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STEP 1 (3) > Psychiatry- Pathology (1) > Flashcards

Psychiatry- Pathology (1) Flashcards

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1
Q

What are the results of long-term deprivation of affection in infants?

A
  • failure to thrive
  • poor language/socialization
  • lack of basic trust
  • anaclitic depression

deprivation for 6+ months can lead to irreversible changes

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2
Q

What are some common signs of physical child abuse?

A

spiral fractures (or multiple fractures at different stages of healing)

burns

subdural hematomas

posterior rib fractures

retinal detachment

Usually from the biological MOTHER (represent 40% of deaths under 1 yo)

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3
Q

What are some common signs of sexual child abuse?

A

genital, anal, or oral trauma

abuser usually known to victim, usually male (peak incidence around 9-12 yo)

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4
Q

What is child neglect defined as?

A

failure to provide a child with adequate food, shelter, supervision, education, and/or affection(most common form of child mistreatment)

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5
Q

What are some common childhood and early-onset disorders?

A

attention-deficity hyperactivity disorder (ADHD)

conduct disorder

oppositional defiant disorder

separation anxiety disorder

Tourette syndrome

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6
Q

Describe attention-deficity hyperactivity disorder (ADHD)

A

Onset is commonly before 12, presenting with children with limited attention spans and poor impulse control and characterized by hyperactivity.

Intelligence is normal but commonly affects school performance

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7
Q

How common is attention-deficity hyperactivity disorder (ADHD) in adulthood?

A

persists in up to 50%

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8
Q

What anatomic changes are seen in attention-deficity hyperactivity disorder (ADHD)?

A

decreased frontal lobe volume/metabolism

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9
Q

How is attention-deficity hyperactivity disorder (ADHD) tx?

A

stimulants (e.g. methylphenidate) +/- cognitive behavioral therapy

atomoxetine may be an alternative to stimulants in selected pts.

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10
Q

What is a conduct disorder?

A

repetitive and pervasive behavior violating the basic rights of others (e.g. physical aggression, destruction of property, theft).

After age 18, most of these pts will meet the criteria for antisocial personality disorder

tx with CBT

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11
Q

What is oppositional defiant disorder?

A

enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms

tx with CBT

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12
Q

What is seperation anxiety disorder?

A

common onset at 7-9 yo, presenting with overwhelming fear of seperation from home or loss of attachment figure. May lead to factitious physical complaints to avoid going to or staying at school.

tx with CBT, play therapy, and fam therapy

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13
Q

Describe Tourette syndrome

A

Onset before 18 yo, characterized by sudden, rapid, recurreny, nonrhythmic, motor and vocal tics that persist for 1+ yr.

Associated with OCD and ADHD

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14
Q

_______ is found in 10-20% of all Tourette pts.

A

Coprolalia (involuntary obscene speech)

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15
Q

How is Tourettes tx?

A

psychoeducation, behavioral therapy

for intractable tics, low-dose high-potency antipsychotics (e.g. fluphenazine, pimozide), tetrabenazine, and clonidine may be used

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16
Q

What are pervasive developmental disorders?

A

characterized by difficulties with language and failure to acquire or early loss of social skills

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17
Q

What are some common pervasive developmental disorders?

A

Autism spectrum disorder

Rett syndrome

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18
Q

Describe Autism spectrum disorder

A

characterized by poor social interaction, communication deficits, repetitive behaviors, and restricted interests. MUST present in early childhood.

more common in boys

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19
Q

T or F. Autism spectrum disorder may or may not present with intellectual disability

A

T. Rarely accompanied by unusual by unusual abilities (sevants)

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20
Q

Describe Rett syndrome

A

X-linked disorder seen almost exclusively in GIRLS (affected males die in utero or shortly after birth)

Symptoms usually become apparent around ages 1-4, including regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and sterotyped hand-wringing

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21
Q

What neurotransmitter changes are seen in Alzheimer disease?

A

decreased ACh

increased glutamate

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22
Q

What neurotransmitter changes are seen in Anxiety disorders?

A

increased nor

decreased GABA, 5-HT

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23
Q

What neurotransmitter changes are seen in depression?

