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Flashcards in Psych Deck (110):
1

Defense mechanism: Splitting

Seeing the world in black & white (people or groups are either wholly good or wholly bad)-- common in patients with borderline personality disorder

2

Defense mechanism: Projection

Transplanting your own unacceptable impulses on to another person (a pt who has sexual desires for her doc accusing him of having desires for her)

3

Defense mechanism: Reaction formation

The redirection of an unacceptable impulse into the opposite (a former smoker who avidly enforces a no smoking rule)

4

Defense mechanism : Sublimation

One of the mature defense mechanisms, involves channeling an unacceptable behavior into an acceptable form (a pt with sexually explicit thoughts becoming a sex therapist)

5

Defense mechanism : Acting out

Expressing unacceptable thoughts via actions (throwing a tantrum)

6

Defense mechanism : Intellectualization

Suppressing one's feelings by thinking about the problem

7

pt with chronic fatigue, unhappiness, low energy, anhedonia (not caring) for 4 years, no suicidal thoughts, no changes in eating or sleeping, no concentration changes...

Dysthymic disorder ----> depressed mood most days for at least 2 years*, a low intensity mood disorder that responds well to antidepressants

(not MDD -- have to have 5 or more of the "SIGECAPS" criteria for 2 weeks or more)

8

What are the mature defense mechanisms?

"SASH"

Sublimation
Altruism
Suppression
Humor

9

Defense mech: Dissociation

Temporary drastic change in personality or behavior to avoid emotional stress (classic w/ child or sex abuse victims)

10

Defense mech: Displacement

fellings or ideas are transferred to some neutral person (ie: parent blames child for something spouse did)

11

Defense mech: Fixation

partially remaining at a more childish level of development

12

Defense mech: Identification

modeling behavior after a more powerful person (though not necessarily admired)

13

Defense mech: Isolation of affect

separating feelings from events (ie: witness describing a murder without showing emotion)

14

Defense mech: Rationalization

proclaiming logical reasons for actions actually done for a different reason (ie: get fired -- say you didn't like the job anyway)

15

Defense mech: Regression

going back to earlier modes of dealing with the world (ie: child who reverts back to bedwetting even after he has been potty trained)

16

Defense mech: Repression

INVOLUNTARY withholding of an idea or feeling

17

Defense mech: Altruism

alleviating your guilty feelings by doing nice things for others

18

Defense mech: Suppression

VOLUNTARILY withholding an idea or feeling from awareness ( the more 'mature' form) 00 ie: choosing not to worry about Step 1 until the day before

19

Child w/ poor muscle tone, language skills, lack of trust, weight loss, illnesses...

Long term deprivation of affection to the child

20

Most common form of child mistreatment, poor hygiene, malnutrition, social withdrawl, failure to thrive

neglect (failure to provide food, shelter, supervision, education, affection) --> REPORTABLE JUST LIKE ABUSE

21

boy who destroys property, steals, violates social norms repeatedly, under age 18

Conduct disorder

22

defiant toward authority figures, but generally stays within social norms in other areas

Oppositional defiant disorder

23

to be diagnosed w/ Tourette's , you must have 'tics' for more than ___________

1 year

24

language impairment in a young boy, below normal intelligence, focuses on objects not people

Autism

25

milder than Autism, normal intelligence but problems socially

Asperger's

26

X-linked mutation in MECP-2 gene, only effects girls, loss of development, regression around age 1-4 , classic "hand-wringing" behavior

Rett's syndrome

27

similar to Rett's, but more common in boys and onset is age 3-4

Child disintegrative disorder ("Hellers")

28

anterograde amnesia caused by Thiamine (B1) deficiency, destruction of the mamillary bodies

Korsakoff's amnesia -- seen in alcoholics

29

waxing & waning level of consciousness with acute onset, often reversible, often w/ visual hallucinations, can be secondary to infection, trauma, substance abuse, will have an abnormal EEG if you did one...

