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1

What is classical conditioning?

Learning in which a natural response is elicited by a conditioned stimulus that used to be paired with an unconditioned stimulus (involuntary)

2

What is operant conditioning? Positive reinforcement? Neg rein? Punishment? Extinction?

Particular action is elicited b/c it produces a punishment or a reward (voluntary responses)

Pos: Desired reward produces action
Neg: Target behavior is followed by removal of aversive stimulus
Punishment: aversive stimulus extinguishes unwanted behavior

Extinction: discontinuation of reinforcement eventually eliminates behavior. Can occur in operant or classical conditioning

3

What is transference? What is countertransference?

Patient projects feelings about formative or important persons onto physician

Doctor projects feelings about formative or other important persons onto patient

4

What are ego defenses? What are the mature ego defenses?

Unconscious mental processes used to resolve conflict and prevent undesirable feelings

Mature adults wear a SASH

Sublimation, altruism, suppression, humor

5

Describe acting out, denial, displacement, dissociation, fixation, identification, isolation of affect, passive aggression, projection, rationalization, reaction formation, regression, repression, splitting, altruism, humor, sublimation, suppression.

AO: expressing unaccetable feelings and thoughts through actions (tantrums)

Denial: Avoiding the awareness of some erality

Displacement: Transferring avoided ideas and feelings to a neutral person or object

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

Fixation: Partinally remaining at a mre childish level of development (video games)

Identificiation: Modeling behavior after another person that is more powerful (though maybe terrible and hated)

isolation: Separating feelings from ideas and events

Passive agg: Expressing negative and performing below what is expected as an indirect show of opposition

Projection: Attributing an unacceptable internal impulse to an external source

Rationalization: Proclaiming logical reasons for actions actually performed for other reasons to avoid blame

Reaction formation: Replacing a warded off idea r feeling by an emphasis on the opposite

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

Repression: Involuntarily withholding an idea or feeling frm conscious awareness

Splitting: People are either alll good or all bad at different times due to intolerance of ambiguity

Altruism: Alleviating negative feelings via unsolicited generosity

Humor: Appreciating the amusing nature of an anxiety provoking or adverse situation

Sublimation: Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with ones value system

Suppression: Intentionally withholding an idea or feeling from conscious awareness; temporary

6

What does long term deprivation of affection in infants result in? 4W's? What length of time can lead to irreversible changes? Whats the ultimate consequence?

Failure to thrive
Poor language/socialization skills
Lack of basic trust
Anaclitic depression (infant withdrawn/unresponsive)

Weak, wordless, wanting, wary

>6 months

Eventually can lead to death

7

Compare and contrast physical and sexual child abuse concerning evidence present? Abuser? epid ?

PHYSICAL

Spiral fractures (or multiple fractures at different stages of healing)
Burns (cigarette, buttocks/thighs)
Subdural hematomas
Posterior rib fractures
Retinal detachment
Children avoid eye contact

Biological mother

40% of deaths in children < 1 year old

SEXUAL

Genital, anal, or oral trauma
STDs
UTIs

Known to victim, usually male

9-12 years old

8

What is considered child neglect? Evidence? What must be done?

Failure to provide a child with adequate food, shelter, supervision, education, and/or affection

Poor hygiene
malnutrition
withdrawal
impaired social/emotional development
failure to thrive

CPS

9

What is the onset of ADHD? Basic symptms? How is it characterized? What is normal? Prognosis? Associated brain abnormalities? Treatment?

Onset before 12.

Limited attention span and poor impulse control

Hyperactivity
Impulsivity
and/or inattention in multiple settings

Normal intelligence

50% continue into adulthood

Decr. frontal lobe volume/metabolism

Stimulants (methylphenidate)
maybe CBT
Atomoxetine in some individuals

10

What is conduct disorder? Association? Treatment?

Repetitive and pervasive behavior violating the basic rights of others.

