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ICM2 > Psych > Flashcards

Psych Flashcards

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1
Q

Echolalia

A

Repeating questions

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2
Q

Neologisms

A

New words

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3
Q

Dissociation

A

Split off mental contents from conscious awareness

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4
Q

Projection

A

Unconsciously reject and attribute unacceptable aspects of the self to others

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5
Q

Reaction formation

A

Adopting ideas and behaviors that are the opposite of impulses harbored un-/consciously

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6
Q

Sublimation

A

Unacceptable conscious drives are redirected to personally/socially acceptable channels

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7
Q

Anxiety disorders: Features

A

Familial pattern of 30-50% concordance in identical twins

Disrupted limbic circuits with less cortical modulation

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8
Q

Treatment of anxiety disorders

A

Strengthen prefrontal cortex (therapy)
Increase serotonin levels (SSRIs for anxiety/SNRIs for lethargy)
Increase GABA inhibition in amygdala/hippocampus (benzodiazepines)

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9
Q

MAOIs do what?

What other things do this?

A

Increase Nor, Dopa, and Sero levels

Cocaine, Ecstasy, Exercise

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10
Q

Wellbutrin does what?

A

Increases Nor & Dopa

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11
Q

Panic disorders

A

Recurrent, unexpected panic attacks not due to organic causes
Usual onset as teen/young adult
Treat with therapy & SSRIs, TriCycs, Benzos, MAOIs
Responds to lower doses than depression

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12
Q

Social anxiety disorders

A

Marked and persistent fear of social situations for >6mths that significantly interferes with life.
Onset usually 11-15yo
More common in females

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13
Q

Generalized anxiety disorder

A

General anxiety symptoms lasting >6mths interfering with functioning.
Early onset more common in women, associated with childhood fears
Can treat with therapy & benzos, SSRIs, buspirone

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14
Q

OCD

A

Less activity and control in extrapyramidal and basal ganglia pathways
SSRIs are most effective in higher doses

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15
Q

PTSD

A

Severe trauma re-experienced
Therapy, SSRIs help ~50%, anticonvulsants may be helpful
Most common in abused patients, military

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16
Q

Schizophrenia

A

~1% of population
Onset 15-25
Chronic
Affected thought process and content on mental status exam = disorder of impaired thought
Psychotic: Hallucinations, delusions, disorganization
Restricted/inappropriate affect, avolition, alogia
Cognitive impairment in attention, processing information
Patient has lost touch with reality and lacks insight into condition due to frontal, parietal lobe abnormality
Psychosocial dysfunction, lack of relationships
Attitude: Suspicious, guarded
Appearance: Disheveled, inappropriate for weather
Behavior: Awkward, Parkinsonian gait/tremors
Mood and Affect: Flat, irritable, hostile
Thought processes: Tangential, word salad
Thought content: Distorted reality, paranoid, delusions of thought broadcasting, auditory hallucinations
Accelerated brain gray matter loss
Increased morbidity and mortality

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17
Q

ASD (Autism)

A

Persistent difficulties in social interaction, non-/verbal communication, and repetitive behaviors
Symptoms present early in development (6mths-2yrs), but may not manifest until social demands exceed limitations
Language delay
Restricted, repetitive behaviors - insistence on sameness
More common in boys
Unknown etiology, BUT NOT BAD PARENTING
M-CHAT survey of child’s habits, behaviors for screening
Vaccines not related to occurrence

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18
Q

ADHD

A

Symptoms start Block Nor, Dop reuptake) and behavioral interventions together are best

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19
Q

1st gen antipsychotics

A

E.g. Haldol, Prolixin
Effective at sedating psychotic patients
Long-term Parkinsonian side effects are irreversible

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20
Q

2nd gen antipsychotics

A

E.g. Abilify, Seroquel

Fewer psychological side effects, however insulin resistance and T2DM may develop

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21
Q

Purpose of defense mechanisms

A

To unconsciously provide relief from emotional conflict and anxiety

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22
Q

Somatoform disorders

A

Patient has physical symptoms that cause significant distress and impairment that are far in excess of what would be expected based on patient history, physical, and labs
More common in females

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23
Q

Somatization vs. Somatoform illness

A

Somatization = tendency to experience and communicate psychological/emotional distress as physical symptoms
Somatoform illness = somatization causing significant dysfunction in patient’s life

