Psych First Aid Flashcards
(232 cards)
1
Q
What is classical conditioning?
A
Learning in which a natural response is elicited by a conditioned or learned stimulus that was previously coupled to an unconditioned stimulus
Ex. Salivation (natural response) elicited by bell ringing (learned stimulus) that was previously coupled to food (unconditioned stimulus)
2
Q
What is operant conditioning?
A
Learning in which a particular action is elicited because it produces a punishment or reward, this usually deals with a voluntary response (Types are: positive reinforcement, negative reinforcement, punishment, extinction)
3
Q
What is positive reinforcement?
A
Action for a desired reward (mouse pushes button to get food)
4
Q
What is negative reinforcement?
A
Target behavior is followed by removal of the aversive stimulus (mouse now pushes button to turn off a loud ass sound)
5
Q
What is punishment?
A
Repeated application of aversive stimulus to remove unwanted behavior
6
Q
What is extinction?
A
Discontinuation of all reinforcement (positive and negative) that will eventually eliminate behavior. Can occur in both operant and classical conditioning.
7
Q
What is transference?
A
Patient projects feelings about formative or important person to doc
8
Q
What is countertransference?
A
Doc projects feelings about formative or important person to patient
9
Q
What are ego defenses?
A
Unconscious mental processes used to resolve conflict and prevent undesirable feelings.
10
Q
What is acting out?
A
Expressing unacceptable feelings and thoughts through actions (tantrum)
11
Q
What is dissociation?
A
Temporary drastic changes in personality/memory/consciousness/motor behavior to avoid an emotional stress
12
Q
What can happen with extreme dissociation (ego defense)?
A
Dissociative identity disorder, a multiple personality disorder
13
Q
What is denial?
A
Straight up avoiding the awareness of a painful reality (this is common in AIDS/cancer diagnosis)
14
Q
What is displacement?
A
Transferring avoided ideas and feelings to neutral person/object (mom yelling at her kid because dad yelled at mom… FINISH YOUR VEGETABLES!!!)
15
Q
What is fixation?
A
Partially remaining at a childish level of development (vs regression), this is like men fixating on sports games (dag gummit UT, when you gonna win a game?)
16
Q
What is identification?
A
Modeling a behavior after another person who is more powerful (not necessarily admiration, example is an abused child who identifies with an abuser)
17
Q
What is isolation (of affect)?
A
Separating feelings from ideas and events (ability to describe murder in detail with no emotional response, war vets…. Frank Underwood)
18
Q
What is projection?
A
Attributing an unacceptable internal impulse to an external source (vs displacement) (A guy who wants to get with another girl says his girlfriend is cheating on him to break up with her and get his mack on)
19
Q
What is rationalization?
A
Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self blame (claiming you didn’t like your car anyway after rear ending the shit out of someone)
20
Q
What is reaction formation?
A
Replacing a warded-off idea/feeling by an (unconscious) emphasis on its opposite (A patient who is sexually promiscuous enters a monastery) (vs. sublimation)
21
Q
What is regression?
A
Turning back the maturational clock and going back to earlier modes of ealing with the world (vs fixation) (This is seen with children under stress; bedwetting when hospitalize in a potty trained patient)
22
Q
What is repression?
A
Involuntary withholding an idea or feeling from conscious awareness (vs. suppression) (not remembering a conflict or experience)
23
Q
What is splitting? What can it be seen in?
A
Believing that people are all bad or all good due to intolerance of ambiguity, can be seen in borderline personality disorder
24
Q
What are the mature ego defenses?
A
Sublimation, Altruism, Humor, Suppression (Mature adults wear a SASH)
25
What is Sublimation?
Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's values (vs. reaction formation)... Simpler: Using anger toward something (certain professors) as motivation to do well on a test (taking a negative to a positive, society likes this)
26
What is Altruism?
Alleviating guilty feelings by unsolicited generosity toward others (Mafia boss donates to charity)
27
What is Humor?
Appreciating the amusing nature of an anxiety-provoking or adverse stimulations (Nervous M2's make a joke of how much shit there is to know for STEP 1)
28
What is suppression?
Intentional withholding of an idea or feeling from conscious awareness (vs. repression is voluntary vs involuntary; vs. denial is the fact that in denial you think it never happened, here you know it happened/will happen) (Choosing not to worry about studying for step until March 15th - MISTAKE!)