At age 18, will likely meet criteria for Antisocial PD

CBT

11

What is oppositional defiant disorder? Treatment?

Enduring pattern of hostile, defiant behavior toward authority figures in absence of seirous violations of social norms

CBT

12

What is separation anxiety disorder? age of onset? Signs? Treatment?

7-9 years

Overwhelming fear of separation from home or loss of attachement figure

Fictitious physical complaints to avoid going to or staying at school

CBT, play therapy, family therapy

13

Onset of Tourette syndrome? How is it characterized (lenght of time)? What is coprolalia? Commonality in tourettes? Assocations? Treatment? For intractable tics?

Before age 18

Sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for > 1 year

Involuntary obscene speech (10-20%)

OCD, ADHD

Psychoeducation
behavioral therapy

Low-dose high potency antipsychotics (fluphenazine, pimozide)
Tetrabenazine
Clonidine

14

How are pervasive developmental disorders characterized? How is Autism spectrum disorder characterized (age)? What is intellect like? Epid?

Difficulties with language and failure to acquire or early loss of social skills

Poor social interactions
communication deficits
repetititive/ritualized behaviors
restricted interests

Early childhood***

May or may not have intellectual disability
Savants rare

More common in boys

15

What is epid of Rett syndrome? Why? Genetics? Age of onset? Presentatin?

Girls (boys die early)

x-linked

1-4

regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, sterotyped hand-wringing

16

What are the NT changes in
Alz:
Anx:
Dep:
Hunt:
Park:
Schizophrenia:

Alz: Decr ACh, incr. glut.
Anx: incr. NE, decr. GABA, decr. 5-HT
Dep: Decr. 5-HT, decr. DA, decr. NE
Hunt: Decr. GABA, decr. ACh, incr. DA
Park: Decr. DA, incr. ACh
Schizophrenia: Incr. DA

17

What is orientation? What are some common causes of loss of orientation? Order of loss?

Ability to know

Identity (last)
location (2nd)
time (1st)

Alcohol
drugs
fluid/electrolyte imbalances
head trauma
hypoglycemia
infection
nutritional defic.

18

What is Retrograde amnesia? Anterograde amnesia? What is Korsakoff amnesia like? What is dissociative amnesia like? What might accompany it?

Retro: Can't remember things that occurred before a CNS insult

Antero: Can't remember things that occurred after a CNS insult

Korsakoff: Anterograde > Retrograde. Confabulations

Dissociative amnesia: Inability to recall important personal info, usually subsequent to severe trauma or stress. Dissociative fugue (abrupt travel or wandering)

19

What is delirium? How is it characterized? Causes? EEG finding? An approach for management? Treatment?

Waxing and waning level of consciousness with acute onset
Rapid decr. in attention span and level of arousal

Disorgranized thinking
hallucinations (visual)
Illusions
Misperceptions
Disturbance in sleep wak cycle
Cognitive dysfunction

Secndary to other illness (CNA disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urainary/fecal retention)
Medications (anticholinergics), especially in elderly

Reversible

Abnormal EEG

Identifying and addressing underlying condition
Haloperidol as need
Benzos for EtOH withdrawal

T-A-DA approach=Tolerate, anticipate, don't agitate

20

What is dementia? How is it characterized? What can it lead to? Irreversible causes? Reversible causes? Epid? EEG finding?

Decr. in intellectual function w/o affecting level of consc.

Memory deficits, apraxia, aphasia, agnosia, loss of abstract thought, beh/pers changes, impaired judgment

Can develop delirium (Alz w/ pneumonia)

Irreversible: Alz, Lewy Body Dementia, Huntington, Pick disease, cerebral infarct, Creutzfeldt-Jakob, chronic substance abuse

Reversible: Hypothyroidism, depression, vit. b12 defic, normal pressure hydrocephalus

Incr. incidence w/ age

EEG normal

21

What is psychosis? In which patients does it occur? What are hallucinations? What are delusions? What is disorganized speech?

A distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking

Pts. with medical illness, psych illness, or both

Hallucinations: perceptions in the absence of ext stim
Delusions: Unique, false beliefs about oneself or others that persist despite facts
Disord speech: Words and ideas are strung together based on sounds, puns, or loose associations

22

What are visual hallucinations more commonly a feature of? Auditory? When does olfactory hallucinations occur? What due gustatory hallucinations occur? Tactile? What are hypnagogic halluc? When are they seen? What are hypnopompic halluc? When are they seen?

Vis: Medical illness
Aud: Psych illness
Olfactor: Aura of psychomotor epilepsy and in brain tumors
Gust: Rare, epilepsy
Tactile: alcohol withdrawal, cocaine use
Hypnagogic: Going to sleep, sometimes in narcolepsy
Hypnapompic: Waking up, sometimes in narc.

23

What is shizophrenia? Brain changes? What does the diagnosis require? Etiologies? Epid? Age of onset? Risks? Treatment?

Chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning.

Incr. DA, decr Dendritic branching

2 or more of the following symptoms for > 6 months

Delusions
Hallucinations
disorganized speech (loose associations)
Disorganized or catatonic behavior
negative symptoms-flat affect, social withdrawal, lack of motivation, lack of speech or thought

Genetics and environment
Frequent cannabis use in teens

Lifetime prevalence 1.5% (males=females, white=black)
Presents earlier in men (late teens to early 20s vs. late 20s to early 30s)

Incr. risk of suicide

Atypical antipsychotics (risperidone) are first line

24

What is a brief psychotic disorder? What is schizophreniform disorder? What is shizoaffective disorder? Length of time for each?

Lasting < 1 month, usually stress related

lasting 1-6 months

lasting > 2 weeks: psychotic symptoms superimposd with major depression or mania (or both). Psychosis present w/ and without affective symptoms. Affect only present w/ psyhotic symptoms.

25

What is a delusional disorder? Time?

Fixed persistent belief system > 1 month

Functioning otherwise not impaired

26

What is Dissociative Identity Disorder? epid? Associations? What is depersonalization/derealization disorder?

DID

2 or more distinct identities or personality states.
More common in women
History of sexual abuse, PTSD, depression, substance abuse, BP, somatoform conditions


Persistent feelings of detachment or estrangement from one's own body, thoughts, perceptions or action (deperson) or ones environment (derealiz)

27

How are mood disorders? Examples? What may be presesnt?

Abnormal range of moods or internal emotional states and loss of control over them. Cause distress and impairment in social and occupational funcitoning

Major depressive disorder
bipolar disorder
dysthymic disorder
cyclothymic disorder

Episodic psychotic features

28

What is a manic episode? Time length? Diagnostic criteria?

Distinct period of abnormally and perstistently elevated, expansive, or irritable mood and abnormal and persistently elevated activity or energy

1 week

Hospitalization or at least 3 of the following:

Distractibility
Irresponsibility-pleasure w/o regard to conseq
Grandiosity-inflated self esteem
Flight of ideas
Incr. in goal directed activity/psychomotor agitation
Decr. need for Sleep
Talkativeness or pressured speech

DIG FAST

29

What is a hypomanic episode?

Like manic episode except not enough to cause marked impairment in functioning or necessitate hospitalization.

No psychotic features

At least 4 consecutive days

30

How is Bipolar I defined? Bipolar II? What can precipitate mania? Risk? Treatment? What is cyclothymic disorder?

BPI=at least 1 manic episode with or without a hypomanic or depressive episode

BPII=Presence of a hypomanic and a depressive episode

Patients mood and functioning usually return to normal between episodes

Mood stabilizers (lithium, valproic acid, carbamazepine)
Atypical antipsychotics


Cyclo=dysthymia and hypomania, at least 2 years

31

How long do episodes usually last in MDD? How is an episode defined? What changes occur in sleep stages? Treatment? What is dysthymia?

