Psychiatry MNTH Flashcards

Question

Experiments of Harry Harlow?

Answer 1

Monkeys deprived of contact w/ mothers. They chose cloth over food.

Answer 2

Strange Situation Test 1. Anxious-Avoidant Insecure Attachment: Avoids or ignores caregiver, won’t explore 2. Secure Attachment: Explores w/ caregiver, upset when they leave 3. Anxious Resistant Insecure Attachment: Distress even before separation and hard to comfort on return

Answer 3

Imprinting

Answer 4

Maternal Deprivation Theory: No mother causes trouble | Built off Lorenz

Answer 5

Hope, Basic Trust vs Basic Mistrust 0-18 months Will, Autonomy vs Shame 1-3 years Purpose Initiative vs guilt 3-5 years Competence, Industry vs Inferiority 6-11 years Fidelity, Identity vs Role Confusion 12-18 years Love, Intimacy vs Isolation 18-40 years Care, Generativity vs Stagnation: 40-65 years Wisdom, Ego Integrity vs Despair: 65+

Answer 6

Sensorimotor 18-24 months - Object permanence Preoperational 24 months to 7 years - Symbolic thinking Concrete operational: 7-11 years - Acquisition of Conservation Hallmark Formal Operational Adolescence to Adulthood -Abstract thinking, creativity, Third eye question

Answer 7

Sigmund Freud ``` Oral 0-2 Anal 2-3 Phallic 3-7 Latency 7-11 Sexual 11+ ``` Trauma can cause fixation or regression on or to different stages.

Answer 8

Neurotic Anxiety: Worry we loose control of the Id (our compulsions) Reality Anxiety: Fear of real world events (dog bite) Moral Anxiety: Fear of violating our own moral principles

Answer 9

Abrupt onset of intense fear or discomfort that peaks in minutes with at least 4 of the following: ``` Palpitations Sweating Short of breath Chest pain Dizziness Paresthesias Fear of loss of control Shaking Sensations of choking Nausea Chills Fear of dying ```

Answer 10

``` Fear of needles Fear of pain Fear of public speaking Fear of snakes Fear of hospitals Fear of spiders Fear of clowns Fear of doctors ```

Answer 11

42 billion

Answer 12

Marked anxiety about humiliating or emabarrassing yourself in social situations for at least 6 months. Symptoms are out of proportion to the threat

Answer 13

Perisitent unreasonable excessive fear cause by the presence or anticipation of a specific object or situation Can cause panic attacks The object or situation is generally avoided May become GAD

Answer 14

Intense anxiety to or in anticipation of entering two or more situations where the person feels stuck, unable to escape, or not able to get help ``` Public transport Open areas Closed areas Lines or crowds Alone outside the house ``` For at least 6 months, fear out of proportion

Answer 15

Recurrent unexpected panic attacks followed by one or both of the following for 1 month: Persistent concern of having more panic attacks Maladaptive change in behavior in response to the panic attacks Divorce/separation

Answer 16

Excessive anxiety and worry about a number of activities or events in multiple contexts on a near daily basis for 6 months with three of the following: ``` Restlessness Fatigue Poor concentration Muscle tension Irritability Sleep disturbance ```

Answer 17

Trusting relationship Cognitive behavioral therapy Exercise SSRIs/Benzodiazepines - Low dosage, slow titration

Answer 18

``` CAD, CHF, Arrhythmia, PE Asthma, pneumonia Thyroid dysfunction, Menopause, Cushing disease, Anemia Seizure disorder Substance Abuse ```

Answer 19

Indications: Rapid symptom control Lack of effect of multiple antidepressants Infrequent symptoms ``` Contraindications/Risks: Chronic opiate therapy Subastance abuse disorder Memory impairment Elderly ```

