Infant deprivation effects Long-term deprivation of affection results in: Deprivation for \> 6 months Severe deprivation

Long-term deprivation of affection results in: Decreased muscle tone Poor language skills Poor socialization skills Lack of basic trust Anaclitic depression (infant withdrawn / unresponsive) Weight loss Physical illness The _4_ _W_’s: _W_eak _W_ordless _W_anting (socially) _W_ary Deprivation for \> 6 months Can lead to irreversible changes. Severe deprivation Can result in infant death.

Child abuse For each Evidence Abuser Epidemiology Physical abuse Sexual abuse

Physical abuse _Evidence_: Healed fractures on x-ray (e.g., spiral fractures are highly suggestive of abuse), burns (e.g., cigarette, scalding), subdural hematomas, pattern marks/bruising (e.g., belts, electrical cords), rib fractures, retinal hemorrhage or detachment _Abuser_: Usually biological mother _Epidemiology_: ~3000 deaths/yr in U.S., 80% \< 3 yr old Sexual abuse _Evidence_: Genital, anal, or oral trauma; STDs; UTIs _Abuser_: Known to victim, usually male _Epidemiology_: Peak incidence 9–12 years old

Child neglect Definition Evidence

Definition Failure to provide a child with adequate food, shelter, supervision, education, and/or affection. Most common form of child maltreatment. As with child abuse, child neglect must be reported to local child protective services. Evidence Poor hygiene, malnutrition, withdrawal, impaired social/emotional development, failure to thrive.

Attention-deficit hyperactivity disorder Definition Findings Treatment

Definition Childhood and early-onset disorder Onset before age 12. Limited attention span and poor impulse control. Normal intelligence, but commonly coexists with difficulties in school. Continues into adulthood in as many as 50% of individuals. Findings Characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.) Associated with decreased frontal lobe volume/metabolism. Treatment Methylphenidate, amphetamines, atomoxetine, behavioral interventions (reinforcement, reward).

Childhood and early-onset disorder Repetitive and pervasive behavior violating the basic rights of others (e.g., physical aggression, destruction of property, theft). After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder.

Tourette syndrome Definition Findings Treatment

Definition Childhood and early-onset disorder Onset before age 18. Lifetime prevalence of 0.1–1.0% in the general population Associated with OCD and ADHD Findings Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for \> 1 year. Coprolalia (involuntary obscene speech) found in only 10–20% of patients. Treatment Antipsychotics and behavioral therapy.

Separation anxiety disorder Definition Treatment

Definition Childhood and early-onset disorder Common onset at 7–9 years. Overwhelming fear of separation from home or loss of attachment figure. May lead to factitious physical complaints to avoid going to or staying at school. Treatment SSRIs and relaxation techniques/behavioral interventions.

Pervasive developmental disorders Definition Examples

Definition Characterized by difficulties with language and failure to acquire or early loss of social skills. Examples Autism spectrum disorder Rett disorder

Autism spectrum disorder Definition Findings

Definition Pervasive developmental disorder Must present in early childhood More common in boys Findings Characterized by poor social interactions, communication deficits, repetitive/ritualized behaviors, and restricted interests. May or may not be accompanied by intellectual disability Rarely accompanied by unusual abilities (savants).

Rett disorder Definition Findings

Definition Pervasive developmental disorder X-linked disorder seen almost exclusively in girls (affected males die in utero or shortly after birth). Findings Symptoms usually become apparent around ages 1–4, including regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing.

