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Fundamentals II > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

used Axis Classification system

A

DSM IV

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2
Q

uses Primary Diagnosis, Secondary Diagnosis, and Medical Diagnosis as classification system

A

DSM V

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3
Q

Order of Mental Status Exam

A 
General Appearance
Attitude
Behavior 
Speech
Mood
Affect
Though Process
Though Content
Perceptual Abnormalities
Cognitive Functioning
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4
Q

a thought process where patients wander from the original point and never return towards that original point

A

Tangentiality

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5
Q

a thought process of unnecessary digression which eventually reaches the point

A

Circumstantiality

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6
Q

echoing of words and phrases

A

echolalia

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7
Q

mention of new words by the patient

A

Neologisms

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8
Q

speech and sound, such as rhyming and punning rather than logical connections

A

Clanging

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9
Q

repetition of phrases or words in the flow of speech

A

Preservation

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10
Q

a kind of though content where the patient has fixed false beliefs that are firmly held in spite of contradictory evidence

A

Delusions

ex. the government is out to get me, I’m being followed, I’m the president

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11
Q

a perceptual abnormality of full sensory perception (which may be auditory, visual, tactile, gustatory, or olfactory), true hallucinogenic patients seem internally preoccupied

A

Hallucinations

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12
Q

ability of a patient to display an understanding of his current problems and the ability to understand the implications of these problems

A

Insight

example: failed suicide attempt patient tells you that they are being admitted (good insight)

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13
Q

the ability to make sound decisions regarding everyday activities, best judged by evaluating the patients history of decision making, not hypothetical questions

A

Judgement

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14
Q

What are the causes of suicide?

A

Untreated Mental Illness (depression, psychosis, manic)

Substance Abuse/Dependence

Genetics

Acute Stress Reaction

Crying Out for Help

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15
Q

What are the current trends in suicide?

A

overall the rate is decreasing

increasing for people between 10-18

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16
Q

most common reason for committing suicide

A

untreated depression

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17
Q

SAD PERSONS are at risk for suicide…what does that stand for?

A

Sex (male
Age (adolescent or elderly)
Depression

Previous Attempt
Ethanol Abuse
Rational Thinking Loss
Sick
Organized Plan
No Spouse
Social Support Lacking
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18
Q

Protective Factors of Suicide

A 
children
family support
Religion
friends
health
supervised living situation
education
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19
Q

Warning Signs of a Suicidal Patient

A 
appear depressed or sad
talking or writing about death or suicide
withdrawing from family/friends
strong anger/rage
felling like there is no way out
abusing drugs or alcohol in excess
losing interest in activities
change in sleeping habits
change in eating habits
performance at school or work suffers
giving away possessions
writing a will/telling family about important documents
excessive guilt or shame
acting recklessly
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20
Q

What is the test to tell if a person is suicidal/depressed?

A

there is NONE. must rely on interview and clinical judgement

consider MMSE

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21
Q

Active Suicide Attempt

A

ATTEMPTS

taking steps to end someone’s life, writing suicide note, giving meaningful items away, or planning on how to end it all

anything that could potentially harm the patient (getting a rope and making a noose, loading a gun, hoarding meds to overdose, obtaining a weapon to kill oneself)

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22
Q

Passive Suicide Attempt

A

PASSIVE

“I wish I were dead” thoughts secondary to life stressors w/o concrete thoughts or intent

doing something hoping it would kill yourself, not purposely attempting to harm oneself, driving and hoping another person hits you

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23
Q

How to interview a suicidal patient

A

Take a mental snapshot of how they appear

Start with broad open questions

If engaged, then go to questions relating to presentation and more specific quesetions

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24
Q

True/False- If someone says they are suicidal they need to be treated as an inpatient

A

FALSE- you need to assess their lethalilty risk

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25
Q

Good Collateral vs Bad Collateral

A

Police Report vs Family Report (ask them to leave the room)

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26
Q

Suicide Facts

A

People who die via suicide usually talk about it first. They are often in pain and reach out for help because they have lost hope

People who talk about wanting to die by suicide often times kill themselves

Asking people about suicide does not give them the idea for suicide

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27
Q

a state of heightened mental and motor excitation and activity, manifested by destructive attacking behaviors or covert attitudes of hostility and obstruction

A

agitated patients

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28
Q

Who will present as agitated?

