Psych Flashcards
(109 cards)
1
Q
Personality traits are
A
enduring patterns of perception/thinking about environment/social setting.
2
Q
Personality Disorder is?
A
When personality traits are inflexible, maladaptive, and impairs life/fx.
3
Q
General personality disorder criteria
A
- Patterns deviate from culture in >1 areas (Cognition, Affect, Interpersonal Fx, impulse control)
- Pattern is inflexible/pervasive
- Distressing/impairs
- Hx Stable/tracing back to adolescence/early adult
4
Q
Cognition is…
A
Ways of perceiving/interpreting self, people, events
5
Q
Affectivity is…
A
Emotional response
6
Q
Cluster A personality disorders list?
A
Paranoid
Schizoid
Schizotypal
7
Q
Paranoid Personality D/O def?
A
Pervasive distrust that is interpreted as malevolent.
8
Q
Paranoid Personality D/O criteria
A
> 3 of
- suspects exploitation/harmful/deceitfulness
- preoccupied w/ unjustified doubts of loyalty/trust
- reluctant to confide in others due to fear of reprise
- reads demeaning/threatening messages into NL things
- persistently has grudges and is unable to forgive
- perceives attacks of character/reputation
- recurrent suspcisions of fidelity
9
Q
Schizoid Personality d/o def?
A
Pervasive detachment from social relations and restricted range of expression or emotions in interpersonal settings.
10
Q
Schizoid Personality d/o criteria
A
> 3 of
- No desire/enjoyment of close relationships friend/fam
- Almost always chooses solitary activities
- No interest in sex
- Few if any activities that please
- Lacks close friends/confidents
- Indifferent to praise or criticism
- Appears emotionless, detached, or flat
11
Q
Premorbid schzoid personality disorder indicates?
A
Prior to onset of schizophrenia
12
Q
Schizotypal Personality d/o def?
A
Pervasive of social deficits w/ discomfort/reduced capacity for close relationships and cognitive/perceptual distortions/eccentric behaviors.
13
Q
Schizotypal Personality d/o criteria?
A
> 4
- Ideas of reference
- Odd beliefs/magical thinking influencing behavior
- Odd behavior/appearance
- Unusual perceptual experiences (illusions)
- Odd thinking/speech
- Suspicious/paranoid ideation
- Affect inappropriate or constricted
- Lack of close friends/confidents
- Excess social anxiety from paranoid fears
14
Q
Premorbid Schizotypal Personality d/o indicates?
A
Prior to onset of schizophrenia
15
Q
Cluster B personality disorders list?
A
Antisocial
Borderline
Histrionic
Narcissistic
16
Q
Antisocial Personality d/o def?
A
Pervasive disregard/violation of others rights since 15yo
17
Q
Antisocial Personality d/o criteria?
A
Conduct d/o <15yo but must be >18yo for dx and w/ >2
- Fail to conform to lawful behaviors
- Deceitfulness/conning for personal profit/pleasure
- Impulsivity/fails to plan ahead
- Aggressiveness (repeated fights)
- Irresponsibility (fail to sustain work/debts)
- Lack of remorse
18
Q
Borderline Personality d/o def?
A
Pervasive relationship instability, self image, and impulsivity.
19
Q
Borderline Personality d/o criteria?
A
Chronic feelings of emptiness
Inappropriate, intense anger
Transient stress related paranoia/dissociative s/s
—
>4
- Frantic efforts to avoid real/imagines abandoment
- Unstable intense relations + alter ideals/deavualtion
- Identity disturbance (unstable self image)
- Impulsivity w/ >1 ($,sex,drugs,reckless driving, eating)
- Recurrent suicidal behavior, threats, SIB
- Affect instability (alternating w/in hrs)
20
Q
Histrionic Personality d/o def?
A
Pervasive excessive emotions and attention seeking
21
Q
Histrionic Personality d/o criteria?
A
> 4
- Uncomfortable if not the center of attention
- Inappropriate seductive/provoctive behavior
- Rapid shifting/shallow expression of emotions
- Uses physical appearance to draw attention
- Excess impressionistic speech lacking in detail
- Self dramatization
- Easily influenced by others
- Thinks relations more intimate than really are
22
Q
Narcissistic Personality d/o def?
A
Pervasive grandiosity, need for admiration, and lacks empathy.
