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Flashcards in Psych DIT Deck (148):
1

Erickson's stages of development 8

birth - 1.5 yrs - Trust vs mistrust
1.5 -3 yrs Autonomy vs shame (potty train, feeding)
3yrs- 5yrs - Initiative vs guilt
6yrs - 12yrs Industry vs inferiority
12yrs - 18 yrs Identity vs role confusion
18yrs - 35 yrs Isolation vs intimacy
35yrs - 55 yrs Generativitty vs self absorption
55yrs - death Integrity vs despair

2

Maslovs hierarchy of needs (5)

Physiological needs
Safety
Belonging and love
Esteem (confidence)
Self actualization (creativity, morality)

3

Cognitive behavioral therapy principle

that thoughts -> emotions

∆thought you can ∆ the emotion; need to identify the thought first though through journaling, challenging beliefs, mindfulness, relaxation

4

Psychoanalysis

analysis of dreams, fantasies, associations and verbal/physical expression of thoughts

confront and recognize inner conflict

5

Kluver Bucy syndrome due to?

Characterized by (4)

bilateral lesion of the amygdala( part of the limbic system)

hyperorality
hypersexuality
disinhibited behavior/lack of fear
docile

6

Amygdalas job?

receive input from a lot a of parts (limbic, neocortex, sensory)
transmit back to the cortical areas

-> changes in sympathetic and anti sympathetic
- BP. HR, GI rage, sexual response, licking chewing etc

bilateral lesion in Kluver Bucy syndrome

7

Limbic systems job(5)

Fucking
Fighting
Fleeing
Feeding
Feeling

also long term memory
-connect to prefrontal cortex as well so have emotional response to intellectual stimulation

8

Kid presents with bald spot of hair which he says relieves stress

Dx?

Rx?

trichotillomania - hair pulling disorder
-more common in girls

Rx - cognitive behavioral therapy
-flouoxitine or clomipramine if not working

9

ADHD medications (3)

methyphenidate - ritalin
dextramphetamine - adderol
- Increases NE release


atomoxetine - straterra
-SNRI

10

Characteristics of severe autism spectrum disorder

Patient is disengaged w/ the social world finding more interest in objects than people

lack of responsiveness to others, poor eye contact, absent social smile

impaired communication, language delay, repetitive phrases

ritualistic behavior (hand flapping/spinning)

11

Infant presents with weakness, poor language skills that is untrusting and has lost weight. Maybe is sick a lot. Be concerned of

Infant deprivation effect

Must report to CPS. > 6 months can have

Can lead to disinhibited social engagement disorder

12

Bruising that may lead one to suspect child abuse

buttocks, cheek or torsue

just need suspicion, CPS job to prove. My job to report
-child neglect is also reportable

13

ADHD is features limited (2) and characterized by (3)

Onset by what time

Limited attention and restraint

characterized by hyperactivity, impulsivity and inattention

onset before age 12

14

Conduct disorder is?

behavior that violates the basic rights of others

<18 otherwise antisocial personality disorder

15

Oppositional defient disorder

Retative behavior where the child has problems with authority figures, hostile and vindictive

no serious violations though

16

Tourettes syndrome(2)

Rx (3)

Verbal and motor ticks that persist > 1 yr, onset before 18

coprolalia - swearing (only 20%)

Fluphenazine, pimozide, Terabenazine

17

Disruptive mood dysregulation disorder

baseline irritability
recurrent temper tantrums
symptums present for a yr.

onset before 10 and diagnosed between 6-10

18

Childhood onset fluency disorder

stuttering

19

Rett Syndrome

presentation and acquired how

X linked dominant

Seen in only girls where you lose major milestones round age 1-4,

loss of verbal skills, mental retardation, ataxia, stereotype hand within*** (bring hand up to mouth)

20

Aspergers is characterized by?

all absorbing interests and repetitive behavior, problems w/ social relationships (maybe verbal/cognitive deficits)

Normal intelligence and NO language impairment

21

Anorexia nervosa diagnosed by(3)

associated complications

1. distorted body image
2. intense fear of gaining weight
3. Low body mass - BMI <17

Can have purging behavior

Can see - amennorrha, metatarsal fractures w/ early onset osteoporosis, electrolyte imbalances,

Can have Depression

Rx: difficult

22

Bulemia nervosa diagnosed by (2)

Associated w/(3)

episodes of uncontrolled waiting followed by purging episodes to prevent weight gain

-normal weight

also hypokalemic hypochloreimic metabolic alkalosisarotitis, enamel erosions, russels signs,

Rx maybe SSRI - fluoxetine

23

Gender identity disorder

Severe persistent cross gender identification that may cause significant distress and /or impaired functioning.

