PSYCH Flashcards
(275 cards)
1
Q
how does traumatic brain injury affect your iq?
A
IT DOESN’T
2
Q
what is somatic symptom disorder characterized by?
what can be a potential cause
what population is it more common in
what is a good way to treat them?
A
- over amplification of symptoms that aren’t explained by physical exam findings; may or may not have condition that explains symptoms; peristent thoughts, increased anxiety about, or excess time/energy dedicated to symptoms; >6 months
- childhood abuse/sexual abuse, being sick is the only time they can reliably get love/attention/care
females
- maintain regular appointments (to help them talk through symptoms and not reinforce their cycle of going when they are sick), cbt
3
Q
what is very effective in treating severe neuroleptic malignant syndrome?
A
ELECTROCONVULSIVE THERAPY
4
Q
how does post partum blues and post partum depression
A
- happens within 1-2 weeks following pregnancy and resolves on its own
- happens within pregnancy or 1-4 weeks after as a major depressive episode that can prevent ability to take care of baby and self
5
Q
what is isolation of affect
A
inability to express emotions about a negative event even though you fully understand the significance/severity of the event
6
Q
what are the effects of pcp intoxication
A
- alertered/distored perception
- elevated mood/ violent mood swings
- pcp psychosis (esp with chronic use or ppl with schizophrenia and bpd)
- poor decision making
- reduce pain sensitivity
7
Q
define infertility
A
inability to conceive after 12 months or after 6 months if you are older than 35
8
Q
name the main tracts that dopamine affects and how antipsychotics are implicated
A
- meso-limbic/cortical (vta to limbic and prefrontal) : implicated in treatment for schizo
- nigrostriatal: extrapyramidal symptoms
- tuberoinfundibular: connection between hypothalamus and pituitary, responsible for prolactinemia
- area postrema: can be effective anti-emetic
9
Q
describe features of paranoid personality disorder
what cluster is it
is psychosis possible?
A
- distrust of everyone;
- mistrusting of coworkers loyalty for no reason
- mistake benign comments as something worse
- suspicious of significant others
- always counterremark if attacked
- holds grudges
A
yes, but brief, no prolonged preiods of delusions, hallucination or disorganized though
10
Q
describe features of schizotypal personality disorder
what cluster is it
is psychosis possible?
A
- Ideas of reference (excluding delusions of reference).
- Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).
- Unusual perceptual experiences, including bodily illusions.
- Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
- Suspiciousness or paranoid ideation.
- Inappropriate or constricted affect.
- Behavior or appearance that is odd, eccentric, or peculiar.
- Lack of close friends or confidants other than first-degree relatives.
- Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
A
yes, brief under stress
11
Q
what is altruism
A
avoiding negative personal feelings by doing good for others
12
Q
how can you treat asd and ptsd?
what medication should you avoid
A
- asd: cbt, sleep aids and anxiolytics
- ptsd: trauma based therapies, sertralline paroxetine, venlafaxine, sleep aid, anxiolytics
NO BENZOS
13
Q
what is the difference between majorr depressive disorder and dysthymic/progressive depressive disorder
A
major depressive disorder has a much more significant depression with suicidal ideation and impairment in ability to function; it also usually resolved in a year if untreated
progressive depressive disorder is a milder form of depression usually without suicideal ideation or impairment in every day life but does n’t resolve in a year, can be baseline for a long period of itme
14
Q
what is rumination disorder
what population is it associated with
what should you rule out beforehand
what is the treatment
A
- disorder that involves regurgitating food, with potentially rechewing or reswallowing; last about a month and can be out of patient’s control
- intellectual disability, children, infants
- gi motility disorder, malnutrition or underlying cause
- behavioral or family therapy
15
Q
name 3 drugs you can use to treat alcohol dependence?
A
acamprosate
naltrexone
disulfuram
16
Q
what is hoarding disorder
A
- difficulty discarding possessions, with significant distress caused if you try to get rid of them
causes significiant impairment
17
Q
describe the pathways of the brain involved instimulant abuse
A
- dopaminergic activaiton of mesolimbic and mesocortical pathways
- vta to nucleus accumbans (reward and reinforcement) and to prefrontal cortex (focus, judgment, adhd focus)
18
Q
who is more likely to get a substance use disorder : men or women
A
men
19
Q
what is the inheritance /etiology of rett syndrome
what population is it common in
what are the features
A
- mostly denovo mutation in MECP2, can be x linked
- females (almost never in men)
- 6-18 months of normal/stagnated development, followed by rapid regression of acquired skills; seizures and handwringing very common, motor deterioration
20
Q
what physical development happens in the first year of life
A
growth ten inches
weight triples
cerebellum matures, myelination, ossifying of bone
crawling
purposeful grasping
21
Q
describe reactive attachment disorder
A
- a condition in which a child (older than 9 months) doesn’t seek or react or emotional support or affection from caregivers
- doesn’t have much positive affect or much emotional response to others
- also may have period of irritability or fearfulness or sadness that don’t seem to be caused by anything (acting out)
22
Q
name in decreasing order of affinity of what caffeine can bind to
what is the mechanism of action
A
a2a (adenosine) receptor >a1 >a3 >camp phosphodiesterase
- a2a GPCR is most commonly involved in inhibiting motor activity via the indirect pathway, but caffeine blocks this receptor, –> increased Ca thereby causing movement
23
Q
what contains memories that are not immediately available but can be retrieved readily and brought to consciousness
A
- preconsciousness
24
Q
what is cognitive behavioral therapy
A
- therapy directed at examining automatic negative distorted thoughts and testing the validity of those assumptions as a way to realize they are wrong and bring about change
25
# define the following
flooding
implosion
aversion therapy
flooding: full on exposure all at once to maladaptive anxiety/phobia; very effective but v intolerable
implosion: imagining/fantasizing the maladaptive anxiety
associating something noxious with addictive substance to stop addiction
26
what are obsessions and compulsions
what is the three variants of ocd
obsessions: persistent intrusive thoughts that cuase anxiety/distress
compulsions: behaviors/mental acts done to relieve anxiety from obsessions
ocd with good/fair insight: aware that obsessions are not or probably not true
ocd with poor insight: think that obsessions are probably true
ocd with absent insight/delusional beliefs: belive obsessions are completely true
27
what are the stages of language for babies
Cooing – 2 – 4 months
Babbling – 6 months
10 – 12 months can comprehend simple words
12 -13 months – first few words
2 years- 250-400 words, can understand that words represent things
28
what are signs of a stimulant overdose?
what can you do to treat?
- htn, tachycardia, dilated pupils, seizures, tremors, arrhythmia, paranoia, anxiety, psychosis
- supportive, most likely to die from cardiac causes, so treat that
nitroprusside, nitro, hydralazine, alpha blocker like phentolamine
benzos for anxiety
anti psychotics if psychotic
29
what is the minnesota multiphasic personality inventory 2 ? (MMPI 2)
is it an objective or subjective measure?
what is considered a normal score on a measure? what are critical areas for an abnormal score
what are the three validity measures?
what are clinical measures ( name at least 5)
- tests for potential psychopathology
- objective
- 50= normal, 35 or 65 enters critical area (so above or below the mean)
- L= lie, F= frequency of unusual responses, K= suppressor/defensiveness
```
- Paranoia
Psychasthenia
Schizophrenia
Hypomania
Social Introversion
Hypochondriasis
Depression
Hysteria
Psychopathic Deviance
Masculinity-Femininity
```
30
name symptoms of neuroleptic malignant syndrome (mnemonic)
what two lab findings would you see?
how long does it last?
how do you treat it?
what are risk factors
CAME
- consciousness altered
- autonomic dysfunction (labile bp, tachycardia, tachypnea) sweating)
- Muscle rigidity
- Elevated temperature
```
elevated cpk (sometimes 4x as high as normal)
elevated wbc
```
2 weeks if taken oral meds
4 weeks if taking depot
- supportive care! (hydration, anti pyretics,, maybe heparin, cooling techniques), stop neuroleptics, lithium, anticholinergics, d2 blockers, ECT (FOR SEVERE CASES V EFFECTIVE), maybe dantrolene, maybe dopamine agonist like bromocriptine
- previous nms, lithium, malnourished, dehydrated, iron deficiency
31
what are two prenatal risk factors for adhd?
what are things that can cause/increase risk for adhd
- smoking, etoh use
- thyroid disorder, malnourished, constipation, lead, recreational stimulants, theophylline, phenobarbital, phenytoin, cns infection
32
name three clusters of psychiatric disorders that are commonly seen today
- mood and anxiety disordesr
alcohol and drug disorders
mood and alcohol disorder
33
what anatomical findings have been found with schizophrenia
- large lateral/third ventricle
| - cortical atrophy (prefrontal cortex, temporal lobe, anterior limbic structures)
34
name effects of amphetamines/stimulants?