A

intoxicated patients
acutely manic or psychotic
under arrest by police
antisocial disorder

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29
Q

Can you conduct an interview on an intoxicated patient?

A

NO, must wait until they are below 0.08 BAC

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30
Q

these kind of patients often try to ask the practitioner questions during the interview, set up the room with an escape route, and you’ll need to use very direct questioning

A

Antisocial Patients

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31
Q

When do you medicate a suicidal patient?

A

when they continue to place staff in harms way

Benzo (Ativan 2mg which is sedating)

Antipsychotics (single dose will not cure psychosis)
commonly Haldol with Ativan or Zypreza if intoxicated)

No Benzo if intoxicated due to fear of respiratory/circulatory depression

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32
Q

4 point restraints

A

> 12 y/o for up to 1 hour

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33
Q

the process whereby an individual develops stable and enduring patterns of thinking, feeling, and behavior

adaptations to both the internal demands of instinctual drives as well as external demands of conformity and socialization

both genetic and environmental components

A

Personality Formation

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34
Q

early, inflexible pattern of disturbance in behaviors, thinking patterns, and inner experience

inflexible = always possess this and don’t change from it regardless of age/scenario, don’t jump to conclusions

heterogeneous group of disorders

divided into A, B, and C

A

Personality Disorders

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35
Q

Adaptive Defense Mechanisms

A

Humor

Altruism

Sublimation

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36
Q

Less Adaptive Defense Mechanisms

A

Suppression

Idealization/Devaluation

Intellectualization

Isolation of Affect

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37
Q

Maladaptive Defense Mechanisms

A

Splitting

Denial

Repression

Projection

Protective Identification

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38
Q

Pervasive Enduring (surfaces in every aspect of life) affects what realms of life the most?

A
  1. ) Cognition
  2. ) Affect Tolerance
  3. ) Impulse Control
  4. ) Interpersonal Relationships (most affected)
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39
Q

the ability to experience emotion and the ensuing comfortability in controlling this emotion

think of this as the action potential of human interactions

A

Affect Tolerance

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40
Q

the ability to resist temptation or urge, has alot to do with affect tolerance, can be linked to aggression

ex: increased spending, sexual promiscuity

A

Impulse Control

41
Q

lack of desire for or fear of interpersonal relationships

chose solitary activities, odd and eccentric, stay in their room

anxious people

A

Cluster A

42
Q

absolute need for and manipulation of interpersonal relationships

depressed and affectively unstable

A

Cluster B

43
Q

absolute need for interpersonal relationships but NO manipulation

driven and high achieving people

anxious

A

Cluster C

44
Q

What are the disorders that are classified as Cluster A?

A

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

45
Q

suspects, without sufficient basis, that others are expoliting, harming, or deceiving them

persistently bears grudges, unforgiving of insults, injuries, or slights

perceives attacks on their reputation that are not apparent to others and is quick to react angrily or to counterattack

recurrent suspicions without justification regarding fidelity of sexual or sexual partner

quick to react with aggression, treat people as angry, sadomasochistic sexually

A

Paranoid Personality Disorder

46
Q

neither desires nor enjoys close relationships, including being part of a family, usually chooses solitary activities

takes pleasure in few, if any activities

lack close friends or confidants other than 1st degree relatives

shows emotional coldness, detachment, or flattened affectivity

A

Schizoid Personality Disorder

47
Q

odd beliefs or magical thinking that influences behavior and is consistent with sub-culture norms

odd thinking and speech

behavior or appearance that is odd, eccentric, or peculiar

excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self

have never been admitted to a psych hospital unlike a schizophrenic patient

A

Schizotypal Personality Disoder

48
Q

What disorders fall under Cluster B?