6-12 months

5 of 9 symptoms for 2 or more weeks (must include patient reported depressed mood or anhedonia)

SIG E CAPS

Sleep disturbance
loss of Interest
Guilt or feelings of worthlessness
Energy loss and fatigue
Concentration problems
Appetite/weight changes
Psychomotor retardation or agitation
Suicidal ideations
Depressed mood

Decr. slow wave sleep
Decr. REM latency
Incr. REM early in cycle
Incr. total REM
Repeated nightitme awakenings
Early morning awakening

CBT and SSRIs
SNRIs, mirtazapine, bupropion
ECT in select patients

Dysthymia: 2 years of depression, often milder.

32

What is atypical depression? Characterized? Epid? Treatment?

Mood reactivity (able to experience improved ood in response to positive events, albeit briefly)
Reversed vegetative symptoms (hypersomnia/hyperphag)
Leaden paralysis
Long standing interpersonal rejection sensitivity

Most common subtype of depression

CBT and SSRIs
MAOIs

33

When do postpartum mood disturbances occur? Epid of maternal blues? Characterized? timeline? Treatment? Epid of postpartum depression? Characterized? Timeline? Treatment? Postpartum psychosis? Epid? Characterized? Risk factors? Treatment?

Within 4 weeks

Blues: 50-85% incidence rate.
Depressed affect, tearfulness, fatigue.
Starts 2-3 days after delivery, ends after 10 days.
Supportive, Follow up

Depression: 10-15%.
Depressed affect, anxiety, poor concentration
Within 4 weeks
CBT and SSRIs

Psychosis: .1-.2%
Mood congruent delusions, hallucinations, and thoughts of harming the baby or self
History of bipolar or psychotic disorder, first pregnancy, FH, recent discontinuation of psychotropic med

Hospitalzation
Atypical antipsych
ECT?

34

How is normal grief characterized? Length? How is pathologic grief characterized? What are not pathologic in the absence of other psychotic symptoms?

NOrmal bereavement characterized by shock, denial, guilt, and somatic symptoms.
Duration varies

Pathologic lasts > 6 months, satisfies major depressive crieteria and/or includes psychotic symptoms.

Hallucinations

35

When is ECT used? How does it work? Adverse effects/duration of effects?

Treatment refractory depression
Depression with psychotic symptoms
Acutely suicidal patients

Grand mal seizure in anesthetized patient

Disorientation
Temporary headache
Partial anterograde/retrograde amnesia

6 months

36

What are some risk factors for suicide completion?

SAD PERSONS

Sex (male)
Age (teenager or elderly)
Depression

Previous attempt
Ethanol or drug use
loss of Rational thinking
Sickness (medical illness, > 3 prescription medications)
Organized plan
No spouse
Social support lacking

Women try more often; men succeed more often

37

What is an anxiety disorder? Examples? Treatment?

Inappropriate experience of fear/worry and its phys manifestations incongruent with stressor
Symptoms interfere w/ daily functioning

Panic disorder
phobias
GAD
PTSD

CBT
SSRIs
SNRIs

38

How is a panic disorder defined/diagnosis? How is a panic attack defined? Treatment?

Recurrent panic attacks.
1 attack followed by 1 month or more of one of these:
Persistent concern of additional attacks
Worrying about consequences of attack
Behavioral change related to attacks

Panic attack=periods of intense fear and discomfort peaking in 10 min. w/ at least 4 f the following:

Palpitations
Paresthesias
Abdominal distress
Nausea
Intense fear of dying or losing control
Lightheadness
Chest Pain
Chills
Choking
Disconnectedness
Sweating
Shaking
SOB

CBT
SSRIs
Venlafaxine
Benzos in acute setting

39

How is specific phobia characterized? What is a social anxiety disorder? Treatment? What is agoraphobia? treatment?