A

decreased nor, 5-HT, AND dopamine

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24
Q

What neurotransmitter changes are seen in Huntington disease?

A

decreased GABA, ACh

increased dopamine

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25
What neurotransmitter changes are seen in Parkinson disease?
decreased dopamine increased ACh
26
What neurotransmitter changes are seen in Schizophrenia?
increased dopamine
27
Orientation is a pts. ability to know where they are, the date, etc. Common causes of loss of orientation include:
alcohol, drugs fluid/electrolyte imbalance head trauma hypoglycemia infetion malnutrition
28
What things are lost first with disorientation?
1st-time 2nd-place 3rd- person
29
What are the major types of amnesias?
retrograde (cant remember old memories) anterograde (cant make new memories) Korsakoff syndrome Dissociative amnesia
30
What is Korsakoff syndrome?
amnesia (anterograde \> retrograde) caused by vitamin B1 deficiency and associated destruction of mammillary bodies. Seen in alcoholics. Confabulations are characteristic
31
What is dissociative amnesia?
inability to recall important personal info, 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)
32
What is delirium?
'waxing and waning' level of consciousness with acute onset marked by rapid decrease in attention span and level of arousal. characterized by disorganized thinking, hallucinations (often visual), illusions, misperceptions, cognitive dysfunction
33
\_\_\_\_\_ is the most common presentation of altered mental status in inpatient setting
Delirium
34
When does delirium commonly occur?
2ndry to other illness (e.g. CNS disease, infection, trauma, substance abuse/withdrawal, hemorrhage, urinary/fecal retention) may be due to meds (e.g. anticholinergics, especially in the elderly)
35
How is delirium tx?
tx is aimed at IDing and addressing udnerlying condition Haloperidol may be used as needed Use benzodiazepines for alcohol withdrawal
36
What is dementia?
Decrease in intellectual function with affecting level of consciousness, characterized by memory deficits, apraxia, aphasia, agnosia, loss of abstract thought, and/or impaired judgement NOTE: A pt with dementia can develop delirium (e.g. a pt with Alzheimer who develops pneumonia is at risk of delirium)
37
What are some irreversible causes of dementia?
Alzheimer disease Lewy body dementia Huntington disease Pick disease cerebral infarct Creutzfeldt-Jakob disease chronic substance abuse
38
What are some reversible causes of dementia?
hypothyroidism depression vitamin B12 deficiency normal pressure hydrocephalus
39
EEG is usually normal in ____ while abnormal in \_\_\_\_\_\_
normal in dementia; abnormal in delirium
40
In the elderly, depression and hypothyroidism can present like dementia (pseudodementia). How should this be handled?
screen for depression and measure TSH, B12 levels
41
What is psychosis?
a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking. Can occur in pts with medical illness, psychiatric illness, or both.
42
What are the types of hallucination?
visual, auditory, olfactory, gustatory, tactile hypnagogic hypnopompic
43
Visual hallucinations are most commonly a feature of what?
medical illness (e.g. drug intoxication) over psych illness
44
Auditory hallucinations are most commonly a feature of what?
psych illness over medical illness
45
Olfactory hallucinations are most commonly a feature of what?
often occur as an aura of psychomotor epilepsy and in brain tumors
46
Gustatory hallucinations are most commonly a feature of what?
epilepsy
47
Tactile hallucinations are most commonly a feature of what?
alcohol withdrawal (e.g. formication- the sensation of bugs crawling on the skin). Also seen in cocaine abuse ('cocaine crawlies')
48
When does hypnagogic hallucination occur?
when going to sleep (sometimes seen in narcolepsy), whereas hypnopompic hallucinations are seen when waking from sleep
49
How is Schizophrenia defined?
chronic mental illness with periods of psychosis, disturbed behavior and thought, and decline in functioning lasting 6+ months. Associated with increased dopamine activity and decreased dendritic branching
50
How is schizophrenia diagnosed?
2+ of the following: 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
51
T or F. Genetics and environment contribute to the etiology of schizophrenia
T. As does frequent cannabis use in teens
52
The lifetime prevelance of schizophrenia is \_\_\_\_