- increased arousal
- alpha and beta activation
- increased attention
- increased athletic performance
- decreased appetite
- euphoria
35
what are end organ damages due to alcohol?
- hepatitis, cirrhosis, pancreatitis, pontine demyelination syndrome, cardiomyopathy
36
what is illness anxiety disorder
- what are the two types
what other two conditions is it associated with
how do you treat
- significant worry/anxiety about potentially getting a disease (disease phobia) without having physical symptoms; associated with excessive health relatd bhaviors (ex: keep listenign to pulse)
- those that will go to doctors af because of their preoccupation and those that will avoid doctors due to fear and will go to alternative doctors/self medicate
- ocd and depression
- cbt and regular maintained appointments
37
how does transcortical magnetic stimulation work
- uses magnetic field to create an electrical current that depolarizes large neurons that are perpendicular to the field
- can be excitatory or inhibitory
38
what drugs can cause neuroleptic malignant syndrome?
- all neuroleptics AKA ANTIPSYCHOTICS
- any d2 blocker (promethazine, prochlorperazine, droperidol, metaclopramide)
- withdrawing a dopamine agonist too quickly
39
give an example of an organic volatile nitrite?
what effects does it produce
- VASODILATION (can cause significant hypotention in the brain)
- blood pooling in extremities (diziness +erection)
- smooth muscle relaxation
40
what is cyproheptadine? what can it be used to treat?
```
- anti serotonin drug
serotonin syndrome (not much evidence that it works)
```
41
what is premature ejaculation
what is the treatment
when a man ejaculates wthin a minute before he wants to
- cbt sex therapy etc also pinch when you feel like ejaculating and stop until you are calmer
42
describe the “Incentive salience” model of addiction
what role does dopamine play
- visual or auditory cues associating with drug effects/drug seeking behavior cause increase activation of motivation pathways and can then control behavior on their own
- dopamine, which usually increased in response to reward, can shift and increased in presence of the cue , creating incentive salience (it's a learning nt, it helps attach the cue to the reward)
43
what is the dopamine hypothesis of schizophrenia
what supports and doesn't support it?
- schizophrenia is due to excess dopamine
- giving amphetamines causes schizophrenia delusions
- giving bromocriptine doesn't cause delusions
44
what are the four cluster b personalities
what is something special about this cluster
- antisocial, borderline, histrionic, narcissistic
(bad, borderline, flamBoyant, Best)
- mellows with age
45
where in the country is suicide the highest?
how about the lowest?
- mid west
new england and cali
46
what population is stimulants contraindicated for
name three indications for stimulants
- htn and heart failure
| - weight control, narcolepsy, adhd
47
what is the active metabolite of diazepam?
what modification of a diazepam derivative causes it to be cleared faster?
- desmethyl diazepam
| - hydroxylation (ex: oxazepam has shorter half life)
48
what is selective mutism
- consistent inability to speak in a specific situation for >1 month that is not associated with a lack of comfort with or lack of knowledge of the spoken language or the situation
- impairs educational/occupational achievment
49
name the two parts of the social consequences aspect of the definition of a substance use disorder
- inability to complete work/school obligations due to being high
- continuing to use substance despite negative social feedback or interpersonal problems
50
how does ect work (4)
- increases turnover of serotonin, norepi, and dopamine
- downregulates 5ht and norepi receptors
- ehances gabaergic inhibition of hyperactive moa circuits (frontal lobe, limbic system and subcortical basal ganglia)
- reset diencephalon neuronal tone
51
where is etoh absorbed?
what would increase absorption
what woudl decrease absorption?
- small intestine
- increased concentration of drink (or drinking more)
- food
52
name the criteria for intellectual disability
- must have limitation in both of the following BEFORE the age of 18:
- intellectual functioning (aka IQ less than 70)
- adaptive behavior
- --- conceptual (reading, writing, math, language, memory, judgment)
- --- social (communication, empathy, following rules)
- --- practical (activities of daily living, health and safety, occupational skills)
53
where are the wanting/motivation pathways in the brain vs the liking/valuation pathways
- base of brain (nucleus accumbans, VTA, etc)
| - front of the brain
54
describe the difference between positive reinforcement, negative reinforcement, and punishment in regards to operant conditioning?
- positive: giving a reward in response to a behavior in order to increase frequency of behavior
- negative: removing a noxious stimulus in response to doing behavior in order to increase frequency of behavior
- punishment: taking away something positive or giving something negative in order to discourage a behavior
55
wat are the three greatest risk factors for post partum depression
1) previous history of post partum depression
2) history of peri natal depression
3) history of depression
56
what population is most likely to have a paraphillic disorder
males, heterosexual
57
name the criteria for global developmental delay
- must have delay two of the following BEFORE the age of 5-6:
- fine motor
- gross motor
- social/personal
- activities of daily living
- cognitive function
58
what is the underarousal hypothesis of adhd
- hypothesis that the brains of children with adhd are actually underaroused/asleep, so if you give stimulants, you can improve their conditions
(also have low levels of serotonin, norepi, and dopamine)
59
what are common comorbid conditions for anorexia?
what are common comorbid conditions for bulimia
major deprssive disorders, panic disorder, ocd, personality disorder
substance abuse, and borderline personality disorder
60
name three types of schedules for giving a reinforcement and rank them in order of increasing ability to cause extinction
1) variable ratio/interval- give reinforcement randomly, more compelled to keep doing behavior since they don't know when they will get reward
2) fixed ratio- give reinforcement after set number of times doing behavior
3) continuous- give reinforcement after each time they do behavior
61
in regards to family therapy, what is the term where there are no proper boundaries of family members?
enmeshment
62
what is post partum psychosis
what is the treatment
psychosis after pregnancy that can have confusion, delusions and erratic behavior
immediate hospitalization, psychiatric emergency
63
what is the difference between fluid and crystallized intelligence?
how does age influence them?
- fluid: mental processes (declines with age) (not affected by a poor childhood exposure)
- crystallized: knowledge base (increases with age) (affected by poor childhood exposure to culture/knowledge)
64
what is the effect of iq on schizophrenia
the lower the predicted iq, the higher the risk of getting schizophrenia (6x risk)
65
what are piaget's stages of development
- sensorimotor (0-2)- learning object permanence, experiencing the world through senses and motion
- preoperational- (2-7) pretend play and everything is egocentric
- concrete operational- (7-11) can understand conservation and math
- formal operational (11- onward)- can form abstract thought, reason, and form moral reasoning
66
what mental health diagnoses put you at increased risk for suicide? (for men and women)
men: bipolar, unipolar depression, schizophrenia
women: schizophrenia, bipolar
67
what is body dysmorphic disorder?
- preoccupation with a perceived physical defect on your body that is not very perceptable to other people
- results in you doing certain behaviors like looking in themirror repetitively, skin picking, grooming or mental acts (comparing your body to others)
68
describe features of patau syndrome and what is the cuase
- trisomy 13
- intellectual disability
- congenital heart defect
- rocker bottom feet
- polydactyly or syndactyly
- microcephaly
- malformed low set ears
- hyper or hypotonia
- small eyes
69
what eating disorder is associated with underweight
anorexia nervosa
70
what is suboxone
what can it be used to treat?
