Psych pt ii Flashcards

Question

Alcohol withdrawal DSM 5

Answer 1

>/2 of: 1. ANS hyperactivity 2. Hand tremor 3. Insomnia 4. Nausea 5. Hallucinations/illusions 6. Psychomotor agitation 7. Anxiety 8. Generalized seizures

Answer 2

Cluster o cognitive, behavioural, and physiological symptoms indicating that individual continues to use a substance despite significant substance related problems. Maladaptive pattern as manifested by >/2 of the folllowing 11 over a 12 month period (1 year). Impaired control ie 1. Larger amt than intended 2. Persistent unsuccessful cutting back 3. Time consuming 4. Cravings Social impairment: 5. Fail to fulfill major role 6. Social.interpersonal problems 7. Reduction of important activities Risky use: 8. Use in physically hazardous situations 9. Use despite having a problem Pharmacological criteria: 10. Tolerance 11. Withdrawal syndrome upon cessation -- if tolerance and withdrawal are only two after appropriate use of prescribed drugs, DO NOT DIAGNOSE SUD. Severity based on # of sxs

Answer 3

Now merged as USE disorder Dependence (addiction) - pattern of drug use involving compulsive, drug seeking behaviour Drug abuse: pattern of drug use with recurrent adversive consequences (ie role failure, risky situations, run-ins with law)

Answer 4

I. NO safe accepted med use. Heroin, marijuana, LSD, ecstasy II. High harm risk , but with safe accepted med use. Highly addictive ie opioids and stimulants, some barbiturates. III, IV, V: harm risk less than schedule II with safe adn accepted uses III: several barbiturates, anabolic steroids, codeine (tylenol III) IV: Most benzodiazepines V: liquid codeine preparations (eg robitussin)

Answer 5

CNS depressants Alcohol, Benzodiazepines (diazepam, lorazepam), Barbiturates (phenobarbital, secobarbital) - barbitiruates have low safety margine and high abuse potential