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24
Q

Facititious disorder

A

Symptoms are produced/feigned in order to appear ill without a perceivable benefit
Can be imposed on self or others (usually mothers to children)
Patient may be evasive/argumentative, dramatic with history, have multiple malpractice claims, predict their own decline before discharge, or be unwilling to undergo testing
Most patients sign out rather than accept diagnosis

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25
Malingering
Symptoms are produced/feigned in response to external incentive (discrepancy between claimed disability and physical exam) Uncooperative, associated with antisocial personality disorder
26
Somatic symptom disorder | How to manage?
Frequent doctor visits May refuse to acknowledge psychological contribution to symptoms Excessive use of analgesics for pain Common co-morbid depressive symptoms Manage with single physician, regular followup, discussing stressors, full physical exam, and realistic goals to reduce pain and increase function
27
Illness anxiety disorder | How to manage?
Excess worry regarding mild/absent symptoms Prev. hypochondriasis 4 D's: Disease fear, preoccupation, conviction; and Disability Manage by identifying stressors, refer for supportive and cognitive therapy, SSRIs
28
Conversion disorder | Best management?
Requires clear evidence of incompatibility with neurological disease At least 1 symptom (e.g. pseudoseizures) of altered voluntary motor/sensory function that is incompatible with neurological syndromes Symptoms are distractible and don't cause atrophy Sensory symptoms may split at midline Indifference about major disability Outcomes improve with identifiable trauma/stressor at onset, anxiety/depression treatment, and framing the issue as "stress related" to the patient
29
Common examples of psychological factors affecting other medical conditions?
Anxiety and asthma Occupational stress and hypertension Alcohol abuse and liver disease
30
Cluster A personality disorders
Odd, eccentric behavior Paranoid Schizoid Schizotypal
31
Cluster B personality disorders
``` Dramatic, erratic emotional behavior Antisocial Borderline Histrionic Narcissistic ```
32
Cluster C personality disorders
Anxious and fearful behavior Avoidant Dependent Obsessive-compulsive
33
Personality
Enduring pattern of thinking, feeling, and behaving uniquely recognizable in each individual
34
Personality disorders in general are due to ... causing impairment in ... ? Other important features?
Use of limited coping strategies regardless of adaptability Cognition, social functioning, and impulse control Generally lifelong and diagnosed in adults who are egosytonic (think everything is fine)
35
Paranoid Personality Disorder
Scan environment for signs of slight See/make hidden meanings Bear grudges Use projection
36
Schizoid Personality Disorder
Loner indifferent to others' responses | Non-goal directed fantasies
37
Schizotypal Personality Disorder
``` Unusual loner with social anxiety and odd beliefs, speech, and perceptions Has ideas (not delusions) of reference Uses magical (superstitious) thinking ```
38
Antisocial Personality Disorder
Deficits in conscience: Defies social norms, irresponsible, without empathy or remorse Act out, rationalize
39
Borderline Personality Disorder
Fractured identity manifested in anger, mood swings, self-injurious acts, and intense relationships Use splitting things as good/bad and projection
40
Histrionic Personality Disorder
Lives to convince others Dramatic, seductive, must be center of attention, preoccupied with appearance, "shallow" Use repression and physical conversion
41
Narcissistic Personality Disorder
Self-absorbed, entitled, exploitative Lacks empathy Uses denial and projection
42
Avoidant Personality Disorder
Sensitive to rejection, but interested in interaction | Views self as socially inept, needs lots of reassurance
43
Dependent Personality Disorder
``` Needs someone else to nurture/care for Fearful of independence Stays in relationships or quickly finds new ones No anger Uses denial, repression ```
44
Obsessive/Compulsive Personality Disorder
Lives for structure/control, perfectionist Emotionally constricted Uses isolation, reaction formation, undoing
45
Isolation of affect (defense mechanism)
Attempt to avoid painful thought/feeling by objectifying and emotionally detaching oneself from it
46
