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STEP 1 RECALL > Psych > Flashcards

Psych Flashcards

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1
Q

Defense mechanism: Splitting

A

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

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2
Q

Defense mechanism: Projection

A

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)

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3
Q

Defense mechanism: Reaction formation

A

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

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4
Q

Defense mechanism : Sublimation

A

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)

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5
Q

Defense mechanism : Acting out

A

Expressing unacceptable thoughts via actions (throwing a tantrum)

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6
Q

Defense mechanism : Intellectualization

A

Suppressing one’s feelings by thinking about the problem

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7
Q

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…

A

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)

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8
Q

What are the mature defense mechanisms?

A

“SASH”

Sublimation
Altruism
Suppression
Humor

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9
Q

Defense mech: Dissociation

A

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

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10
Q

Defense mech: Displacement

A

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

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11
Q

Defense mech: Fixation

A

partially remaining at a more childish level of development

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12
Q

Defense mech: Identification

A

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

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13
Q

Defense mech: Isolation of affect

A

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

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14
Q

Defense mech: Rationalization

A

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

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15
Q

Defense mech: Regression

A

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

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16
Q

Defense mech: Repression

A

INVOLUNTARY withholding of an idea or feeling

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17
Q

Defense mech: Altruism

A

alleviating your guilty feelings by doing nice things for others

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18
Q

Defense mech: Suppression

A

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

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19
Q

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

A

Long term deprivation of affection to the child

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20
Q

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

A

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

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21
Q

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

A

Conduct disorder

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22
Q

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

A

Oppositional defiant disorder

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23
Q

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

A

1 year

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24
Q

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

A

Autism

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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

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