Answer 20

``` Exposure to actual physical or sexual trauma With one from each group 1. Negative alterations in mood 2. Hyperarousal: Hypervigilence 3. Avoidance 4. Intrusion symptoms: Nightmares ``` All more than 1 month duration with impaired function

Answer 21

Psychotherapy, Exposure Therapy SSRI, SNRI, Prazosin, Clonidine, Quetiapine, TCA Not Benzos

Answer 22

Criteria are the same as PTSD but apply only if 3-30 days have elapsed.

Answer 23

Emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressors. Distress out of proportion with significant impairment. Once the stressor is gone, the symptoms leave within 6 months. No anhedonia, they still enjoy the things they love unlike MDD

Answer 24

Psychotherapy No Medications

Answer 25

Obesissions - Persistent thoughts or urges that are unwanted and cause anxiety - Individual attempts to ignore or suppress the thoughts by doing something Conpulsions - Repetitive Behaviors - Behavior or mental acts are aimed at preventing or reducing anxiety. Must take more than 1 hour a day and cause significant distress or impairment

Answer 26

Exposure and Response Therapy SSRI/SNRI Fluoxetine, Fluvoxamine Atypical antipsychotics, TCA, Benzos

Answer 27

Orbitofrontal Cortex problems

Answer 28

Pervasive pattern of preoccupation with orderliness, perfectionism, mental control, at the expense of flexibility, openness, and efficiency. - Preoccupied with details - Excessive devotion to work - Overconscientious - Unable to get rid of worn out things - Reluctant to delegate - Adopts frugalness, money only for future catastrophe - Stubbornness

Answer 29

A. Paranoid, Schizoid, Schizotypd B. Antisocial, Narcissistic, Histrionic, Borderline C. Dependent, Avoidant, Obsessive-compulsive

Answer 30

Humorless manner Distrust: Everyone is out to get you Affect is restricted and they appear to be unemotional

Answer 31

Cold and Aloof Use the defense of fantasy They appear normal, speech is goal oriented, but they may answer questions in short sentences Make up that they know people well that they haven’t seen in a long time

Answer 32

Distorted thinking Linked with SCZ Speech is distinctive or peculiar. They may claim to have special powers. Use the defense of fantasy

Answer 33

Composed, but have tension, irritability and rage Complete absence of delusions or other signs of irrational thinking, “normal” Don’t tell the truth and can’t be trusted Show no remorse for behavior

Answer 34

Grandiose sense of self-importance Can’t show empathy May feign sympathy to get what they want

Answer 35

Attention Seeking Uses defenses of repression and dissociation Seductive Behavior May through tantrums, or accuse people when they aren’t the center of attention

Answer 36

Suicidal and Self Mutilitation Chaotic sexual behavior, pansexuality Outbursts of anger or violence Intense and unstable relationships Neuroses of anxiety, depression, depersonalization Most challenging for physicians

Answer 37

Hypersensitivity to rejection Socially inhibited Shows lack of self confidence Not willing to enter relationships

Answer 38

Can’t be alone Avoids responsibility May stay in harmful relationships due to fear of void and loss of someone to take care of them

Answer 39

Preoccupied with rules, neatness, and perfection Have stiff, formal demeanor that is constricted Things that break their routine will cause anxiety

Answer 40

DIALECTICAL BEHAVIOR THERAPY, TRANSFERENCE-Based psychodynamic psychotherapy

Answer 41

E=MC3 Empathy, can’t cure but can Manage, Comorbidities, Countertransference, Consistent

Answer 42

One or more somatic symptoms that are distressing or result in significant disruption of daily life for greater than 6 months. With one of the following: -persistent thoughts about the seriousness of symptoms -Persistent high level of anxiety about health or symptoms -Excessive time and energy devoted to the symptoms Pain is the predominant somatic symptoms Tx: CBT, regular visits

Answer 43

Preoccupation with having or acquiring a serious illness ***Somatic symptoms not present or are only mild. High level of anxiety about their health At least 6 months of symptoms that are better explained by any other mental disorder.

Answer 44

One or more symptoms of altered voluntary motor or sensory function: Usually after Trauma (Abuse)***** The symptoms cause clinically significant distress (Visceral or motor symptoms, sensory deficits)

Answer 45

Imposed on self Falsification of physical or psych signs or symptoms. The deceptive behavior is evident even in the absence of obvious external rewards Not better explained by delusional disorder or psychotic disorder ***Gain comes from going to the Dr****

Answer 46

Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. Multiple personalities Recurrent gaps in the recall of everyday events or personal info Symptoms cause clinically significant distress Not a normal part of accepted cultural or religious practice Not from substance abuse Tx: Psychotherapy

Answer 47

Inability to recall important info, usually of a traumatic or stressful nature Significant distress No substance abuse Not from any other dissociative identity disorder, PTST, or ASD. Specified with Dissociative fugue: travel or bewildered wandering. Tx: CBT, hypnosis, group therapy

Answer 48

Presence of persistent or recurrent experiences of depersonalization, derealization, or both. Reality testing remains intact Clinically significant distress Not from substance abuse or another mental disorder Tx: SSRIs Psychotherapy

Answer 49

Detached from body as an outside observer with respect to thoughts feelings, or body Things around you don’t seem real (feature of PTSD)

Answer 50

Restriction of energy intake Intense fear of gaining weight Disturbance in the way in which one’s body weight or shape is experienced ***Underweight. Lower than 18.5 BMI Hospitalization, Weight Restoration, Psychotherapy (family)

Answer 51

Seen in AN Hypophosphatemia**** ``` Hypocalcemia CHF Peripheral Edema Rhabdomyolysis Seizures ```

Answer 52

Binge eating (lots within 2 hours, lack of control) Recurrent inappropriate compensatory behaviors for weight (vomiting, exercise, laxatives) Once a week for at least 3 months Self-evaluation is unduly influenced by body shape and weight Not low body weight***** Over 18.5 Tx: CBI, SSRIs

Answer 53

Parotid Swelling Dental erosion Hypokalemic, hypochloremic metabolic acidosis

Answer 54

Episodes of binge eating (lots in 2 hrs, loss of control) Eating until you are uncomfortably full, once a week for 3 months Marked distress from the eating NO compensatory mechanisms (vomiting, laxative, enema) Tx: CBT, SSRIs

Answer 55

Eating or feeding disturbance with one or more: Significant weight loss <18.5 BMI Significant nutritional deficiency Dependence on enteral feeding or supplements No cognitive distortions of body weight. Just doesn’t want to eat Not explained by lack of available food or cultural practice Not from another medical condition or mental disorder

Answer 56

Screening for eating disorders ``` S: Sick because your full? C: Control of how much you eat? O: One stone weight loss (14 lbs) F: Fat belief when others say you are too thin? F: Food dominates your life? ```

Answer 57

Acute confusional state: impairment of memory, orientation, language, perception A. Disturbance in attention B. Develops over a short period of time that tends to fluctuate in severity during the course of a day C. Additional disturbance in cognition (memory, disorientation, language) D. A and C not better explained by preexisiting established neurocognitive disorder E. Disturbance is a direct physiological consequence of another medical condition (meds)

Answer 58

Substance intoxication or withdrawal Medication-induced Another medical cause Multiple etiologies Hypoactive, hyperactive, mixed

Answer 59

Check serial 7’s, spell world backwards, ask about visual hallucinations (bugs), and the year that they are in

Answer 60

