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PSYCHIATRY- Pathology Flashcards

1
Q

What are the results of long term deprivation of affection?

A 
↓ muscle tone
Poor language skils
Poor socialization skills
Lack of basic trust
Anaclitic depression (infant withdrawn/ unresponsive)
Weight loss
Physical illness
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2
Q

When is consider that infant deprivation can lead to irreversible changes?

A

> 6 months

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3
Q

What could be the result of infant severe deprivation?

A

Can result in infant death

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4
Q

Evidence of Physical child abuse

A 
Healed fractures on x-ray
Burns
Subdural hematomas
Pattern marks/ bruising
Rib fractures
Retinal hemorrhage or detachment
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5
Q

Which healed fracture is highly sugestive of physical child abuse?

A

Spiral fractures

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6
Q

Which burns are highly sugestive of physical child abuse?

A

Cigarette, scalding

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7
Q

Patterns marks/ bruising of physical child abuse

A

Belts, electrical cords

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8
Q

Evidence of sexual child abuse

A

Genital, anal or oral trauma
STDs
UTIs

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9
Q

Usually who is the physical child abuser?

A

Usually biological mother

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10
Q

Usually who is the sexual child abuser?

A

Known to victim, usually male

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11
Q

How is the mortality rate of child caused by physical abuse?

A

3000 deaths/year in US

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12
Q

Which is the child group of age with the highest mortality rate caused by physical abuse?

A

80%

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13
Q

Peak incidence of sexual child abuse

A

Peak incidence 9-12 years old

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14
Q

Failure to provide a child with adequate food, shelter, supervision, education, and/or affection

A

Child neglect

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15
Q

Most common form of child maltreatment

A

Child neglect

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16
Q

Evidence of child neglect

A

Poor hygiene, malnutrition, withdrawal, impaired social/ emotional development, failure to thrive

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17
Q

Situations that must be reported to local child protective services

A

Child abuse

Child neglect

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18
Q

Childhood and early onset disorders

A 
Attention deficit hyperactive disorder
Conduct disorder
Oppositional defiant disorder
Tourette syndrome
Separation anxiety disorder
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19
Q

Age of onset of Attention deficit hyperactive disorder

A

Before age 12

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20
Q

Findings of Attention deficit hyperactive disorder

A

Limitted attention span and poor impulse control

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21
Q

Characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of workship)

A

Attention deficit hyperactive disorder

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22
Q

How is the intelligence in Attention deficit hyperactive disorder patients?

A

Normal intelligence, but commonly coexists with difficulties in school

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23
Q

Can Attention deficit hyperactive disorder affect the patinet even during adulthood?

A

In as many as 50 % of individuals

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24
Q

What is associated with Attention deficit hyperactive disorder?

A

With decreased frontal lobe volume/ metabolism

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25
Q

Which is the treatment for Attention deficit hyperactive disorder?

A

Methylphenidate, amphetamine, atomoxetine, behavioral interventions (reinforcement, reward)

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26
Q

Repetitive and pervasive behavior violating the basics right of others (eg. physical aggression, destruction of property, theft)

A

Conduct disorder

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27
Q

How is the evolution of patients with conduct disorder?

A

After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder

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28
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

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29
Q

When is the onset of Tourette syndrome?

A

Before age 18

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30
Q

What is Tourette syndrome?

A

Characterized by sudden, rapid, recurrent, nonrhytmic, stereotyped motor and vocal tics that persist for > 1 year

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31
Q

How many cases of Tourette syndrome have a lifetime prevalence?

A

0.1-1.0 % in the general population

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32
Q

How many cases of Tourette syndrome have coprolalia?

A

In only 10-20% of patients

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33
Q

What is coprolalia?

A

Involuntary obscene speech

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34
Q

What diseases are associated to Tourette syndrome?

A

OCD and ADHD

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35
Q

Treatment for Tourette syndrome

A

Antipsychotics and behavorial therapy

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36
Q

Which is the age of onset of Separation anxiety disorder?

A

Common onset at 7-9 years

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37
Q

Overwhelming fear of separation from home or loss of attachment figure

A

Separation anxiety disorder

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38
Q

What can Separation anxiety disorder lead to?