29
DIT Bonus: What is blocking?
Temporary inhibiting thinking about continuing to build more tension (word for word); Seen in schizos
30
DIT Bonus: What is anticipation? (mature defense)
Realistically planning for a future discomfort
31
DIT Bonus: What is intellectualization?
Uses intellectual processes to avoid affective expression
32
DIT Bonus: What is a schizoid fantasy?
Avoiding interpersonal intimacy to resolve conflict and receive gratification
33
DIT Bonus: What is escapism?
Having a completely different life pretty much; think about TV and video games (World of Warcraft)
34
What are the effects of infant deprivation?
Long term deprivation of affection result in: decreased uncle tone, poor language/social skills, lack of basic trust, anaclitic depression, weight loss, and physical illness (4 W's mnemonic)
35
What are the 4 W's of infant deprivation?
Weak, Wordless, Wanting, Wary
36
How long does it take for irreversible changes in infant deprivation? What can result from severe deprivation?
>6 months, infant death
37
What are the two types of child abuse?
Physical and Sexual?
38
As a physician what is your responsibility in child abuse?
You are legally obligated with the SUSPICION of child abuse to report the abuse in an effort to keep the child from being sent home with an abuser
39
What is some evidence of physical abuse?
Healed fractures on xray (think locations like scapula and ribs and big bones; kids break weak bones all the time from playing, not these bones - SPIRAL FRACTURES), burns (cigarettes/scalding), patten marks/bruising (from an object), retinal hemorrhage/detachment, subdural hematoma (crescent shape; I like my babies shaken; bridging vein rupture)
40
Who is usually the abuser in a physical abuse case?
Biological mother (most children are <3)
41
What is some evidence of sexual abuse?
Genital, anal, or oral trauma; STD's/UTI's
42
Who is usually the abuser in a sexual abuse case?
Someone known to victim (not necessarily dad), and male (peaks around 9-12 yrs old)
43
What is child neglect?
Failure to provide a child with adequate food, shelter, supervision, education, and/or affection; it is the MC type of child abuse
44
Do you report child neglect?
Fuck you if you don't
45
What is some evidence of child neglect?
Poor hygiene, malnutrition, withdrawal, impaired social/emotional development, failure to thrive
46
What are the childhood and early onset disorders?
ADHD, conduct disorder, oppositional defiant disorder, tourette syndrome, separation anxiety disorder, and trichotillomania (DIT Bonus!)
47
When does ADHD start by?
Onset before Age 12
48
What is ADHD?
Limited attention span and poor impulse control; hyperactivity, impulsivity, and/or inattention in multiple settings. No mental retardation but still coexists with difficulty at school. Continues into adulthood in 1/2 of individuals (100% of med students)
49
What brain findings are associated with ADHD?
Decreased frontal lobe volume/metabolism
50
What is the treatment of ADHD?
Seek to increase NE so; Methylphenidate/Amphetamines (increase NE release), atomoxetine (SNRI), and behavioral interventions
51
What is conduct disorder? What happens if it persists past age 18?
Repetitive and pervasive behavior violating the basic rights of others; after age 18 they will fit criteria for Antisocial Personality Disorder (only difference is age)
52
What is oppositional defiant disorder?
Enduring pattern of hostile, defiant behavior toward authority figures int he absence of serious violations of social norms
53
What is the difference between conduct disorder and oppositional defiant disorder?
```
CD = HARM
ODD = NO HARM
```
54
When does tourette syndrome start?
Onset before 18 (can't claim this when you yell out the wrong answer on rounds anymore)
55
What is tourette syndrome characterized by?
Sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for GREATER THAN 1 YEAR.
56
What is the shouting of obscenities in tourettes?
Coprolalia (not too common, 10-20%, and it also literally means excrement mouth)
57
What diseases is tourettes associated with?
OCD and ADHD
58
What is the treatment for tourettes?
Antipsychotics and behavioral therapy
| Antipsychotics block dopamine D2 (increase cAMP); Fluphenazine, Pimozide, Tetrabenazine
59
What is separation anxiety disorder? When does it begin?