"Reward center" of mesolimbic dopamine system affected in all addicts either in-/directly
Nucleus accumbens
47
Alcohol - mechanism of action
Indirectly stimulates dopamine release in NuAcc Directly stimulates GABA-a receptor (disinhibits) Inhibits NMDA receptor (excitatory transmitter)
48
Cocaine - mechanism of action
Blocks reuptake of dopamine Stimulates release of noradrenaline Blocks Na+ channels (cardiac signs)
49
Amphetamines - mechanism of action
Directly stimulate dopamine release
50
Opiates - mechanism of action
Bind to mu, sigma, and kappa receptors centrally and peripherally Indirectly stimulate release of dopamine in VTA
51
Substance use disorder
Maladaptive pattern of substance use leading to clinically significant impairment/distress over at least 3 months Criteria: 1. Increasing amounts or increasing time period of use 2. Unsuccessful at cutting down 3. Lots of time spent to obtain 4. Craving 5. Failure to fulfill obligations (work, school, home) 6. Continued use despite problems 7. Giving up/reducing important social/recreational/occupational activites 8. Recurrent use in hazardous situations 9. Continued use despite insight into problem 10. Tolerance 11. Withdrawal Patient may intentionally hide this from you
52
How to diagnose substance abuse?
Take a good history - smell, hepatomegaly, mental status, track marks, weight loss, withdrawal symptoms, pupil size CAGE: Have you ever tried to Cut down? Have you been Annoyed by criticism? Have you felt Guilty of things done while intoxicated? Have you had an Eye-opening experience? Mildly elevated AST, ALT (100s)
53
How to present substance abuse diagnosis?
Don't present diagnosis while patient is intoxicated Don't argue with/threaten/shame patient Don't hedge (only partially explain) diagnosis Don't expect rapid change State the diagnosis Express concern Explain this is a disease, not a moral weakness Explain treatment is possible, but there is individual responsibility Develop a plan
54
Drugs requiring detox?
Alcohol, opiates, sedative hypnotics
55
Disulfiram
Inhibits aldehyde dehydrogenase --> aldehyde accumulation on alcohol consumption Causes flushing, nausea, hypotension, hepatotoxicity
56
Naltrexone
Blocks mu-opioid receptor May decrease risk and length of relapse Hepatotoxicity
57
Methadone and Buprenorphine
Replaces opiates Administered in controlled setting combined with counseling and other interventions --> Most successful treatment for heroin addiction
58
Major depressive episode - criteria
``` Depressed mood, or anger/irritability Anhedonia (^^^at least one of these two^^^) Weight/appetite change In-/hypersomnia, not restful Psychomotor agitation/retardation Fatigue Feelings of guilt/worthlessness/hopelessness, nihilistic delusions Diminished ability to think/concentrate Recurrent thoughts of suicide ^^^At least 5 every day for 2 weeks^^^ Impairment/distress No organic cause No schizophrenia (May present with non-specific somatic complaints) ```
59
Major depressive episode - pathogenesis
Genetic contribution, variable sensitivity to life stressors Increased cortisol/CRH secreation (Dexomethosone suppression test) ~15% of population in lifetime
60
Suicidality risks?
Family history, previous attempts, male
61
Manic episode - diagnosis
``` Elevated or irritable mood characterized by at least 3 of the following with "marked impairment" in functioning: Grandiosity Little need for sleep More talkative Racing thoughts Distractability Increased activities/agitation and risk-taking Impulsiveness ``` Patient compliance is low since they may feel pleasure in manic state
62
Mixed episode
Patient satisfies criteria of both manic and major depressive episodes over 1 week
63
Hypomanic episode
4 days plus 3-4 symptoms of manic episode | Moderate or mild impairment in function, but may also ENHANCE function
64
Major Depressive Disorder
Episodes of depressed mood daily for >2wks Ser, Nor, and Dop implicated Treat with Cognitive Behavioral Therapy and SSRI/SNRI/TCA/MAOI ECT or TMS for memory loss Address suicidality with direct questioning Educate patient to adhere to meds and that this is a disorder, not a character weakness
65
Dysthymic Disorder
Chronic ongoing (>1yr) mild depressive symptoms
66
Bipolar I
Mixed episodes of mania and depression within the same week
67
Bipolar II
History of depression with hypomanic episodes
68
Cyclothymia
Cyclic hypomanic and depressive episodes
69
Bipolar disorders - Pathogenesis
"Kindling effect" - over time patient is more susceptible to episodes