23
Q
Narcissistic Personality d/o criteria?
A
> 4
- Grandiose self importance
- Fantasizes of unlimited success/power/beauty
- Believes they are special and only associates w/ like
- Req excess admiration
- Sense of entitlement
- Exploits people
- Lacks empathy
- Envious of others envious of them
- Arrogant attitude
24
Q
Cluster C personality d/o list?
A
Avoidant
Dependent
Obsessive-Compulsive
25
Avoidant personality d/o def?
Pervasive social inhibition, inadequacy, and hypersensitivity to negative criticism.
26
Avoidant personality d/o criteria?
>3
- Avoids activities w/ significant contact
- Unwilling to befriend people unless will be liked
- Restraint w/in intimate relations; fear of shame
- Preoccupied w/ being criticized/rejected
- Inhibited w/ people due to inadequacy
- Views self as socially inept/inferior
- Reluctant to take personal risks/new activities
27
Dependent personality d/o def?
Pervasive excess need to be taken care leading to submissiveness and fear of separation
28
Dependent personality d/o criteria?
>4
- Cant make decisions w/out excess advice
- Req others to take over major areas of life
- Difficulty expressing disagreement
- Lacks self confidence to start new projects
- Feels helpless when alone
- Preoccupied w/ fears to have to take care of oneself
29
Obsessive-compulsive personality d/o def?
Pervasive preoccupation w/ orderliness/perfection and control at the expense of flexibility/efficiency
30
Obsessive-compulsive personality d/o criteria?
>3
- Preoccupies w/ details that core point of task is lost.
- Perfection affects task completion
- Devoted to work/productivity to exclusion of leisure
- Overconscientious
- Unable to discard meaningless worn objects
- Cant delegate tasks
- Money is something to be hoarded for catastrophes
- rigid and stubborn
31
Specifiers of personality change due to medical conditions
```
Labile
Disinhibited
Aggressive
Apathetic
Paranoid
Other
Combined
Unspecified
```
32
Cluster A personality d/o's are described as?
Odd or eccentric
33
Cluster B personality d/o's are described as?
Dramatic, Emotional, Erratic
34
Cluster C personality d/o's are described as?
Anxious/fearful
35
Somatization is?
Physical S/S that mimic a disease that is not there
| - Pyschological stress expressed physically
36
Somatization is AKA?
Hysteria
37
Reasons pts have Somatic S/S?
- Cry for help
- Secondary gains
- Physical/sexual trauma is for communicating
- Socially acceptable illness that explains failures
- Physical illness has less stigma than mental illness
38
Reasons somatization occurs?
- Learned behavior
| - Pt perceives provider ignore non-physical S/S
39
Somatic Symptom disorder characteristics?
- High levels of worry
- Think the worst about their health despite evidence
- Central focus of life
- High level of medical care but unsatisfied
- Cant let fear of health GO!
40
Somatic Symptom disorder criteria?
>6mo (S/S may alternate or change but for >6mo)
41
Somatic Symptom disorder specifiers?
1. Predominant pain
| 2. Persistent >6mo
42
Type of S/S ass/w somatic symptom disorder?
Symptoms that cant be measured (Constitutional)
43
Somatic symptom disorder presents as?
Multiple constitutional S/S
Vague history that doesn't add up
History out of proportion to exam
44
Best treatment for Somatic symptom disorder?
Psychotherapy/pharmacotherapy while legitimizing d/o w/ regular visits of education and reassurance
45
Rx for Somatic Symptom disorder?
1L - SSRI
2L - SNRI
St Johns wort
46
Illness anxiety disorder def?
High level of anxiety of having serious illness w/ or w/out mild somatic S/S that result in excess health related checks for >6mo (illness may change)
47
Illness anxiety d/o Eval/txt?
Same as somatic s/s d/o
CBT/Rx - 1L SSRI - 2L SNRI - St john wort
Multiple visits w/ education/reassurance
48
Conversion d/o is AKA?
Fx neurological symptom d/o
49
Conversion d/o often ass/w?
Comorbid psych Dx
50
Dx criteria of conversion d/o?
1 or more S/S of altered VOLUNTARY motor/sensory fx
| that doesnt match medical condition
51
Dx criteria of conversion d/o?
1 or more S/S of altered VOLUNTARY motor/sensory fx
| that doesnt match medical condition
52
TXT of conversion d/o?