Delirium (very common in hospitalized patients)

30

gradual decline in cognition with no changes in LOC, memory loss, aphasia, personality changes, impaired judgment, can be caused by Alzhiemers, HIV, Picks dz, Stroke... would have a normal EEG

Dementia (usually irreversible)

31

Auditory hallucinations are common in what dz?

Schizophrenia

32

Olfactory hallucinations assoc with ____

epilepsy or brain tumor

33

Tactile halucinations are assoc w/ _____

alcohol withdrawal or cocaine abuse (bugs crawling on skin)

34

chronic mental disorder w/ periods of psychosis, disturbed behavior and thought, decline in functioning for GREATER THAN 6 MONTHS -- has + and - symptoms

Schizophrenia

35

Positive symptoms of Schizophrenia

delusions, hallucinations, disorganized speech, disorganized / catatonic behavior

36

Negative symptoms of schizophrenia

flat affect, social withdrawal, no motivation, lack of speech or thought

37

Schizophrenia symptoms that last btw 1-6 months (but not more than 6 mos)

Schizophreniform disorder

38

Schizophrenia symptoms for at least 2 weeks, PLUS a mood disorder (mania or depression or both)

Schizoaffective disorder

39

an untrue belief that is persistant > 1 month but is not totally bizzare

Delusional disorder

40

an untrue belief that is persistant > 1 month but is not totally bizzare

Delusional disorder

41

What are the mature defense mechanisms?

"SASH"

Sublimation
Altruism
Suppression
Humor

42

anterograde amnesia caused by Thiamine (B1) deficiency, destruction of the mamillary bodies

Korsakoff's amnesia -- seen in alcoholics

43

waxing & waning level of consciousness with acute onset, often reversible, often w/ visual hallucinations, can be secondary to infection, trauma, substance abuse, will have an abnormal EEG if you did one...

Delirium (very common in hospitalized patients)

44

gradual decline in cognition with no changes in LOC, memory loss, aphasia, personality changes, impaired judgment, can be caused by Alzhiemers, HIV, Picks dz, Stroke... would have a normal EEG

Dementia (usually irreversible)

45

Auditory hallucinations are common in what dz?

Schizophrenia

46

Olfactory hallucinations assoc with ____

epilepsy or brain tumor

47

Tactile halucinations are assoc w/ _____

alcohol withdrawal or cocaine abuse (bugs crawling on skin)

48

chronic mental disorder w/ periods of psychosis, disturbed behavior and thought, decline in functioning for GREATER THAN 6 MONTHS -- has + and - symptoms

Schizophrenia

49

Positive symptoms of Schizophrenia

delusions, hallucinations, disorganized speech, disorganized / catatonic behavior

50

Negative symptoms of schizophrenia

flat affect, social withdrawal, no motivation, lack of speech or thought

51

Schizophrenia symptoms that last btw 1-6 months (but not more than 6 mos)

Schizophreniform disorder

52

Schizophrenia symptoms for at least 2 weeks, PLUS a mood disorder (mania or depression or both)

Schizoaffective disorder

53

an untrue belief that is persistant > 1 month but is not totally bizzare

Delusional disorder

54

Presence of 2 or more distinct identities or personality states , common in women with a history of sexual abuse

Dissociative identity disorder

55

An abrupt change in location, inability to recall past, confusion, assumption of a new identity, and the patient doesn't remember this state after its over---- associated with trauma, natural disasters ...

