow or blunted emotional state
16
Q
Tactile sensation of insects crawling over body
A
Formicaton
17
Q
Feelings of movement in absence of movement (hallucination–not vertigo)
A
Kinesthetic hallucination
18
Q
Hallucinations that occur while falling asleep
A
Hypnagogic hallucination
19
Q
Hallucinations that occur while waking up
A
Hypnopompic hallucination
20
Q
What are illusions
A
Misrepresentations of actually sensory input (occurs in schizophrenia but most common in delirium)
21
Q
Depersonalization
A
Patients feel detached and unreal
22
Q
Derealization
A
Objects in outside world feel altered, distorted, unreal
23
Q
Shift of ideas from one to another with no logical connection
A
Loose associations
24
Q
Patient wanders off subject but with clear connections between thoughts
A
Tangential thinking
25
Patient loses point of what they are saying but stay on the general topic
Circumstantiality
26
Patients mind goes blank
Blocking
27
Repetition of the same word or phrases, even when directed to stop
Perseveration
28
Direct repetition of interviewers words
Echolalia
29
Rapid speech with quick changes of ideas
Flight of ideas
30
Delusions
False beliefs that are outside of the PTs culture
31
Obsessions
Realized intrusive thoughts, ideas, impulses
32
Axis I: clinical syndromes (major disorders)
1. Organic mental disorder
2. Schizophrenia
3. Depression
4. Substance abuse
5. etc
33
Axis II: General medical disorders (personality and developmental disorders)
1. Maladaptive personality disorders
2. Defense mechanisms
3. Mental retardation
34
Axis III: General medical disorders
Physical disorders that might not be causing psych symptoms but that will affect the treatment
35
Axis IV: Psychosocial and environmental problems (stress that could trigger disorders)
Stresses that may affect the context in which the disorder developed
• PTSD
36
What is panic anxiety?
Anxiety that arises quickly and does not have particular content associated with it
37
Generalized anxiety disorder?
Worry about actual circumstances, events, or conflicts
38
What is panic disorder
Recurrent panic attacks with autonomic arousal
39
What are treatments for panic disorder?
* Antidepressants
* Benzodiazapines
* Cognitive behavior therapy
40
What is agoraphobia
Fear of being in a place where escape might be difficult or impossible
41
What is treatment for generalized anxiety disorder?
* SSRI
* SNRI
* Buspirone
* Benzodiazepines
* B-adrenergic
* Cognitive behavioral therapy
42
What are treatments for OCD
* Drug therapy
| * Psychotherapy
43
What is the duration for PTSD?
Greater than one month
44
Acute stress disorder
What is the diagnosis for PTSD-like syndrome that lasts 2 days to 4 weeks?
45
What condition is mitral valve prolapse often correlated with?
Anxiety
46
What is Axis V?
* The GAF
| * This is a score that shows how illness impacts PT and family (this can show progress of treatment)
47
What is supportive psychotherapy
Encourages teaching defensive strategies that are as adaptive as possible
48
What is psychodynamic psychotherapy
Uncover the psychological meaning of the anxiety and resolving unconscious conflict
49
What is systemic desensitization
* Teach relaxation
| * Teach patient to visualize scene and pair it with comforting thoughts
50
SSRIs
* Antidepressants
* As effective as tricyclics
* Can be used for anxiety disorders
* Safer and less side effects
51
SNRIs
* For panic, anxiety, social phobias
| * Side effects similar to SSRIs (maybe increased blood pressure)
52
Tricyclic antidepressants
* For generalized and panic anxiety, OCD
| * Side effects - anticholinergic effects
53
MAOIs
* Atypical depression, panic disorders, social phobias, anxiety disorders
* More side effects with other drugs and food than SSRIs, SNRIs, used as a last line treatment
54
Buspirone
* Serotonin agonist
* For GAD
* Unlike benzos, not a rapid onset of action
* Generally well tolerated (maybe serotonin syndrome when put with MAOIs)
55
Benzodiazepines
* Increased GABA action
* Sedation, tolerance, dependence, respiratory depression
* Diazapam, lorazapam
56
Antipsychotic drugs
* Can be used to augment SSRIs, SNRIs for anxiety, PTSD, OCD
| * Can produce tardive dyskinesis (which can outweigh benefits)
57
B-blockers for anxiety
This can be used to help with anxiety in patients that experience sympathetic symptoms with their attacks
58
What two psych conditions has NE been implicated in?