Answer 6

``` Sedation, sleepiness, decreased anxiety Disinhibition, impaired judgment Slurred speech, incoordination Stupor or coma Respiratory depression ** OD on these drugs is potentially lethal ``` Other effects: anticonvulsant and anaesthetic, disrupted sleep architecture -- unrefreshing sleep, alcohol related brain damage (korsakofs), cross tolerance to other sedatives

Answer 7

Agitation, insomnia, anxiety. ANS hyperactivity**(can be fatal), nausea or vomiting --- all are extreme "panic" reaction Hand tremor, transient hallucinations, seizures Hallucinations can occur in any sensory modality, incl tactile - formication (bugs Nader skin) - can occur as the main symptom of withdrawal without physical symptoms - ie alcohol hallucinoses. Delirium Tremens (DTs) - a delirium (confusional state) may also occur: severe and uncommon, seen after chronic heavy use of a sedative (esp alcohol), associated with high mortality rate.

Answer 8

Opioid receptor blocker, reduces pleasurable effects of alcohol. This drug helps a person stop drinking after a few drinks when a 'slip' occurs. (Ie helps to avoid a full relapse)

Answer 9

An NMDA receptor antagonist that decreases craving for alcohol by reducing the discomfort of the protracted abstinence syndrome. Helps prevent the slip from occurring in the first place, because person feels euthymic and thus doesn't crave alcohol.

Answer 10

CNS depressants - substances with psychoactive vapours (ie glues, paints). Similar to sedative intoxication. Teenage experimentation common. Signs: rashly, red, runny nose, chemical smell, face discolouration Associated with morbidity (organ failure)/mortality (sudden sniffing death)

Answer 11

Major stimulants, ie methamphetamine, MDMA, Adderall

Answer 12

Major CNS Stimulants. Ie methylphenidate (Ritalin)

Answer 13

CNS stimulant

Answer 14

Psychological: euphoria and grandiosity, psychomotor acceleration and steroetypies, paranoia and hallucinations Physical: elevated HR and bp (life threatening), appetite loss and insomnia, mydriasis.

Answer 15

Both are major stimulants, especially addictive due to direct action on reward pathway, producing intense rush followed by euphoria. Cocaine shorter lasting (hal life - 30 min versus 12 hours in meth) Cocaine use is more frequent Physical changes with meth (meth mouth and meth face)

Answer 16

Dysphoric mood (MUST BE SEEN) Fatigue and psychomotor slowing Hypersomnia with vivid and unpleasant dreams Increased appetite Symptoms non-life threatening and relatively mild

Answer 17

Stimulant effects PLUS mild hallucinogenic effects (perceptual alterations) Common things look more interesting, empathogenesis, concern about neurotoxicity, other health consequences (ie hyperthermia), reputation as a safe drug despite schedule I status.

Answer 18

Designer drug containing, in part, amphetamine-like chemicals (MDPV) Acut toxicity includes: agitation, paranoia, hallucination, chest pian, tachycardia, HTN, suicidality

Answer 19

Responding to similar CSs with the same CR

Answer 20

Through trial and error, organism can learn to respond only to original CS

Answer 21

CS-CR bond will tend to decay if CS no longer followed by US - get a classical extinction curve as CR weakens and is eliminated

Answer 22

Following extinctino, CR may 'spontaneously' reappear if CS is presented

Answer 23

Classical conditionig of an immune response. Rob Ader. Ie pair saccrin with immunosuppresant, start to see immunosuppression with only saccrin. Hospital chemo: UR = immunosuppresion CR= immunosuppression and anticipatory nausea

Answer 24

Classical cond - treatment of nocturnal enuresis CS (sensation of full bladder) - US (alarm), CR/UR awakening and tightening of muscles.

Answer 25

Classical conditioning - CS (docs office ) US (past anxiety provoking event in office) - CR/UR anxiety/elevated BP

Answer 26

Classical conditioning - CS sights sounds smells drug environ, US drug injected (receptors occupied), CR/UR - drug like physio changes/psych effects. CR mimics aspects of the UR

Answer 27

Compensatory response of body to drug effects - also subject to conditioning US - morphine injection UR - homeostatis mechanisms to counter CS - sights sounds etc CR - homeostatic responses

Answer 28

Aspects of tolerance response via Classical Conditioning - become assoc with enviro stimuli prior to drug admin. Viewed as anticipatory, prepare body for arriveal.

Answer 29

Obrien. Ie physicially dependent methadone users in detox. Pair spearmint smell with withrdawal period Classical cond, CS later produced a CR mimicking withrdawal symptoms. Concusion - conditioned withrdawal symptoms increase likelihood of relapse

Answer 30

CS's play a significant role in continued drug use, craving, and relapse Treatments based on classical extinction - break the learned association between stimuli in drug-using enviro and drug use

Answer 31

CS repeatedly presented (alleyway) but not followed by US (drug injection), diminished CR/UR

Answer 32

Thru classical cond, anxiety associated with enviro objects, events and situations, and somatic sensations ex - phobias (specific and SAD), PTSD and ASD, panic attack, panic disorder, agoraphobia.

Answer 33

many phobias acquired through classical conditioning - CS previously neutralstimulus (heights), US (naturally fear-producing stim ie perceived threat of falling), CR/UR feat/anxiety/avoidance

Answer 34

Fear prodocing US does not ALWAYS lead to a phobia can also be acquired through vicarious learning or verbal report Acquired through classical conditioning, maintained by operant conditioning

Answer 35

Most do not seek. Anxiolytics limited, SSRIs OK CBT: exposure & systematic desensitization good Purely cognitive: less effective, pt usually realizes illogical.

Answer 36

Classical: initial attack occur in enviro with external and intrnal stim External (exterioceptive) ie shopping mall Internal (interioceptive) ie somatic sensation incr HR Stimuli become CSs that elicit anxiety Spiraling anxiety and physical symptoms Maintenance however is operant... see later

Answer 37

Panic attacks and PD often develop agroraphobic avoidance of external and internal stimuli assoc Learned avoidance - often involves external CSs Can also avoid CSs producing internal stimuli - ie activities producing elevatd HR - exercise, sex.

Answer 38

Exposure: Gradual exposure to fearful stimulus (NO RELAXN TRAINING) Flooding: Abrupt, prolonged full intesnsity exposure to fearful stim (careful, can be counterproductive) Exposure and response prevention: Exposure followed by prevention of rituatlistic avoidance behaviour - first line for OCD - BOTH CLASSICAL AND OPERANT*

Answer 39

Behavior followed by a pleasant consequence is strengthened & tends to be repeated; that followed by an unpleasant consequence is weakened & less likely to be repeated (operant)

Answer 40

Too littl positive reinforcement in life --> depression Downward emotinoal spiral of increasing levels of depression Less you do, worse you feel, worse you feel, less you do. CBT gold standard

Answer 41