A

May lead to factitious physical complaints to avoid going to ot staying at school

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39
Q

Treatment for Separation anxiety disorder

A

SSRIs and relaxation techniques/ behavioral interventions

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40
Q

What are the Pervasive developmental disorders?

A

Characterized by dificulties with language and failure to azquire or early loss of social skills

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41
Q

Pervasive developmental disorders

A

Autism spectrum disorder

Rett disorder

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42
Q

Characterized by poor social interactions, comunications deficits, repetitive/ritualized behaviors, and restricted interes

A

Autism spectrum disorder

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43
Q

When is Autism spectrum disorder presented?

A

Must present in early childhood

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44
Q

How is the intelligence in Autism spectrum disorder?

A

May or may not be accompanied by intellectual disability; rarely accompanied by unusual abilities (Savants)

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45
Q

In whom is it more common to see Autism spectrum disorder?

A

In boys

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46
Q

Mode of inheritance of Rett disorder

A

X linked disorder

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47
Q

In whom is Rett disorder seen?

A

Seen almost exclusively in girls (affected males die in utero or shortly after birth)

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48
Q

When do symptoms become apparent in Rett disorder?

A

Around ages 1-4

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49
Q

Clinical findings of Rett disorder

A

Regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing

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50
Q

Which neurottansmiter is affected in Alzheimer disease?

A

↓ ACh

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51
Q

Neurotrasmitters affected in Anxiety

A

↑ norepinephrine

↓ GABA, ↓ 5 HT

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52
Q

Which neurotransmitters are affected in Depression?

A

↓ norepinephrine

↓ dopamine, ↓ 5 HT

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53
Q

Neurotransmitters affected in Huntington disease

A

↓ GABA
↓ ACh
↑ dopamine

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54
Q

If you see ↑ 5 HT ↑ ACh and ↓ dopamine, what disease is?

A

Parkinson disease

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55
Q

Which neurotransmitter is affected in Schizophrenia?

A

↑ dopamine

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56
Q

Patient’s ability to know who he or she is, where he or she is, and the date and time

A

Orientation

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57
Q

Common causes of loss of orinetation

A

Drugs, fluid/ electrolyte imbalance, head trauma, hypoglicemia, infection, nutritional deficiencies

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58
Q

How is the order of loss orientation?

A

1st time; 2nd place; last person

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59
Q

Who is orientation abbreviated in the medical chart?

A

As “alert and oriented X 3” (AOx3)

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60
Q

How is amnesia classified?

A

Retrograde amnesia
Anterograde amnesia
Korsakoff amnesia
Dissociative amnesia

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61
Q

Inability to remeber things that occured before a CNS insult

A

Retrograde amnesia

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62
Q

Inability to remeber things that occured after a CNS insult (no new memory)

A

Anterograde amnesia

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63
Q

What is Korsakoff amnesia?

A

Classic anterograde amnesia caused by thiamine deficiency

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64
Q

What is the result of Korsakoff amnesia?

A

Associated destruction of mammilary bodies

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65
Q

Type of amnesia seen in Korsakoff amnesia

A

Anterograde amnesia

May also include some retrograde amnesia

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66
Q

In which patients is Korsakoff amnesia seen?

A

In alcoholics and associated with confabulations

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67
Q

Inability to recall important personal information

A

Dissociative amnesia

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68
Q

When is Dissociative amnesia seen?

A

Usually subsequent to severe trauma or stress

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69
Q

What is associated to Dissociative amnesia?

A

May be accompanied by dissociative fugue

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70
Q

Abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances

A

Dissociative fugue

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71
Q

What does cognition includes?

A

Memory
Attention
Language
Judgment

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72
Q

What is cognitive disorder?

A

Significant change in cognition from previous level of function

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73
Q

What are causes associated to cognitive disorders?

A

Associated with abnormalities in CNS, a general medical condition, medications, or substance abuse

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74
Q

What does Cognitive disorder includes?

A

Dementia

Delirium

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75
Q

“Waxing and waning” level of consciousnes with acute onset; rapid ↓ in attention span and level of arousal

A

Delirium

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76
Q

Characterisitcs of Delirium

A

Disorganized thinking, hallucinations (often visual), illusions, misperception, disturbance in sleep-wake cycle, cognitive dysfunction

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77
Q

What is the cause of of delirium?