1. Too little → depression
| 2. Too much → mania
59
How is dopamine linked to depression?
* Not as strongly as NE and serotonin
| * Buproprion is dopaminergic
60
Low serotonin levels have been implicated with that?
Depression and mood disorders
61
What psych condition can be hypothyroid be mistaken for?
Depression
62
What psych condition can hyperthyroidism be mistaken for?
Mania
63
What is kindling?
Repeated subthreshold stimulation of the brain that leads to seizure activity
64
What are the four types of mood episodes?
1. Major depressive episode
2. Manic episode
3. Mixed episode
4. Hypomanic episode
65
MDE criteria?
1. Depressed state or lack of interest
2. Somatic symptoms (neurovegetative) like sleep disturbances, changes in eating, etc.
3. Persists at least 2 weeks
66
Manic episode criteria?
```
Elevated or irritable mood that lasts > 5 days
• Grandiosity
• Need little sleep
• Pressured speech (racing, flighty)
• Easily distracted, inattentive
• Increase in goal related activities
```
67
Mixed episode criteria?
Period during which patient has both depressive and manic episodes over 1 week
68
What is a hypomanic episode?
* Similar to manic but less severe
* Lasts at least 4 days
* Can't have psychotic symptoms (delusions, etc)
69
How do you diagnose major depressive disorder (not event)?
Have one or more MDE without mania, hypomania, or mixed episode
70
What are some common features that can be seen with major depressive disorder?
1. Psychotic features
2. Melancholic features (more profound neurovegitaton)
3. Catatonic
4. Atypical
5. Post partum onset
71
How high is recurrence after a major depressive episode?
50% will have recurrence
72
What is the only real criteria for BPD I?
* One manic episode
| * Most have depression episodes too though
73
Clinical features of a manic episode?
* Delusions or hallucinations
| * Disorganization
74
Percentage of BPD I patients that complete suicide
25%
75
What is BPD II?
At least MDE and one hypomanic episode
76
What is cyclothymic disorder?
* The same as dysthymic disorder but with hypomanic episodes
| * I think this is less severe than BPD II because there is hypomania and depression but not a major depressive disorder
77
What is melancholia?
Almost complete loss of all joy and happiness with a few other symptoms
78
Delirium vs confusion
Delirium is a special type of confusion where individual experiences distorted perceptions, hallucinations, vivid dreams, intense emotions
79
What is amneisa?
Inability to form memories and it assumes that hearing, cognition is otherwise working normally
80
What is dementia?
Loss of ability to reason. Deterioration of cognitive function.
81
What type of memory is most prone disease?
Short term memory
82
What is Pick's disease?
Degeneration of the frontal and temporal lobes (similar to Alzheimers except for it's distribution)
83
Time course of delirium?
Typically over hours to days and fluctuates over this period
84
What is apraxia?
Loss of ability to execute previously learned complex motor commands
85
What is agnosia?
Failure to recognize or identify previously known objects
86
Can you have delirium and dementia at the same time?
* Yes and this is known as delirium with dementia
| * The new cause of delirium should be investigated
87
What is confabulation?
PT's have memory deficits (amnesia) and therefore generate stories to fill in the gaps
88
Huntington's Disease?
* Loss of GABA neurons in basal ganglia (caudate)
| * Choreoathetosis and dementia
89
What is substance dependence?
Pathologic pattern of substance use or abuse that results in distress or impairment
90
What is tolerance?
* Increased amount to reach same desired effect
| * Same amount has less of an effect
91
What is withdrawal?
* A predefined set of symptoms that occur when a substance is stopped
* When a person takes the substance in order to avoid symptoms
92
What is a substance induced disorder?
A diverse group of physical and mental syndromes that occur in response to psychoactive substances or their withdrawal
• Substance intoxication
• Substance withdrawal
93
Illness vs disorder in psychiatry?