Immediacy - reinforce most effective when presented immediately after the bhaviour Consistency - reinforcing every infstance of behaviour, most quick learning contingencies should be made clear

Answer 42

Every instance of behaviour is reinforced - quicker learning, but extinguished more quickly

Answer 43

Not every behavior reinforced , learned less quickly but more resistant to extinctino intermittent reinforcement Delivered on a variable ratio schedule is the MOST resistant to extinction

Answer 44

Creating new behaviours through reinforcing successive approximations of the desired ehaviour

Answer 45

accidental conditioning | RAndom, non-continget reinforcement may lead humans to infer causality

Answer 46

Primary: naturally reinforcing, ie food, water, sex, some drugs, nurturance Secodnary: acquire reinforcing ability through learning, ie applause, grades, gold medals, money

Answer 47

Primary: naturally, ie shock, pain, nausea Secondary: learned ie ridicule, banishment, F grade

Answer 48

OC. incl Avoidance behaviour: Behaviour allows subject to avoid an unpleasant stimulus. See in phobias, OCD, PTSD, panic attack, substance use neg reinforcement: Ie. seeking medical treatment, results in alleviation of discomfort, pain, anxiety. Negatiely reinforced

Answer 49

Two-factor theory posits that both classical & operant conditioning are operating in the case of phobias & a number of other psychological disorders. Acquired through classical, maintained via operant

Answer 50

Incl Positive reinforcement: psychoactive drugs are reinforcers and stregthn drug taking and seeking behaviours Negative reinforcement: physically dependent ppl, drug terminates unpleasant withdrawal effects. strengthening behaviour

Answer 51

Whether previously reinforced behaviour is actually performed, depends on presence of stimuli in enviro. If previously associated with reinforcement - they are antecedent or discriminative stimuli (SDs) make the behaviour more likely because they predict reinforcement --> behaviour result of consequence AND antecedent environmental stimuli

Answer 52

Eating associated with stimulus situatins and internal mood states. Presence of these discriminatory stimuli make behaviour of eating more likely. Goal: bring eating behaviour under appropriat stimulus control ie only at meal time in dining room.

Answer 53

Reason Conditioned behaviours are not forgotten. Maintains conditioned fear for phobias etc. Patients avoidance of feared object is negatively reinforced - avoidance or alleviation of anxiety. Learned fear does not extinguish

Answer 54

Involves patient remaining in presence of feared stimulus until anxiety diminishes

Answer 55

Involves avoidance conditioning. Obsessions & compulsions Performance of compulsive behaviour reduces anxiety assoc with obsessive thought - performance of ritualistic behaviour serves as avoidance behaviour, and is thus negatively reinforced. Treatment: Exposure&Ritual/Response Prevention (CC and OC)

Answer 56

Reinforcement is consistently withheld following previously reinforced behaviour. Post-extinction burst - rapid burst of behaviour at beginning of extinction trials, followed by extinction

Answer 57

Extinction: previously reinforced behav, NOTHING happens Punishment: behaviour, followed by consequence

Answer 58

Focus on behaviour itself and role of learning and environment in maintnance Shift from psychoanalysis - concept behaviour as a symptom of underlying conscious conflic.

Answer 59

OC Treatment Using reinforcement to encourage desirable behaviours, and punishment or extinction to elminiate undesirable. - ie parents restrict teenagerscar if doesnt keep curfew, praise if someone adheres, encourageent if exercise

Answer 60

OC Creating new desirable behaviour by reinforcing successive approximations of it - used with population of limited speech - ie young children, intllectual probs, autism specturm

Answer 61

OC Providing auditory or visual feedback to pt contingent upon modifaction of physiological correlates of anxiety and pain ie EMG feedback indicating level of tension in neck/back in treatment of tension headaches. - ie they have tried this meditation tchnique, real life proof that it is working. Reinforces their relaxation behvaiour.

Answer 62

OC | Contingent upon misbheavior child is removed from all sources or reinforcement (negative punishment)

Answer 63

OC Pt learns behaviour only under certain stimulus condtions - ie commonly seen in CBT programs ainmed at weight reduction and insomnia treat, bring eating and sleeping behaviour under stim crl.

Answer 64

reinforcement is delivered after a specified time period during which the undesirable behaviour is not performed TIME dependent rather than response

Answer 65

Person wants to engage in some enjoyable behaviour - so that behaviour can be a reinforcer for some less enjoyable activity.

Answer 66

OC Theraputic understanding, family or couple and therapist, pertainig to desirable and undesirable behaviours made explicit and agreed to by all parties. If i do this then this

Answer 67

Operant based system often employed in residential treatment facilities, prisons, and halfway houses. Secondary reinforcers (ie tokens) used to reinforce desirable behaviours - tokens redeemed for merchandise/privileges

Answer 68

To establish effectiveness of a single case behavioral intervention A - inital baseline B - treatment intervention stage - not whether A changed Treat withdrawn - note if returns to baselin Treatment reinstated - noted whether behaviour again imrpoves Dtermine whether our cog behav intervention has been effective.

Answer 69

Primarily cognitive therapy. A (event) B (interpretation of event) C (emotion). C is caused by B, not A.

Answer 70

Negative triad - depression is caused by negative interpretations of self, life events, and future Negative thinking CAUSES depression. Negative 'self schema' - negative filters through which we view the world distort the world and cause depression Learned helplessness: avoidance behaviours are prevented - passivity and depression result

Answer 71

Emphasizes learning through observation (modeling and vicarious cond) Reciprocal relationship between behavriour, cognition, and personal factors. Person;s behavior both influenced by and influences personal factors (eg personality and thinking), and by the social environment

Answer 72

Empirically demonstrated success with difficult patient populations - ie borderline PD, suicidal self harm, depressed teens, chronic eating D, drug dependent, chronic pain. Cog behav therapy - incl behavioral skills training, emotion regulation, and mindfulness Emphasis on patient acceptance of themselves as they ARE, and their commitment to CHANGE destructive behaviours. MINDFULNESS - aware moment by moment of emotions and thoughs that precede destructive behaviour. learn to experience emotions without acting

Answer 73

Just below 1/4 of americans smoke - most report they would like to quit Leading preventable cause of death (1/5) 70% see a physician each year, advice to quit by MD significantly increasing cessation rate Cessation has benefits even after age 65, or quitting after disease Decrease risk of lung cancer etc. 10-15 yrs of abstience, mortality rates approach non-smokers 30% with state of art treatment not smoking 1 yr later, most resume after 3 months Only 5% who self quit succeed for 1 year