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

Exaggerated fear of embarrassment in social situations
CBT and SSRIs

Exaggerated fear of open or enclosed spaces, using public tansport, being in a line or crowds, or leaving hoome alone
CBT, SSRIs, MAOIs

40

How is an anxiety disorder characterized? Length? treatment?

Anxiety lasting > 6 months unrelated to a specific person, situation, or event.
Associated w/ sleep disturbance, fatigue, GI disturbance, difficulty concentrating
CBT, SSRIs, SNRIs
Buspirone, TCAs, Benzos

41

What is adjustment disorder? Characterized? Timeline?

Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (divorce or illness)

6 months w/ chronic stressor

CBT, SSRIs

42

What is obsessive compulsive disorder like? How is it different from OCPD? ASsociation? Treatment?

Recurring thoughts, feelings or sensations that cause severe stress
Relieved in part by performance of repetitive actions

Egodystonic: Behavior inconsistent w/ ones own belief and attitudes

Tourettes

CBT, SSRIs, Clomipramine

43

What is body dysmorphic disorder? Treatment?

Preoccupation w/ minor or imagined defect in appearance leading to significant emotional distress or impaired functioning

Seek cosmetic surgery

CBT

44

What is PTSD like? Timeline? Treatment? What is acute stress disorder? Timeline? Treatment?

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

Lasts > 1 month and impairs social-occupational functioning

CBT, SSRIs, Venlafaxine


Acute Stress: 3 days and 1 month
CBT only

45

What is malingering?

Patient consciously fakes, exaggerates, or claims to have a disorder to attain a specific secondary gain

Poor compliance w/ treatment or F/U of diagnostic tests

Complaints cease after gain

46

What are factitious disorders like? What is munchausen syndrome? What is munchausen by proxy?

Consciously creates physical and/or psychological symptoms in order to assume sick role and get attention

Chronic factitious disorder with predominantly physical signs and symptoms. History of multiple hospital admissions and willingness to undergo invasive procedures

Illness in a child or elderly patient is cause or fabricated by caregiver.

47

What are somatic symptom and related disorders? Epid? What is a conversion disorder like? What is illness anxiety disorder (hypochondriasis)? What is somatic symptom disrder?

Category of disorders characterized by physical symptoms with no identifiable physical cause. Unconscious drives. Not intentionally produced or feigned.
Women.

Loss of sensory or motor function often following an acute stressor.
patient is aware of but sometimes indifferent toward symtpoms
More common in females, adolescents, young adults

Preoccupation and fear of having a serious illness despite medical eval and reassurance

Variety of complaints in one or more organ systems lasting for months to years.
Excessive persistent thoughts and anxiety about symptoms
May co-occur with medical illness

48

What is a personality trait? What is a personality disorder?Age of onset? What are the three clusters? What are they like? What is included in each category?

An enduring, repetetive pattern of perceiving, relating to, and thinking about the environment and oneself

Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning; person usually not aware of the problem
Early adulthood

A=Weird

Paranoid, schizoid, shizotypal

B=Wild

Antisocial, Borderline, Histrionic, Narcissistic

C=Worried

Avoidant, OC, Dependent

49

What are cluster a personality disorders like? What do they like? Genetic association? What is paranoid PD like? major DM? What is Schizoid PD like? What is schizotypal like?

Odd or eccentric; can't develop meaningful social relationships. No psychosis
Schizophrenia

Paranoid: Pervasive distrust and suspiciouness; projection

schizoid: voluntary social withdrawal, limited emotional expression, content with social isolation

schizotypal: eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness

50

What are cluster B PDs like? Genetic association? Diagnosis of Antisocial PD? Epid? What is borderline PD like? Epid? Major DM? Treatment? What is histrionic PD like? What is narcissistic PD like?

Dramatic, emotional, or erratic
Mood disorders and substance abuse

A/S: disregard for and violation of rights of others, criminality, impulsitivity. Males. >18 years and have conduct disorder before 15.