Neuro eval +- inpt admit
Education then CBT
(NO RX)
53
Factitious d/o def?
Purposefully producing, simulating or exaggerating physical illness (esp during sick call)
54
DIfferences between malingering and factitious d/o?
Malingering - intentional reporting s/s for gain
| Factitous d/o - req absence of obvious reward
55
Factitious d/o criteria?
Deception of physical/pyschological S/S by presenting oneself to others as impaired/ill but w/out external rewards
56
Factitious d/o eval and TXT?
Thoroughly analyze Hx for gains and document everything
57
Somatic d/o w/ highest potential for litigation?
Factitous d/o
58
General eval of sleep related disorders components?
Sleep log w/ Rx/diet
Hx, PE (airway, thyroid)
Screening exams
CBC, TFT, Polysomnography, asthma/copd, GERD
59
Name of scale used to screen for sleep disorders?
Epworth sleepiness scale
60
Sleep study is AKA?
Polysomnography
61
A sleep study is often used to Dx what?
OSA - obstructive sleep apnea
62
What is the name of the test following a sleep study?
Multiple sleep latency test is performed the day after a sleep study
63
How is a Multiple sleep latency test performed?
Pt attempts to take a nap times for 20min inbetween 2hrs of activity on 5 different occasions.
64
What parameters are recorded during a Multiple sleep latency test
Electro-encephalography
Electro-oculography
Electro-myography (mental/submental)
Electro-cardiography
65
What is the goal of Multiple sleep latency test and what is it trying to Dx?
Time it takes to from wake to REM (latency) and how many sleep onset REMs occur during that time - for narcolepsy
66
Insomnia d/o def?
Dissatisfaction w/ sleep quality or quanity due to dificulty falling/staying asleep w/ impairment
67
What are Insomnia d/o subclassifications?
1. Initial/sleep-onset - (Cant fall)
2. Middle/Sleep maintenance - (frequent wakings)
3. Late/terminal - Early wake w/out return; >30m before alarm and <6hrs total.
68
Diagnostic criteria of Insomnia d/o?
Sleep difficulty at least 3x/wk for >3mo
69
Insomnia d/o TXT?
No 1L - (CBT(sleep hygiene), Rx, Combo)
70
What is stimulus control therapy?
TXT for Insomnia d/o - Alternating between 20m of trying to sleep in bed and relaxing activity out of bedroom until sleepy
- Same alarm time Q/Day per week w/out any day naps
71
What is sleep restriction therapy?
TXT for Insomnia d/o - Limit time spent in bed to at least 5hrs and when 85% efficiency is reached increase time by 15-30m and repeat to 85%.
72
2 specific therapy TXTs for Insomnia d/o?
Stimulus control therapy and sleep restriction therapy
73
Rx TXT for 'sleep onset' Insomnia d/o?
```
Short acting/lower dose used first
Zaleplon (Sonata)
Zolpidem (Ambien)
Benzo's - (triazolam/lorazepam)
Ramelteon (Rozerem)
```
74
Difference between
-Zaleplon (Sonata)
VS
-Zolpidem (Ambien)
Zaleplon (Sonata)
- Onset 5-15m AND t1/2 1-1.5hrs (Falling asleep)
Zolpidem (Ambien)
- Onset 15-30m AND t1/2 3-4hrs (Staying asleep)
75
What Rx are non-benzodiazepine hypnotics?
Zaleplon (Sonata)
| Zolpidem (Ambien)
76
2 important points about Zaleplon (Sonata)?
1. Tobacco/caffeine reduce effectivness
| 2. CI w/ ETOH (respiratory depression) or Cimetidine
77
2 important points about Zolpidem (Ambien)?
1. SE: Night eating syndrome or ataxia
| 2. Reversed w/ FLUMAZENIL if OD
78
2 Simiarities of Zolpidem (Ambien) and Zaleplon (Sonata)?
Less morning grogginess
Anterograde amnesia
Withdrawal (DOA)
79
Ramelteon MOA?
Melatonin Receptor agonist (mimics melatonin)
80
Ramelteon is better for what sleep d/o?
Circadian rhythm sleep d/o
81
Ramelteon is CI if pt is taking what Rx?