A

Usually secondary to other illness (eg. CNS disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention

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78
Q

Most common presentation of altered mental status in inpatients setting

A

Delirium

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79
Q

Which study is abnormal in delirium?

A

EEG

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80
Q

Which is the treatment for delirium?

A

Identify and address underlying cause
Optimize brain condition (O2, hydration, pain, etc.)
Antipsychotics

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81
Q

Which is the main antipsychotic use for delirium?

A

Haloperidol

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82
Q

Is delirium reversible?

A

Yes

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83
Q

What do you need to check in patients with delirium?

A

Check for drugs with Anticholinergic effect

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84
Q

What is helpful for management of delirium patients?

A

T-A-DA approach (Tolerate, Anticipate, Don’t Agitate)

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85
Q

Gradual ↓ in intellectual ability or “cognition” without affecting level of consciousness

A

Dementia

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86
Q

Clinical findings of Dementia

A

Characterized by by memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/ personality changes, impaired judgment

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87
Q

What can demetia patients develop?

A

Can develop delirium (eg. patient with Alzheimer disease who develops pneumonia is at ↑ risk for delirium)

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88
Q

Irreversibles causes of Dementia

A

Alzheimer disease, Lewy body dementia, Huntington disease, Pick disease, cerebral infarcts, Creutzfeldt Jakob disease, chronic substance abuse (due to neurotoxicity of drugs)

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89
Q

Reversible causes of Dementia

A 
Normal Pressure Hydrocephalus 
Vitamin B12 deficiency
Hypothyroidism
Neurosyphilis
HIV (partially)
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90
Q

What increases the incidence of Dementia?

A

↑ incidence with age

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91
Q

What characterizes dementia?

A

By memory loss

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92
Q

Which is the usual type of dementia?

A

Irreversible

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93
Q

How can depression be presented in eldery patients?

A

Depresion may present as dementia (pseudodemnetia)

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94
Q

A distorted perception of reality

A

Psychosis

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95
Q

Characteritics of Psychosis

A

Delusions, hallucinations, and/or disorganized thinking

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96
Q

In whom can psychosis occur?

A

In patients with medical illness, or both

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97
Q

Perceptions in the absece of external stimuli (eg. seeing a light that is not actually present)

A

Hallucinations

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98
Q

Unique, flase beliefs about oneself or others that persist despite the facts (eg. thinking aliens are comunicating with you)

A

Delusions

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99
Q

Words and ideas are strung together based on sounds, puns, or “loose associations”

A

Disorganized speech

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100
Q

Types of Hallucination

A 
Visual
Auditory
Olfactory
Gustatory
Tactile
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101
Q

More commonly what is the causes of visual hallucination

A

More commonly a feature of medical illness (eg. drug intoxication) than psychiatic illness

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102
Q

More commonly what is the causes of auditory hallucination

A

More commonly a feature of psychiatic illness (eg. schizophrenia) than medical illness

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103
Q

When does olfactory hallucination occurs?

A

Often occurs as an auraof psychomotor epilepsy and in brain tumors

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104
Q

Rare type of hallucinations

A

Gustatory

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105
Q

Common situations of Tactile hallucinations

A

In alcohol withdrawal (eg. formication )

Also seen in cocaine abusers (“cocaine crawlies”)

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106
Q

What is hypnagogic?

A

State of consciousness, during the onset of sleep

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107
Q

What is Hypnopompic?

A

Sstate of consciousness leading out of sleep

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108
Q

What is schizophrenia?

A

Chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts > 6 months

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109
Q

What is needed to make the diagnosis of schizophrenia?

A

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 effect, social withdrawak, lack of motivation, lack of speech or thought
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110
Q

What is associated to squizophrenia?

A

↑ dopaminergic activity, ↓ dendritic branching

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111
Q

What is a Brief psychotic disorder?

A
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112
Q

How long does Schizophreniform disorder lasts?

A

1-6 months

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113
Q

What is Schizoaffective disorder?

A

At least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, maniac, or mixed (both) episode

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114
Q

Which are the subtypes of Schizoaffective disorder?

A

Bipolar or depressive

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115
Q

What contributes to the etiology of schizophrenia?