- naloxone and buprenorphine
| - opioid withdrawal
71
what is the difference between panic attack and panic disorder
what is the treatmnt
- panic attack is a one time thing
- panic disorder is at least 1 panic attack followed up by at least a month of preocupation/fear about getting another with subsequent maladaptive behavior
cbt, ssri, benzo
72
name in increasing order of potency: fentanyl, morphine, heroin
morphine < heroin < fentanyl
heroin 3x> morphine
fentanyl 80x> morphine
73
what is more likely to cause withdrawal symptoms faster: a short acting drug or long acting drug?
what is more likely to cause more severe withdrawal symptoms : short or long acting?
what is more likely to have longer lasting withdrawal symptoms
- short acting
- short acting
- long acting
74
in classical conditioning, what do you need to make sure the association between the conditioned stimulus and response don't go away? what is it called when it goes away?
- keep showing the unconditioned stimulus and conditioned stimulus together
- extinction
75
what is pseudocyesis?
what can be a risk factory
- patient is convinced she is pregnant when she isn't
previous pregnancy loss, infertility
76
What are signs of opioid withdrawal? (mnemonic)
The CDC bans SeVeN opioids
```
Cravings
Diarrhea
Chills
Sweating
Nausea
Vomiting
```
77
what type of receptor is the nicotinic receptor
where is it located in the brain
what happens when nicotine binds?
what system in the brain gets activated?
- excitatory pentameric ligand gated channel (Na, Ca)
- forebrain
- excites and quickly desensitizes
- limbic system, nucleus accumbans, amygadala, causes release of dopamine that is implicated in reward
78
what is contingency management?
- voucher system in which you give positive rewards/vouchers/take home methadone in exchange for abstinence and negative drug screens
- good to give positive feedback fo those who aren't used to getting any, over time the habits become intrinsic
79
why does it take a few weeks for anti depressants to start working?
because they can bind to 5ht 1a autoreceptors in the presynaptic receptors, which decrease serotonin release, BUT they quickly desensitize, which takes a few weeks
80
what is the difference between supression and repression
suppression is intentionally pushing something aside/down so that you don't have to deal with it
repression is unconsciously pushing something down so that you don't have to deal with it (ex: don't remember rape)
81
for mild intellectual disability:
what is the IQ range
describe their capability in conceptual, social, and practical
- IQ 50-70
- conceptual: impaired reading, financial planning, need help
- social: immature social and judgement skill; can be taken advantage of
- practical: can live independently and hold a job with simple skills required; may need help with family and healthcare planning
82
what age range do most babies become potty trained
15 months to 3 years
83
what are two proposed causes for perimenopausal depression and why? (2)
- decreasing hormone levels --> hot flashes/vaginal dryness --> sleep and mood disturbances
- peri menopause happens at time in life where women go through significant stressors : divorce, children leaving home, illness in spouse, parents dying
( also previous history of premenstrual or postpartum depression puts you at risk)
84
what reflex is when you drop a baby and they lift their arms
MORO
85
what is the mechanism of action for PCP?
what drug has the same mechanism of action
- noncompetitive allosteric inhibitor (antagonist) of glutamate/nmda receptor
ketamine
86
name the two parts of the pharmacological aspect of the definition of a substance use disorder
- tolerance (need a higher dose in order to achieve high
| - withdrawal (symptoms when not using)
87
describe the allostasis or reward-deficiency hypothesis of addiction
- when you repeated use a substance, your baseline mood point gets lower and lower so that with each subsequent use, you have to drink more to feel good until eventually you are just drinking to feel normal
- there are also decreases in the reward systems in the brain (nucleus accumbans) so that nothing motivates you except the drug
88
describe disinhibited social engagment disorder
a child (> 9 months ) has no restraint in approaching strangers that are not their caregivers
- don't check in with caregiver
- do familiar physical behaviors that are not socially appropriate
- is willing to go with another adult with limited hesitation
89
what medication, when given with opioids, is dangerous and can cause significant sedation
benzodiazepines
90
what is alexithymia
what condition is this common in?
inability to describe symptoms in words
somatic symptom disorder (can only express emotions through physical symptoms)
91
what is delayed ejaculation
what is the treatment
when you either have a delay in ejaculation or a marked infrequency or absence of ejaculation
- psychotherapy, cbt, dual sex therapy, analytically oriented sex therapy
92
what is excoriation?
skin picking with fingers or objects, can be anywhere on the body
not attributed to any hallucinations or other condition
93
autism spectrum disorder is thought to be due to a lack of normal ______
pruning (keeping the synapses you use and losing the synapses you don't use)
94
what eating disorder is more likely to be evenly split between men and women
binge eating disorder
95
what is rationalization
distorting one's perception of a negative event so that it seems reasonable
ex: do poor on an exam --> opportunity to do better
96
what are the four phases of human sexual response?
desire (fantasize, minutes to days)
excitement (foreplay, clitoral engorgement and vaginal lubricaiton, penis erection)
orgasmic phase (climax)
resolution phase (euphoria and relaxation)- women can orgasm multiple tiems before needing a refractory period, men need a 15 min refractory period after each orgasm
97
how does buprenorphine work?
what is one potentially dangerous side effect?
- high affinity, low activity partial agonist of the mu receptor, great for withdrawal because it's long acting with a slight agonist activity
- if you have a v strong depenence on full agonist opioids or it's been a short interval since taking last taking opioid, this can actually precipitate withdrawal.
98
name some common psychological reactions to a medical diagnosis/illness?
arre they bad?
```
DDDAAO
dependency
depression
denial
Anxiety
anger
obsessive/compulsive
```
no, a little dependency/anxiety, anger, depression etc is normal and can actually help u be compliant/seek help
99
describe how depression can increase chance of CAD
- can cause silent ischemia
- increase autonomic imbalance
- increases cytokines
- increases arrhythmias
- effects platelets
- decreases heart variability
100
what is an opioid blockade an what does it refer to?
- refers to when treating a chronic opioid addiction, when you give buprenorphine or methadone, if you relapse and take heroin or another opioid, the receptor will be blocked so the drug won't work and you can help break the cycle of reward that the drug gives as well as prevent and overdose/return of your addiction
101
what is the difference between somatic amplification and somatic deamplification?
- somatic amplification, you perceive pain as significantly worse than it is (nail between the toes)
- somatic de-amplification- you perceive pain as significantly less severe than it truly is (nail in the head)
102
how does malingering and factitious disorder differ?
- malingering is in order to gain something, but will most likely not be willing to go through alternative treatments
- factitious disorder is just in order to fool a doctor, they would also be willing to go through treatment
103
what is the cause of fragile x syndrome
what is the possible likelihood of inheritances
what are the features ?
- >200 CGG repeats on fmr-1 gene on exon 1 (50-200 is premutation)
- full mother can pass down to daughters and sons --> all sons will get fragile x, 50% of daughts will get fragile x
- premutation mother can pass premutation to children or can pass full mutation to hildren --> sons will get it and 50% of daughts
- big and long head, large protruding ears, large gonads, moderate intellecual disability, speech delay, large chin, loose joints
104
for moderate intellectual disability:
what is the IQ range
describe their capability in conceptual, social, and practical
- 35-50
- conceptual: elementary school level
- social: good relationship verbally with family but social impairment, language impairment, poor judgment
- practical: can do personal care with support and teaching; can work if supported environment
105
what are the features of bipolar mania (7)
- grandiosity or inflated self esteem
- flight of ideas
- distractibility
- talkative
- increase in goal oriented work
- increased impulsivity (that could get you in trouble)
- decreased sleep
106
what are the freudian stages of development
oral (expore everything through your mouth)
anal (potty training era)
phallic/oedipal (sexual feelings for opposite sex parent)
latency (start relating to same sex parent and same sex peers)
genital (have sex)
107
what are the two types of psychoanalytic psychotherapy
insight oriented: helps you understand the dynamics of your disease so you can eventually get relief, better for people who want to get better and are more articulate/expressive
supportive: focuses on shifting from immature/poor defense mechanisms to mature/better mechanisms and help/encourage maintaining them; better for people who don't function optimally
108
what is the difference between shaping and modeling
shaping: giving rewards for closer and closer approximations to the true behavior
modeling: teaching behavior by showing and them observing
109
name symptoms of serotonin syndrome
- restlessness, agitation, delirium
- MYOCLONUS(v specific sign), seizures, rigidity
- nausea vomiting DIARRHEA
- hyperthermia
- autonomic dysfunction (labile bp, tachycardia and tachypnea, sweating)
110
what mental illness increases mortality after an MI by 4x
depression
111
what is reaction formation
adopting opposite emotions to avoid unacceptable emotions (ex: hating a guy cuz you secretly like him)
112
what is agoraphobia?