1.5% (white=black, male-female). presents earlier in men (late teens to early 20s vs late 20s to early 30s in women on avg.)
53
What is the first line tx of schizophrenia?
atypical antipsychotics (e.g. risperidone)
54
What are some variants of schizophrenia?
- brief psychotic disorder (lasting less than 1 month, usually stress related) - Schizophreniform disorder (lasting 1-6 months) - Schizoaffective disorder (lasting 2+ weeks and presenting with psychotic symptoms with episodic superimposed major depression or mania)
55
What is delusional disorder?
fixed, persistent false belief system lasting 1+ month. Functioning otherwise not impaired (ex. a women who genuinely believes she is married to a celebrity when she isnt)
56
What are the dissociative disorders?
- Dissociative identity disorder - Depersonalization/derealization disorder
57
Describe 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 a hx of sexual abuse, PTSD, depression, borderline personality
58
Describe depersonalization disorder
persistent feelings of detachment or estrangement from one's own body, thoughts, perceptions, and actions (depersonalization) or one's environment (derealization)
59
What is a Mood disorder?
characterized by an abnormal range of moods or internal emotional states amd 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.
60
What is a manic episode?
distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased actiivty or energy lasting at least a week.
61
Diagnosis of a manic episode requires hospitalization or at least 3 of the following:
Distractibility Irresponsibility (seeks pleasure with regard to consequences (hedonistic)) Grandiosity (inflated self-esteen) Flight of Ideas Increase in goal-directed activity decreased sleep
62
What is a hypomanic episode?
like manic episode except mood disturbance is not severe enough to caused marked impairment in social and/or occupational functioning or to necessitate hospitalization Lasts at least 4 consecutive days
63
What is Bipolar I disorder defined as?
the presence of at least 1 manic episode with or without a hypomanic or depressive episode
64
What is Bipolar II disorder defined as?
presence of a hypomanic and a depressive episode
65
More on Bipolar disorder
pts. mood and functioning usually returns to normal in between episodes. High suicide risk use of antidepressants can precipitate mania
66
How is bipolar disorder tx?
mood stabilizers (e.g. lithium, valproic acid, carbamazepine), atypical antipsychotics
67
What is a cyclothymic disorder?
dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 yrs
68
Major depressive disorder
may be a self-limited disorder, with episodes usually lasting 6-12 months. Episodes marked by at least 5 of the 9 major symptoms for 2+ weeks
69
What are the major symptoms of major depressive disorder?
SIG E CAPS Sleep disturbance Loss of interest (anhedonia) Guilt or feelings of worthlessness Energy loss and fatigue Concentration problems Appetite/weight changes Psychomotor retardation Sucidial ideations
70
How is depressive disorder tx?
CBT and SSRIs are first line SNRIs, mirtazapine, and bupropion can also be used and electroconvulsive therapy in select pts.
71
Pts. with depression typically have what change sin their sleep stages?
decreased slow-wave sleep, REM latency Increased REM early in sleep cycle, and total REM sleep repeated nighttime awakenings Early-morning wakening (terminal insomnia)
72
What is persistent depressant disorder (dysthymia)?
depression, often milder, lasting at least 2 yrs
73
What is atypical depression?
differs from classical forms and marked by mood reactivity (being able to experience improved mood in response to positive events, albiet brief), 'reversed' vegetative symptoms (hypersomnia, hyperphagia), leadn paralysis (heavy feelings in arms and legs), and long-standing interpersonal rejection sensitivity.
74
How is atypical depression tx?
CBT and SSRIs are first line MAO inhibitors are effective also
75
Postpartum mood disturbances occur by definition within 4 weeks of delivery and include:
Maternal (postpartum) "blues" Postpartum depression Postpartum psychosis
76
Describe postpartum blues
50-85% incidence rate. Characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery and usually resolving after 10 days. Tx is supportive and follow up appropriate
77
Describe postpartum depression
10-15% incidence rate characterized by depressed affect, anxiety, and poor concentration starting within 4 weeks of delivery. Tx: CBT and SSRIs
78
Describe postpartum psychosis
