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STEP 1 (3) > Psychiatry- Pathology (2) > Flashcards

Psychiatry- Pathology (2) Flashcards

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1
Q

What is a personality trait?

A

an enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself

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2
Q

What is a personality disorder?

A

Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning (person is usually not aware of the problem).

usually presents in early adulthood.

Three clusters: A, B, and C

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3
Q

Describe Cluster A personality disorders

A

Odd or eccentric; inaility to develop meaningful social relationships

no psychosis

genetic association with schizophrenia

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4
Q

What are the three main types of Cluster A personality disorders

A

Paranoid (projection is the major self defense)

Schizoid (voluntary social withdrawal, limited emotional expression, and content with social isolation (vs. avoidant)

Schizotypical (eccentric appearnace, odd beliefs or magical thinking, interpersonal awkwardness

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5
Q

Describe Cluster B personality disorders

A

Dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse

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6
Q

What are the main types of Cluster B personality disorders

A
  • Antisocial
  • Borderline
  • Histrionic

Narcissitic

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7
Q

Describe Antisocial PD

A

Disregard for and violation of rights of others, criminality, impulsivity; males more than females

must be 18+ yo and have a hx of conduct disorder before 15

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8
Q

Describe Borderline PD

A

Unstable mood and interpersonal relationships, impulsivity

self-mutilation, boredom, and a sense of emptiness

females more common

splitting is a major defense mechanism

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9
Q

Describe Histrionic PD

A

Excessive emotionality and excitability, attention seeking, sexually provacative, overly concerned with appearance

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10
Q

Describe Cluster C personality disorders

A

Anxious or fearful; genetic association with anxiety disorders

Includes: Avoidant, Obsessive-compulsive, and Dependent subtypes

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11
Q

Describe Avoidant PD

A

hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid)

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12
Q

Describe Obsessive-Compulsive PD

A

Preoccupation with order, and control; ego-syntonic (behavior consistent with one’s one beliefs and attitudes (vs. OCD))

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13
Q

Describe Dependent PD

A

Submissiv and clincy, excessive needs to be taken car of, low self-confidence

these pts often get stuck in abusive relationships

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14
Q

“Schizo-“

A

Schzoid < Schizotypical (Schzoid + odd thinking) < Schizophrenic (greater odd thinking than schizotypical) < Schizoaffective (schizophrenic symptoms + bipolar or depressive mood disorder)

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15
Q

Schizophrenia time course:

A

<1 mo- brief psychotic disorder, usually stress related

1-6 mo- schizophreniform disorder

6+ mo- schizophrenia

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16
Q

Describe anorexia nervosa

A

Excessive dieting +/- purging; intense fear of gaining weight and body image distortion

BMI <18.5

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17
Q

What are some associations of anorexia nervosa

A

osteopenia, metatarsal stress fractures

amenorrhea

lanugo

anemia

electrolyte problems

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18
Q

Describe bulimia nervosa

A

Binge eating with recurrent compensatory behavior (e.g. vomiting, laxatives, fasting, excessive exercise) occurring weekly for 3+ months

Body weight often within normal range

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19
Q

What are some associations of bulimia nervosa

A

parotitis

enamel erosion

alkalosis (vomiting)

dorsal hand calluses from vomiting (Russell sign)

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20
Q

What is general dysphoria?

A

Strong, persistent cross-gender identification characterized by persistent discomfort with one’s sex assigned at birth, causing significant distress (aka transgender0

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21
Q

What is transsexualism?

A

desire to live as the opposite sex, often through surgery or hormone tx

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22
Q

What is transvestism?

A

paraphilia (aka cross-dressing), not gender dysphoria

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23
Q

Describe sleep terrors

A

Periods of terror with screaming in the middle of the night occurring during slow-wave sleep (non-REM sleep- no memory of arousal) (as opposed to nightmares that occur during REM sleep)

usually self-limited

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24
Q

What is nacrolepsy?

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A

dysregulation of sleep-wake cycles with excessive day time sleepiness caused by decreased hypocretin (orexin) production in the lateral hypothalamus