Gender - psychosocial, Sex - mechanical parts

Transsexual -> desire to live as the other sex -> actions such as surgery and hormone replacement

24

Transvestite

Sexual arousal that comes w/ wearing women clothes.

Not the same transsexual. No desire to become a female. Does not feel trapped in the wrong sex.

25

Medications for preventing relapse in alcoholics (5)

Alcoholics anonomous
Naltrexone - blocks endogenous opiates
Disulfiram
Topiramate
Acamprosate

26

Why is giving glucose to a hypoglycemic drunk a bad idea

Probably have thiamine deficiency and glucose metabolism uses thiamine as a cofactor. Exacerbates underlying condition

27

Wernicke ecephalopathy characterized by (4)

thiamine deficiency

confusion
nystagmus
ataxia
opthalmoplegia

sluggish pupillary refexes
coma and death if untreated
Korsakoff includes memory issues

28

Korsakoff syndrome characterized by (4)

Anterograde amnesia
Retrograde amnesia
Confabulation
Hallucinations

29

More specific test for recent alcohol abuse

serum gamma gultamyltransferase

30

Delerium tremins is?

Sets in?

severe alcohol withdrawal

Seen as autonomic hyperactivity(hyper/hypo tension) and seizures, nightmares, disorientation, hallucination diaphoresis

2-3 days after

Rx benzodiazepine

31

Withdrawal of alcohol symptoms

Agitation
anxiety
insomnia
tremor
tachycardia

32

Alcohol acts on what receptor

Acute recovery?

GABA

time and supportive, if severe(Delerium tremens) lang acting benzodiazapine

33

hemorrhage and necrosis of which 2 structures seen in Wernicke-korsakoff

Mammillary bodies*
medial thalamus

34

post op constipation and or respiratory depression due to what drug effect

opiods

35

Sever depression, HA, fatigue, insomina/hypersomina, hunger-> withdrawal due to

Cocaine withdrawal

36

Pinpoint pupils, N/V, seizures due to intoxication w/

opioids - heroin

37

belligerience, impulsiveness, nystagmus, homicidal idealizations, psychosis due to

PCP intoxication

38

HA, anxiety/depression and weight gain due to this drug effect

Nicotine/caffeine withdraw

39

Anxiety/depression, delusions hallucinations and withdrawal due to this drug effect

LCD use

40

euphoria, social withdrawal, impaired judgement, hallucinations due to

Marijuana use

41

rebound anxiety, tremors, seizures that may be life threatening due to this drug effect

Alcohol withdrawal

also benzos/barbs

42

anxiety, piloerection, yawing, fever, rhinorrhea, nausea and diarrhea due to

opioiod withdrawal

43

PCP overdose Rx w/

benzodiazapines, maybe haloperidol

44

Alcohol overdose Rx w/

time and fluids, respiratory support, Benzos if delirium tremins

45

Barbituate overdose Rx

no reversal agent, supportive

46

Benzodizapine overdose Rx

flumenazil, be wary of seizures

47

Drug overdoses that result in miosis(2)

organophosphate poisoning
opioid overdose

48

Nystagmus key for what drug overdose

PCP

49

Ecstasy overdose characterized by(5)

euphoira
decreased anxiety
jaw clenching
sense of intimacy
tachycardia

-increased serotonin released

50

dry mouth and conjunctival injections that may lead to increase social withdrawal with time

marijuana use

51

methadone use

long acting low dose opioid agonist that limits "high"

useful for heroin relapse prevention

52

Suboxone use

partial agonist combined with an antagonist -> useful for relapse prevention

Naloxone and buprenophine

53

hallucinations vs delusions vs illusions

hallucinations - perceptions w/out stimuli
Delusions - falls beliefs
illusions - misinterpretations of stimuli

54

Visual hallucinations more associated w?