Common onset at 7-9 years. Overwhelming fear of separation from home/loss of attachment figure. Can lead to faking sick to stay home from school.
60
What is the treatment for Separation anxiety?
SSRI's, relaxation techniques, behavioral interventions
61
What is trichotillomania?
Compulsive hair puling MC in young girls (do not confuse with allopecia areata); you will see hairs of varying length
62
How do you treat trichotillomania?
Education, behavioral therapy, SSRI (Fluoxetine), TCA (Clomipramine)
63
What are pervasive developmental disorders?
Difficulties with language and failure to acquire/early loss of social skills (Autism/Rett disorder)
64
What is Autism?
Child "living in their own world", symptoms must be evident PRIOR TO AGE 3 w/ lack of responsiveness to others, impaired communication, peculiar repetitive rituals, fascination with mundane objects, and may or may not be accompanied by intellectual disability (MC in boys, rare to be a savant)
65
What is childhood disintegration?
Normal development until about age 2, then regression.... so close
66
What is Rett disorder and inheritance?
X-linked exclusively in girls (affect males will die in utero or shortly after). Symptoms age 1-4, regression leading to loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand wringing (ALL DAMN DAY LONG); slowed head growth from age 5mo-4yrs (DIT bonus fact)
67
What are the NT changes of Alzheimers?
decreased ACh
68
What are the NT changes of Anxiety?
Increased NE; Decreased GABA + 5-HT
69
What are the NT changes of Depression?
Decreased NE + 5-HT + Dopa
70
What are the NT changes of Huntington?
Increased Dopa; Decreased GABA + ACh
71
What are the NT changes of Parkinson?
Increased 5-HT + ACh; Decreased Dopa
72
What are the NT changes of Schizophrenia?
Increased Dopa
73
Why is knowing NT changes important?
Makes the pharmacology a shitload easier
74
What is orientation?
The ability for a person to know who you are and where they are.
75
What is the order of loss of orientation?
Time --> Place --> Person --> Situation (AOX3 is normal, 4 is extra)
76
What is retrograde amnesia?
Inability to remember before the event
77
What is anterograde amnesia?
Inability to remember after the event (no new memory)
78
What is Korsakoff amnesia?
Classic anterograde amnesia caused by thiamine deficiency and the associated destruction of maxillary bodies, can include some retrograde, seen in alcoholics and associated with confabulation
79
What is Dissociative amnesia?
Inability to recall important personal information, usually subsequent to severe trauma or stress (can be associated w/ fugue)
80
What is dissociative fugue?
Abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances (war, natural disaster, etc)
81
What is Aspergers?
A mild form of Autism characterized by normal intelligence with decreased social skills; they have all absorbing interests, and will always have problems with relationships
82
What are cognitive disorders?
Significant change in cognition (memory, attention, language, judgement) from previous level of functioning, associated w/ CNS abnormalities, a general medical condition, medication, or substance use. Delirium and Dementia.
83
What timeframe is Delirium?
Rapid/Acute
84
What is Delirium characterized by?
A "Waxing and waning" level of consciousness w/ acute onset; rapid decrease in attention span and level of arousal. REVERSIBLE AND ACUTE
85
What are the symptoms of delirium?
Disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep cycles; patient has an abnormal EEG
86
What causes delirium?
Usually secondary to another illness, it is the MC inpatient setting (called "ICU psychosis")
87
What is the treatment of delirium?
Treat the underlying concern; optimize brain condition (O2, hydration, pain), and Antipsychotics = Haloperidol (inverse agonist of dopamine)
88
What two causes should you check for in a delirious patient?
Drugs (Diphenhydramine = anticholinergic = MAD AS A HATTER) and UTI's
89
What is the T-A-DA approach to the management of a delirious patient?
Tolerate, Anticipate, Don't Agitate
90
What is dementia?
It is a GRADUAL loss in intellectual ability that does not affect the level of consciousness
91
What is dementia characterized by?
Memory oss, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement, loss of executive function
92
Can a patient w/ dementia develop delirium?
Yes, dementia isn't a gain of function disease, but for real, example: a patient with alzheimer disease who develops pneumonia is at increased risk for delirium
93
What is the MCC of dementia in the elderly?
Alzheimers
94
What causes of dementia are always irreversible?
