Flashcards in Psychiatry Deck (93):
to seize hold of
deficient, less than, below
external expression of emotion
loss of memory
absence of emotions
uncontrollable urge to perform an act repeatedly
anxiety becomes a bodily symptom that has no physical basis
flight from customary surroundings, dissociative disorder
confused thinking, disorientation, changes in alertness, difficulty paying attention, fearfulness. Usually reversible
fixed false belief that cannot be changed by logical thinking
loss of intellectual abilities w/ impairment of memory, judgement, and reasoning
unstable, undergoing rapid emotional change
overly suspicious thinking w/ fixed delusions of being harrassed, persecuted, or unfairly treated
a disorder marked by loss of contact w/ reality, often associated w/ delusions and hallucinations
Medical doctor, able to prescribe medications. Oversees diagnosis and treatment of psychiatric patients.
Advanced degree but not a medical doctor, often w/ extensive training in research. Treat patients w/ psychotherapy. May aid in evaluation of disorders.
Psychotic disorder characterized by gross distortion of reality, disturbances of language & communication, withdrawal from social interaction, disorganization & fragmentation of thought, perception, and emotional reaction. Prevalence in men=women, mostly from 18-25 yo. 50% mz concordance. Unknown causes, although genetic factors are implicated.
Positive symptoms of Schizophrenia
-Delusion (false beliefs)
-Hallucination (false perception, usually auditory, "voices" commenting on patient's behavior)
-Thought disorder (disorganized thinking manifested in non-goal-directed speech)
-Bizarre behavior (silliness, agitation, inappropriate appearance/conduct, poor hygiene, catatonic behavior, rigid posture)
Negative symptoms of Schizophrenia
-Loose thought associations
-Anhedonia (diminished capacity to experience pleasure)
-Loss of ego boundaries (inability to perceive self as a separate individual)
-Concrete thinking (inability to abstract)
Schizophrenic subtype in which patient is mute & does not move or react to external stimuli
Schizophrenic subtype in which patient exhibits disorganized speech and bizarre behavior
Schizophrenic subtype in which patient exhibits prominent delusions of grandeur or persecution and auditory hallucinations
Treatment of Schizophrenia & its posible side effects
-Antipsychotic medications are the treatment of choice, positive symptoms improve quickly but negative symptoms improve slowly.
-Side effects include sedation, dystonia, tremor, increased prolactin level, weight gain, akathisia (motor restlessness), tardive dyskinesia, neuroleptic malignant syndrome.
Disorders characterized by an unpleasant emotional state. Behavioral & psychological changes often accompany these disorders; fatigue & sleep disturbance are very common. Lack of a daily structure is commonly a contributing factor (ex. Sunday neurosis; inability to cope in an unstructured environment). Cause is generally unknown, although hyperthyroidism, drug usage (corticosteroids, cocaine, amphetamines), and mood disorders such as major depression have been associated.
A short-lived, recurrent, unpredictable, intense anxiety disorder associated w/ psychological manifestations
Fear of open, crowded, or public places. A common panic disorder.
Signs/symptoms of an anxiety disorder (diagnosis based on the presence of at least 3-4 of these for 6 mos or greater)
-Motor tension (shakiness, jumpiness, trembling)
-Inability to relax
-Autonomic hyperactivity (sweating, palpitation, dry mouth, dizziness, hot/cold spells, frequent micturition, diarrhea)
-Apprehensive expectation (worry, anticipation of personal misfortune)
-Vigilance & scanning (distractibility, poor concentration, insomnia, edginess)
Management of Anxiety disorders
-Behavioral therapy (helps provide a more structured environment for mild condition)
-Anxiolytic medications (Benzodiazepines are the drug of choice, sometimes antidepressants as well)
-For panic attacks SSRIs are the initial drug of choice, sublingual doses of lorazepam or alprazolam for urgent treatment
The most common psychiatric disorder
Depressive disorder associated w/ adverse life situation such as death of a loved one or any family/financial crisis
Adjustment disorder w/ a depressed mood
Depressive disorder characterized by at least one episode of serious mood depression occurring at any time of life
Major depressive disorder
Depressive disorder w/ symptoms milder than in major depressive episodes but longer lasting w/ two or more episodes in 1 year
Depressive disorder w/ a combination of depression and hypomania lasting for 2 years, resolving and recurring
Depressive disorder associated w/ some drug; alcohol dependence, reserpine, corticosteroids, oral contraceptives, methyldopa, digitalis, beta blockers, sedatives etc.