Auditory hallucinations more associated w?

visual hallucinations more associated w/ medical illness - drug intoxication, dementia

auditory more associated w/ psychotic illness

55

Formication associated w/(2)

tactile hallucinations (bugs crawling all over you)

alcohol and cocaine withdrawal

56

Hypnagoic vs hypnopompic hallucinations

hypnaGOic hallucinations occur when Going to bed

hypnopompic hallucinations occur when waking up

57

Positive symptoms of schizophrenia associated with what change in what tract vs negative symtoms

positive associated w/ increased dopamine in the mesolimbic tract

negative associations associated w. decreased dopamine in the mesocortical tract

58

Timeline of schizophrenia, schizophreniform and brief psychotic episode

schizophrenia is > 6 months

schizophreniform is 1-6 months

brief psychotic episode is < 1 month

59

Positive symptom sof schizophrenia (4)

delusions*
hallucinations- auditory*
disorganized speech - loose associations*
disorganized behavior (catatonic)

60

Negative symptoms of schizophrenia (4)

flat affect
social withdrawal
stop in thought/ speech - alogoia
lack of motivation

61

Timeline of diagnosis of schizophrenia and risk factors

early 20s in men and later 20s-30s in females

Some genetic risk - 50% in monozygotic twins
pschyoactive drug use in adolescence

62

schizoaffective disorder

Episode of psychosis lasting at least 2 weeks prior to onset of mood disorder (major depressive, maniac or mixed0

63

Delusional disorder

timing?

Differs from schizo how?

the persistent belief in an idea that is not true lasting for at least a month.

Functioning otherwise not impaired

64

High potency typical antipsychotics (5)

Haloperidol
Fluphenazine
trifluperazine
thiothixene
loxapine

65

Low potency typical anipsychotics (2)

Chlorpromazine
thioridazine

66

Atypical antipsychotics (5)

clozapone
olanzapine
risperidone
quetiapine
apripiprazole

67

low potency antipsychotics typically have what side effects compared to high potency (4)

antimuscarinic

High potency has
- extrapyramidal symptomsand
-risk of neuroleptic malignant syndrome
-endocrine dysruptino - hyperprolactinemia

68

Uses of typical antipsychoitcs(4)

Schizophrenia
agitation
touretts -fluphenazine
acute mania

69

Timeline of HP typical antipsychotics


initially
-acute dystonia
-toricollis (twisting head movement)
(treat w/ antimuscarinics - >benztropamine)

1 month
- akensia

2 months
-bradykinesia
-akathriesis (restless)

4 months tardive dyskenisa

70

Tardive dyskeneisa presentation

Rx?

systematic lip smacking and face movement that occurs after 4 months on a typical antipsychotic

not an extrapyramidal side effect

Rx - stop the medication, usually irreversible

71

Neuroleptic malignant syndrome presentation (6)

Rx (2)

excessive muscle movement and rigidity brought on by high potency antipsychotic use
-Delerium
-autonomic instability
- myoglobinuria
-hyperpyrexia
-rigidity
- autonomic instability

Treat w/ dantrolene or bromocriptine (D2 agonist)

72

Atypical antipsychotic use over typical

side effect profile due to?

helps return some negative symptoms of sychophrenia but still has better action w/ the positive symptoms

some spill over w/ H1 and alpha -> hypotension, sedation and weight gain but not as bad as the typical antipsychotics

73

biggest risk of one atypical antipsychotic

Clozapine and agranulocytosis
- need weekly checks

also in general have weigh gain

74

which atypical antipsychotic is their increased risk of metabolic disorder and DM

Olanzaprine

75

mania characterized by what symptoms

must last how long?

DIG FAST

Distractable
Impulsive
Grandiosity (delusions, self worth)
Flight of ideas
Agitation/activity
Sleed (decreased)
Talkative (pressured speech)

must last 1 week -> impairment w/ function

76

hypomania differs from mania how?

less severe symptoms in that it does not impair functioning

only needs to present for 4 days

77

Bipolar Type I vs Bipolar Type II

Type I - Episode of Mania w or w/o depression

Type II hypomania w/ depression

78

Cyclothymic disorder

Timeline?

hypomania and minor depression over the course of 2 years

only 2 months a normal mood allowed

79

Rx for Bipolar (3)

Lithium

Antipsychotics - atypical
-Apiprazole
-Olanzapine
-Risperidone

Anti epileptics
-valproic acid
-carbamazapine
-lamotrigune

80

Lithiums side effects(7)

tremors
teratogen - ebsteins anomaly
heart block
polyuria - ADH antagonist -> nephrogenic DI
Sedation
hypothyroidism
goiter

Narrow TI

81

Diagnosis of Depression (9)

need at least 5 for 2 weeks

SIG E CAPS + depressed mood*

Sleep changes
Interest decreased (anhedonia)*
Guilty/worthless
Energy is down
Concentration is down
Appetite changes
Psychomotor retardation/agitation
Suicidal idealation