Dissociative fugue state

56

Distinct period of abnormally elevated, expansive or irritable mood lasting at least 1 week, must have 3 or more of the traits

Manic episode

Must have 3 of these:

Distractibility
Irresponsibility
Grandiosity
Flight of ideas/ racing thoughts
Agitation, increased activity
Decreased need for sleep
Talkativeness or pressured speech

57

Like a manic episode, still lasts longer than 1 week but doesn't affect the persons life enough to warrant hospitalization

Hypomanic episode

58

Only need one manic or hypomanic episode for diagnosis

Bipolar disorder

59

Depressive symptoms for longer than 2 weeks with episodes that usually last 6-12 months (must include patient reported depression or anhedonia plus 4 of the SIGECAPS)

Major depressive disorder

60

SIGECAPS for depression

Sleep disturbance
Interest loss (anhedonia)
Guilt
Energy loss
Concentration loss
Appetite/ weight changes
Psychomotor retardation
Suicidal ideations

61

Milder form of depression, lasts 2 years or more

Dysthymia

62

Most common form of depression, characterized by hypersomnia, overeating, mood reactivity, but can experience improved mood in response to positive events

Atypical depression

63

Treatment for atypical depression

MAOIs, or SSRIs

64

Hypervigilance, avoidance, distress, and re-experiencing event for > 1 month

PTSD

65

PTSD symptoms for <1 month

Acute stress disorder

66

Anxiety that isn't related to any specific person or thing, lasts longer than 6 months , includes sleep disturbances, fatigue, GI distress....

Generalized anxiety disorder

67

Pt consciously fakes a disorder in order to obtain a secondary gain (drugs, getting out of work)

Malingering

68

Pt consciously fakes symptoms in order to obtain a primary gain (attention for being sick)

Factitious disorder

69

Munchausens and Munchausens by proxy are categories of ____________________ disorder

Factitious disorder ( they want attention for being sick or for their child being sick)

70

Cluster A personality disorders

"Weird"

1- paranoid -- distrustful, accusatory, projection is common
2- schizoid -- voluntary social withdrawal, content being alone, limited emotional expression
3- schizotypal -- odd beliefs, magical thinking, awkward

71

Cluster B personality disorders

"Wild"

1- antisocial -- sociopaths, criminals, > 18 years old
2- borderline -- splitting is common, females, unstable mood, impulsive
3- histrionic -- attention seekers, theatric
4- narcissistic -- requires excessive admiration, sense of entitlement

72

Cluster C personality disorders

"Worried"

1- avoidant -- socially inhibited, timid, but desires to be social**, sensitive to rejection
2- obsessive- compulsive -- needs order, control, perfection
3- dependent -- submissive, clingy, low self confidence

73

Personality type that is socially inhibited, timid, feels inadequate BUT desires to have relationships ((compared to Schizoid which do not want relationships))

Avoidant personality

74

body weight < 85% of ideal for height, decreased bone density, excessive dieting / + or - purging, amenorrhea for > 3 months, anemia...

Anorexia nervosa

75

binge eating / purging, body weight often maintained around a 'normal' range, assoc with parotitis, enamel erosion, metabolic alkalosis

Bulimia nervosa

76

Lab AST is twice the value of ALT and serum gamma-glutamyltransferase is elevated

signs of Alcohol intoxication

77

treatment fot Delirium tremens (DT's)

benzodiazepines

78

Intoxication w/ these drugs cause pupillary constriction (miosis) -- "pinpoint pupils"

Opioids ( morphine, heroin, methadone)

79

Treatment for Opioid intoxication (Heroin, Morphine...)

Naloxone, Naltrexone

80

Sweating, dilated pupils, N/V, fever, runny nose -- all signs of _____ withdrawal

Opiod withdrawal (tx = symptomatic)

81

these drugs can cause marked respiratory depression

Barbiturates

82

have a smaller risk of respiratory depression and treatment for intoxication is Flumazenil

Benzodiazepines

83

Intoxication with _____, ______ & ________ can cause pupillary dilation (mydriasis)

Amphetamines, LSD & Cocaine

84

this drug can cause angina, premature labor, pupillary dilation, hallucinations and sudden cardiac death

Cocaine

85

this drug can cause belligerence, aggression, agitation, nystagmus, tachycardia, homicidality