``` Age of 65 Male Dementia Depression Immobility Functional dependence Dehydration ```

Answer 61

``` Opioids Benzos Anticholinergics Antifungals Dopamine agonists ```

Answer 62

Only as a last resort. It should be explained to the patient. You can also use 1:1 patient monitoring

Answer 63

ETOH or Benzo withdrawal: Benzos or barbiturates Anything else: Haldo (monster QTc, check K+ and Mg+)

Answer 64

``` Modifiable: Major depressive episode, with prominent anxiety symptoms Alcohol abuse Hopelessness Suicidal ideation and plan Access to lethal means ``` ``` Nonmodifiable: Past suicide attempt Male Age over 65 Caucasian or Native American Divorced, widowed Unemployment Childhood sexual and physical abuse Alcohol dependence when facing losses Chronic neurologic illness Family history of suicide ```

Answer 65

``` Strong religious beliefs against suicide Strong social network Responsibility for children Hope for the future Good therapeutic alliance Positive affect ```

Answer 66

Passive: Morbid thinking Active: “I want to jump in front of a bus)

Answer 67

Low: + SI but no plan or no intention Medium: +SI and +plan but no intention; or +SI and + intention but no plan High: +SI, +plan, and +intention to kill him/herself

Answer 68

``` Suicide Homicide/violence Medication side effects: Serotonin syndrome, NMS Malignant Catatonia Overdoses/Toxidromes Delirium Tremens ```

Answer 69

ED 50% of health care providers experience violence in their careers

Answer 70

Broset Violence Checklist

Answer 71

Take and empathetic and non-judge mental stance Allow for personal space Don’t overreact Pick your battles Set limits Validate or at least acknowledge the patient’s feelings Offer oral medications (lorazepam, olanzapine) Tell the pt why your are putting them in restraints, and how they can get out? Then administer medications to reduce agitation: Haldol, lorazepam, diphenhydramine

Answer 72

Substance use doubles the risk Mental illness itself doesn’t increase the risk.