BPD: Unstable mood and interpersonal relationships, impulsivity, self-mutilation, boredome, sense of emptiness. Females. Splitting. DBT

Histrionic: Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance

Narcissistic: Grandiosity, sense of entitlement; lacks empathy and requires excessive admiration. demands the best and reacts to criticism w/ rage.

51

What are cluster C PDs like? Genetic association? What is avoidant PD like? What is OCPD like? How does it differ from OCD? What is dependent PD like?

Anxious or fearful
Anxiety disorders

Avoidant: hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others

OCPD: Preoccupation with order, perfectionism, and control; egosyntonic

Dependent: Submissive and clingy; excessive need to be taken care of, low self confidence.

52

What is the difference b/w schizoid, schizotypal, schizophrenic, and schizoaffective? B/W brief psychotic disorder, schizophreniform disorder, and schizophrenia?

Schizoid=isolation
schizotypal=eccentric thinking
schizophrenia=psychotic thinking
schizoaffective=psychotic thinking plus mood disorder

Brief= 6 months

53

What is anorexia nervosa like? BMI? ASsociated symptoms? Epid? ASsociations? Treatment? What is refeeding syndrome?

Excessive dieting with possible purging
Intense fear of gaining wieght and body image distortion

<18.5

Decr. bone density, severe weight loss, metatarsal stress fractures, lanugo, anemia, electrolyte disturbances

Adolescent girls

Excessive exercise and depression

Psychotherapy and nutritional rehab

Refeeding syndrome (hypophosphatemia upon eating again) may occur

54

What is bulimia nervosa? Timeline? BMI? Associated symptoms? Epid?

Binge eating with recurrent inappropriate compensatory behaviors (vomiting, laxatives/diuretics, fasting, excessive exercise) occuring weekly for 3 months

BMI within normal range

Parotitis
Enamel erosion
Electrolyte disturbances
Alkalosis
Dorsal hand calluses

Adolescent girls

55

What is gender dysphoria? Characterization?

Strong persistent cross gender identification.
Persistent discomfort with one's sex assigned at birth, causing significant distress and/or impaired functioning.
Transgender

56

What does sexual dysfunction include? What is in the differential diagnosis/

sexual desire disorders, sexual arousal disorder, orgasmic disorders, sexual pain disorders

Drugs (antihypertensives, neuroleptics, SSRIs, ethanol)
diseases (depression, diabetes, STIs)
psychological (performance anxiety)

57

What is sleep terror disorder? At what stage does it occur? Implications? Epid? Cause? Triggers? Prognosis?

Periods of terror with screaming in the middle of the night

Slow wave sleep (no memory of it)

Children

Cause unknown

Stress, fever, lack of sleep

Self limited

58

What is narcolepsy? Primary characteristic? Pathophys? Symptoms? Genetics? Treatment?

Disordered regulation f sleep-wake cycles
Primary characteristic is excessive daytime sleepiness

Decr. hypocretin (orexin) production in lateral hypothalamus

Hypnagogic or hypnopompic hallucinations
Nocturnal and narcoleptic sleep episodes that start with REM sleep
Cataplexy (loss of all muscle tone in response to strong emotional stimulus)

Strong genetic component

Daytime stimulants (amphetamines, modafinil)
Nightime sodium oxybate (GHB)

59

How is a substance use disorder defined?

Maladaptive pattern of substance use defined as 2 or more of the following signs in 1 year:

Tolerance
Withdrawal
Substance taken in larger amounts, or over longer time, than desired
Persistent dersire or unsuccessful attempts to cut down
Significant energy spent obtaining, using, or recovering from substance
Important social/occup/recr. activities reduced
Continued use despiet knowing consequences
Craving
Recurrent use in physically dangerous situations
Failure to fulfill major obligations
Social or interpersonal conflicts.

60

What are the 6 stages of change in overcoming substance addiction?

Precontemplation
Contemplation-acknowledge problem
Preparation/Determination=getting ready
Action/willpower=changing behaviors
Maintenance
Relapse