Neurotransmitter changes with these diseases Alzheimer disease Anxiety Depression Huntington disease Parkinson disease Schizophrenia

Alzheimer disease Decreased ACh Anxiety Increased norepinephrine Decreased GABA Decreased 5-HT Depression Decreased norepinephrine Decreased 5-HT Decreased dopamine Huntington disease Decreased GABA Decreased ACh Increased dopamine Parkinson disease Decreased dopamine Increased 5-HT Increased ACh Schizophrenia Increased dopamine

Orientation Definition Common causes of loss of orientation Order of loss

Definition Patient’s ability to know who he or she is, where he or she is, and the date and time. Often abbreviated in the medical chart as “alert and oriented × 3” (AO×3) Common causes of loss of orientation Alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, infection, nutritional deficiencies. Order of loss 1st—time 2nd—place Last— person

Amnesias Retrograde amnesia Anterograde amnesia Korsakoff amnesia Dissociative amnesia

Retrograde amnesia Inability to remember things that occurred before a CNS insult. Anterograde amnesia Inability to remember things that occurred after a CNS insult (no new memory). Korsakoff amnesia Classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies. May also include some retrograde amnesia. Seen in alcoholics, and associated with confabulations. Dissociative amnesia Inability to recall important personal information, usually subsequent to severe trauma or stress. May be accompanied by dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances).

Significant change in cognition (memory, attention, language, judgment) from previous level of functioning. Associated with abnormalities in CNS, a general medical condition, medications, or substance use. Includes delirium and dementia.

Psychiatry - Pathology (1) Flashcards by Heather Acuff

Infant deprivation effects

Long-term deprivation of affection results in:
Deprivation for > 6 months
Severe deprivation

Long-term deprivation of affection results in:
- Decreased muscle tone
- Poor language skills
- Poor socialization skills
- Lack of basic trust
- Anaclitic depression (infant withdrawn / unresponsive)
- Weight loss
- Physical illness
The 4 W’s:
- Weak
- Wordless
- Wanting (socially)
- Wary
Deprivation for > 6 months
- Can lead to irreversible changes.
Severe deprivation
- Can result in infant death.

How well did you know this?

Not at all

Perfectly

Child abuse

For each
- Evidence
- Abuser
- Epidemiology
Physical abuse
Sexual abuse

Physical abuse
- Evidence: Healed fractures on x-ray (e.g., spiral fractures are highly suggestive of abuse), burns (e.g., cigarette, scalding), subdural hematomas, pattern marks/bruising (e.g., belts, electrical cords), rib fractures, retinal hemorrhage or detachment
- Abuser: Usually biological mother
- Epidemiology: ~3000 deaths/yr in U.S., 80% < 3 yr old
Sexual abuse
- Evidence: Genital, anal, or oral trauma; STDs; UTIs
- Abuser: Known to victim, usually male
- Epidemiology: Peak incidence 9–12 years old

How well did you know this?

Not at all

Perfectly

Child neglect

Definition
Evidence

Definition
- Failure to provide a child with adequate food, shelter, supervision, education, and/or affection.
- Most common form of child maltreatment.
- As with child abuse, child neglect must be reported to local child protective services.
Evidence
- Poor hygiene, malnutrition, withdrawal, impaired social/emotional development, failure to thrive.

How well did you know this?

Not at all

Perfectly

Attention-deficit hyperactivity disorder

Definition
Findings
Treatment

Definition
- Childhood and early-onset disorder
- Onset before age 12.
- Limited attention span and poor impulse control.
- Normal intelligence, but commonly coexists with difficulties in school.
- Continues into adulthood in as many as 50% of individuals.
Findings
- Characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.)
- Associated with decreased frontal lobe volume/metabolism.
Treatment
- Methylphenidate, amphetamines, atomoxetine, behavioral interventions (reinforcement, reward).

How well did you know this?

Not at all

Perfectly

Conduct disorder

Childhood and early-onset disorder
Repetitive and pervasive behavior violating the basic rights of others (e.g., physical aggression, destruction of property, theft).
After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder.

How well did you know this?

Not at all

Perfectly

Oppositional defiant disorder

Childhood and early-onset disorder
Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms.

How well did you know this?