```
- fear of :
using public transportation
being in open spaces
being in enclosed space
being in crowded areas or lines
leaving home alone
```
- situation must provide anxiety and also you must avoid it
>6 months
113
what is the matrix model of therapy?
- used for substance abuse (initially stimulants)
- incorporates 12 step, motivational interviewing, family therapy cbt
- 6 months intense therapy
- 6 months weekly support group
114
what is the difference between psychological and physiological dependence?
psychological: persistent, compulsive drug seeking and taking behavior in the face of negative consequences (ex: stimulants)
physiological : withdrawal would occur if you stopped the drugs (opioids)
can have each in isolation or both togther
115
what variations of which subunit on the gaba receptor is responsible for the many affects of benzos
- alpha 1: sedation (sleep effect)
- alpha 2: anxiolytic (anxiety)
- alpha 2,3,5: muscle relaxant
116
what is the mechanism of action of buproprion
what is it used to treat
what are side effects
- antidepressant, blocks reuptake of dopamine and norepi
- smoking addiction (start it 10-14 days before quitting)
- anxiety, insomnia, maybe seizures
117
what is the impulsivity hypothesis of addiction
the idea that the impulsivity parts of the brain (limbic and paralimbic) are hyperactive and executive system (prefrontal cortex) is hypoactive in substance use disorder, leading to extensively impulsive behavior, with severe devaluation of reward as time passes without the reward
118
what are the three cluster a personality types?
Paranoid, Schizoid, Schizotypal
(accusatory, aloof, awkward)
(WEIRD, wild, and worried)
119
what are designer stimulants made of
what is the main route of consumption
- synthetic derivatives of african khat herb
- can be made of methedrone,mephredrone, butylone, mdpv
- snort
120
is alcohol abuse more genetically or environmentally caused?
genetically
| shown in family studies and adoption studies
121
what is biofeedback
you use a physiologic response (ex: HR) as a measure of your problem/anxiety and you work on methods to decrease that response
122
what two meds can be used for nacrolepsy
modafenil (promotes wakefullness)
gamma hydroxybutyrate (promotes normal sleep)
123
the more sever the intellectual disability, the more likely that the etiology is _______ and that there will be more ______
genetic
medical conditions (seizures, hearing, visual, autism, depression, anxiety, self harm
124
what is the most common substance that is abused
alcohol!
125
where do you stimulate for dbs for someone with major depression
anterior cingulate gyrus, under the genu
126
what is displacement
- taking emotions about an intolerable situation and placing it on a situation that is more tolerable
- ex: have cancer and come in for chemo but tell yourself you have an infection and are coming for antibiotics
127
what are signs of opioid withdrawal?
what can you use to treat?
- flu like symptoms, nausea, vomiting, diarrhea, abd pain, chills, hot flashes, muscle pain, joint pain, yawning, lacrimation, rhinorhea, maybe dilated pupils anxiety
- buprenorphine (long acting partial agonist) or methadone (long acting full agonist)
128
what are the type of delusions you can have in schizophrenia
made feelings: someone is inserting feelings in your head that you don't necessarily want to feel
- thought insertion: someone is inserting thoughts into your head
- thought broadcasting: everyone can hear your thoughts/are aware of your thoughts
- ideas of reference: everything you see is a sign/symbol of something for you (ex: you see someone talking on the phone and you think it's someone reporting you to the police)
129
name the most heritable psychiatric disorders in order from most heritable to least
autism > schizophrenia, bipolar > alcohol and drug abuse > anxiety,depression, bulimia
130
what parts of the brain can be impacted by vagus nerve stimulation
which vagus nerve is stimulated and why
- orbitofrontal cortex, insular lobe, mid cingulate gyrus
| - left, right innervates the heart
131
what part of the brain is underdeveloped during adolscence and what two parts of the brain are overdeveloped?
what problem does this pose
- prefrontal cortex
- amygdala and nucleus accumbands
- part of the brain that helps with judgement is underdeveloped and part of brain with reward and emotion is over active --> risky decisions
132
describe features of schizoid personality disorder
what cluster is it
is psychosis possible?
- Almost always chooses solitary activities.
- Has little, if any, interest in having sexual experiences -with another person.
- Takes pleasure in few, if any, activities.
- Lacks close friends or confidants other than first-degree relatives.
- Appears indifferent to the praise or criticism of others.
- Shows emotional coldness, detachment, or flattened affectivity.
A
yes, brief under stress
133
describe criteria for borderline personality disorder
what cluster is it
what other conditions are common with it
- constant fear of abandonment
- classify people in either good or bad, can quickly move between the two
- impulsive behavior
- self harming/suicidal bhavior
- feel empty
- hella mood changes due to excessive mood reactivity
- excessive, uncontrollable anger
- sometimes paranoid ideation
b
mood disorder, substance abuse, ptsd , eating disorder
134
how early can you start screening for autism spectrum disorder
18 months
135
what is the mechanism of action for disulfuram/antabuse
what are presenting features when using it
what is a serious side effect
what can it be used to treat?
- acetylaldehydrate dehydrogenase blocker
- nausea, anxiety, headache, chest tightness, flushing, hypotension
- hepatotoxicity
- alcohol dependence
136
describe criteria for avoidant personality disorder
what cluster is this
- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
- Is unwilling to get involved with people unless certain of being liked.
- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
- Is preoccupied with being criticized or rejected in social situations.
- Is inhibited in new interpersonal situations because of feelings of inadequacy.
- Views self as socially inept, personally unappealing, or inferior to others.
- Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
137
what is congenital rubella most likely to be transmitted from mother to baby during pregnancy
how would the baby present?
first trimester
- intrauterine growth restriction, intellectual disability, microcephaly, hearing loss, congenital heart defects, cataracts, blueberry muffin thrombocytopenic purpura, hepatosplenomegaly
138
name some associated symptoms/disorders that might accompany adhd
- tourettes
- positive babinski
- poor coordination
- conduct disorder
- eeg findings
- learning disability
139
name at least 4 paraphillic disorders
Voyeuristic disorder—observing unsuspected persons
Exhibitionistic disorder—exposing genitals to unsuspecting persons
Frotteuristic disorder—rubbing against nonconsenting persons
Sexual masochism disorder—Recurrent sexual arousal from the act of being humiliated, bound, beaten
Sexual sadism disorder—recurrent sexual arousal from the physical and psychological suffering of another person
Pedophilic disorder—prepubescent children
Does not have to cause distress
Fetishistic disorder—non-living objects or non-genital body parts
Transvestic disorder—cross-dressing
140
what is the inheritance/cause of sotos syndrome
describe the features
- autosomal dominant, nsd1 mutation
- rapid early growth, advanced bone growth, large long and thin head, down slanting palperal fissures, variable intellectual disability
141
what age do babies start to get stranger anxiety and when does it usually end?