A

Genetics and environment

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116
Q

What is associated to psychosis/schizophrenia in teens?

A

Frequent cannabis use

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117
Q

Lifetime prevalence of schizophrenia

A

1.5 % (males = females, blacks= whites)

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118
Q

In whom does schizophrenia presents earlier?

A

Presents earlier in men (late teens to early 20s vs late 20s to early 30s in women)

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119
Q

What risk is increased with schizophrenia?

A

For suicide

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120
Q

What is Delusional disorder?

A

Fixed, persistent, untrue belief system lasting > 1 month

Functioning is not impaired

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121
Q

Example of delusional disorder

A

A woman who genuinely believes she is married to a celebrity when, in fact, she is not

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122
Q

Types of dissociative disorders

A

Dissociative identity disorder

Despersonaslization/ deralization disorder

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123
Q

Formerly known as multiple personality disorder

A

Dissociative identity disorder

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124
Q

Presence of two or more distinct identities or personality states

A

Dissociative identity disorder

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125
Q

In whom is more common the dissociative identity disorder?

A

Women

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126
Q

What is associated to dissociative identity disorder?

A

With history of sexual abuse, PTSD (Posttraumatic stress disorder), depression, substance abuse, borderline personality and somatoform conditions

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127
Q

Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions

A

Despersonaslization disorder

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128
Q

Persistent feelings of detachment or estrangement from one’s enviroment

A

Deralization disorder

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129
Q

Characterized by an abnormal range of moods or internal emotional states and loss of control over them

A

Mood disorder

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130
Q

What does severity of moods in mood disorder causes?

A

Distress and impairment in social and occupational functioning

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131
Q

Pathologies included in Mood disorders

A

Major depressive disorder
Bipolar disorder
Dysthimic disorder
Cyclothymic disorder

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132
Q

What else can be presented in mood disorders?

A

Psychotic features (delusions or hallucinations) may be presented

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133
Q

What is a manic episode?

A

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

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134
Q

What is needed to make the diagnosis of Maniac episode?

A

Requires hospitalization or at least 3 of the following (maniacs DIG FAST):

  • Distractibility
  • Irresponsibility- seeks pleasure without regard to consequences (hedonistic)
  • Grandiosity- Inflated self esteem
  • Flight of ideas- racing thoughts
  • ↑ in goal-directed Activity/ psychomotr Agitation
  • ↓ need for Sleep
  • Talkativeness or pressured speech
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135
Q

What is hedonistic?

A

Seeks pleasure without regard to consequences

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136
Q

What is Hypomaniac episode?

A

Like maniac episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necesitate hospitalization

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137
Q

Does Hypomaniac episode has psychotic features?

A

No

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138
Q

How long does Hypomaniac episode last?

A

At least 4 consecutive days

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139
Q

How is Bipolar I defined?

A

By the presence of at least 1 maniac episode with or without a hypomaniac or depressive episode

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140
Q

How is Bipolar II defined?

A

By the presence of a hypomaniac and a depressive episode

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141
Q

What is spected in Bipolar disorder?

A

Patient’s mood and functioning usually return to normal between episodes

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142
Q

What is the result of using antidepressants in Bipolar disorder?

A

Can lead to ↑ mania

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143
Q

What risk is increased in Bipolar disorders?

A

Suicide

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144
Q

Which is the treatment for Bipolar disorders?

A

Mood stabilizers

Atypical antipsichotics

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145
Q

Mood stabilizers

A

Lithium
Valproic acid
Carbamazepine

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146
Q

How are Bipolar disorders classified?

A

Bipolar I
Bipolar II
Cyclothymic disorder

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147
Q

What is a cyclothymic disorder?

A

Dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 YEARS

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148
Q

How much does the episodes of major depressive disorder last?

A

Usually lasting 6-12 months

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149
Q

Characteristics of major depressive disorder

A

Episodes characterized by at least 5 of the following 9 symptoms for more 2 or more weeks (symptoms must include patient- reported depressed mood or anhedonia and occur more frequently as the disorder progresses)

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150
Q

What is dysthimia?

A

Persistent depressive disorder

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151
Q

Depression, often milder, lasting at least 2 years

A

Persistent depressive disorder (Dysthimia)

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152
Q

When is more common to see seasonal affective disorder?