Alzheimers, Lewy Body Dementia, Huntington, Pick Disease, infarcts, CJD, chronic substance abuse
95
What causes of dementia can be reversible if caught?
NPH, vitamin B12 def, hypothyroidism, neurosyphilis, HIV (partially)
96
Is dementia normal?
NO! It is NOT normal but is common as you age
97
What common thing can present like dementia in the elderly?
Depression - they start to lose things and have decreased performance
98
What is psychosis?
A distorted perception of reality characterized by delusions, hallucinations, disorganized thinking, or illusions (DIT BONUS!); Can occur in patients with medical/psychiatric illness or both
99
What is a hallucination?
Perceptions in the absence of stimuli (seeing something that isn't there at all)
100
What is a delusion?
Unique, false beliefs about oneself or others that persist despite facts (aliens trying to communicate with you)
101
What is disorganized speech?
Words and ideas strung together based on sounds, puns, or "loose associations". (doritos --> dori from finding nemo --> ellen degeneres --> hates penis.... therefore, penis)
102
What is an illusion?
Something that is there but is misinterpreted.
103
What are the types of hallucinations?
Visual auditory, olfactory, gustatory, tactile, hypnagogic, hypnopompic
104
What is visual hallucination more commonly a feature of?
Medial illness/dementia
105
What is auditory hallucination more commonly a feature of?
Psychiatric illness
106
What is olfactory hallucination associated with (Specifically burnt rubber)?
Psychomotor epilepsy (rubber) and brain tumors
107
What is tactic hallucination? When does it occur?
Common in EtOH withdrawal (formication = bugs crawling on skin) and cocaine abusers (cocaine crawlies)
108
What is hypnagogic hallucination?
Occur while GOing to sleep
109
What is hypnopompic hallucination
Occur while waking up (POMPous upon awakening)
110
What is schizophrenia?
A chronic mental disorder with periods of having psychosis, disturbed behavior and though, and decline in functioning that lasts MORE THAN 6 MONTHS (before this it is called other things).
111
What are the NT findings in schizophrenia? What is it associated with in the brain?
Increased Dopamine; Decreased dendritic branching
112
What does the diagnosis of schizophrenia require?
```
2 or more of the following:
Delusions
Hallucinations (usually auditory)
Disorganized speech (loose associations)
Disorganized/catatonic behavior
Flat Affect, social withdrawal, lack of motivation, lack of speech or thought
```
113
What is the difference between positive and negative symptoms?
Positive symptoms ADD behavior, negative symptoms SUBTRACT behavior
114
What can contribute to the etiology of schizophrenia?
Genetics and environment, frequent cannabis use (teens), LSD, cocaine, amphetamines
DIT BONUS: In utero viral infectons, Toxin exposure, birth trauma
115
Who gets it more, men or women? blacks or whites? age of presentation differences?
Men = females
Blacks = whites
Men get it teens to early 20's, females 20's-30's (10 year gap)
116
What are schizophrenic patients at an increased risk for?
Suicide
117
What brain findings are found on CT?
Brains are smaller w/ enlarged ventricles and thinner cortex
118
What is a brief psychotic disorder?
Subset of schizophrenia, lasts LESS THAN 1 MONTH and usually stress related
119
What is a schizophreniform disorder?
Same things as schizophrenia except 1-6 months duration
120
What is schizoaffective disorder?
AT LEAST 2 WEEKS of stable mood w/ psychotic symptoms, plus a major depressive, manic, or mixed episode; 2 subtypes = bipolar and depressive
121
What is a delusional disorder?
Fixed, persistent, untrue belief system lasting LONGER THAN 1 MONTH, functioning is otherwise not impaired (compared to schizophrenics who do have impaired function)
122
What is a shared psychotic delusion?
When a couple is delusional together (real fuckin cute ya'll)
123
What is dissociative identity disorder?
Formerly known as multiple personality disorder; presence of 2 or more distinct identities or personalities, MC in women, associated w/ history of sexual abuse, PTSD, depression, borderline personality, and somatoform conditions (remember sex abuse here)
124
What is depersonalization/derealization disorder?
Persistent feelings of detachment or estrangement from one's own body, thoughts, perceptions, and actions.... "out of body experience"
125
What is a mood disorder?