Answer 74

Behavioural change is a process occurring over time. PRECONTEMPLATION - initial disinterest, patint doesnt see prob or has given up. listen educate and raise doubt CONTEMPLATION - thinking of health risks and quitting - ambivalent, vacillation. Emphasize risks and benefits, self efficacy, past successes PREPARATION - preparing to quit in near future - explor options, set quit date, realistic. ACTION - taking steps to stop - identify risk situations, coping strat, reinforce self efficacy MAINTENANCE - maintaining non-smoking

Answer 75

Smoking cessation pdt. Sustained release buproprion - antidepressent with dopaminergic and noaradrenergic activity

Answer 76

Smoking cessation pdt. Partial agnoist - eases withdrawl by stimulating nicotine receptors, blocks them if patient takes up smoking again - associated with suicidal ideation - banned in 2008 by FAA for use amont pilots and air trafic ctrllers.

Answer 77

Few withrawl sx relapse > 2weeks low FTND

Answer 78

History of withrdrawl sx relapse < 1 wk high FTND

Answer 79

1. Roll with resistance - don't fight, avoid righting reflex, dont directly persuade 2. Develop discrepancy - pt is stuck and needs hlep, help patint see discrepancy btwn where they want to be and where they are now, if accept your invitation will be for their own reasons 3. Express empathy - accepting patient frees them to change, judging blaming is counterproductive, accepting does nt necessarly mean you agree 4. Enhance self-efficacy - critical, have to believe they can do it, be supportive, creative

Answer 80

Major stimulant. Ivory wave, purple wave, vanilla sky, bliss. Designer drug, containing, in part, amphetamine like chemicals (MDPV) Acute toxicity incl: agitation, paranoia, hallucinations, chest pain, tachycardia HTN, suicidality.

Answer 81

Intoxication; typically after 250 mg - increased energy, insomnia, nervousness, rambling thoughts, tachycardia, diuresis, GI disturbance, muscle twitches Withdrawal: headache, dysphoria, fatigue, decreased concentration.

Answer 82

Classic hallucinogens: LSD, mescaline, psilocybin -- hallucinations Cannabis: marijuana, hashis -- distortions Dissociative anaesthetics: PCP, ketamine (animal tranquillisiez) -- depersonalization

Answer 83

1. Perceptual altering ie hallucinations (classic), distortions (cannabis), depersonalitatino (disscoiateive anaesthetics) 2. Mind calming effects - despite sympathomimétique effects - sometimes associated with agitation/paranoia (bad trip) 3. Concerns exist that they cause persisting psychosis (ie marijuana causing schizophrenia, largely unproven)

Answer 84

V potent hallucinogen, long lasting (8-12 hours) Visual, poorly formed hallucinations (unlike those in schizophrenia). Myrdriasis NO withrdawal syndrome recognised. Associated with "flashback" perceptual experiences long after LSD is metabolized - "hallucinogen persisting perception disorder" Ie; false perceptions of movement, intensifications of colour. Generally not pleasant.

Answer 85

Gateway drug along Rx opioids Rarely causes hallucinations unless ingested shorter acting than LSD (2-4 hours) unless ingested Associated with amotivational syndrome INTOXICATION: perceptual distortions, intensification of senses, perception of slowed time Pyshical: conjunctival injection, increased appetite, dry mouth WITHRDAWAL: psychological: irritability and nervousness (agitation), dysphoric mood, sleep disturbance (insomnia, vivid dreams), decreasd appetite Physical: headaches, night sweats, stomach cramping, shakiness Currently schedule I

Answer 86

Ie PCP Intoxication: depersonalization, agitation, belligérance and confusion, impulsivity and unpredictability, nystagmus, hyperacusis, decreased responsiveness to pain, ataxia, muscle rigidity, seizures, coma. Intox is a psych emergency because of violent and unpredictable behaviours Treatment: benzos, antipsychotics, reduced environmental stimulation, restraints might be needed. No withrdawal syndrome recognised.

Answer 87

Main medical use of opioids (narcotics) - analgesia. Additional effects: euphoria in varying intensities Incl heroin - intense euphoria, highly addictive, can be smoked/snorted (not always needle tracks) INTOXICATION: initial intense rush followed by euphoria and drowsiness, dysphoria (as high dissipates), MIOSIS, unconscious, respiratory depression WIthrdawal: dysphoria, nausea, vomiting, diarrhoea, muscle aches, lacrimation and rhinorrhea, piloerecetino, sweating, fever, yawning, pupillary dilation. Sever "flu like symptoms" Withdrawal usually non-life threatening, opioid use deadly by OD and health hazards associated with addiction

Answer 88

Short acting opioid receptor antagonist used for acute OD (not used for addiction treatment)

Answer 89

Abstinence based therapy - patient to be completely abstinent, often involves use of naltrexone (long acting opioid receptor blocker) to block opioid effects if relapse occurs. Tends to be unsuccessful (compliance) ``` Replacement Therapy (RT) - giving patient a safer opioid drug (methadone, buprenorphine) - regulated, still get a high just not like heroin Tends to be more successful than abstinence-based therapies. ``` Chronic, heavy opioid use resultsin anhedonia (reduced dopamine), physical discomfort (reduced avail of endogenous opioids).- make abstinence difficult RT choices - methadone (schedule II) - only available at OTP, canno be prescribed. Buprenoprhine (schedule III) - is available from a doctors office after approval by DEA when used for addiction, can be prescribed administered or dispensed. Subodore -= buprenorphine +naloxone - naloxone only released when patient abuses medication, get negative effects overpowering.

Answer 90

Methadone (schedule II) cannot be prescribed, only in opioid treatment program - dispensed/administered Buprenorphine (schedule III) - available from doctor after DEA approval. Prescribed dispensed or administered. Suboxone - buprenorphine and naloxone - naloxone only released if patient abuses drug. Duration: 1-2 years, Benefits of RT: oral admin, stable drug levels, less euphoria and less drowsiness. RT plus other interventions -- healthier, productive, and less crime-causing heroin addicts.

Answer 91

Performance and adaptive learning are optimal under moderate levels of stress Corollary 1: learning new or difficult tasks is optimal with low/moderate arousal levels Corollary 2: performance of well-learned tasks is optimal with moderate/high arousal levels

Answer 92

SNS - stimulates inflammation, suppressed by glucocorticoids resting HR increased by SNS, suppressed by glucocorticoids Basal metabolic energy expenditure accelerated by SNS, suppressed by HPA

Answer 93

Glucocorticoid receptor response becomes impaired, resulting in a flood that - inhibits protein synthesis, - accelerates protein catabolism - increased lipolysis - decreases peripheral glucose utilisation

Answer 94