PCP

86

this drug can cause flashbacks, pupillary dilation, visual hallucinations

LSD

87

Heroin users are at risk for ______

hepatitis, abscesses, overdose, AIDS, right sided endoarditis

88

Methadone use

for Heroin detox, long term maintenance

89

confusion, ophthalmoplegia & ataxia

Wernicke's encephalopathy

90

how Disulfiram works

causes Acetaldehyde to build up by blocking Acetaldehyde DH --> makes pt feel very sick if they consume any alcohol

91

life threatening alcohol withdrawal syndrome, peaks 2-5 days after last drink, tactile hallucinations

Delirium tremens (treat with Benzos)

92

SSRI's ---> used to treat a huge variety of psych disorders EXCEPT ____ & ______

bipolar or schizophrenia (use mood stabilizers and antipsychotics for these)

93

What are the "mood stabilizers" used to treat bipolar?

Lithium, Valproic acid, Carbamazepine

94

CNS stimulates (amphetamines) act by ________________________

increasing NE & dopamine at the synaptic cleft

Used for ADHD, narcolepsy & appetite control

95

What are the TYPICAL antipsychotics?

Haloperidol, and anything that ends in
"-azine"

-they all block Dopamine (D2) receptors, increasing cAMP

-treat the + schizo symptoms, psychosis, mania, & Tourette's

96

What are the main side effects of the Typical Antipsychotics? (haloperidol + "-azines")

Extrapyramidal side effects (dystonia, akinesia (like parkinson's) , restlessness, tardive dyskinesia)

and also SE's from blocking muscarinic, alpha and histamine receptors (dry mouth, constipation, hypotension, sedation)

and hyperprolactinemia and galactorrhea

97

What are the ATYPICAL antipsychotics?

Olanzapine, Clozapine, Quetipine, Risperidone, Aripiprazole, Ziprasidone

"It's Atypical for OLd CLosets to QUietly RIsper from A to Z"


-can treat both the + and - effects of Schizo

--have less severe side effects so these are preferred!

98

Mechanism of Atypical antipsychotics?

not totally understood (effect various receptors)

99

the atypical antipsychotic __________________ can cause granulocytosis so you must monitor WBC count

Clozapine

"Clozapine traps granulocytes in the closet"

100

Lithium mechanism & side effects

mechanism = inhibits IP3 cascade

Side effects = "LMNOP"

Lithium causes
Movement (tremors)
Nephrogenic DI
hypOthyroidism
Pregnancy probs (Epstein's anomaly)

101

Buspirone mechanism and use

stimulates 5HT 1A receptors -- used for generalized anxiety disorder

102

Amitriptyline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, Amoxapine

Tri- cyclic Antidepressants

(end in "-iptyline" or "-ipramine" mostly)

103

Mechanism of TCA's

block the reuptake of NE and Serotonin

-used for MDD, bedwetting (Imipramine) , OCD (clomipramine) & fibromyalgia

104

SSRI mechanism & side effects

block the reuptake of Serotonin only

SE's = sexual dysfunction, Serotonin syndrome ((hyperthermia, flushing, diarrhea, siezures))

105

Name the SSRI's

Fluoxetine
Paroxetine
Sertraline
Citalopram

106

Pt starts taking an antidepressant and comes to you 2 weeks later complaining that they are not working.... what do you advise them?

Antidepressants usually take 4-8 weeks to have an effect!

107

SNRI mechanism and SE's (Venlafaxine, Duloxetine)

block Serotonin and NE reuptake

SE's -- less than SSRI's, may have incr in BP

- used for depression ((*Duloxetine can also be used for diabetic peripheral neuropathy))

108

MAOI's mechanism

increase the levels of NE, Dopamine and Serotonin (**do not eat Tyramine containing foods when on b/c will cause HTN crisis)

109

What are the MAOI's

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

"MAO Takes Pride In Shanghai"

110

What are the atypical antidepressants?

Bupropion -- incrs NE & Dopamine
Mirtazapine -- alpha 2 blocker
Maprotiline --blocks NE reuptake
Trazodone -- blocks Serotonin reuptake