Abnormal range of moods or internal emotional states and loss of control over them, severity causes distress and impairment in social and occupational function (Includes major depressive, bipolar, dysthymic, cyclothymic)
126
What is a manic episode?
Distint period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistent increased activity or energy lasting AT LEAST ONE WEEK
127
How do you diagnose a manic episodes?
```
remember that manics DIG FAST!! (3 of the following)
Distractibility
Irresponsibility (please w/o consequence)
Grandiosity (I'm Jesus)
Flight of ideas (racing thoughts)
Activity/Agitation (goal oriented)
Sleep (decrease)
Talktativeness/pressure speech
```
128
What is a hypomanic episode?
Like manic except mood disturbance is not severe enough to cause marked impairment in social/occupational function, no need to hospitalize. No psychotic features. AT LEAST 4 CONSECUTIVE DAYS
129
What is bipolar I disorder?
Presence of at least 1 manic episode with/without a hypomanic or depressive episode
130
What is bipolar II disorder?
Presence of a hypomanic and depressive episode w/ a manic episode
131
Does the patient's mood return to normal between bipolar episodes?
Yes
132
What can use of antidepressants lead to in a bipolar patient?
Increased Dopa, 5-HT, NE = increased mania
133
Are bipolar patients at high suicide risk?
Yes
134
What is the treatment for bipolar?
Mood stabilizers (lithium, valproic acid, carbamazepine and atypical antipyschotics)
135
What is cyclothymic disorder?
Dysthymia and hypomania, milder bipolar lasting AT LEAST 2 YEARS (notice there was no time frame for bipolar, just on the manic episode = 1 week)
136
What is major depressive disorder?
May be self-limited, with major depressive episodes LASTING 6-12 MONTHS
137
What are major depressive episodes characterized by?
AT LEAST 5 of the 9 symptoms of (SIG E CAPS + Depressed mood for 2 OR MORE WEEKS
138
What must symptoms of major depressive episodes include, regardless of how many SIGECAPS they get?
Patient reported depressed mood or anhedonia
139
What is SIGECAPS? (*= one of these required for Dx)
```
Sleep Disturbance
Loss of Interest (adhedonia)*
Guilt or feelings of worthlessness
Energy loss and fatigue
Concentration problems
Appetite/weight changes (gain or loss)
Psychomotor retardation/agitation
Suicidal Idealations
Depressed mood* (self reported)
```
140
What sleep changes are seen in depression?
Decreased: slow wave sleep, REM latency
Increased: REM early in sleep cycle, total REM
Repeated nighttime awakenings, early-morning awakening (important screening question)
141
What is persistent depressive disorder? (Dysthymia)
Depression, milder, AT LEAST 2 YEARS
142
What is seasonal affective disorder?
Symptoms associated with seasons, improves w/ full spectrum light (don't forget to go outside)
143
What is atypical depression?
Differs from classical b/c it is characterized by mood reactivity, so you are able to experience a brief improved mood in response to positive events; "reversed vegetative" = hypersomnia and weight gain; leaden paralysis; and long standing interpersonal rejection sensitivity
144
Is atypical depression common?
Yes, it's the most common subtype
145
What is the treatment of atypical depression?
MAO inhibitors and SSRI's
146
What is the timeframe for postpartum mood disturbances?
Within 4 weeks
147
What is Maternal (postpartum) blues?
50-85% incidence = depressed affect, tearfulness, and fatigue usually 2-3 DAYS AFTER deliver and RESOLVES WITHIN 10 DAYS
148
What is tx for maternal postpartum blues?
Supportive (3 hugs) and f/u to assess for postpartum depression
149
What is postpartum depression?
10-15% incidence = depressed affect, anxiety, poor concentration starting 4 weeks after delivery and LASTS 2 WEEKS TO A YEAR+
150
What is tx for postpartum depression?
Antidepressions/psychotherapy
151
What is postpartum psychosis?
.1-.2% incidence rate (but will probably be overrepresented on multiple choice tests...) = delusions, hallucinations, confusion, unusual behavior, and possible homocidal/suicide attempts LASTS DAYS TO 4-6 WEEKS
152
What is tx of postpartum psychosis?
Antipsychotics, antidepressants, possible inpatient hospitalization
153
What must you check for in postpartum psychosis?