``` Anxiety disorders (high cortisol) Depression (high cortisol) PTSD (high and low cortisol) History of child abuse (high cortisol) Professional burnout (high cortisol) ```

Answer 95

- Variations in HPA afferents - personality types and HPA response - Shorter form of serotonin transporter - assoc with increased stress response and vulnerability to depression and alcoholism - Val 66Met allele of the brain-derived neurotrophic factor (BDNF) gene leads to reduced hippocampal plasticity and increased anxiety.

Answer 96

Early experiences can hard wire stress response (modelling, secure attachement) Greatest learning occurs in first 9 months Early trauma/abuse Uncertainty in food supply Novelty/enriched environment (protective factor)

Answer 97

1. Alarm stage - Adaptive responses are mobilised 2. Resistance stage - organism attempts to cope by utilising available resources - in state of immunocompromise. 3. Exhaustion stage - demands exceed available resources and defensive efforts fail, and individual becomes increasingly susceptible to disease.

Answer 98

Acute stress activates immune system Chronic stress suppresses it. - excess glucocorticoids in blood impairs production of natural killer T cells and B cells. Reduced antibodies - chronic stress can also lead to heightened autoimmune response - attacks itself - get MS, RA, juvenile diabetes, allergies

Answer 99

Excess glucocorticoids from chronic stress are diabetogenic - impair cell response to insuline Increased glucose and fat in blood stream, decreased O2 flow and organ efficiency. Chronic stress induced hyperinsulinemia is associated with Type II diabetes, CAD, metabolic syndrome.