7-9 months - 1.5 yrs
142
for each of the antipsychotics below, state what they are the prototype for?
chlorpromazine
trifluoperazine
haloperidol
thioridazine
- chlorpromazine- aliphatic phenothiazine
- thioridazine- piperadine phenothiazine
- trifluoperazine- piperazine phenothiazine
- haloperidol- butyrophenone
143
what are main 5 main principles of psychoanalysis (mnemonic)
RIFFT
- Rule of abstinence- therapist should be as neutral as possible to avoid adding any bias to patient (white male with beard least biased lmao)
- Interpretation- after listening and watching patient, offer observations/opinions that might be help understand unconscious behavior more
- free association- patient just says whatever is in their mind without interruption, whatever transitions they randomly make have unconscious meaning
- free floating attention- speaks about what they see in the room, memories, feelings about therapist, all have meaning about unconscious
- Transference- talk about feelings/fantasies about therapist, reflects feelings about someone else in their life
144
name the two parts of the risky use aspect of the definition of a substance use disorder
- using in physically hazardous situations
| - using despite psychological disturbance or medical problem
145
what does PANDAS stand for ?
what does it cuase
pediatric autoimmune neuropsychiatric disorder associated with strep (group a beta hemolytic)
causes ocd/tics
146
describe female sexual interest/arousal disorder
what is the treatment
what is the male equivalent of this condition
- partial or complete inability to attain and maintain lubrication during the excitement phase or just a lack of excitement; no sexual interest, fantasies, initiation of sexual activity, enjoyment of sexual activity
- good communication, flibanserin (don't take alcohol)
male hypoactive sexual desire disorder
147
how does depression affect pathophysiology? (5)
- increased inflammation
- decreased insulin sensitivity
- increased cortisol secretion with decreased circadian variation
- increased chance of osteoporosis
- causes autonomic imbalance
148
what 5 categories of symptoms do people with acute stress disorder and ptsd share?
how do asd and ptsd differ?
- dissociation ( inability to remember parts of traumatic event
intrusion (thoughts and distressing memories consistently keep intruding thoughts)
avoidance (try to avoid memories or triggers for event)
negative mood (hard to have positive affect)
arousal (hypervigilance, easily startled)
asd lasts for 3 days to a month
ptsd lasts greater than a month
ptsd also may have extra symptoms, like inability to remember a significant part of traumatic event, persistent negative mood, persistant negative thoughts about self world or others, persistant desire to do things
149
what is a good measure of recent smoking? and why?
what is another measure of smoking?
expired CO
smokers usually have increased levels of CO in the blood (>8% --> carboxyhemoglobin)
- cotinine levels, metabolite of nicotine, stays in blood longer than nicotine
150
what is avoidant/restrictive food intake disorder
how does it differ from anorexia nervosa?
what is the treatment?
- a disorder in which you are not eating enough to meet nutritional requirements; can be due to lack of interest or sensory avoidance of foods; asociated with weight loss or inability to gain and dependence on supplements or enteral feeding
- there are no features of body dysmorphia or obsession with weight
- behavioral therapy and family eval therapy
151
name the four parts of the impaired control aspect of a substance use disorder
CAPS
- CRAVING
- A great deal of time spent doing activities necessary to obtaining the substance
- persistent desire, or failed attempts at cutting down
- substance used at greater dose or longer period of time than intended
152
what is munchausen by proxy?
- and adult feigning illness in their children?
153
describe the general criterion for a personality disorder
- an inflexible, persistent pattern of behavior and experience that causes significant impairment or distress and deviates from the norm in at least 2 of the following: cognition, affect, interpersonal relationships, and impulse control.
154
what is splitting
what condition is it most common in
categorizing people into two categories: all good or all bad, and one minor inconvenience can cause you to recategorize the person as bad
borderline personality disorder
155
what is SBIRT
SCREENING- can involve breathalyzers, urine screen, blood or saliva, also surveys (EX: AUDIT survery)
Brief Intervention- talk to the patient about their score, what that means in context of other people with that score, then hook them by asking what they think about it (trying to make them aware of the problem)
Referral for Treatment- if severe, need to refer, even if mild can refer to treatment or for more evaluation
156
name some neurochemical findings associated with autism spectrum disorder
- decreased urine catecholamines
increased dopamine metabolism in csf
increased serum serotonin
autoantibodies against serotonin receptors
157
what is generalized anxiety disorder and what is the treatment
- feeling fear and worry for >6 months that is impairing about several aspects of life with at least 3 of the following :
- muscle tension
- irritability
- weakening fatigue
- restlessness
- sleep changes
- difficulty concentrating
cbt, ssri,snri, buspirone, benzo
158
through what method is nitrous oxide abused?
what effects does it produce
inhalation via whipped cream propellant cans (whip its) or via balloons
euphoria and analgesia
cuts off blood supply to the brain (hypoxia), accidents/falls
159
what can hydroxyzine be used for?
what is the mechanism of action
- anxiety
h1 antagonist, cns depression, sedation and anticholinergic
160
name some abused solvents, fuels and anesthetics
what are their effects
what is the mechanism of action
- 111 tricholoethane, butane toluene gasolene ether
- cns depression like depressants
- GABAa agonism and nmda antagonism
161
name 4 conditions that electroconvulsive therapy can be used for
name 2 conditions that can use transcranial magnetic stimulation
what 2 conditions can cause vagus nerve stimulation
major depressive disorder
schizophrenia
bipolar mania
catatonia
major depressive disorder
ocd
major depressive disorder and epilepsy
162
what is genito pelvic pain/penetration disorder?
what is the treatment
- when there is muscle tightening (outer 1/3 vagina), pain during penetration, and fear about pain during sex
- topical estrogren
- dilators
- psychotherapy
- lubrication
163
describe criteria for histrionic personality disorder
what cluster is it
- overly dramatic/theatrical
- rapidly shifting and shallow behavior/language
- suggestible
- sexually provocative
- things relationships are closeer than they actually are
- wants to be center of attention
- uses physical body to draw attention to one's self
- b
164
what parts of the brain may be effected in adhd
- frontal lobe, locus ceruleus
- also smaller dorsal prefrontal cortex and anterior temporal lobe but increased posterior temporal lobe and inferior parietal lobe
165
what is systematic desensitization
counter conditioning technique to slowly help someone overcome a maladaptive anxiety/phobia by slowly exposing them to things closer and closer to the actual anxiety/phobia
166
what are symptoms of schizophrenia
how long do you need to have them?
- delusions, hallucinations, disorganized thought (derailment and incoherence), disorganized/catatonic behavior
- negative symptoms: affect flattening, avolition (lack of desire to do self directed activity, alogia (no desire to do unprompted activity), asociality (decreased need for human intimacy/love/desire/ interaction)
- 6 months
167
What ensures the least likelihood of addiction when prescribing opioids?
- giving the lowest effective dose (do not exceed >90 Morphine equivalent/day)
- giving no more than 3 days amount
- giving immediate release opioids vs longer acting/extended release
168
describe criteria for dependent personality disorder
what cluster is it
what could be the source of this disorder?
- Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
- Needs others to assume responsibility for most major areas of his or her life.
- Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
- Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
- Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
- Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
- Urgently seeks another relationship as a source of care and support when a close relationship ends.
- Is unrealistically preoccupied with fears of being left to take care of himself or herself.
cluster c
childhood illness/abandonment/separation anxiety
169
what is conversion disorder
name symptoms (at least 5)
what can be the cause?
what are tests that can help diagnose?
- a disorder in which a patient is experiencing neurologic symptoms that can't be explain by known neuropathology (not malingering)
- paralysis, weakness, visual or auditory loss, nonepileptic seizures, dystonia, dysphagia, aphonia
- can be due to unconscious trauma/abuse in the past that is manifesting, also can be due to improper wiring in the brain
- hoover sign, seizures with normal eeg, give way weakness, tubular visual fields, sensory loss that doesn't follow known patterns
170
describe criteria for obsessive compulsive personality disorder
what cluster is it
- Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
- Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
- Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
- Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
- Is unable to discard worn-out or worthless objects even when they have no sentimental value.
- Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
- Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
- Shows rigidity and stubbornness.
c
171
what are features of fetal alcohol syndrome
- smooth filtrum, small upper lip, small eyes, small head, underdeveloped chin, adhd behaviors, intellectual disability, congenital heart disease
172
describe criteria for narcissistic personality disorder
what cluster is it
how can it be differed from antisocial personality disorder
- grandiose sense of self
- love and want admiration
- jealous of others
- exploitative
- lacks empathy
- has fantasies about success, ideal love, job etc
- arrogant
- entitled
- thinks they are special
b
impulsiveness is not violent, not aggressive, not trying to deceive for the sake of decieving
173
what are the six steps of a safety plan?