* Legal implications
* Disorder not a mental illness (personality disorder, etc)
* Illness is (schizophrenia, MDD)
94
Cluster A personality disorders
```
WEIRD
Odd or eccentric behaviors (these don't bother the patient but bother everybody else)
• Projection
• Fantasy
• Paranoia
```
95
Paranoid personality disorder (cluster A)
Person who is afraid of a lot of things
96
Schizoid personality disorder (cluster A)
Shy person that prefers to stay home, especially avoids emotional interactions
97
Schizotypal personality disorder (cluster A)
* Magical thinking
* Very weird character, low capacity for social interactions, behavioral eccentricities
* No psychosis (so not schizophrenia)
98
Cluster B personality disorder
```
WILD
Dramatic, emotional, erratic
• Dissociation from unpleasant thoughts
• Denial
• Splitting objects into all good or bad
• Acts out thoughts and feelings
```
99
Dissociation vs denial
* Dissociation-person does not recognize existence of something (alcoholic-I don't drink)
* Denial-person knows something exists but says it's not important (alcoholic-I drink but its not a problem)
100
Splitting
Person sees things abnormally (sees things as all good or all bad)
101
Antisocial personality (cluster B)
Person that doesn't care about anyone or anything so they disregards rights and feelings of others
102
Borderline personality disorder (cluster B)
```
Unstableness in every aspect of their life
• Impulsive
• Self-mutilating behaviors
• Object splitting
• Unstable affects
```
103
Narcissistic personality disorder (cluster B)
Expects admiration from other people and does not have admiration or respect for other people
104
Histrionic personality disorder (cluster B)
* Excessive emotionality
| * Attention seeking behavior (Ms. Piggy)
105
Cluster C personality disorder
```
WORRIED
Anxious and fearful
• Isolation from emotions
• Passive aggressive behaviors
• Hypochondriasis
```
106
Avoidant personality disorder (cluster C)
* Social inhibition
* Feeling inadequate
* Hypersensitivity to negative evaluation (McFly)
107
Dependent personality disorder (cluster C)
Meek, dependent personality
108
What cluster is OCD in?
Cluster C
109
Dissociative identity disorder (used to be multiple personality disorder)
* Person has multiple personalities (alternate realities in which they exist)
* Host personality-normal self-spends most time here
* Altered personalities-patient will flip into these randomly
* Each "altered" serves a purpose
* Generally felt that this occurs when a PT is sexually abused as a child -- defense mechanism (allows them to endure the abuse)
110
What is critical distinction between AN and BN?
Body weight (AN are underweight, BN are normal weight)
111
AN rates?
1% of women (males make up 10% of total)
112
BN rates?
1-3% of women (males make up 10% of total)
113
Binge-eating rates?
* 2% of women
* 1% of men
* 10% of total are in morbidly obese category
114
Factors that can lead to increased incidence in eating disorders?
* Higher incidence in monozygotic twins
* Psychological (coping mechanism)
* Familial incidence
* Environmental (cultures that value thinness)
* Social teasing leads to increased rates
115
Risk factors for eating disorder?
* Female
* Early puberty
* Perfectionist personality
* Low self-esteem
* Difficulties with communication, conflict resolution
* Drive to excel in sports
116
AN diagnostic criteria?
* Restriction of energy intact leading to low body weight
* Intense fear of becoming fat
* Disturbances in which ones body weight or image is experienced
117
Restricting type AN?
During last 3 months, no binge eating or purging
118
Binging type AN?
History binge eating and purging
119
Levels of AN?
* Mild >17
* Moderate 16-17
* Severe 15-16
* Extreme <15
120
BN diagnostic criteria?
* Recurrent episodes of binge eating
* Sense of lack of control over eating during period
* Recurrent inappropriate compensatory behaviors (purging, laxatives)
* Episodes at least once a week for 3 months
* Self-image unduly influenced by body image
121
Levels of severity for BN
* Mild 1-3
* Mod 4-7
* Severe 8-13
* Extreme 14+
122
Binge-eating disorder criteria?
* Recurrent episodes of binge eating
* More rapid eating
* Eating until completely full
* Eating when not hungry
* Eating alone because of embarrassment
* Feeling depressed about eating
123
Common symptom of eating disorder in female patients only?
Amenorrhea or disturbances in menstrual cycle
124
Odd symptoms associated with AN
* Acrocyanosis (blueness of fingers and toes)
* Bradycardia
* Hypotension
* Lanugo (fine hair)
* Edema of extremities
* Flat affect
* Alopecia
* Salivary gland enlargement
125
Odd symptoms associated with BN?
* Salivary gland enlargement
* Calluses on knuckles (Russell's sign)-from gagging themselves
* Mouth sores
* Dental erosions
* Hypotension (same with AN)
* Edema of extremities (same with AN)
* Mallory-Weiss tear
126
AN lab findings?