A

Usually associated with winter season

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153
Q

When does seasonal affective disorder improves?

A

In response to full spectrum bright-light exposure

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154
Q

Findings of Major depressive disorder

A 
SIG E CAPS
Sleep disturbance
loss of Interest (anhedonia)
Guilt or feelings of worthlessness
Energy loss and fatigue
Concentration problems
Appetite/ weight loss and fatigue
Concentration problems
Appetite/ weight changes
Psychomotor retardation or agitation
Suicidal ideations
Depressed mood
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155
Q

How is the sleep affected in patients with depression?

A 
↓ slow wave sleep
↓ REM latency
↑ REM early in sleep cycle
↑ total REM sleep
Repeated nighttime awakenings
Early morning awakening
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156
Q

Important screening question in patients with depression

A

Early morning awakening?

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157
Q

Differs from classical forms of depression

A

Atypical depression

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158
Q

What characterizes Arypical depression?

A

By mood reactivity (being able to experience improved mood in response to positive events, albeit briefly), “reversed” vegetative symptoms, leaden paralysis, and long standing interpersonal rejection sensitivity

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159
Q

What are the “reversed” vegetative symptoms?

A

Hypersomnia and weight gain

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160
Q

What is the leaden paralysis?

A

Heavy feellings in arms and legs

161
Q

Most common subtype of depression

A

Atypical depression

162
Q

Which is the treatment for Atypical depression?

A

MAO inhibitors, SSRIs

163
Q

When do postpartum mood disturbances onset?

A

Onset within 4 weeks of delivery

164
Q

Postpartum mood disturbances

A

Maternal (postpartum) “blues”
Postpartum depression
Postpartum psychosis

165
Q

Which is the most comon type of Postpartum mood disturbance?

A

Maternal (postpartum) “blues” with 50-85% incidence rate

166
Q

Characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery

A

Maternal (postpartum) “blues”

167
Q

Usually in how much time does Maternal (postpartum) “blues” resolves?

A

Usually resolves within 10 days

168
Q

Which is the treatment of Maternal (postpartum) “blues”?

A

Suportive

Follow up to assess for possible postpartum depression

169
Q

Incidence rate of Pospartum depression

A

10-15%

170
Q

Characterized by depressed affect, anxiety and poor concentration starting within 4 weeks after delivery

A

Pospartum depression

171
Q

How long does Pospartum depression lasts?

A

Lasts 2 weeks to a year or more

172
Q

Treatment for Pospartum depression

A

Antidepressants, psychotherapy

173
Q

Incidence rate of postpartum psychosis

A

0.1 -0.2 % incidence rate

174
Q

Characteristics of Postpartum psychosis

A

Delusions, hallucinations, confusion, unusual behavior, and possible homicidal/suicidal ideation or attemps

175
Q

How much time does Postpartum psychosis lasts?

A

Usually lasts days to 4-6 weeks

176
Q

Treatment of Postpartum psychosis

A

Antipsychotics, antidepressants, possible impatient hospitalization, assessment of child safety

177
Q

Characteristics of Normal bereavement grief

A

Characterized by shock, denial, guilt, and somatic symptoms

178
Q

How much time does Normal bereavement lasts?

A

Duration varies widely, up tp 6-12 months

179
Q

What may Normal bereavement patients experience?

A

Simple hallucinations (eg. hearing name called)

180
Q

What does Pathologic grief includes?

A

Excessively intense gried
Prolongued grief lasting > 6-12 months
Gried that is delayed, inhibited or denied

181
Q

What may Pathologic grief experience?

A

Depressive symptoms, delusions, and hallucinations

182
Q

When is Electroconvulsive therapy an option?

A

For major depressive disorder refractory to other treatment and for pregnant women with major depression disorder

183
Q

Other possible situations when Electroconvulsive therapy is consider

A

When immediate response is necesary (acute suicidality), in depression with psychotic features, and for catatonia

184
Q

What happens in electroconvulsive therapy?