A

Borderline Personality Disorder

Narcissistic Personality Disorder

Histrionic Personality Disorder

Antisocial Personality Disorder

49
Q

most commonly seen, commonly abused in their youth

frantic effects to avoid real or imagined abandonment

a pattern of unstable and intense personal relationships characterized by alternating extremes of idealization and devaluation

chronic feelings of emptiness

transient stress related paranoid ideation or severe dissociative symptoms

patients present when undergoing a crisis

A

Borderline Personality Disorder

50
Q

What are the Big Signs of a Borderline Person?

A
  1. ) fear of abandonment
  2. ) hot/cold relationships
  3. ) do things for everyone else
  4. ) non-assertive and don’t stand up for themselves
  5. ) want to feel special but then push them away
51
Q

What is the treatment for a patient with Borderline Personality Disorder?

A

Dialectial Behavioral Therapy

52
Q

internal core of shame

has a sense of entitlement

has a grandiose sense of self-importance

believes they are “special” and unique and can only be understood by or should associate with other special or high status people (institutions)

requires excessive admiration

is interpersonally exploitative (takes advantage of others to achieve their goal)

lack empathy

A

Narcissistic Personally Disorder

53
Q

uncomfortable in situations in which they are not the center of attention

displays rapidly shifting shallow expression of emotions

shows a self-dramatization, theatricality, and exaggerated expression of emotions

considers relationships more intimate than they really are

often display inappropriate sexually seductive or provocative behavior

A

Histrionic Personality Disorder

54
Q

failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest

deceitfulness

reckless disregard for safety of self or others

lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

having strong overlap of substance abuse (most of the cluster B’s

evidence of conduct disorder before age 15

A

Antisocial Personality Disorder

55
Q

What is the main stay of therapy for all Cluster B patients?

A

***Cognitive Behavioral Therapylit

psychotherapy

DBT for Borderline Patients

56
Q

lithium and Valproic Acid require a lower/higher dose to treat personality disorder as compared to acute mania

A

lower

57
Q

What disorders are classified as Cluster C?

A

Dependent Personality Disorder

Avoidant Personality Disorder

Obsessive-Compulsive Personality Disorder

58
Q

has difficulty making everyday decisions without an excessive amount of advice and reassurance from others

has difficulty expressing disagreement with others because of feat of loss of support or approval

feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself

A

Dependent Personality Disorder

59
Q

avoids occupational activities that involve significant interpersonal contact, because of fears of criticism disapproval, or rejection

shows restraint within intimate relationships because of being shamed or ridiculed

is usually reluctant to take personal risks or to engage in any new activities because they may prove embarassing

A

Avoidant Personality Disorder

60
Q

is preoccupied with details, rules, lists, orders, organization, or schedules to the extent that the major point of the activity is lost

perfectionsism that interferes with task completion

excessively devoted to work and productivity to the exclusion of leisure activities and friendships

shows rigidity and stubbornness

is over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

likely won’t come in for treatment bc its not a problem for them

A

Obsessive-Compulsive Personality Disorder

61
Q

warning signs of psychosis

A

drop in grades or job performance

trouble thinking clearly or concentrating

suspiciousness or uneasiness when dealing with others

decline in self care of personal hygiene

spending more time than usual in social isolation

strong emotions or no feelings

62
Q

Risk Factors for psychosis

A

equal among race and gender

men usually experience symptoms earlier than females

OVER AGE 55 with psychosis is a brain tumor or infection

63
Q

these symptoms are psychotic behaviors that are not seen in healthy people. people often lose touch with reality. symptoms can come and go. range from severe to hardly noticeable

includes: Hallucinations, Delusions, Though Disorders, and Movement Disorders

A

Positive Sympotms

64
Q

disruptions of normal emotions and behaviors, hard to recognize and may be interpreted as depression

include: flat affect, lack of pleasure of everyday life, lack of ability to begin and sustain planned events, speaking little even when forced

A

Negative Symptoms

65
Q

affect task and function in a community, may be difficult to recognize

include: poor executive functioning, trouble focusing or paying attention, problems with working memory

A

Cognitive Symptoms

66
Q

What are the causes for psychotic disorders/breaks?