82

When symptoms of depression last at least 2 years this calls

persistent depressive disorder

can't be non depressed > 2months during that time
may only be minor

83

Atypical depression is (4)

The most common subtype of depression

- Hyperphagia
-Hypersomnia
-Mood reactivity
- rejection hypersensitivity

84

Seasonal pattern sub type of depression you need to have

2 years of temporal changes in mood w/ 2 MDD in that time

Responds positively to light

85

peripartum subtype of depression diagnosis

diagnosis of depression w/in 4 weeks of giving birth

- meets 5/9 criteria for >2weeks

- longer than the post partum blues (resolves in 10-14 days and starts w/in couple days after birth)

psychosis is a rare complication

86

electroconvulsive therapy indications(3)

Side effects (2)

refractive depression, pregnancy, catatonic schizophrenia

Retrograde/anterograde memory loss that resolves in 6 months

disoreintation

87

Risk factors for completing suicide(10)

SAD PERSONS

Sex - male
Age - 45
Depression
Prior attempts
Ethanol
Rational thought absent
Sickness (chronic)
Organized plan
No social support
Stated attempt

88

SSRIs are used for what other than depression? (6)

GAD
panic disorder
bulimia- fluoxitine
OCD
social phobias
PTSD

89

Serotinin syndrome is due to?

presents as? (5)

Use of an SSRI w/ another drug that increases Serotinonin in the body like
-St johns wart and Kava Kava
-Triptans
-MAOIs, TCAs, SNRIs
-tryptophan
-amphetamine

Seen as:
Myoclonic(neuromuscular changes)
autonomic instability (tachy, cardio collapse)
mental status changes;
with fever , flushing diarrhea

90

RX for seratonin syndrome

Benzodiazapines and cooling

91

Side effects of SSRIs(2)

sexual dysfunction
Serotonin syndrome (excess -> autonomic instab, neuro muscular changes, mental status changes)

92

SNRIs (3)

cymbalata
venlafaxine

milacipran - fibromyalgia only

93

SSRIs(4)

fluoxetine
paroxetine
citalopram
sertraline

94

Clinical use of SNRIs in addition to depression (2)

GAD
duloxetine - diabetic peripheral neuropathy/fibromyalgia

95

SFX w/ SNRIs(3)

Increased BP
stimulent -> increased NE
sedation and nausea

96

TCA(7)

Amitriptyline
nortriptyline
imipramine
desipiramine
clomipramine
doxepin
amoxapine

97

Other uses of TCAs other than depression

fibromyalgia
-amytriptyline

OCD
-clomipramine

bedwetting
-imipramine

98

Side effects of TCAs(4)

sedation

Alpha 1 blocking
- hypotension

Antimuscarinic
-dry mouth
-sedation
-tachy
-urinary retention

Overdose - convulsions, Coma, cardiotoxicity

99

TCA overdose be concerned w/ (6)

Rx

Cardiotoxicity
Convulsions
coma

fever,
confusion/hallucinations
respiratory depression

Rx: NaHCO3 (alkalize the urine)

100

MAOi(4)

trancyproamine
Phenelzine
isocarboxazid
selegiline (MAOI B for Parkinsons rx)

101

What is tyramine and why is it a bad idea w/ MAOIs?

substance found in aged foods that leads to increased NE on its own. Normally broken down by MAOI.

On medication this process is inhibited leading to excess NE release -> hypertensive crisis (stroke, cardiac arrhythmia)

102

Medication primary used for insomnia but may cause priaprism

Trazadone a tetracyclic

103

Antidepressant of choice that may increase appetite

Mirtazapine an alpha 2 antagonist tetracyclic

104

medication that increases dopamine and NE

buproprion

- good choice for those convened w/ side effects
-aslo smokers

105

Buproprion carries an increase risk w/ what patients

those prone to seizures
-bulemics

106

Toxicity w/ mirtazapine (3)

sedation
increased hunger
dry mouth

107

Rx for Panic Disorder (4)

Cognitive behavioral therapy

beta blockers
benzos
SSRI

108

Panic disorder described as (2)

recurrent panic attacks

anxiety of future panic attacks

109

Agoraphobia

anxiety w/ fear of open places

110

Social anxiety disorder

exaggerated fear of embarrassment in social situations
- public speaking, bathrooms
Rx w/ beta blockers or SSRIs

111

Obsessive compulsive disorder presents as

Rx?(2)

recurrent intrusive thoughts or obsessions that are relieved by ritualized actions or compulsions

SSRI and clomipramine (TCAs)

112

PTSD and timeline

recurrent flashbacks to traumatic events in the life -> nightmares, intense fear, helplessness

hyper vigelent

has to last greater than 1 month

Rx - CBT and SSRIs

113

Acute stress disorder

like PTSD but lasts only 2 days - 1 month; longer is PTSD

114

Generalized anxiety disorder presents as?