Not at all

Perfectly

Tourette syndrome

Definition
Findings
Treatment

Definition
- Childhood and early-onset disorder
- Onset before age 18.
- Lifetime prevalence of 0.1–1.0% in the general population
- Associated with OCD and ADHD
Findings
- Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for > 1 year.
- Coprolalia (involuntary obscene speech) found in only 10–20% of patients.
Treatment
- Antipsychotics and behavioral therapy.

How well did you know this?

Not at all

Perfectly

Separation anxiety disorder

Definition
Treatment

Definition
- Childhood and early-onset disorder
- Common onset at 7–9 years.
- Overwhelming fear of separation from home or loss of attachment figure.
- May lead to factitious physical complaints to avoid going to or staying at school.
Treatment
- SSRIs and relaxation techniques/behavioral interventions.

How well did you know this?

Not at all

Perfectly

Pervasive developmental disorders

Definition
Examples

Definition
- Characterized by difficulties with language and failure to acquire or early loss of social skills.
Examples
- Autism spectrum disorder
- Rett disorder

How well did you know this?

Not at all

Perfectly

Autism spectrum disorder

Definition
Findings

Definition
- Pervasive developmental disorder
- Must present in early childhood
- More common in boys
Findings
- Characterized by poor social interactions, communication deficits, repetitive/ritualized behaviors, and restricted interests.
- May or may not be accompanied by intellectual disability
- Rarely accompanied by unusual abilities (savants).

How well did you know this?

Not at all

Perfectly

Rett disorder

Definition
Findings

Definition
- Pervasive developmental disorder
- X-linked disorder seen almost exclusively in girls (affected males die in utero or shortly after birth).
Findings
- Symptoms usually become apparent around ages 1–4, including regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing.

How well did you know this?

Not at all

Perfectly

Neurotransmitter changes with these diseases

Alzheimer disease
Anxiety
Depression
Huntington disease
Parkinson disease
Schizophrenia

Alzheimer disease
- Decreased ACh
Anxiety
- Increased norepinephrine
- Decreased GABA
- Decreased 5-HT
Depression
- Decreased norepinephrine
- Decreased 5-HT
- Decreased dopamine
Huntington disease
- Decreased GABA
- Decreased ACh
- Increased dopamine
Parkinson disease
- Decreased dopamine
- Increased 5-HT
- Increased ACh
Schizophrenia
- Increased dopamine

How well did you know this?

Not at all

Perfectly

Orientation

Definition
Common causes of loss of orientation
Order of loss

Definition
- Patient’s ability to know who he or she is, where he or she is, and the date and time.
- Often abbreviated in the medical chart as “alert and oriented × 3” (AO×3)
Common causes of loss of orientation
- Alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, infection, nutritional deficiencies.
Order of loss
- 1st—time
- 2nd—place
- Last— person

How well did you know this?

Not at all

Perfectly

Amnesias

Retrograde amnesia
Anterograde amnesia
Korsakoff amnesia
Dissociative amnesia

Retrograde amnesia
- Inability to remember things that occurred before a CNS insult.
Anterograde amnesia
- Inability to remember things that occurred after a CNS insult (no new memory).
Korsakoff amnesia
- Classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies.
- May also include some retrograde amnesia.
- Seen in alcoholics, and associated with confabulations.
Dissociative amnesia
- Inability to recall important personal information, usually subsequent to severe trauma or stress.
- May be accompanied by dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances).

How well did you know this?

Not at all

Perfectly

Cognitive disorder

Significant change in cognition (memory, attention, language, judgment) from previous level of functioning.
Associated with abnormalities in CNS, a general medical condition, medications, or substance use.
Includes delirium and dementia.

How well did you know this?

Not at all

Perfectly

Delirium

Definition
Findings
Treatment

Study These Flashcards

Definition
- “Waxing and waning” level of consciousness with acute onset
  - Delirium** = changes in sensorium.**
- Usually 2° to other illness (e.g., CNS disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention)
- Most common presentation of altered mental status in inpatient setting
- Check for drugs with anticholinergic effects.
- Often reversible.
Findings
- Rapid decrease in attention span and level of arousal
- Characterized by disorganized thinking, hallucinations (often visual), illusions, misperceptions, disturbance in sleepwake cycle, cognitive dysfunction.
- Abnormal EEG.
Treatment
- Identify and address underlying cause.
- Optimize brain condition (O2, hydration, pain, etc.).
- Antipsychotics (mainly haloperidol).
- T-A-DA approach (Tolerate, Anticipate, Don’t Agitate) helpful for management.