Child Safety! Mom is fuckin nuts!
154
What is normal bereavement?
Normal bereavement characterized by shock, denial, guilt, and somatic symptoms. Duration can vary, up to 6-12 months.
155
What are some symptoms of normal bereavement?
Simple hallucinations (hearing name called), depressive symptoms, delusions, and hallucinations
156
What does pathologic grief include?
Intense grief, prolonged (>6-12 mo.); or grief that is delayed, inhibited, or denied. You may experience depressive symptoms, delusions, and hallucinations.
157
What is ECT a treatment option for? What is it?
Treatment for major depressive disorder refractory to other treatment and for pregnant women with major depressive disorder... Also consider when immediate response is necessary (suicide). It produces a painless seizure in a knocked out patient
158
What are adverse effects of ECT?
Disorientation, temporary h/a, and partial/retrograde amnesia usually resolving in 6 months
159
What are the risk factors for suicide? (mnemonic)
```
SAD PERSONS kill themselves
Sex (females try more, men succeed more)
Age (45)
Depression
Previous attempt
Ethanol or drug use
Rational thinking loss
Sickness (illness/3 or more Rx meds)
Organized plan to do it
No spouse/children
Social support lacking
Stated attempt ("I'm gonna do it!")
```
160
What disorders/situations did DIT say were more likely for suicide?
Schizophrenia
Access to gun
Borderline personality disorder
Think about Dx of a new dz, especially cancer or something terminal
161
What is anxiety disorder?
Inappropriate experience of fear/worry and its physical manifestations when the source of the fear/worry is either not real or insufficient to account for the severity - interfere with daily functioning (panic disorder, phobias, generalized anxiety disorder)
162
What is panic disorder?
Defined by the pretense of recurrent panic attacks (intense fear and discomfort peaking in 10 minutes with 4 from the PANICS mnemonic)
163
What is the PANICS mnemonic for panic disorder?
Palpitations, Paresthesias
Abdominal distress
Nausea
Intense fear of dying/loss of control, lightheaded
Chest pain, chills, choking, disconnectedness
Sweating, Shaking, SOB
Symptoms are the manifestations of fear!
164
What is the diagnosis of Panic Disorder based on?
Attack followed by 1 month of 1 or more of the following: concern about attacks, worrying about consequences of attacks, behavioral changes related to attacks
165
What is the Tx for panic disorder?
Cognitive behavioral therapy, SSRI, venlafaxine, benzos
166
What can be used for a person afraid of public speaking?
Beta blockers; If asthmatic use cardioselective (A-M), otherwise propanolol works
167
What is a specific phobia?
Fear that is excessive or unreasonable and interferes with normal function, cued by presence or anticipation of a specific object/situation. The person knows the fear is excessive, tx with desensitization
168
What is a social anxiety disorder?
Exaggerated fear of embarrassment in social situations; tx with SSRI
169
What is agoraphobia?
Exaggerated fear of open or closed places, using public transport, being in line/crowds, leaving home alone
170
What is generalized anxiety disorder?
Uncontrollable anxiety for AT LEAST 6 MONTHS that is unrelated to anything
171
What is the treatment of generalized anxiety disorder?
SSRI, SNRI, Busiprone, cognitive behavioral therapy
172
What is adjustment disorder?
Emotional symptoms causing impairment following a psycosocial stressor (Divorse/illness) and lasting LESS THAN 6 MONTHS (diagnosis can be >6 months if the event is dragged on)
173
What is OCD?
Recurring intrusive thoughts, feelings, or sensations that cause severe distress and are partially relieved by performance of the actions. They are behaviors inconsistent with the person's own beliefs (not the same as OC personality disorder)
174
What is the treatment of OCD?
SSRI and climipramine
175
What is body dysmorphic disorder?
Obsession with minor or imagined defect in appearance, leads to lots of surgical procedures and emotional distress that impairs functioning (somatic disorder)
176
What is PTSD?
Persistent reexperiencing of a previous traumatic event; can involve nightmares, flashbacks, fear, helplessness, horror. Leads to avoidance of stimuli that increase the arousal. MORE THAN 1 MONTH OF DISTURBANCE. Can begin any time after event.
177
What is treatment for PTSD?