Timeline

uncontrollable anxiety for at leas 6 months that is not identifiable in any one thing (vs adjustment disorder, also timeline is different)

-> sleep disturbance, fatigue, difficulty concentrating

Rx - Busprione

115

Adjustment disorder timeline

emotional symptoms causing impairment due to an identifiable event - divorce, illness

lasts less than 6 months;

> 6 months in presence of chronic stressor

116

Malingering

playing the sick role for secondary gain (time off money)

The motivation is conscious and has poor compliance in treatment

117

Factitious disorder (2 types)

in general patient veins being sick due to some unconscious motivation (likes the sick role); no secondary gain
-called munchausen's syndrome when chronic
-called munchausns syndrome by proxy when an adult does it to a kid ( now called factitious disorder imposed on another)

118

Somatic symptom disorder

timeline

used to be called somatoform disorder

1 symptoms causing explicit distress and anxiety despite no identifiable physical cause lasting 6 months

if primarily pain - > w/ predominate pain

119

Conversion

Sudden loss of Voluntary sensory or motor function (NOT PAIN); can be paralysis, blindness, mutism, pseudosiezures

Patient is aware but may be indifferent

120

Illness anxiety disorder

new name for hypochondriacs

121

Body dysmorphic disorder

preoccupation with perceived defects in normal anatomy that leads to significant emotional distress

122

unacceptable feelings and thoughts are expressed through actions

acting out

123

temporary drastic change in personality, memory or conscious to avoid emotional stress

dissociation

can lead to dissociative identity disorder

124

avoidance of awareness of a painful reality

denial

125

avoided ideas and feelings are transferred to some neutral object or person

displacement

126

remaining at a more childish level of development

fixation

127

modeling behavior of someone perceived as more powerful

identification

128

separation of feelings from ideas and events

isolation

war vet and cold details

129

unacceptable thoughts and actions are perceived to be held by others

projection

if I'm racist so are you

130

proclaiming logical reasons for action to avoid self blame

rationalization

131

ideas that are distressing are replaced by or warded off by actions (unconsciously) to the opposite

reaction formation

132

turning back the maturational clock to an earlier stage

regression

133

involunary (unconscious) withholding of an idea or feeling to prevent anxiety

repression

suppression is voluntary

134

categorizing people as either all bad or all good

splitting

seen in borderline patients

135

guilty feelings alleviated by unsolicited generosity to others

altrusism

136

appreciating amusing nature of an anxiety producing event

humor

137

replacing an unacceptable behavior with socially acceptable alternatives to release tension w/out violating morality

sublimation


conscious of action (vs reaction formation)

138

holding back adverse thought consciously to stop interference with function

suppression

vs repression which is unconcious

139

Schizoid personality disorder

avoids social circumstance and likes it that way

A

140

Paranoid personality disorder

consistent beliefs of persecution and distrust. Uses a lot of projection

A

141

Schizotypal personality disorder

odd behavior and beliefs, eccentric or magical thinking
may be avoidant in addition but not predominant

A

142

Antisocial personailty disorder

lack of empathy, persistent disregard and violation of the rights of others
<18 - conduct disorder

B

143

Histrionic personality disorder

easily excitable, and emotional, attention seeking and sexually provocative

B

144

Borderline personality disorder

unstable mood and relationships, impulsive, self mutilationand boredom

commonly uses splitting

B

145

Narcisstic

grandiosity and sense of entitlement, low empathy

B

146

Avoidant personality disorder

hypersensitivity to rejection and socially inhibited timid, feeling of inadequacy; Desires relationships with others

social anxiety disorder is fear of embarrassment

147

obsessive compulsive personality disorder

preoccupation with order, perfection and control, egocentric (vs disorder -> ritualized habits to relieve obsessions)

148

Dependent personality disorder

submissive and clinging, excessive need to be taken crd of, low self confidence