A

Genetics

Trauma

Substance

Physical Illness or Injury

67
Q

what are the examples of symptoms that must be demonstrated by a psychotic patient?

either requires 1 or 2 of the following…

CANNOT BE BETTER EXPLAINED BY any other kind of disorder (Major Depressive, Bipolar with Psychotic Features, Schizophrenia, Catatonia, or due to a drug)

A

Delusions

Hallucinations

Disorganized Speech

Grossly disorganized or catatonic behaviors

68
Q

1 or more of the symptoms that last for at least 1 day but less than 1 month

A

Brief Psychotic Disorder

69
Q

2 or more of the symptoms that last for at least 1 month but less than 6 months

A

Schizophreniform Disorder

70
Q

2 or more of the symptoms that are a continuous disturbance for at least 6 months (must include at least 1 month of delusions and may include periods of residual symptoms)

A

Schizophrenia Disorder

71
Q

during a period of residual symptoms, what symptoms are the only kind of symptoms that can be manifested for Schizo patient?

A

Negative Symptoms

72
Q

an uninterrupted period of illness during which there is a major mood episode concurrent w/criteria for schizophrenia

delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the life-time duration of the illness. Psychotic symptoms w/o mood symptoms for at least 2 weeks.

A

Schizoaffective Disorder

73
Q

What are the different classifications of Schizoaffective Disorder?

A

Bipolar Type- if manic episode is part of the presentation

Depressive Type- applies if only major depressive episodes are part of presentation

With catatonia- extremely rare

74
Q

either delusions or hallucinations that occur during or soon after substance intoxication or withdrawal or after exposure to a medication

can’t be exclusively during a period of derilium

usually intense for a day then they resolve quickly

can last for hours to days to weeks to months (can mess with brain chemistry even though its out of your system

A

Substance Induced Psychotic Disorder

75
Q

prominent hallucinations or delusions with evidence of another medical condition

A

Psychotic Disorder Secondary to Medical Condition

76
Q

delusions with a duration of 1 month or longer without the criteria for Schizophrenia ever having been met

functioning is not markedly impaired and behavior is not obviously bizarre or odd

A

Delusional Disorder

77
Q

drug treatment for psychosis that can only treat positive symptoms

A

typical antipsychotics

78
Q

can attack both positive and negative symptoms with less overall SE’s

A

atypical antipsychotics

79
Q

all psychosis patients need to be managed as inpatients

A

FALSE

only when risks to others, can’t function and not support from family

80
Q

the FIRST LINE TREATMENT for psychosis, one of the most effective ways to treat and prevent psychosis, wires on the head and they give you an induced seizure, pregnant women ok for this treatment

part of out patient treatment along with medical management and psychotherapy

A

ECT

81
Q

bizarre delusions

A

impossible to happen

ex. I’m the President

82
Q

nonbizzare delusions

A

unlikely

ex. My children are trying to kill me

83
Q

Mood episodes are NOT diagnostic entities. What are the 4 kinds of mood episodes?