Psychotherapy/SSRI
178
What is acute stress disorder?
PTSD but only between 3 days and a month
179
What are PTSD patients at risk for? (DIT BONUS!)
90x for somatisization
180
What is Malingering?
Consciously faking or profoundly exaggerating, or claiming to have a disorder for a secondary gain, generally have poor compliance w/ tx or tests. Complaints cease after gain (someone trying to get out of work)
181
What is a factitious disorder?
Patient consciously creating a physical and/or psychological symptoms in order to assume the rick role and get medical attention (Munchausen +/- by proxy)
182
What is munchausen syndrome?
Chronic factitious disorder with predominantly physical signs and symptoms, characterized by hx of multiple hospital admissions and willingness to receive surgical procedures
183
What is munchausen by proxy?
When illness in a child/elderly patient is caused by caregiver, motivation is to assume sick role by proxy, form of child/elder abuse
184
What is a somatic symptom or disorder?
Physical symptoms with no identifiable cause, both illness production and motivation an unconscious (vs factitious disorders). This is NOT intentional, more common in women
185
What is somatic symptom disorder?
Variety of complaints in one or more organ systems that last for months to years, associated with excessive, persistent thoughts and anxiety about symptoms. Can co-occur with real illness
186
What is conversion disorder?
Sudden loss of sensory or motor function, often following an acute stressor; patient is aware of but sometimes indifferent toward symptoms (IDGAF); more common in females, adolescents and young adults
187
What is an illness anxiety disorder (hypochondriasis)?
Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance
188
What is a personality trait?
An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself - this is who you are
189
What is a personality disorder?
Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning; person is usually not award they even have a problem. Usually presents by early adulthood and separated into A, B, and C (Weird, Wild, and Worried)
190
What category of disease has unexplained symptoms with no conscious attempt to deceive?
Somatoform disorders
191
What category of disease has unexplained symptoms with a conscious attempt to deceive for an external goal?
Malingering
192
What category of disease has unexplained symptoms with a conscious attempt to deceive for psychological gain?
Factitious disorder
193
What is common in the diagnosis of all personality disorders?
They must interfere with the ability to work with people and with every day life
194
What are cluster A personality disorders?
"Weird" (Accusatory, Aloof, Awkward); odd or eccentric, inability to develop meaningful social relationships. no psychosis; These are paranoid, schizoid, schizotypal
195
Is there a genetic association or cluster A with schizophrenia?
Yes
196
What is paranoid?
(Cluster A) Pervasive distrust and suspiciousness; projection is the major defense mechanism
197
What is schizoid?
(Cluster A) Voluntary social withdrawal, limited emotional expression, they WANT TO BE ISOLATED!!, Remember, Schizoid's avoid.
198
What is schizotypal?
(Cluster A) Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness. (Schizotypals dress like pickles)
199
What are cluster B personality disorders?
"Wild" (Bad to the Bone) Dramatic, emotional, or erratic; They are antisocial, borderline, histrionic, and narcissistic.
200
Is there a genetic association of cluster B with mood disorders and substance abuse
Yes and Yes
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What is antisocial?
(Cluster B) Disregard and violation of rights of others, criminality, impulsivity. Males > females; must be > 18 w/ a history of conduct disorder before age 15 (remember the difference btwn conduct disorder and oppositional defiant = harm vs no harm). This is just straight conduct disorder if <18!
Antisocial = Sociopath
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What is borderline?
(Cluster B) Unstable mood and interpersonal relationships, impulsiveness, self-mutilation!, boredom, sense of emptiness. Females > males; splitting is the major defense mech here. Increased likelihood of suicide (see self-mutilation)
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What is histrionic?
Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance (dressing to get attention, this is not Body Dysmorphic)
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What is narcissistic?
Grandiosity, sense of entitlement, lack of empathy and requires admiration; often demands the best and is pissed with criticism.
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What are cluster C personality disorders?
"Worried" (Cowardly, Compulsive, Clingy)
| Anxious/fearful
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Is there a genetic association of cluster C with anxiety disorders?
Yes
207
What is avoidant?
(Cluster C) Hypersensitivity to rejection, socially inhibited, timid, feelings of inadequacy, WANTS TO BE LOVED! (vs schizoid)
208
What is obsessive compulsive personality?