Dementia

Definition
Findings
Irreversible causes
Reversible causes

Study These Flashcards

Definition
- Gradual decrease in intellectual ability or “cognition” without affecting level of consciousness.
- A patient with dementia can develop delirium (e.g., patient with Alzheimer disease who develops pneumonia is at increased risk for delirium)
- Increased incidence with age.
- Usually irreversible.
- In elderly patients, depression may present like dementia (pseudodementia).
Findings
- Characterized by memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgment.
  - “Dememtia” is characterized by memory loss.
- EEG usually normal.
Irreversible causes
- Alzheimer disease, Lewy body dementia, Huntington disease, Pick disease, cerebral infarcts, Creutzfeldt-Jakob disease, chronic substance abuse (due to neurotoxicity of drugs).
Reversible causes
- NPH, vitamin B12 deficiency, hypothyroidism, neurosyphilis, HIV (partially).

Psychosis

Definition
Hallucinations
Delusions
Disorganized speech

Study These Flashcards

Definition
- A distorted perception of reality (psychosis) characterized by delusions, hallucinations, and/or disorganized thinking.
- Psychosis can occur in patients with medical illness, psychiatric illness, or both.
Hallucinations
- Perceptions in the absence of external stimuli
- e.g., seeing a light that is not actually present
Delusions
- Unique, false beliefs about oneself or others that persist despite the facts
- e.g., thinking aliens are communicating with you
Disorganized speech
- Words and ideas are strung together based on sounds, puns, or “loose associations.”

Hallucination types

Visual
Auditory
Olfactory
Gustatory
Tactile
Hypnagogic
Hypnopompic

Study These Flashcards

Visual
- More commonly a feature of medical illness (e.g., drug intoxication) than psychiatric illness.
Auditory
- More commonly a feature of psychiatric illness (e.g., schizophrenia) than medical illness.
Olfactory
- Often occur as an aura of psychomotor epilepsy and in brain tumors.
Gustatory
- Rare.
Tactile
- Common in alcohol withdrawal (e.g., formication—the sensation of bugs crawling on one’s skin).
- Also seen in cocaine abusers (“cocaine crawlies”).
HypnaGOgic
- Occurs while GOing to sleep.
HypnoPOMPic
- Occurs while waking from sleep
- “POMPous upon awakening”

Schizophrenia

Definition
Etiologies / associations
Prevalence
Diagnosis
Brief psychotic disorder
Schizophreniform disorder
Schizoaffective disorder

Study These Flashcards

Definition
- Chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts > 6 months.
- Associated with increased dopaminergic activity, decreased dendritic branching.
- Patients are at increased risk for suicide
Etiologies / associations
- Genetics and environment contribute to the etiology of schizophrenia.
- Frequent cannabis use is associated with psychosis/schizophrenia in teens.
Prevalence
- Lifetime prevalence—1.5% (males = females, blacks = whites).
- Presents earlier in men (late teens to early 20s vs. late 20s to early 30s in women).
Diagnosis requires 2 or more of the following (first 4 in this list are “positive symptoms”):
- Delusions
- Hallucinations—often auditory
- Disorganized speech (loose associations)
- Disorganized or catatonic behavior
- “Negative symptoms”—flat affect, social withdrawal, lack of motivation, lack of speech or thought
Brief psychotic disorder
- < 1 month, usually stress related.
Schizophreniform disorder
- 1–6 months.
Schizoaffective disorder
- At least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episode.
- 2 subtypes: bipolar or depressive.