A
  1. ) Major Depressive Disorder
  2. ) Manic Episode
  3. ) Mixed Episode
  4. ) Hypomanic Episode
84
Q

change from previous functioing that occurs over 2 week period, never had a manic or hypomanic episode, cause impairment in social/occupational setting (5 of the following)

decreased interest in activities, change in weight or diet (either way), change in sleep habits, worthlessness, fatigue

feelings of hopelessness and helplessness are common

may appear demented, preoccupation with physical health may occur, FHx of a mood disorder or suicide is common

A

Major Depressive Disorder

85
Q

at least one week (or less if hospitalized) of persistently elevated, expansive or irritable mood

(3 of the following) inflated self-esteem, decreased need for sleep, more talkative than usual, flight of ideas, distractibility, excessive involvement in pleasurable activities

does not meet criteria of a mixed episode

MC presentation is mixed euphoria (some may have irritability alone, poor judgement, reckless behavior with negative consequences, may be assaultive, lability of mood, grandiose delusions

A

Manic Episode

86
Q

at least 4 days of abnormally and persistently elevated, expansive or irritable mood

(at least 3 of the following) inflated self-esteem, decreased need for sleep, flight of ideas

THE CHANGE IN FUNCTIONING IS UNCHARACTERISTIC OF THE PATIENTS BASELINE BUT DOES NOT CAUSE MARKED SOCIAL OR OCCUPATIONAL DYSFUNCTION

DOES NOT REQUIRE HOSPITALIZATION

A

Hypomanic Episode (Mania Light)

87
Q

What are the marked differences between hypomania and manic episodes?

A

lack of social or occupational dysfunction in hypomania

88
Q

patients meet the criteria for mania and depression for at least one week

causes marked impairment in occupational or social functioning, require hospitalization, or psychotic features are present

organic factors have been excluded

patients subjectively experience rapidly shifting moods

A

Mixed Mood Episode

89
Q

diagnostic criteria for Major Depressive Disorder

A

history of one for more major depressive episode

no history of manic, hypomanic, or mixed episodes

90
Q

high mortality rate

often follows episode of severe stress

ask all patients about suicidal ideation (most closely related to the degree of hopelessness)

more females and families

50% of those with 1 episode will have recurrent episodes

chronic MDD is for at least 2 years

A

Major Depressive Disorder

91
Q

depressed mood for most of the day (more days than not) based on subjective account or observation of others that lasts at least 2 years

has never been w/o major symptoms for more than 2 months at a time

A

Dysthymic Disorder

92
Q

what are the symptoms (need at least 2 of the following) to be diagnosed with dysthymic disorder?

A

poor appetite or overeating

insomnia or hypersomnia

low energy or fatigue

low self-esteem

poor concentration/difficulty making decisions

feelings of hopelessness

93
Q

developmental of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor

marked stress that is out of proportion to the severity or intensity of the stressor, significant impairment in social, occupational, or other important areas of functioning

once the stressor/consequences have terminated the symptoms do not persist for more than an additional 6 months

symptoms do not represent normal bereavement (normal is up to 3 months)

A

Adjustment Disorder

94
Q

gold standard for moodstabilization in a bipolar patient

A

Lithium

95
Q

diagnosed based on one or more manic or mixed episodes, can’t be due to a psych disorder

starts as depression for females and mania for males

10-15% suicide rate

episodes more frequently with age

very familial and equal between men and women

A

Bipolar I

96
Q

diagnosed based on one or more major depressive episode and at least one hypomanic episode and mood episode is not secondary to medication or medical problem

hypomania episodes tend to occur in close proximity to depressive episodes

consequences can include job loss and divorce

more common in women

A

Bipolar II

97
Q

function well in the community, at least 2 years of numerous periods of hypomania symptoms that do not meed criteria of a hypomania episode

symptoms not present for at least half the time

A

Cyclthymic Disorder

98
Q

something scary with symptoms that lasts for 3 days to 1 month due to traumatic event, need at least 9 of the symptoms from the categories of:

intrusive symptoms
negative mood
dissociative symptoms
avoidance symptoms
arousal symptoms
A

Acute Stress Disorder

99
Q

same as acute stress disorder symptoms that last for at least one month

most common in soldiers and assault victims

8% prevalence

acute = less than a month
chronic = more than a month

usually medicated with anti-depressants

A

PTSD

Fundamentals II (5 decks)

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