Depression secondary to substance abuse
Causes of depressive disorders
-Adverse life changes
-Financial & family crises
-Postpartum, premenstural, postmenopausal in women
Signs/symptoms of Depressive disorders
-Anhedonia (withdrawal from activities, loss of sexual desire)
-Feelings of guilt, worthlessness, melancholia
-Inability to concentrate, cognitive impairment
-Anxiety, fatigue, insomnia or hypersomnia
-Somatic complaints; anorexia, constipation
-Psychotic ideations (paranoid thinking & somatic delusions)
Management of depressive disorders
-Hospitalization for patients w/ suicidal ideation
Disorder characterized by one or more manic episodes alternating w/ depressive episodes
Bipolar I Disorder
Inflated self esteem, feelings of grandiosity, decreased need for sleep, increased energy, racing thoughts, excessive involvement in pleasurable activities that may have negative consequences
Disorder characterized by one or more hypomanic episodes alternating w/ major depressive episodes
Bipolar II Disorder
Hypomania vs Mania
In hypomania; self esteem may be inflated but not as much as mania, mental overactivity but more organized thoughts than mania (thoughts are quick, creative & productive as opposed to aimless overactivity). Speech can be loud & rapid but easier to interrupt than manic speech. Psychosocial functioning may be improved or just mildly impaired. Risk taking behavior is mild to moderate as opposed to severe.
A group of disorders that manifest as maladaptive, rigid, and damaging to personal work and interpersonal relationships. May occur as a response to stress or as a way of dealing w/ other people.
Cluster A Personality disorders
A person who is functioning but shy, introverted, socially isolated, lonely, emotionally cold, afraid of closeness & intimacy, oversensitive & a daydreamer.
A person who is socially isolated, emotionally detached, has ideas of reference or paranoid ideation, claims to use magical thinking, clairvoyance, and telepathy.
An extremely suspicious and distrustful person who blames others for his/her mistakes and goes to great lengths to find hostility, prejudice, and malevolence in other people's innocent actions
Cluster B Personality Disorders
The most common of personality disorders, which affects mostly women who are unstable in their self-image, interpersonal relationships and mood. The person feels empty, angry, and entitled to seek care
Previously called psychopathic or sociopathic. The person disregards the feelings and rights of others and exploits others for materialistic gain.
A self-centered, self-absorbed individual w/ grandiose ideation, who constantly needs admiration and is sensitive to criticism, failure, or defeat
A very dramatic attention seeker, with exaggerated emotions and childish, superficial behavior usually evoking sympathetic or erotic attention in others
Cluster C Personality Disorders
An insecure person who lacks self-confidence, is unable to make decisions, and depends on others
A person hypersensitive to rejection, who suffers from social phobias; unlike a schizoid person they are openly distressed by isolation.
A perfectionist who is self-centered, rigid in thought patterns, and needs to control things. These feelings considerably affect his or her occupational, social, or interpersonal functioning.
A refusal to eat adequately resulting from a distorted body image. May produce profound weight loss, amenorrhea, and emotional disturbances. They're intensely fearful of becoming obese. Occurs primarily in adolescents, mostly in girls of middle & upper socioeconomic levels.