Answer 100

Stress induced SNS can lead to : spasms of arterial vasculature (migraines), broken heart syndrome (takotsubo cardiomyopathy) Chronic stress-induced arterial constriction can result in: Atherosclerosis, impeded blood oxygen flow (myocardial ischemia), chest pain (angina), cell death (infarct) , heart muscle lapse (arrhythmia or fibrillation).

Answer 101

Reduces adrenaline and cortisol, stimulates endorphin release. Provides an acute physical stress to "reset" the stress response

Answer 102

Psychodynamic: behaviour determined by unconscious processes Behaviourism: focuses on learning and environment Cognitive: learning based, but emphasises role of thoughts and beliefs in behaviour Humanistic: human behaviour reflects a self-actualising principle

Answer 103

Posits that most human behaviour is learned through associative le earning. Learned association made between two different stimuli, or events. - Two types of associative learning are classical and operant conditioning

Answer 104

Classical conditioning of an immune response - Robert Ader's research

Answer 105

Anticipatory response, homeostatic responses to counter direct drug effects (compensatory) are the UR, become CR to CS of environmental cues CRs viewed as anticipatory, and prepare body for arrival of drug. Animals that dont have conditioned tolerance higher mortality rate.

Answer 106

``` Spearmint smell (CS) paired with withrdawal period Through classical conditioning, the CS later elicited a CR mimicking aspects of withdrawal syndrome. Conditioned withrdawal symptoms increase likelihood of relapse (use of drug quells such aversive withrdawl-like symptoms) ```

Answer 107

Intermittent reinforcement (not every instance of behaviour reinforced, learned more slowly) delivered on a variable ratio schedule (ie slot machine pay off on average every 10x)

Answer 108

Nothing in mental life occurs solely by chance (freudian slip) Basis for free association - défenses relax and repressed material can emerge.

Answer 109

Abnormal cortisol levels - anxiety disorders HIGH, depression HIGH, PTSD high and low history of child abuse HIGH, professional burnout HIGH.

Answer 110

Acute stress activates immune system Chronic stress associated with immunosuppression - excess glucocorticoids in blood impairs production of natural killer T cells and B cells, reduced antibodies Paradoxically, chronic stress can also lead to heightened autoimmune response (MS, RA, juvenile diabetes, allergies)

Answer 111

1. Test-retest (administer same test again) 2. Alternate form method (different form) 3. Internal consistency - establish correlation between different parts of the exam 4. Inter-scorer (or inter-rater) method: correlation between scores by different clinicians - not an issue with objective-forat tests, more important with subjective tsts ie ROrschach and TAT

Answer 112

1. Content validity - are the test items representative of the domain, commonly used to validate teacher-made tests 2. Criterion-referenced validity - how well do test results correlate with a direct and independent measure (ie criterion) of what it is designed to measure. - used for aptitude and clinical/diagnosit tests ie MCAT, HAM-D - two types of criterion referenced - predictive ie correlation between tst and future GPA - concurrent -HAM D and current clinicians rating

Answer 113

Measure specific abilities relevatnt to performance in academic or vocational settings ie MCAT GRE SAT US civil srvice exams

Answer 114

How much a person has learned in a specificed educational domain - in the US, tests given in primary school such as the iowa and stanford achievment tests

Answer 115

Assess behavioural, cognitive, and personality deficits following head trauma or neurological disease - based on behavioural deficits, inferences made re location of damage. Complement neuroimaging - incl Halstead Reitan Battry, Luria nebraska , bender visual motor gestalt.

Answer 116

Standard score, mean = 100, SD = 15 Not an absolute score, is a COMPARISON among people Tends to be stable throughout adulthood, fluctuate in teens In mental disorders: varies, symptoms can interfere with IQ assessment, IQ is NOT related to suicide risk.

Answer 117

Very little decline in elderly, VERBAL ability holds up best, perceptual and motor abilities show some decline, increased exposure to verbal behaviour EARLY in life leads to HIGHER IQ

Answer 118

``` <69: Very low, approx 2.5% of population 70-79 low 80-89 low average 90-109 average (~50% of the population) 110-119 high average 120-129 superior >130 very superior, approx 2.5% ```

Answer 119

For children ages 6-16 Measures of general intelligence along with specific indices incl. 1. verbal comprehension, 2. fluid reasoning 3.working memory, 4. processing speed 5. visual spatial. 45-65 minutes

Answer 120

Similiarities subtest - two words of everyday objects, describ how the objects are similar - ie shoe and shirt Comprehension subtest - asked questions that have to do with appropriate behaviour - why do people was their hands? Information subtest: Questions that sample a braod range of areas inv. general knowledge- wheels on a bicycle, who is einstein, where do raisins come from

Answer 121

Subtest of visual spatial category of WISC V. Red and white blocks, child asked to recreate an increasingly more complex stimulus design within a specified TIME LIMIT.