70
Bipolar disorders - Treatment
Mania: Mood stabilizers (lithium, valproic acid) Depression: Atypical antipsychotics (Seroquel, Symbyax)
71
Diseases that may cause depression
Endocrine: Hypothyroidism, Cushing's disease Neuro: CVA (esp. frontal), Parkinson's, Huntington's, AZD Infectious: HIV, hepatitis, mono, flu Neoplastic: lung, pancreas, CNS Metabolic: Folate/B12 deficiency, high Ca++, low Mg++ Other: Alcoholism, drugs/other causes of CNS depression
72
Drugs causing mania
Stimulants, decongestants, weight loss preps Dopamine agonists (L-DOPA) Antidepressants Steroids
73
Diseases causing mania
``` Endocrine: Hyperthyroidism Neuro: Temporal lobe seizures or CVA, MS, Huntington's Infectious: HIV, encephalitis Neoplastic: CNS Metabolic: Low Ca++ ```
74
Important general history questions related to depression?
Sleep, appetite, enjoyment of activities, depressive thoughts, family history
75
Organic brain syndromes - cause
Disorders of the cerebrum
76
Delirium
Confusion in which the individual experiences terrifying hallucinations, usually with increased psychomotor activity
77
Amnesia
Loss of ability to form memories despite alert state of mind
78
Dementia
Loss of ability to reason without disturbance of perception
79
Always supplement a history of someone with a probable brain/psychiatric disorder with what?
Information from a person other than the patient
80
Causes of acute confusion?
Medical illness - uremia, hypoxia, hypoglycemia, hyponatremia; high fever; heart failure; PTSD Drug intoxication Nervous system disease - CVA, tumor, abscess; subdural hematoma; meningitis; encephalitis
81
Causes of delirium?
Medical illness - typhoid, pneumonia, septicemia, rheumatic fever, alcoholism Nervous system disease - vascular, neoplastic; cerebral contusion; meningitis; subarachnoid hemorrhage; encephalitis
82
Causes of dementias?
(Lots) Associated w/labs/other diseases: Hypothyroidism, Cushing's, nutritional deficiency (Trp, thiamine, B12), Wilson's, chronic intoxication Associated w/other neuro signs: CVA, tumor, trauma, hydrocephalus, Huntington's, Tay-Sach's, prion disease Only evidence of neuro disease: AZD
83
Eating disorder risk factors
``` Genetics Environment - higher in cultures valuing thinness Social - teasing Psychological stress - means of coping Female gender Early puberty Perfectionist personality Low self-esteem Family troubles ```
84
Eating disorder protective factors
``` High self-esteem Participation in non-elite sports Successful in multiple areas Good family and social support Well-developed problem solving skills ```
85
Anorexia Nervosa diagnosis
Restriction of energy intake leading to body weight lower than minimally normal or expected Intense fear of gaining weight, becoming fat Disturbance in experience of body weight or shape Undue influence of body weight/shape on self-evaluation
86
Subtypes of anorexia
Restricting type - for last 3 months, no binge eating or purging have occurred Binge Eating/Purging type
87
Bulimia Nervosa
Recurrent episodes of binge eating together with a sense of a lack of control with inappropriate compensatory behaviors to prevent weight gain, >1/wk for 3mths Self-evaluation unduly influenced by body shape/weight
88
Binge-eating disorder
Recurrent binge eating episodes without inappropriate compensatory behavior as in bulimia
89
Symptoms of eating disorders
Menstrual irregularities Abdominal pain/bloating Cold intolerance and constipation (more AN) Fatigue GERD (BN) Palpitations, syncope (due to orthostatic hypotension)
90
Anorexia physical exam findings
``` Acrocyanosis Bradycardia Emaciation Orthostatic hypotension Lanugo, alopecia Hypothermia Flat affect Salivary gland enlargement ```
91
Bulimia physical exam findings
Salivary gland enlargement Calluses on knuckles from inducing emission Mouth sores, enamel erosion from acid Orthostatic hypotension Mallory-Weiss tear of esophageal mucosa --> Blood in vomit
92
Clinical components of refeeding syndrome
Hypophosphatemia, -kalemia, -magnesaemia Deficiencies of vitamins, other trace minerals Volume overload, edema
93
Labs for suspected eating disorder
``` CBC, ESR (normochromic, -cytic anemia; low glucose) CMP (hyponatremia, liver enzymes?) Urinalysis (water loading?) Mg Urine B-hGC (pregnant?) FSH, LH, etc. Serum amylase (high if purging) Stool for blood (inflammatory bowel?) ```

ICM2 (5 decks)

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