A

Produces a relatively painless seizure in an anesthetized patient

185
Q

Adverse effects of Electroconvulsive therapy

A

Disorientation, temporary headache, and partial anterograde/retrograde amnesia usually fully resolving in 6 months

186
Q

Risk factors for suicide completion

A 
SAD PERSONS
Sex (male)
Age (teenager or eldery)
Depression
Previous attempt
Ethanol or drug use
loss of Rational thinking
Sickness (medical illness, 3 or more prescription medications)
Organized plan
No spouse (divorced, widowed, or single, especially if childless)
Social support lacking
187
Q

How is the suicide completion in each gender?

A

Women try more often, men succeed more often

188
Q

What is anxiety disorder?

A

Inappropiate exprerience 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

189
Q

How does symptoms affect in anxiety disorder?

A

Interfere with daily functioning

190
Q

Lifetime prevalence of Anxiety disorder

A

30% in women and 19% in men

191
Q

What is included in anxiety disorder?

A

Panic disorder, phobias, and generalized anxiety disorder

192
Q

Defined by the presence of recurrent panic attacks

A

Panic disorder

193
Q

What is a panic attack?

A

Periods of intense fear or discomfort peaking in 10 minuts with at least 4 of the following: PANICS

  • Palpitations, Paresthesias
  • Abdominal Distress
  • Nausea
  • Intense fear of crying or losing control, light headedness
  • Chest pain, Chills, Choking, disConnectedness
  • Sweating, Shaking, Shortness of breath
194
Q

What is associated to Panic disorders?

A

Strong gentic component

195
Q

Treatment for Panic disorder

A

Cognitive behavioral therapy
SSRIs
Venlafaxine
Benzodeazepines (risk of tolerance, physical dependece)

196
Q

In order to make the diagnosis of Panic disorder what is required?

A

Diangosis 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, or behavorial change related to attacks

197
Q

Which are the symptoms of Panic disorder?

A

Are the systemic manifestations of fear

198
Q

Fear that is excessive or unreasonable and interferes with normal function. Cued by presence or anticipation of a specific object or situation

A

Specific phobia

199
Q

How is the fear in specific phobia?

A

Person recognizes fear is excessive

200
Q

How can specific phobia be treated?

A

With systematic desensitization

201
Q

Main types of specific phobia

A

Social anxiety disorder

Agoraphobia

202
Q

Exaggerated fear of embarrassment in social situations (eg. public speaking, using public restrooms)

A

Social anxiety disorder

203
Q

Which is the treatment for Social anxiety disorder?

A

SSRI

204
Q

What is agarophobia?

A

Exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone

205
Q

What is generalized anxiety disorder?

A

Pattern of uncontrollable anxiety for at least 6 MONTHS that is unrelated to a specific person, situation or event.

206
Q

What is associated to generalized anxiety disorder?

A

With sleep disturbance, fatigue, GI disturbance, and difficulty concentrating

207
Q

Which is the treatment for Generalized anxiety disorder?

A

SSRIs, SNRIs, buspirone, cognitive behavorial therapy

208
Q

What is Adjustment disorder?

A

Emotional symptoms (anxiety, depression) causing impairment following and identifiable psychosocial stressor (eg. divroce, illness) and lasting 6 months in presence of chronic stressor)

209
Q

Subtype of Generalized Anxiety disorder

A

Adjustment disorder

210
Q

Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions

A

Obsessive compulsive disorder

211
Q

What is Ego dystonic in obsessive compulsive disorder?

A

Behavior incosistent with one’s own beliefs and attitudes (vs. obsessive-compulsive disorder)

212
Q

What is pathology is associated to obsessive compulsive disorder?

A

Tourette disorder

213
Q

Which is the treatment for obsessive compulsive disorder?

A

SSRI, clomipramine

214
Q

Subtype of obsessive compulsive disorder

A

Body dysmorphic disorder

215
Q

Preocupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning

A

Body dysmorphic disorder

216
Q

Example of Body dysmorphic disorder

A

Patients often repeatedly seek cosmetic surgery

217
Q

Persistent reexperiencing of a previous traumatic event (eg. war, rape, robbery, serious accident, fire)

A

Postraumatic stress disorder

218
Q

What can post-traumatic stress disorder involve?

A

Nightmares or flashbacks, intense fear, helplessness, or horror

219
Q

What does post- traumatic stress disorder leads to?

A

Leads to avoidance of stimuli associated with the trauma and persistently ↑ arousal

220
Q

How long does disturbance of post- traumatic stress disorder lasts?