Answer 122

Subtest of working memory for WISC V. Child presented with sequence of numbers, asked to repeat them either forwards or backwards. Number of digits presented (2-9) increases based upon child's performance.

Answer 123

Subtest for processing speed of WISC V Asked to copy symbols that are paired with geometric shapes into the row of shapes that lack symbols. is a timed exercise.

Answer 124

Asses enduring and stable beliefs values attitudes and traits characterizing behaviour across situations and over time 1. objective ie MMPI 2 2. projective - subjective format and scoring ie Rorschach

Answer 125

Objective personality test. Global. Most commonly used, objective format & scoring - 567 T/F questions yields scores on 10 personality dimensions. Computer scoring yields a narrative report. Often finds its way into patients chart, but should only be used in conjuction with interview data. 0 - social introversion 1. hypochondriasis 2. depression 3. hysteria 4. psychopathic deviancy 5. masculinityfeminiity 6. paranoia 7. psychasthenia - worry anxiet doubts=obsessiveness 8. schizophrenia - odd thinking and social isolation 9. hypomania - excitablity Often used in inpatient psych eval for differential dx and expert witness forensics. And in medical cases with physical symptoms with no apparent organic basis.

Answer 126

Used in development of MMPI - itms chosen from a pool, choose the ones that discriminate betwen "sick" and "healthy" people - basis on whether they discriminate between depressed and normal test takers for whatever reason.

Answer 127

Objective personality/clinical test. Clinician rated. One of most widely used depression scales. GOOD reliablitiy and validity - becoming gold standard in psychopharm antideps clinical trials Rates patint on 21 items assessing: somatic symptoms, insomnia, working capcity & interest, mood, guilt, psychomotor retard, agitation, anxiety, insight.

Answer 128

Assesses cognitions (feelings, guilt), physical symptoms (fatigue, weight loss, libido) - based on beck's negative triad - negative views of self, world, and future. Hopelessness - despair, resignation. Assumes negative cognitions are cause of depression - due to negative schema developed early in life. World viewed negative and hopeless. Itms are weighted and inventory can be self scored 1 - i feel discouraged about the future etc

Answer 129

BDI II and patient health questionnaires (PHQ2 and PHQ9)

Answer 130

Ambiguous tst stimuli - purposeful, pt project own meaning and order subjective scoring - different systems, empirical support difficult lower reliability - partic low inter-rater validityl difficult to demonstrate due to subjectivity and psychodynamic concepts

Answer 131

Stimuli from the envoronment (incl test stimuli) are interpreted according to the pts needs, motive, and unconscious conflicts.

Answer 132

10 bisymmetrical inkblots. B&w and colour. Several scoring systmes. Response features indicate personality traits

Answer 133

provide narrative story of ambiguous scenes of human interaction, subjective scoring looking for common thmes. Characteristic ways of addressing conflict, authority, sexuality lead to hypotheses re underlying MOTIVES, CONCERNS, and how pt VIEWS SOCIAL WORLD.

Answer 134

AKA Acute confusional state, acute brain syndrome, encephalopathy, ICU syndrome 1. Disturbance in awareness and attention 2. + at least one additional disturbance in a cognitive domain (memory, language, thoughts (delusions) and perceptions (hallucinations) 3. Sudden onset of symptoms, and fluctuating during the day 4. Evidence for a direct PHYSIOLOGICAL CAUSE (medical condition, drug intox, withrdawal).

Answer 135

Multiple étiologies (fever, dehydration) Widespread brain regions affected Core deficit is in central cholinergic functioning, deficits in ARAS

Answer 136

Risk: health, old age, male gender. SLeep, immobilisation, benzo use in ICU Course: until cause is reversed, resolution typically within 3-7 days Amnesia for events during delirium is common Poor prognostic sign for longer ICU stays

Answer 137

Treat underlying medical condition, and manage associated symptoms (ie agitation, psychosis). Antipsychotics - agitation, psychosis of most delirium Benzodiazepines - to treat delirium caused by alcohol withrdawal Environmental supportive meausres: regulate amount of environmental stimulation, provide orienting stimuli, and provide for safety needs.