1: what are warning signs that let you know you can be in danger of commiting suicide
2: what can you do on your own to try to get rid of the thoughts (ex: meditation)
3: what can you do with people or in a social setting
4: what people can you contact if you feel like you might commit suicide/need to go to the hospital
5: what agencies/professionals can you call
6: what dangerous things can u remove from the house (make the environment safe)
174
what is the mechanism of action for naltrexone
what can it be used to treat?
- opioid receptor antagonist
| - cravings for etoh and opioids (dont' have to be abstinent)
175
name the routes of opioid ingestion and which are most and least likely to cause addiction
1) oral (least likely to get addicted, little absorption)
2) subcutaneous
3) intranasal
4) smoking
5) iv (most likely to get addicted)
176
what is sublimation
expressing an unacceptable emotion in a way that is productive to society/socially acceptable
ex: anger towards father --> play on football team
ex: erotic feelings --> channel it into art
177
for autism spectrum disorder:
what meds can be used to treat aggressive behavior?
mood?
self injurious behavior?
- haloperidol, risperidone, thorazine (neuroleptics)
- lithium, depakote, clonidine
- naloxone, propanolol
178
name effects of cannabis use
- increased heart rate
- sedation
- injected conjunctiva
- impaired judgment
- altered mood
- mild memory loss
- altered perception
- personality changes
179
what disorder is an infrequency or delay for a female to have an orgasm, or decreased intensity of orgasm
female orgasmic disorder
180
what is the usual cause of phenylketonuria?
do you get intellectual disability
name features
- defect in phenylalanine hydroxylase (converts phenylalanine to tyrosine), also hyperF, mutation in gene for enzyme cofactor
- if untreated, YES
- if untreated, severe intellectual disability, behavioral problems, microcephaly, seizures, fair complexion
181
name features of autism spectrum disorder (name at least 5)
- self absorption
- disinterest in others
- inability to make eye contact
- inability to make affective contact
- stereotyped behavior (hand wringing, toe walking
- usually lower intelligence or uneven deficits (idiot savant)
- maybe self-abusing behavior
- if significantly impaired, inability to speak but make noises, or only perseverate or echolalia
182
when is congenital cmv most likely to be transmited to baby from mother in pregnancy?
how would the baby present after birth
what about if the baby gets cmv during birth?
- first trimester, primary infection
- asymptomatic, may have visual or hearing loss, may have intelelctual disability
- hepatosplenomegaly, petechiae and purpura, neurological sequelae like seizures, feeding difficulty or microcephaly
183
what are the 8 stages of Erikson's model of development
```
Trust vs Mistrust (1st year)
Autonomy vs Doubt (2nd Year)
Initiative vs Guilt (3-5 years )
Industry vs Inferiority (6-12)
Identity vs Role Confusion (12-18)
Intimacy vs Isolation (18-40)
Generativity vs Stagnation (40-65)
Ego Integrity vs Despair (65- death)
```
184
what is the most common anxiety disorder
specific phobia
185
what gwas findings are highly associated with schizophrenia
DRD2 receptor
increased C4A (complement, excessive pruning)
increased variation in hla region
186
name the three cluster c disorders
- avoidant, dependent, obsessive compulsive personality disorder
(cowardly, clingy, compulsive)
187
what is specific phobia?
what is the treatment
- significnt fear or anxiety about a specific stimulus that is out of proportion to what danger it actually poses
- >6 months
- must cause significant distress almost every time and person must actively avoid this stimulus as a result
systematic desensitization therapy
188
what of the three is only present in the unconscious: id, ego, supergo
what of the three is present in the unconscious, conscious and preconscious
id
ego, superego
189
what is the most common illicit drug used?
second most common?
which age group?
- marijuana
- prescription pain killers (misuse)
- 18-25
190
what are the two prevailing theories about why neuroleptic maglinant syndrome happens
- there's a central dopamine blockade
| - skeletal muscle toxicity leads to other symptoms
191
how might progressive depressive disorder present as in children?
irritability
192
what four drugs can cause substance/medical induced sexual dysfunction
SAAS
SSRI's
anabolic steroids
alcohol
sedatives/hypnotics
193
what mental illness can propanalol be used for and why
anxiety, can reduce sympathetic fear and anxiety response
194
what is a panic attack
- an intense surge of fear and anxiety (either from a calm or anxious state) with at least 4 of the following :
- Feeling dizzy, unsteady, light-headed, or faint.
- Chills or heat sensations.
- Paresthesias (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control or “going crazy.”
- Fear of dying.
- Palpitations, pounding heart, or accelerated heart rate.
- Sweating.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
195
Which (non-nicotine) substance is most prone to a new user becoming addicted to it?
heroin
196
is menopause or peri menopause associated with depression? and why?
peri- menopause, hormonal levels are changing
low levels of hormones during menopause doesn't cause depression
197
what coordinates impulsive drives and morality and is also responsible for keeping good interpersonal relations
ego
198
what two drugs can be used to treat adhd
side effects?
what can you give for the irritability?
what selective norepinephrine reuptake inhibitor has been shown to be effective for adhd
methylphenidate (ritalin) and dextroamphetamine (adderall)
gi upset, agitation, sleepiness, tics
clonidine, guanfacine
atomoxetine
199
name 3 causes of prader willi syndrome
what are the symptoms
- paternal deletion of prader willi gene 15q11.2 (maternal gene is methylated), uniparental maternal disomy, imprinting center defect
- mild intellectual disability, small hands feet and gonads, HELLA appetite, hypotonia as baby
200
what drug does peyote contain
what drug class is it
- mescaline
| - hallucinogen
201
what is the criterion A for an acute stress disorder or ptsd?
exposure to actual or threatened death, serious injury or sexual abuse by
- having experienced it yourself
- having witnessed it=
- finding out that it happened to a close family member or friend
- having to be exposed to the extreme details [repetitively] (ex: first responder going to pick up bones)
202
which age range is parallel play and prosocial behavior
what are they
2-6
parallel play- play next to someone
prosocial behavior- teachers/caregivers teach/correct children to control impulsive behavior and share/be good
203
name the four effects of caffeine
what about at higher levels
name some systemic side effects
- increased alertness
- decreased fatigue
- increased ability to sustain activity
- decreased sleep
- nervousness, restless, insomnia, tremors, maybe even convulsions
- arrythmia, tachycardia, relax smooth muscle, constrict cerebrovasculature, constrict myocardium, bring sugar into cells (hypoglycemia), increase gastric secretions
204
what are signs of a benzodiazepine overdose?
what can you use to treat? what significant side effect can it cause?
- slurred speech, memory impairment, nystagmus, incoordination, ataxia, mood lability, inappropriate behavior
- supportive treatment (abc) , activated charcoal, flumazenil (benzo antagonist, not good if dependent), give every hour up to 9 times, can cause seizures
205
when does caffeine withdrawal start and peak? how long can it last
name some symptoms
12-24 hr, 20-48 hours, a week
- HEADACHE, fatigue, irritability, anxiety, inability to concentrate, anxiety
206
what type of receptor is the cannabinoid receptor
what are the types and where are they located
- gpcr
cb1: cns, immune system, testes
cb2: immune system
207
what is the strongest predictor of commiting suicide
previous attempt
- the more lethal, planned, and covert the previous attempt, the more at risk you are for doing it again
208
what is the purpose of a rorschach test/projective testing?
what can it test for?
is it subjective or objective?