25
What are some associations of nacrolepsy?
hypagogic (just before sleep) or hypnopompic (just before awakening) hallucinations nocturnal and narcoleptic sleep episodes that start with REM sleep Cataplexy (loss of all muscle tone following strong emotional stimulus, such as laughter) in some pts. strong genetic component
26
How is narcolepsy tx?
daytime stimulants (e.g. amphetamines, modafinil) and nighttime sodium oxybate (GHB)
27
What are the major stages in overcoming substance addiction?
1. Precontemplation (not yet acknowledging the problem) 2. Contemplation (acknowledgin that there is a problem, but not ready to make a change) 3. Preparation/determination- getting ready to change behaviors 4. Action/willpower- changing behaviors 5. Maintenance 6. Relapse
28
What are the major depressant drugs?
Alcohol Opiods (e.g. morphine, heroin, methadone) Barbiturates Benzodiazepines
29
What are some indications of intoxication with a depressant?
nonspecific: mood elevation, decreased anxiety, sedation, respiratory depression
30
What are some indications of withdrawal with a depressant?
nonspecific: anxiety, tremor, seizures, insomnia
31
What are some indications of intoxication with alcohol?
emotional lability, slurred speech, ataxia, coma, blackouts Serum y-glutamyltransferase elevated AST 2x as high as ALT
32
What are some indications of withdrawal with alcohol?
several withdrawal may cause autonomic hyperactivity and DTs (5-15% mortality rate) Tx DTs with benzodiazepines
33
What are some indications of intoxication with opiods?
euphora, respiratory and CNS depression, decreased gag reflex pupillary constriction seizures Tx: naloxone, naltrexone
34
What are some indications of withdrawal of opiods?
sweating, dilated pupils, piloerection ('cold turkey") fever, rhinorrhea yawning, nausea, stomach cramps diarrhea Tx: long term support, methadone, and buprenorphine
35
What are some indications of intoxication with barbiturates?
low saftey margin, marked respiratory depression tx: symptom management (e.g. assist respiration, and increase BP)
36
What are some indications of withdrawal with barbiturates?
delirium, CV collapse
37
What are some indications of intoxication with benzodiazepines?
greater safety margin; ataxia, minor respiratory depression tx: flumazenil (benzodiazepine receptor antagonist, but rarely used as it can precipitate seizures)
38
What are some indications of withdrawal from benzodiazepines?
sleep disturbance, depression, rebound anxiety, seizure
39
What are the major stimulant drugs?
Amphetamines Occiane Caffeine Nicotine
40
What are some indications of intoxication with stimulants?
mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
41
What are some indications of withdrawal with stimulants?
post-use crash, including depression, lethargy, weight gain, and HA
42
What are some indications of intoxication with amphetamines?
euphoria, grandiosity, pupillary dilation HTN, tachycardia anorexia, paranoisa, fever cardiac arrest, seizure if severe
43
What are some indications of withdrawal from amphetamines?
anhedonia, increased appetitie, hypersomnolence, existential crises
44
What are some indications of intoxication with cocaine?
impaired judgment, pupillary dilation, halucinations (including tactile), paranoid ideations, angina, sudden cardiac death
45
How is cocaine OD tx?
a-blockers, benzodiazepines (BBs not recommended)
46
What are some indications of withdrawal from cocaine?
hypersomnolence, malaise, severe craving, depression
47
What are the main hallucinogens?
PCP, LSD, and marijuana
48
What are some indications of intoxication with PCP?
belligerence, impulsivity, fever, analgesia vertical and horizontal nystagmus tachycarida homicidality Tx: benzodiazepines, rapid-acting antipsychotic
49
What are some indications of withdrawal from PCP?
depression, anxiety irritability restlessness anergia disturbance of thought and sleep
50
What are some indications of intoxication with LSD?
perceptual distortion (visual, auditory) depersonalization anxiety, paranoia psychosis flashbacks
51
What is the pharmaceutical form of marijuana?
dronabinol (tetrahydrocannabinol): used as an antiemetic (chemo) and appetitie stimulant (in AIDS)
52
Heroin addiction places users at increased risk of:
hepatitis, HIV, abscesses, bacteremia, right-heart endocarditis
53
How is heroin addiction tx?
**Methadone** (long acting oral opiate for heroin detox or maintenance) **Naloxone + buprenorphine** (antagonist + partial agonist. Naloxone is not PO bioavailable, so withdrawal symptoms occur only if injected) **Naltrexone** (long acting opiod antagonist used for relapse prevention once detox is complete)
54
What are the main complications of alcoholism?
alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy testicular atrophy
55
How is alcoholism tx?
disulfram acamprosate naltreone supportive care
56
What is Wernicke-Korsakoff syndrome?
caused by vit B1 deficiency, and marked by a triad of confusion ophthalmoplegia, and ataxia with many progressing to irreveersible memory loss, confabulation, and personality change Associated with periventricular hemorrhage/necrosis of mammilary bodies
57
What are Delirium tremens (DTs)?
life-threatening alcohol withdrawal symptoms that peak 2-4 days after last drink and marked by autonomic hyperactivity (.e.g tachycardia, tremor, anxiety, seizures) Classically occurs in hospital settings postsurgery in alcoholics that dont get a drink
58
How are Delirium tremens (DTs) tx?
benzodiazepines
59
What is alcoholic hallucinosis?
condition marked by visual hallucinations 12-48 hrs after last drink tx: long-acting benzodiazepines (e.g. lorazepam, diazepam, and chlordiazepoxide)

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