A

> 1 month

221
Q

Clinical evolution of post- traumatic stress disorder

A

Onset of symptoms beginning anytime after event, and causes significant distress, negative cognitive alterations, and/or impaired functioning

222
Q

Which is the treatment post- traumatic stress disorder?

A

Psychotherapy, SSRIs

223
Q

How long does Acute stress disorder of post- traumatic stress disorder lasts?

A

Between 3 days and 1 month

224
Q

Patient CONSIOUSLY fakes, profoundly exaggerates, or claims to have a disorder in order to attain specific 2º (EXTERNAL) gain (eg. avoiding work, obtaining compensation)

A

Malingering

225
Q

What is the problem with malingering patients?

A

Poor compliance with treatment or follow up of diagnostic tests

226
Q

In malingering patinets when do complains cease?

A

Complaints cease after gain

227
Q

Patient CONSIOUSLY creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (1º (INTERNAL- psychological) gain)

A

Factitious disorder

228
Q

Types of Factitious disorder

A

Munchausen syndrome

Munchausen syndrome by proxy

229
Q

Chronic factitious disorder with predominantly physical signs and symptoms

A

Munchausen syndrome

230
Q

What characterizeses Munchausen syndrome?

A

By a history of multiple hospital admissions and willingless to receive invasive procedures

231
Q

What is Munchausen syndrome by proxy?

A

When illness in a child or eldery patient is caused by the caregivers
Motivation is to asume a sick role by proxy
Form of child/elder abuse

232
Q

Category of disorders characterized by physical symptoms with no identifiable physical cause

A

Somatic symptom and related disorders

233
Q

Both illness production and motivation are UNCONSCIOUS drives

A

Somatic symptom and related disorders

234
Q

Characteristics of symptoms in Somatic symptom and related disorders

A

Symptoms not intentionally produced or feigned

235
Q

In who is it more common Somatic symptom and related disorders?

A

In women

236
Q

Types of Somatic symptom and related disorders

A

Somatic symptom disorder
Conversion disorder
Illness anxiety disorder (hypochondriasis)

237
Q

Variety of complaints in one or more organ systems lasting for months to years

A

Somatic symptom disorder

238
Q

What is associated to Somatic symptom disorder?

A

With excessive, persistent thoughts and anxiety about symptoms

239
Q

Can medical illness occur with Somatic symptom disorder?

A

Yes, may co-occur

240
Q

Sudden loss of sensory or motor function (eg. paralysis, blindness, mutism) often following an acute stressor

A

Conversion disorder

241
Q

How is the relationship of symptoms and the patient in conversion disorder?

A

Patient is aware of but sometimes indifferent toward symptoms (“la belle indifference”)

242
Q

In which patients is it more common to see Conversion disorder?

A

In females, adolescents and young adults

243
Q

Alternative name for Illness anxiety disorder

A

Hypochondriasis

244
Q

Preocupation with and fear of having a serious illness despite medical evaluation and reassurance

A

Hypochondriasis (Illness anxiety disorder)

245
Q

Types of personalities

A

Personality trait

Personality disorder

246
Q

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

A

Personality trait

247
Q

Characteristics of Personality disorder

A

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

248
Q

When does personality disorder usually presents?

A

By early adulthood

249
Q

Types of personality disorders

A

Three clusters, A, B, and C; remem

250
Q

Cluster A personality disorders

A

Paranoid
Shozoid
Schizotypal

251
Q

Cluster A personality disorders characteristics

A

Odd or eccentric; inability to develop meaningful social relationship

252
Q

Pervasive distrust and suspiciousness

A

Paranoid personality

253
Q

Which is the major defence mechanism of Paranoid patients?

A

Projection

254
Q

Voluntary social withdrawal, limited emotional expression, content with social isolation

A

Schizoid personality

255
Q

Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness

A

Schiztypal personality

256
Q

Cluster B personality disorders

A

Antisocial
Borderline
Histrionic
Narcissistic

257
Q

Characteristics of Cluster B personality disorders

A

Dramatic, emotional or erratic

258
Q

What is associated to Clusted B personality disorders?