Delusional disorder

Study These Flashcards

Fixed, persistent, untrue belief system lasting > 1 month.
Functioning otherwise not impaired.
Example: a woman who genuinely believes she is married to a celebrity when, in fact, she is not.

Dissociative disorders

Dissociative identity disorder
Depersonalization / derealization disorder

Study These Flashcards

Dissociative identity disorder
- Formerly known as multiple personality disorder.
- Presence of 2 or more distinct identities or personality states.
- More common in women.
- Associated with history of sexual abuse, PTSD, depression, substance abuse, borderline personality, and somatoform conditions.
Depersonalization / derealization disorder
- Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions (depersonalization) or one’s environment (derealization).

Mood disorder

Study These Flashcards

Characterized by an abnormal range of moods or internal emotional states and loss of control over them.
Severity of moods causes distress and impairment in social and occupational functioning.
Includes major depressive disorder, bipolar disorder, dysthymic disorder, and cyclothymic disorder.
Psychotic features (delusions or hallucinations) may be present.

Manic episode

Definition
Diagnosis

Study These Flashcards

Definition
- Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 1 week.
- Often disturbing to patient.
Diagnosis requires hospitalization or at least 3 of the following (manics DIG FAST):
- Distractibility
- Irresponsibility—seeks pleasure without regard to consequences (hedonistic)
- Grandiosity—inflated self-esteem
- Flight of ideas—racing thoughts
- Increase in goal-directed Activity/psychomotor Agitation
- Decreased need for Sleep
- Talkativeness or pressured speech

Hypomanic episode

* Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization. * No psychotic features. * Lasts at least 4 consecutive days.

Bipolar disorder * Definition * Bipolar I vs. II * Treatment * Cyclothymic disorder

* Definition * Patient’s mood and functioning usually return to normal between episodes. * Use of antidepressants can lead to increased mania. * High suicide risk. * Bipolar I vs. II * Bipolar I defined by the presence of at least 1 manic episode with or without a hypomanic or depressive episode. * Bipolar II defined by the presence of a hypomanic and a depressive episode. * Treatment * Mood stabilizers (e.g., lithium, valproic acid, carbamazepine), atypical antipsychotics. * **Cyclothymic disorder** * Dysthymia and hypomania * Mlder form of bipolar disorder **lasting at least 2 years**.

Major depressive disorder * Definition * Symptoms * Patients with depression typically have the following changes in their sleep stages: * Persistent depressive disorder (dysthymia) * Seasonal affective disorder

* Definition * May be self-limited disorder, with major depressive episodes usually **lasting 6–12 months**. * Episodes characterized by **at least 5** of the following 9 symptoms for **2 or more weeks** * Symptoms must include patient-reported depressed mood or anhedonia and occur more frequently as the disorder progresses * Symptoms (**_SIG_ _E_ _CAPS_**) * **_S_**leep disturbance * **_L_**oss of Interest (anhedonia) * **_G_**uilt or feelings of worthlessness * **_E_**nergy loss and fatigue * **_C_**oncentration problems * **_A_**ppetite/weight changes * **_P_**sychomotor retardation or agitation * **_S_**uicidal ideations * Depressed mood * Patients with depression typically have the following changes in their sleep stages: * Decreased slow-wave sleep * Decreased REM latency * Increased REM early in sleep cycle * Increased total REM sleep * Repeated nighttime awakenings * Early-morning awakening (important screening question) * **Persistent depressive disorder (dysthymia)** * Depression, often milder, **lasting at least 2 years**. * **Seasonal affective disorder** * Symptoms usually associated with winter season * Improves in response to full-spectrum brightlight exposure.

Atypical depression * Definition * Findings * Treatment

* Definition * Differs from classical forms of depression. * Most common subtype of depression * Findings * Mood reactivity (being able to experience improved mood in response to positive events, albeit briefly) * “Reversed” vegetative symptoms (hypersomnia and weight gain) * Leaden paralysis (heavy feeling in arms and legs) * Long-standing interpersonal rejection sensitivity. * Treatment * MAO inhibitors, SSRIs.