* Normocytic anemia
* Hypoglycemia
* Elevated cholesterol (for some reason)
* Hyponatremia
* Elevated liver enzymes
127
BN lab findings?
* Hypokalemia, hypochloremia with metabolic alkalosis (vomiting)
* Hypokalemia with metabolic acidosis (laxative abuse)
* Elevated serum amylase (from salivary gland)
128
What do you have to be very aware of in patients with eating disorders?
Increased suicide risk
129
What are additional lab tests you should get if you suspect eating disorder?
* Magnesium
* EKG
* Thyroid function test
* Bone densitometry
* CBC with SED Rate (exclude something like Crohn's)
* B-hCG
* Serum amylase
* FSH, LH, estradiol, testosterone, prolactin
* Guiac
* GI endoscopy, CXR, Head CT
* PPD
130
What should you hospitalize a patient with eating disorder?
* HR less than 40
* Hypothermia
* Hypotension
* Hypokalemia
* Dehydration
* Prolonged QTc or arrhythmia
131
What is the only FDA approved drug for BN?
* Fluoxetine (Prozac) -- SSRI
| * Much higher dose than for depression
132
What drug might be useful for AN?
* Olanzapine (zyprexa)
* Promotes weight gain and decreases obsessive thinking
* It is hard to get AN patients to take medication
133
Bupropion common name?
Wellbutrin
134
What don't you give to eating disorder patients and why?
* Buproprion (Wellbutrin)
| * Increased risk of seizures
135
What is refeeding syndrome?
* Clinical complications as a result of refeeding a patient after a prolonged absence of food
* Stores of phosphate are depleted during prolonged starvation
* When food is taken, insulin is increased, phosphate goes into cell
* Lack of phosphate leads to hypoxia and cardiovascular collapse
136
What are criteria for autism spectrum disorder?
* Difficulties in social interactions (both verbal and non-verbal) and
* Restricted, repetitive behaviors, interests, behaviors
137
Who is more at risk for ASD?
Boys > girls
138
Clinical features of ASD?
* Language delay (receptive or expressive)
* Impaired social communication and interaction (can be subtle)
* Restricted repetitive behaviors (hand flapping)
* Don't transition well
* Sensory perception issues (only soft cloths, only crunchy foods...)
* Might have some motor delays
139
When is ASD most often diagnosed?
2nd year of life
140
What is thimerosal and what is it?
It is an agent found in many vaccines that had trace amounts of mercury. If a PT had a full schedule of vaccinations it would have been possible for them to have elevated mercury levels. There are now thimerosal-free options.
141
What is illness?
Response of individual or family to symptoms?
142
What is somatization?
Tendency to experience or communicate psychological or emotional distress as somatic symptoms?
143
What is somatic symptom disorder?
Mental disorder characterized by physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder
• One or more somatic symptoms
• Significant distress
• Can't be reassured
144
Who is more at risk for somatic symptom disorder?
* Females > males
* Runs in families
* Males show increased risk of substance issues and antisocial disorders
145
Illness anxiety disorder?
* Disease fear
* Disease preoccupation
* Disease conviction
* Disability
146
Functional Neurological Symptom Disorder (conversion disorder)
Causes patients to suffer from neurological symptoms, such as numbness, blindness, paralysis, or fits without a definable organic cause
• Distractibility
• Splitting of midline
• Gap between tested strength and function
147
How often does conversion disorder typically last?
Typically resolves spontaneously after 2 weeks
148
What is dysthymia?
A form of depression that is more mild but lasts longer than major depression.
149
Hallmarks of serotonin syndrome?
* Can be caused by a number of different medications or interactions
* Possibly after OD
* Has symptoms like HTN, anxiety, HA, etc
150
Medical conditions that can have psychiatric symptoms
* MS
* Neurosyphilis
* Thyroid problems
* Nutritional deficiencies
151
How can methylfolate sometimes aid in depression treatment?
You need folate to convert tryptophan to serotonin. Some PTs are genetically deficient. Methylfolate goes right to the brain and can aid in this conversion.
152
What do hallucinogens act on?
Serotonin
153
Hallucinogen persisting perception disorder
You have residual hallucinations even after discontinuation of hallucinogenic drug
154
What are some symptoms of opiod overdose?
* Constricted pupils (myosis)
* Bradypnic (less than 12)
* Mild hypotension and bradycardia