Answer 138

Significant acquired memory deficit caused by a medical condition or effect of a substance (NOT dissociative) NOT diagnosed if with general cog decline (ie dementia) Typically from damage to HIPPOCAMPUS Intact STM (Working), short duration retrograde (if longer, have a gradient loss), prominent anterograde Treat: underlying cause ie korsakoffs Cog rehab: restoration of function (memory exercises), and compensation (external strategies ie lists calendars) and internal strategies ie acromynms.

Answer 139

Refers to multiple and sever cognitive impairment WITHOUT impaired consciousness. Usually progressive and irreversible Most commonly in elderlyly

Answer 140

Refers to cognitive decline that DOESNT impair activities of daily living - ie maybe cant multitask so well, a bit forgetful, but doesnt significantly impair functioning. But get a baselin, do a neuropsych battery for future comparison. MCI - higher risk fo developing dementia

Answer 141

Significant memory impairment plus impairment in at least one other cognitive domain. Gradual onset, progressive decline Early stages: rapid forgetting, anomia middle: decreased memory and language, visuospatial problems, agnosias, mood, personality changes, psychosis Late: global aphasia, motor dysfunction, death. Neuroanatomical: cortical atrophy, hippocampal atrophy, enlarged ventricles neurochemical: multiple NT deficiency, loss of ACh in nucleus of meynrt. Neurofunctional: POSTERIOR hyPOmetabolism (ie parietal/temporal) Histo: B amyloid plaques and neurofibrillary tangles - in vivo CSF and amyloid tau , PET imaging of amyloid plaques. Definitive diag on post-mortem

Answer 142

3 cholinesterase inhibitors: donepezil, galantamine, rivastigmine (mild-moderate) 1 NMDA receptor blocker - memantine (for moderate-severe AD) Generally considered ineffective, with side effects of hypotension, GI problems, Research on decreased production and increased clearance of B amyloid plaques through antibody drugs. Other: treat neuropsychiatric symptoms ie aggression and agitation Music therapy, Antipsychotics (off label, black box increased mortality), anticonvulsants and anti-depressants (select)

Answer 143

Dementia from multiple infarcts caused by CVD Sudden onset, stepwise progression Focal neurological signs Headache and seizure onset more common than in AD Treatment: treat underlying CVD, and alzheimer's drugs for cognitive problems

Answer 144

Ie Pick's disease Earlier age of onset (40s-50s) than AD Similar to AD but "frontal" signs are prominent early in the dementia (ie disinhibition and personality change) Frontal lobe atrophy and hypometabolism Histopathological changes (ie pick bodies)

Answer 145

Fluctuating cognition/alertness, visual hallucinations, mild parkinsonism (but usually not tremors) Histo changes: lewy bodies REM sleep behaviour disorder often precedes onset by many years Treatment: hallucinations - have severe neuroleptic sensitivity (EPS, NMS so cant give antipsychotics) , instead treat hallucinations with "benign neglect" Parkinson's drugs are relatively ineffective in LBD and worsen psychosis.

Answer 146

Up to 50% of PD patients develop dementia, similar pathology to LBD 1 year rule: If dementia develops >12 months after well established PD --> PDD If develops first or within first 12 months of motor signs --> LBD.

Answer 147

Dementia progresses rapidly over a few months, with death under a year.

Answer 148

AKA dementia syndrome of depression Depressed elderly patients often show memory and other cognitive disturbances that resemble a dementia. Defferential: This is more pinpointable, shorter, inconsistent impairment, highlight their impairment, they answer with "dont know" instead of confabulation, and they have RETRIEVAL problems versus encoding problems - ie cues given help remember.

Answer 149

Cognitive decline associated with normal ageing - neuropsych testing helps determine whether current cognition reflects a pathological process

Answer 150

1. Delirium - awareness and attention disturbance _+additional cognitive disturbance, sudden onset fluctuates during day, and evidence of direct physio cause 2. Major NCD: "Significant": decline in AT LEAST ONE cognitive domain - interferes with independence in daily activities 3. Mild NCD: "modest" decline in at least one cognitive domain, does NOT interfere with capacity for independence in daily activities

Answer 151

Intellligence: Weschler (verbal comp, perceptual reasoning, hemispheric lateralisation and localisation signs) Attention: visual (cancellation test), verbal (serial addition test) Memory: World lists/paragraphs (left hemi), spatial designs (right hemi). Immediate recal versus delayed recall - rate of forgetting encoded info . Free recall (uncued) versus recognition (cued) - cues determines econdign versus retrieval based. Retrieval based(PFC), encoding based (Mesial temporal) Language: naming and verbal fluency Visuospatiel (right parietal) - copying and drawing tests : executive functions (PFC) - abstraction, and concept formation./mental flexibility , inhibiting responses (strop test) motor functions: dexterity and speed (finger tapping, pegboard test)

Psych pt ii Flashcards

(175 cards)