Postpartum mood disturbances * Definition * Maternal (postpartum) “blues” * Postpartum depression * Postpartum psychosis

* Definition * Onset within 4 weeks of delivery. * **Maternal (postpartum) “blues”** * 50–85% incidence rate. * Characterized by depressed affect, tearfulness, and fatigue starting 2–3 days after delivery. * **Usually resolves within 10 days**. * Treatment: supportive. * Follow-up to assess for possible postpartum depression. * **Postpartum depression** * 10–15% incidence rate. * Characterized by depressed affect, anxiety, and poor concentration starting within 4 weeks after delivery. * **Lasts 2 weeks to a year or more**. * Treatment: antidepressants, psychotherapy. * **Postpartum psychosis** * 0.1–0.2% incidence rate. * Characterized by delusions, hallucinations, confusion, unusual behavior, and possible homicidal/suicidal ideations or attempts. * Usually **lasts days to 4–6 weeks**. * Treatment: antipsychotics, antidepressants, possible inpatient hospitalization, assessment of child safety.

Pathologic grief * Definition * Findings

* Definition * Normal bereavement characterized by shock, denial, guilt, and somatic symptoms. * Duration varies widely, up to 6–12 months. * Findings * May experience simple hallucinations (e.g., hearing name called). * Pathologic grief includes excessively intense grief; prolonged grief lasting \> 6–12 months; or grief that is delayed, inhibited, or denied. * May experience depressive symptoms, delusions, and hallucinations.

Electroconvulsive therapy * For... * Definition * Adverse effects

* For... * Treatment option for major depressive disorder refractory to other treatment and for pregnant women with major depressive disorder. * Also considered when immediate response is necessary (acute suicidality), in depression with psychotic features, and for catatonia. * Definition * Produces a relatively painless seizure in an anesthetized patient. * Adverse effects * Disorientation, temporary headache, and partial anterograde/retrograde amnesia usually fully resolving in 6 months.

Risk factors for suicide completion * Risk factors * Gender

* **_SAD_ _PERSONS_ are more likely to complete suicide.** * _**S**_ex (male) * **_A_**ge (teenager or elderly) * **_D_**epression * **_P_**revious attempt * **_E_**thanol or drug use * Loss of **_R_**ational thinking * **_S_**ickness (medical illness, 3 or more prescription medications) * **_O_**rganized plan * **_N_**o spouse (divorced, widowed, or single, especially if childless) * **_S_**ocial support lacking. * Gender * Women try more often * Men succeed more often.

Anxiety disorder

* Inappropriate experience of fear/worry and its physical manifestations (anxiety) when the source of the fear/worry is either not real or insufficient to account for the severity of the symptoms. * Symptoms interfere with daily functioning. * Lifetime prevalence of 30% in women and 19% in men. * Includes panic disorder, phobias, and generalized anxiety disorder.

Panic disorder * Definition * Treatment * Diagnosis

* Definition * Defined by the presence of recurrent panic attacks * Periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following) (**_PANICS_**): * **_P_**alpitations, **_P_**aresthesias * **_A_**bdominal distress * **_N_**ausea * **_I_**ntense fear of dying or losing control, l**_I_**ght-headedness * **_C_**hest pain, **_C_**hills, **_C_**hoking, dis**_C_**onnectedness * **_S_**weating, **_S_**haking, **_S_**hortness of breath. * Symptoms are the systemic manifestations of fear * Strong genetic component. * Treatment * Cognitive behavioral therapy, SSRIs, venlafaxine, benzodiazepines (risk of tolerance, physical dependence). * Diagnosis requires attack followed by 1 month (or more) of 1 (or more) of the following: * Persistent concern of additional attacks * Worrying about consequences of the attack * Behavioral change related to attacks.

Psychiatry - Pathology (1) Flashcards

(34 cards)