Answer 73

``` Red as a beet- cutaneous vasodilation Dry as a bone- anhydrosis Hot as a hare- hyperthermia Blind as a bat- blurry vision Mad as a hatter- hyperactive delirium Full as a flask- urinary retention ``` Tx: Physostigmine

Answer 74

SS vs NMS ``` Abrupt vs Gradual onset Rapid vs Prolonged course Myoclonus and tremor vs Diffuse Rigidity Increased vs Decreased Reflexes Mydriasis vs Normal ```

Answer 75

Catatonia that is hard to distinguish from NMS Management is the same as NMS Those with catatonia shouldn’t be given antipsychotics

Answer 76

Alcohol Withdrawal Syndrome Mortality for DTs is up to 20% without Tx Tx: Supportive interventions Fluids and electrolyte depletion Benzos or phenobarb

Answer 77

PCP BH care manager Psychiatrist Patient

Answer 78

Engaging w/ POARS Focusing Evoking Planning

Answer 79

Part of the engaging of motivational interviewing ``` P: Permission to talk O: Open-ended questions A: Affirm with positive comment R: Reflect and restate what pt. Says S: Summarize ```

Answer 80

Find the Factual Premise (saying they feel fine with high BP) Find the Motivational Premise (My life is hectic) Those are the points that the patient has to work through

Answer 81

Try to help the patient use elicit change talk ``` DARN mnemonic D: Desire A: Ability R: Reasons N: Needs ```

Answer 82

Mobilizing change talk Commitment Activation Taking Steps CATS ``` Use smart goals Specific Measurable Attainable Relevant Timely ```

Answer 83

Evidence of significant cognitive decline in one or more: - Learning and memory - Language - Executive Function - Complex Attention - Perceptual-motor - Social cognition For Major they must interfere with independence in everyday activities. Minor isn’t bad enough to interfere with those activities (paying bills, managing Meds) Not delirium Not MDD

Answer 84

``` Alzheimer’s dementia Dementia with Levy Bodies Frontotemporal dementia Vascular dementia CJD ``` Alzheimer’s and Vascular

Answer 85

``` CBC CMP TSH Head CT HIV, RPR B12/Folate, +/- Vitamin D LFTs for hepatic dysfunction ```

Answer 86

Rapid Forgetting Declarative episodic memory Loss in the hippocampus and medial temporal lobes B amyloid and tau protein deposits Tx: NO real medications to stop dementia or AD Can use SSRI for depression and Trazodone for sleep. NO antipsychotics Control risk factors (vascular), Acetylcholinesterase inhibitors (early AD) -Donepezil, Galantamine, Rivastigmine Memantine (as augmentation for severe AD) +/- Vitamine E supplementation

Answer 87

Apathy and loss of empathy, Hyperorality, Compulsive behaviors, visual hallucinations, REM sleep behavior disorder Pick Cells Loss of frontal and temporal regions Loss of driving Tx: Speech therapy, No Meds

Answer 88

Second most common dementia Age, HTN, DM, Hyperlipidemia, CAD, Smoking Treat symptoms and lower Vascular problems

Answer 89

``` Low energy Sleep disruption (AM awakening) Decreased appetite Weight loss Somatic complaints/hypochondriasis ```

Answer 90

Dementia syndrome of depression “May answer many questions with “I don’t know” Occurs in 15% of older patients with depression

Answer 91

Psychotherapy Use the Beers list! SSRIs but be alert for hyponatremia. Meds are good Start low, go slow, but go! ECT is a good option if 1st or 2nd line treatments fail.

Psychiatry MNTH Flashcards

(118 cards)