- it allows the patient to give structure to an unstructured stimuli, which give an idea of their unconscious thinking
- schizophrenia, obsessive style, coping deficit, depression
subjective
209
what is the inheritance of PTEN hamartoma syndrome
what 4 conditions are part of pten hamartoma syndrome? which one can have intellectual disability
name findings
what cancers are you at more risk for
- autosomal dominant
- cowden (INTELLECTUAL DISABILITY), pten-related proteus, proteus- like, bannayan-riley-ruvilcaba
- trichellemonas, papillomatous papules, macrocephaly
- breast, thyroid, endometrial, renal
210
what are the two mechanisms of action of etoh?
binds to GABAa and increases chloride flux into neuron (low to moderate dose)
binds to nmda and blocks glutamate transmission (higher doses)
211
describe the mechanism of action for hallucinogens
- mescaline, lsd, and psilocybin bind to 5ht2a receptors as partial agonists
- mdma binds to 5ht receptor to promote serotonin release, also binds less preferentially to nepi and dopa
212
what is physical dependence?
when you stop a drug, you have stereotyped classical symptoms of withdrawal that can be reversed by continuing the drug
213
name some effects and dangers of hallucinogens use
- sympathomimetic activation
- altered perception and thought process
- impaired judged/irrational behaviors/taking risks
- panic attacks (bad trip)
- mood lability
- adulteration
- neurotox (mdma)
- psychiatric illness
214
what is the difference between drift and stress when it comes to mental health disorders, and which disorders belong to which
drift- disorder makes you drift into lower socioeconomic status (schizophrenia and alcohol abuse)
stress- lower socioeconomic status causes the disease (depression,anxiety, childhood conduct/oppositional defiant disorders)
215
what is the community reinforcement approach/what is unique about it
- work with a therapist to identify why you want to change, how to change/cope, how to get rid of postive reinforcements of substance abuse, and how to reinforcement abstinence
use family/friends/social support as a positive reinforcement of abstinence
216
are there contraindications for electroconvulsive therapy
no, just cautions
```
increase ICP
uncontrolled htn
ventricular arrhythmia
MI
metal scalp thing
```
217
what is anorexia nervosa
what are the two types
what population is commonly affected
what can be physical sequela of the condition
how does it differ from avoidant/foodrestrictive disorder?
how do you treat?
- disorder in which person is significantly preoccupied with fear of gaining weight and therefore restricts eating and is obsessed with food; must be under weight or low bmi; usually has poor insight; has significant body dysmorphic problems
- restrictive: watch weight by controlling intake, exercising, dieting (haven't purged/binged in 3 months)
- binge eating/purging: engage in binging and purging
- women after puberty
- lanugo, brittle hair, amenorrhea, hypotension, hypothermia, constipation, increased cortisol, decreases thyroid function
- in AN, they have body dysmorphia and preoccupation with weight
- fix nutritional deficit/electrolyte imbalance and then family therapy for youngins, cbt for adults
218
describe the cycle of drug abuse and withdrawal
- binge and intoxication (increased serotonin and dopamine) --> withdrawal and negative effect (dopamine and serotonin crash, increased stress response --> anticipation and preoccupation --> binge
219
who commits suicide more, men or women?
by what method?
men (women make more attempts though)
firearms (women by overdose)
220
what is social anxiety disorder?
how does you treat
- fear or anxiety about one or more social situation where there is the opportunity to be scrutinized or judged negatively, and therefore you avoid those situations
ssri, snri, benzos, cbt
221
what is binge-eating disorder?
are these people usually under weight, overweight, or normal weight
what are treatment options
- you eat rapidly, in excess of a normal amount, and are out of control when you do this, but you don't do any compulsive behaviors after to fix weight
- usually overweight
- ssri (cetalopram and sertraline), cbt
222
what kind of receptor do opioids bind to
GPCR (Gi)
223
where is etoh metabolized
name the order of metabolism
what is the rate limiting step that determiens whether you can "hold your liquer)
what step is usually decreased in asian populations
what order kinetics ?
how much is metabolized in an hour
liver
- alcohol metabolized to acetylaldehyde via alcohol dehdyrogenase; then metabolized by acetylaldehyde dehydrogenase into acetyl CoA which enters the citric acid cycle
- alcohol dehydrogenase
- acetylaldehyde dehydrogenase (causes flushing)
zero order (concentration of drug does not affect ability of enzyme, constant amount metabolized per hour)
- one drink per hour
224
what gender is more likely to get major depressive disorder
what gender is more likely to get bipolar disorder
what is the age of onset for each on average
women (age 40)
equal across genders (age 30)
225
what is cross tolerance and cross dependence?
cross tolerance: tolerance to one drug in a class confers tolerance to other drugs in the same class
cross dependence: withdrawal of one drug can be treated with another drug in the same class (this is the same mechanism of action in using some drugs to stop addiction)
226
name features of adhd
- hyperactivity
- irritability
- no impulse control
- inability to pay attention to things they don't care about (can be hyperfocused on things they care about )
- accident prone
227
name the four categories of drugs that can cause serotonin syndrome and name at least one drug in each category
Increase serotonin release: cocaine, amphetamines, dextromethorphan, meperidine, fentanyl, MDMA (Ecstasy), lithium
Stimulate serotonin receptors: triptans, trazodone, nefazodone, vilazodone, buspirone, ergot alkaloids
Inhibit serotonin catabolism: MAOIs, linezolid, isoniazid, procarbazine, methylene blue
Inhibit serotonin reuptake: SSRIs, SNRIs, TCAs, , tramadol, St. John’s wort
228
does pregnancy put you at increased risk for pregnancy?
name factors that put you at risk for depression during pregnancy
nope
younger age, history of depression, poor social suport, ambivalence about pregnancy, multiple children, marital problems
229
in which mood disorder have males been found to have increased ventricle size?
bipolar disorder
230
what receptor is decreased significantly in a substance use disorder
D2 (dopamine)
231
what is factitious disorder/munchausen disorder?
what personality disorder is this common with?
what population is this common in
- consciously faking an illness/disease in order to fool/dupe a doctor; will fake lab results
- borderline personality disorder
- healthcare workers and their adult children
232
what is malingering
what populations is it common in (3)
- faking a condition/symptoms in order to gain something
| - opioid addicts, prisoners, soliders in wartime
233
what are two drugs that can be used to treat smoking addiction
- bupropion
| - varenicline
234
what is the mechanism of action for acamprosate
what is this used to treat?
how long does its affects last
- cns glutamatergic inhibition
- alcohol dependnce in those that are already abstinent
- treat for 12 months, can last an extra 12 months
235
what is the active ingredient in cannabis?
what are legal uses of it
THC
- chemo induced nausea, wasting syndrome from AIDS, glaucoma
236
what are risk factors for opioid related harms? (4)
- history of overdose
- history of substance use disorder
- history of high opioid dose usage
- concurrent benzodiazepine use
237
what is the most common eating disorder?
binge eating disorder
238
how does bipolar 1 disorder vs bipolar 2 disorder vary
how do they vary in regards to treatment?
- both can have extreme depressive episodes that interfere with ability to function, but bipolar 1 has manic episodes that interfere with ability to function, whereas bipolar 2 has hypomanic episodes, which is features of mania that DON'T interfere with ability to function
- THEY ARE THE SAME
239
what two groups of symptoms in adolescence can be indicative of schizophrenia later on
what "soft signs" of schizophrenia have some parents noticed in adolescence
schizoid: social isolation, few friends/contacts
unsocialized aggression: inpulsive control problems, low frustration tolerance, disciplinary problems
- coordination and speech problems
240
name signs of an opioid overdose
what do you give for an opioid antagonist, how does it work, nd how long does it last
- respiratory depression, bradycardia, pinpoint pupils, slurred speech, altered consciousness, memory impairment, euphoria, coma
- naloxone, mu receptor antagonist, very fast acting but also v short duration of action that is shorter than most opioids so you may need to give multiple doses
241
what is the mechanism of action of varenicline
what is it used to treat?