0.1-0.2% incidence rate characterized by delusions, thoughts of harming the baby or self Risk factors include hx of bipolar or psychotic disorder, **fist pregnancy**, fam hx
79
How is postpartum psychosis tx?
hospitalization and initiation of atypical antipsychotics, if insufficient, ECT may be used
80
What is pathologic grief?
NOTE: normal bereavement is characterized by shock, denial, guilt, and somatic symptoms. Duration varies widely. Pathologic grief lasts 6+ months, and satisfies major depressive criteria (e.g. weight loss, anhedonia, etc.)
81
What are the main uses of electroconvulsive therapy?
used mainly for treatment-refractory depression, depression wit psychotic symptoms, and acutely suicidal patients.
82
How does electroconvulsive therapy work?
produces grand mal seizures in an anesthetized pt.
83
What are the major risk factors for suicide completion?
SAD PERSONS Sex (male) Age (teenager or elderly) Depression Previous attempt Ethanol or drug use loss of Rational thinking Sickness Organized plan No spouse (divorced, widowed, single, especially if childless) Social network lacking
84
T or F. Women try to commit suicide more often
T. But men succeed more often
85
What is a panic disorder?
defined by recurrent panic attacks with symptoms of palpitations, paresthesias, abdominal distress, naisea, light-headedness, chest pain, chills, choking, sweating, shaking, and/or SOB. STRONG genetic component
86
How is panic disorder tx?
CBT, SSRIs, and venlafaxine are first line benzodiazepines occasionally used in acute settings.
87
What is agoraphobia?
fear of open or enclosed spaces, using public transport, being in a line or crowds, or leaving home alone Tx: CBT, SSRIs, and MAOIs
88
What is generalized anxiety disorder?
anxiety lasting 6+ months unrelated to a specific person, situation, or event. Associated with sleep disturbance, fatigue, GI disturbance, and/or difficulty concentration
89
How should generalized anxiety disorder be tx?
CBT, SSRIs, SNRIs are first line Buspirone, TCAs, and benzodiapepines are second line
90
What is an adjustment disorder?
emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g. divorce, illness) and lasting less than 6 months Tx: CBT, SSRIs
91
T or F. Often in OCD, the behavior is inconsistent with one's own beliefs and attitudes (aka ego-dystonic) but they are performed anyways
T.
92
How is OCD tx?
CBT, SSRIs, and clomipramine are first line
93
What is body dysmorphic disorder?
preoccuption with minor or imagined defects in one's appearance causing significant emotional distress or impaired functioning; pts often repeatedly seek cosmetic surgery. Tx: CBT
94
How is PTSD tx?
CBT, SSRIs, and venlafaxine are first line
95
How long does acute stress disorder last?
between 3 days and 1 month Tx: CBT; pharmacotherapy is usually **not** indicated
96
What is malingering?
When a pt consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary (external) gain (e.g. avoiding work, obtaining compensation). Poor compliance with tx or follow-up common Complaints cease after gain (vs. factitious disorder)
97
What is a factitious disorder?
When a patient consciously creates a physical and/or psychological symptoms in order to assume "sick role" and to get medical attention (primary (internal) gain)
98
What is Munchausen syndrome?
chronic factitious disorder with predominantly physical signs and symptoms. Characterized by a hx of multiple hospital admission and willingness to undergo invasive procedures
99
What is Munchausen syndrome by proxy?
Illness in a child or elderly pt. caused or fabricated by the caregiver. Form of abuse
100
What are somatic symptoms/disorders?
a caetgory of disorders characterized by physical symptoms with no identifiable physical cause. Both illness production and motivation are unconscious drives. Symptoms are not intentionally produced or feigned. More common in women
101
What is conversion disorder?
loss of sensory or motor function (e.g. paralysis, blindness, mutism), often following an acute stressor; pt is aware of but sometimes indifferent toward symptoms more common in women, teenagers, and young adults
102
What is illness anxiety disorder (hypocondriasis)?
preoccupation with an fear of having a serious illness despite medical health
103
What is a somatic symptom disorder?
variety of complaints in 1+ organ system lasting months to years associated with excessive, persistent thoughts and anxiety about symptoms May co-occur with medical illness
104

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