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USLME Kiss my ass and pray > Psych DIT > Flashcards

Psych DIT Flashcards

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1
Q

Erickson’s stages of development 8

A

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

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2
Q

Maslovs hierarchy of needs (5)

A 
Physiological needs
Safety
Belonging and love
Esteem (confidence)
Self actualization (creativity, morality)
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3
Q

Cognitive behavioral therapy principle

A

that thoughts -> emotions

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

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4
Q

Psychoanalysis

A

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

confront and recognize inner conflict

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5
Q

Kluver Bucy syndrome due to?

Characterized by (4)

A

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

hyperorality
hypersexuality
disinhibited behavior/lack of fear
docile

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6
Q

Amygdalas job?

A

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

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7
Q

Limbic systems job(5)

A 
Fucking
Fighting
Fleeing
Feeding
Feeling

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

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8
Q

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

Dx?

Rx?

A

trichotillomania - hair pulling disorder
-more common in girls

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

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9
Q

ADHD medications (3)

A

methyphenidate - ritalin
dextramphetamine - adderol
- Increases NE release

atomoxetine - straterra
-SNRI

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10
Q

Characteristics of severe autism spectrum disorder

A

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)

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11
Q

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

A

Infant deprivation effect

Must report to CPS. > 6 months can have

Can lead to disinhibited social engagement disorder

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12
Q

Bruising that may lead one to suspect child abuse

A

buttocks, cheek or torsue

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

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13
Q

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

Onset by what time

A

Limited attention and restraint

characterized by hyperactivity, impulsivity and inattention

onset before age 12

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14
Q

Conduct disorder is?

A

behavior that violates the basic rights of others

<18 otherwise antisocial personality disorder

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15
Q

Oppositional defient disorder

A

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

no serious violations though

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16
Q

Tourettes syndrome(2)

Rx (3)

A

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

coprolalia - swearing (only 20%)

Fluphenazine, pimozide, Terabenazine

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17
Q

Disruptive mood dysregulation disorder

A

baseline irritability
recurrent temper tantrums
symptums present for a yr.

onset before 10 and diagnosed between 6-10

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18
Q

Childhood onset fluency disorder

A

stuttering

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19
Q

Rett Syndrome

presentation and acquired how

A

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)

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20
Q

Aspergers is characterized by?

A

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

Normal intelligence and NO language impairment

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21
Q

Anorexia nervosa diagnosed by(3)

associated complications

A
  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

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22
Q

Bulemia nervosa diagnosed by (2)

Associated w/(3)

A

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

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23
Q

Gender identity disorder

A

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

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24
Q

Transvestite

A

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.

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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

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