- partial nicotinic agonist
| - smoking addiciton (start it 10 days before quitting)
242
what is the mechanism of action of buspirone?
what are some benefits to using it
what condition can it be used for
partial agonist of 5ht1a
no tolerance
no cns depressant effects
no cross toelrance with benzos
anxiety
243
for profound intellectual disability:
what is the IQ range
describe their capability in conceptual, social, and practical
- IQ <20
conceptual: may be able to use objects in goal oriented fashion/recreation
social: limited symbolic communication; may understand a few gestures, may be able to communicate nonverbally
practical: completely dependent for basic care
244
what is the only psychiatric condition that actually needs a neurologic exam?
conversion disorder
245
for premenstrual dysphoric disorder
what one of four symptoms must you have
what other symptoms can you have
how can you treat?
how does it differ from premenstrual exacerbation of depression
- MAID, mood swing, anxiety, irritability, depression
- fatigue, sleep changes, feelings of loss of control, appetite changes, bloating, breast tenderness
- SSRIs during luteal phase or contraception
- PED has symptoms during follicular and luteal phase, PDD is only during luteal phase
246
what is more likely to get mental illness: urban or rural people?
what are two exceptions?
urban
substance abuse no correlation
amphetamine more in rural
247
name the underlying cause of both reacting attachment disorder and disinhibited social engagement disorder? (3)
- a persistent lack of nurturing, comfort, affection or stimulation
- inability to form attachment due to constantly changing caregivers
- limited opportunities to form attachments to caregivers (ex: in orphange way more children than there are caregivers)
248
name the neuromodulation therapies in increasing order of time it takes to work
name their side effects
ECT (2-3 weeks)- cardiac, cognitive, anesthesia, amnesia
TMS( 4-6 week)- local discomfort, seizure (rare)
DBS (12 weeks)- surgical, behavioral
VNS (24+ weeks)- syncope bradycardia
249
name the stages of margart mahler's theory
```
normal symbiotic
separation individuation
--- hatching
--- practicing
---- rapproachment
--------beginning
-------- crisis
-------- solution
```
250
what is adjustment disorder?
- emotional and behavioral response within 3 months of a stressor that is out of proportion to the stressor and causes significant impairment
can manifest as depresson, anxiety, both or conduct disorder
>6 months chronic
<6 months acute
251
what is bulimia nervosa
how does it contrast from binge eating bulimia ?
what physical finding on the hands can you find and why?
name some physical sequela
what is the treatment
- condition in which you overeat in excess of what a normal person would eat (out of control) and then do a compulsive behavior to prevent weight gain (purge, laxative, diuretic, enema)
- you are NOT underweight
russell's sign on the dorsal hand (due to biting on hand during purge)
- hypocalcemia, hyper kalmic metabolic alkalosis from vomiting, hypokalemia metabolic acidosis (diuretics), dental erosion, parotid enlargement
- fluoxetine, topiramate, maybe naltrexone ( BE CAREFUL WITH DRUGS THAT DECREASE SEIZURE THRESHOLD)
252
what is pica
what substances are often involved
what population is it associated with
what should you rule out beforehand
what is the treatment
- disorder in which you eat non-nutritive, non-food substances that are outside of a cultural norm
- hair, chalk, soil
- intellectural disability/autism
- iron/zinc deficiency, other medical underlying cause
- behavioral therapy
253
what is ed 50? what is it a measure of?
amount of drug necessary to have 50% of it's maximal effect
measure of potency
254
what is gender dysphoria?
name some criteria in children
name some criteria in adults
- distress and psychological impairment about one's assigned gender and their experience of gender
- desire to be the other sex
- desire to cross dress
- desire to play with toys of other sex
- no desire to play with toys attributed to own sex
- dislike of sexual anatomy
- feeling mismatch between assigned and experienced gender
- desire to get rid of primary sexual characteristics
- desire to have sexual characteristics of other sex
- desire to be treated as other gender
- desire to belong to other gender
255
what is the most common type of hallucination of schizophrenia?
what is the common age of onset? which gender presents first?
- auditory
| - 3rd decade, men before women
256
what sleep patterns are common for people with mood disorders?
- shortened rem latency (rem happens early)
- first rem is longer
- delayed sleep onset
257
what is used to treat etoh withdrawal and why?
what else should yo ugive
- iv lorazepam, TWO DOSES can bind to gaba receptor and reduce effects of etoh withdrawal (same receptor etoh binds to)
thiamine, folic acid, fluids
258
what is a paraphillic disorder
- disorder in which you have sexual fantasies that are very variant from normal sexual patterns
- you engage in behavior that harms you physically or impairs u/causes distress, involves a nonconsenting person, or child
259
describe features of antisocial personality disorder
what diagnosis must you have before this
what cluster is it
how do you distinguish between this and psychopathy
- must be 18
- complete disregard for law, always doing things that are grounds for arrest
- deceitful and cons people
- irresponsible, can't hold responsibilities/tasks
- never plans ahead
- disregards safety of others
- irritable and aggressive, always getting into fights
- no remorse
- mellows with age
- conduct disorder
- b
- very similar, but very charming/creepy, can lead a secret life you never knew about
260
what is trichotillomania?
is it associated with body dysmorphic disorder?
- repeititive hair pulling off of any part of one's body with attempts to have stopped
no
261
what deficits in the brain support impulsivity hypothesis
- heritable impulsivity due to deficits in the right inferolateral frontal gyurs and anterior cingulate cortex
- loss of/damage to frontal cortex
262
name 4 major hallucinogens and what drug group they belong to
- mdma (ecstasy) and mescaline (phenethylamines)
| - lsd and psilocybin (indolamines)
263
what neurotransmitters are implicated in major depressive disorder and bipolar?
what about cortisol and thyroid levels
- decreased nor epi and serotonin
decreased dopamine in mdd, increased dopamine in mania
increased cortisol and decreased cortisol suppression upon dexamethasone infusion
blunted tsh response to trh
264
what drug can be used for long term treatment of opioid addiction?
is it an agonist or antagonist?
is it long acting or short acting?
what can it also be used in conjunction with?
- buprenorphine, partial long acting agonist
CBT
265
if untreated how long does a major depressive episode or manic episode last?
major depressive- 1 yr
manic- 3 months
266
what are signs of etoh withdrawal within 48 hours
what are later signs of etoh withdrawal
what are signs and symptoms of etoh withdrawal delirium tremens
- sweating, htn, tachypnea, tachycardia, seizures, tremors
- delirium, disorientation, agitation, anxiety
- within 48 hours, nausea, vomiting, sweating, rapid severe fluctuations in vital signs, visual hallucinations
267
what neurotrophic factors can antidepressants increase uptake for?
why is this important
brain derived neurotrophic factor (BDNF)
phosphorylated creb
- BDNF causes neurogenesis, synaptogenesis and increased dendritic spines, which are usualy low in the presence of stress
268
what is hoover's sign
what condition can it hep diagnose
- put hand under heel of affected leg, patient can put resistant, then keep hand there and try to provide resistance for other leg, will feel pressure from affected heel
conversion disorder
269
name 4 causes of angelman syndrome
what are the symptoms
- maternal deletino of 15q11.2 angelman gene (paternal is methylated), paternal uniparental disomy, imprinting center defect, UBE3A mutation
- spasticity, ataxia, severe to profound intellectual disability, smile/random bouts of laughter, seizures
270
what is erectile disorder
what is the treatment
- disorder in which there is an issue in obtaining an erection, maintaining an erectin, or an issue with erectal rigidity
- sildenafil tadalafil or vardenafil (pde inhibitors), or alprostadil (pge1 inhibior that you inject )
271
when do babies first show a social smile
6 weeks/2 months
272
what two non opioid medications can be considered before opioids
what could be one downside of using them
gabapentin and duloxetine
need to be used for longer periods of time before effect occurs
273
for severe intellectual disability:
what is the IQ range
describe their capability in conceptual, social, and practical
- IQ: 20-35
conceptual: little understanding of reading, language, math, reasoning, memory
- social: benefits from healthy relationship with family/friends; can use basic words, phrases or gestures
- practical: can maybe do a few basic tasks of everyday living, but require extensive support/supervision
274
describe features of edward syndrome and what is the cause
- trisomy 18
- congenital heart defects
- malformed low set ears
- odd hand position
- rocker bottom feet
- intellectual disability
- failure to thrive
- growth retardation
- microretrognathia
- hypertonia
275
what are the two types of withdrwal
spontaneous (stop the drug)
precipitated (given an antagonist ex: naloxone)