Amiodarone (Antiarrythmic)
Ciprofloxacin
Fluvoxamine (Luvox)
Ticlopidine (Anti-PLT)
82
Rx TXT for 'sleep maintenance' Insomnia d/o?
Longer acting perferred
- Zolpidem ER (Ambien CR)
- Eszopiclone (Lunesta)
- Temazepam/Estazolam
- low dose Doxepin
83
Rx TXT for 'Late terminal' Insomnia d/o?
Req at least 4hrs in bed after admin
- Zaleplon (Sonata)
- Zolpidem sublingual (Edular)
84
Hypersomnolence d/o def? And Criteria
SELF REPORTED excess sleepiness w/ a main sleep period lasting >7hrs... >2x/wk at least 3mo PLUS 1 or more S/S of...
- Recurrent sleep/lapses during day
- Non-restorative sleep despite >9hrs
- After abrupt waking (Cant stay awake)
85
Hypersomnolence d/o MC population?
Adolescent or young adult
86
Hypersomnolence d/o eval?
Hx, sleep log 1-2w, PE, PSG + Multiple sleep latency test
87
Hypersomnolence d/o TXT?
Consult to sleep - Rx only (No CBT)
DOC - Modafinil (provigil)
- Armodafinil (Nuvigil)
- Methylphenidate (Ritalin, Concerta)
88
Narcolepsy def?
Uncontrollable daytime sleepiness w/ cataplexy, hypnagogic hallucinations, or sleep paralysis.
89
Narcolepsy
>2x/wk at least 3months of irrepressible need to sleep + Cataplexy
OR
+ Hypocretin deficiency (CSF test)
OR
PSG w/ REM <15m or MSL test <8m mean >1 REM
90
Cataplexy def?
1-2m Sudden muscle weakness triggered by strong emotion followed by sleep and patient is aware
91
Hypnagogic hallucinations are? Types?
Brief Hallucinations occuring from
- wake > GO to sleep (HypnaGOgic)
- sleep > wake (Hypnopomic)
92
Sleep paralysis def?
Experience of being aware during sleep but unable to speak, move, or react
93
Hypocretin is?
Neuropeptide that regulates arousal, wakefulness, appetite.
94
Narcolepsy eval?
Hx (cataplexic events)
PE
Studies - PSG/MSL, CBC, TFT, Hypocretin
95
Narcolepsy TXT? Goal?
To improve alertness
- Driving a car mod
- Rx -
Daytime sleepy (Modafinil or Methylphenidate)
Cataplexy (Venlafaxine or Fluoxetine) REM suppressing
96
OSA def?
Recurrent collapse of AW structures causing reduced airflow/oxygen that leads to hypoxemia/hypercapnia and unfulfilling sleep.
97
OSA criteria?
PSG evidence >4 hypopneas/hr + either
- breathing disturbances (Snoring, Gasping, pauses)
or
- Daytime sleepiness
VS
PSG evidence of 15 episodes of hyponea/hr w/out S/S
98
Causes of OSA?
PE -
Large body habitus (esp neck)
Narrow post-pharyngeal
Enlarged tonsils
99
OSA eval?
HX, PE, Studies (PSG w/ 2nd night (CPAP) if positive 1st night) CBC TFT.
Refer - sleep/ENT
100
OSA TXT?
Wgt loss
CPAP
UPPP (uvulopalatopharyngyoplasty)
Tonsillectomy/adenoidectomy
101
UPPP is?
surgical removal of uvula and distal 1/3 of upper palate to open posterior pharyngeal
102
OSA treatment prognosis?
Excellent w/ treatment and compliance
103
Restless leg syndrome def?
Pts moves legs to relieve overwhelming unplesant sensation that is worse at rest and is ass/w periodic leg movements (jerks) of sleep (PLMS)
104
Restless leg syndrome criteria?
3x/wk for 3mo
105
Restless leg syndrome eval?
Hx (diagnosed typically through Subj complaints)
Sleep log
PE - neuro
Studies - Iron panel, CBC, thyroid, PSG
106
Restless leg syndrome TXT?
Iron replacement
Rx
Avoidance
107
Restless leg syndrome Rx TXT?
Pramipexole, Gabapentin, Benzo's intermittent
108
Restless leg syndrome pts should avoid?
Sleep deprivation
Antidepressants
Metoclopramide
Sedating AH
109
Which antidepressant is good w/ Restless leg syndrome?
Buproprion