(Cluster C) Preoccupation with order, perfectionism, and control; ego-syntonic: behavior consistent with one's own believes and attitudes. (OCD doesn't like their own disorder, OCP doesn't know they have it)
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What is dependent?
(Cluster C) Submissive and clinging, excessive need to be taken care of, low self-confidence.
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How do you "Keep schizo- straight"?
Schizoids (avoid, like the unibomber)
Schizotypal (schizoid + odd thinking, do weird things)
Schizophrenic (greater odd thinking than schizotypal)
Schizoaffective (schizophrenic psychotic symptoms + bipolar or depressive mood disorder)
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What is the time course of schizophrenia?
6 mo - schizophrenia
212
What is anorexia nervosa?
Excessive dieting +/- purging, intense fear of gaining weight, distorted body image, increased exercise (BMI < 17).
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What are some signs/consequences of anorexia nervosa?
Decreased bone density, severe weight loss, metatarsal stress fracture, amenorrhea, lanugo (fine body hair), anemia, electrolyte disturbances. Osteoporosis b/c decreased estrogen.
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What age group is anorexia nervosa seen in?
Adolescent girls, it commonly coexists w/ depression
215
How do you treat anorexia nervosa?
Supportive, talking, no Rx tx if no depression
216
What is bulimia?
Binge eating +/- purging; it is often followed by self-induced vomiting or use of a laxative, diuretic, or emetic.
217
What are signs/consequences of bulimia?
Body weight often normal; Associated with parotids, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand callouses (from vomiting = Russells sign).
218
What age group is bulimia nervosa seen in?
Adolescent girls
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What does the vomiting of bulimia lead to (labs wise)
Lose HCl when you vomit;
| Hypokalemic Hypochloremic Metabolic Alkalosis
220
What is binge eating? (DIT BONUS!)
No purging, it is a coping mechanism; it has a deeper psychological may have negative feeling toward food
221
What is Compulsive eating? (DIT BONUS!)
No purging, OCD; you think about and fantasize about food, it is not a coping mech
222
What is Gender Dysphoria?
A strong, persistent cross-gender identification. Characterized by persistent discomfort with one's sex assigned at birth. Causes significant distress and/or impaired functioning. Affected are often referred to as transgender.
223
What is the difference between sex and gender?
Sex is genetic, Gender is psychologic
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What is transsexualism?
The desire to live as the opposite sex, often through surgery or hormone treatment
225
What is transvestism?
Paraphalia, NOT GENDER DYSPHORIA. Ex. This is wearing clothes of the opposite sex to get turned on.
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Is homosexualism a form of gender dysphoria?
NO, men that are homosexual still identify themselves as men
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What is sexual dysfunction?
Includes sexual desire disorders (hypoactive or sexual aversion), sexual arousal disorders (ED), orgasmic disorders (anorgasmia/PMEJ), and sexual pain disorders (dysparenunia and vaginismus)
228
What things cause sexual dysfunction? (Ddx)
Drugs (antihypertensives, neuroleptics, SSRI'sm EtOH), Diseases, Psychological
229
What are the 3 failures that can happen with ED? (DIT)
Failure to initiate (psychogenic, endocrinologic, neurologic)
Failure to fill (atherosclerosis)
Failure to store blood w/in lacunar network
Diabetes, atherosclerosis, and drug >80% of cases
230
What is sleep terror disorder?
Periods of terror with screaming in the middle of the night, occurs during slow wave (III and IV). Most common in children. There is no memory of arousal b/c not in REM. Triggers may include fear, stress. Self limited.
231
What is substance abuse disorder/dependence?
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A maladaptive pattern of substance abuse defined as 2 or more of the following w/in 1 year
Tolerance
Withdrawal
Take more and more, or over longer time
Persistent desire
Significan energy spent obtaining it
Important things put off because of it
```
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These things more serious
Continued use in spite of problems
Craving
Use in dangerous situations
Failure to do your job
Relationships conflicted because of it
```
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What are the stages in overcoming substance addiction?
Precontemplation - not acknowledging problem
Contemplation - acknowledge, not willing
Preparation - getting ready to change
Action - changing
Maintenance - maintaining behavior
Relapse (hopefully not) - returning to old behavior