Causes of Anorexia Nervosa
-Unknown (generally psychiatric origin)
-Achievement oriented family members w/ high goals
-Destructive interpersonal relationships
-Excessive family concerns in dietary matters
Signs/symptoms of Anorexia nervosa
-Increased lanugo body hair
Diagnosis of Anorexia nervosa
-History & physical exam
-Decreased luteinizing hormone & follicle stimulating hormone
-Increased levels of blood urea nitrogen & serum creatinine
Management of Anorexia nervosa
-Structural behavioral therapy
-Parenteral feeding may be necessary
Recurrent episodes of binge eating resulting from a loss of control over eating; patient then engages in self-induced vomiting, use of laxatives and/or diuretics, fasting and excessive exercise.
Causes of bulimia nervosa
-Psychosocia, possibly stress related
Signs/symptoms of bulimia nervosa
-Fluctuating body weight
-Excessive use of diuretics & cathartics
-Strict dieting and/or vigorous exercise
-Impulsive antisocial behavior
-Infection of the pharynx/esophagus
Diagnosis of bulimia nervosa
-Two uncontrolled episodes of binge eating in 1 week for at least 3 months
-Pt's marked concern about weight gain
-Wide fluctuation of body weight
-Excessive use of laxative
-Swollen parotid gland
-Scars on knuckle of the hand
Management of bulimia nervosa
-Psychotherapy (individual, group, family)
-Worse prognosis when bulimia is associated w/ anorexia nervosa
Acute onset fluctuating course of altered state of awareness and consciousness. May be accompanied by hallucinations, illusions, delusions, emotional lability, paranoia, alteration in sleep cycle, psychomotor changes. May be reversible if treating the underlying condition. May be related to external toxin, medications, metabolic abnormality, CNS abnormality, change in pt's usual routine. High risk groups include elderly pt's w/ medical illnesses, post CABG, pt's w/ brain damage, burn patients, HIV patients. Commonly >65yo.
Acquired, persistent impairment in mental function involving at least three of the folowing; memory, language, visuospatial skills, personality or mood, and cognition.
Dementia vs. Delirium
Delirium has acute onset, dementia is hard to tell exactly when it occurred, slow downhill course. Primary distinguishing feature is the retention and stability of alertness in demented patient.
The most common cortical dementia, can affect 20% of pts >80 yo.
Dementia w/ gait disturbances; post-stroke, normal pressure hydrocephalus, Huntington's & parkinson's diseases.
Dementia seen in pt's w/ HIV, MS, ALS, B12 deficiency, hypothyroidism, Wilson's disease
Group of disorders including fugue, amnesia, somnambulism, multiple personality etc. The reaction is precipitated by emotional crisis; symptoms produce anxiety reduction and temporary solution of the crisis. Mechanisms include repression and isolation. Condition similar to symptoms seen in temporal lobe dysfunction.
Sudden, unexpected travel away from one's home w/ inability to recall one's past.
Disorders in which the physical symptoms suggest a medical condition, yet the symptoms are also not fully explained by a medical condition, substance abuse, or by another mental disorder. Symptoms are severe enough to cause significant distress or impaired social, occupational, or other functioning. Symptoms are NOT intentionally produced (vs factitious disorders or malingering).
Disorder characterized by many somatic symptoms that cannot be explained adequately on the basis of physical and lab findings. Usually begins before age 30. Distinguished by a combination of chronic symptoms; pain, GI, sexual, and pseudoneurological. Associated w/ significant psychological distress, impairment in social and occupational functioning. Excessive medical help-seeking behavior. Early name was "hysteria' condition, incorrectly thought to affect only women.
Somatization disorders (Briquet's Syndrome)
Somatization disorder vs. Somatoform disorder
Somatization disorders have a multiplicity of complaints & multiple organ systems affected.
Disorder characterized by the presence of one or more neurological symptoms that cannot be explained by a known neurological or medical disorder. Requires that psychological factors be associated w/ the initiation or exacerbation of the symptoms.