A

Genetic association with mood disorders and substance abuse

259
Q

Disregard for and violation of rights of others, criminality, impuslitivy

A

Antisocial personality

260
Q

Which gender is more common to see antisocial personality?

A

Males

261
Q

When is diagnose Antisocial personality?

A

Must be > 18 years old and have history of conduct disorder before age 15

262
Q

Alternative name for antisocial personality

A

Sociopath

263
Q

How is Antisocial personality known when the patient is

A

Conduct disorder

264
Q

Characteristics of borderline personality

A

Unstable mood and interpersonal relationships, impulsiveness, self mutilation, boredom, sense of emptiness

265
Q

In which gender is more common borderline personality?

A

Females

266
Q

Defense mechanism in borderline personalities

A

Splitting

267
Q

Type of personilty with excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance

A

Histrionic personality

268
Q

Characteristics of Narcissistic personality

A

Grandiosity, sense of entitlement; lacks empathy and requires excessive admiration
Often demands the “best” and reacts to criticism with rage

269
Q

Cluster C personality disorders

A

Avoidant
Obsessive compulsive
Dependent

270
Q

Characteristics of Cluster C personality disorders

A

Anxious or fearful; genetic association with anxiety disorders

271
Q

Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others

A

Avoidant personality

272
Q

Preoccupation with order, perfectionism, and control

A

Obsessive compulsive

273
Q

What is ego syntonic in Obsessive compulsive personalities?

A

Behavior consistent with one’s own beliefs and atitudes

274
Q

What personality is similar to Obsessive compulsive?

A

Obsessive Compulsive disorder

275
Q

Submissive and clinging, excessive need to be taken care of, low self confidence

A

Dependent personality

276
Q

Evolution of disease in order to become Schizoaffective

A

Shizoid

277
Q

What is a Schizotypal?

A

Schizoid + odd thinking

278
Q

What is a Schizophrenic?

A

Greater odd thinking tja schizotyoal

279
Q

What is Schizoaffective?

A

Schizophrenic psychotic symptoms + bipolar or depressive mood disorder

280
Q

Schizophrenia time course

A

6 mo- schizophrenia

281
Q

Eating disorders

A

Anorexia nervosa

Bulimia nervosa

282
Q

Components of anorexia nervosa

A

Excessive dieting +/- purging intense fear of gaining weight, body image distortion, and ↑ exercise, leading to a body weight well below ideal

283
Q

Which is weight bellow ideal?

A

BMI

284
Q

How are the bones affected in Anorexia nervosa?

A

Associated with ↓ bone density

285
Q

Clinical findings of Anorexia nervosa

A

Severe weight loss, metatarsal stress fractures, amenorrhea, lanugo(fine body hair), anemia, and electrolyte disturbances

286
Q

What is the associated cause of osteoporosis in Anorexia nervosa?

A

Caused in part by ↓ estrogen over time

287
Q

In whom is more often seen Anorexia and Bulimia nervosa?

A

Primarily in adolescent girls

288
Q

Which other psychological problem is associated to anorexia nervosa?

A

Commonly coexists with depression

289
Q

Characteristics of Bulimia nervosa

A

Binge eating +/- purging often followed by self induced vomiting or use of laxatives, diuretics or emetics

290
Q

How is the body weight in patients with Bulimia nervosa?

A

Often maintain within normal range

291
Q

Findings in patients with Bulimia nervosa

A

Associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, Russel sign

292
Q

What is Russel sign?

A

Dorsal hand callues from induced vomiting

293
Q

Strong, persistent cross gender identification

A

Gender Dysphoria

294
Q

What characterizes Gender Dysphoria?

A

By persistent discomfort with one’s sex assigned at birth, causing significant distress and/ or impaired functioning

295
Q

How are affected individuals with Gender dysphoria refered as?

A

Transgender

296
Q

Desire to live as the opposite sex, often through surgery or hormone treatment

A

Transsexualism

297
Q

What is Transvestism?

A

PAraphilia, not gender dysphoria. Wearing clothes (eg. vest) of the opposite sex (cross dressing)

298
Q

Disorders included in Sexual dysfunction

A

Includes sexual disorders (hypoactive sexual desire or sexual aversion), sexual arousal disorders (erectile dysfunction), orgasmic disorders (anorgasmia and premature ejaculation) and sexual pain disorders (dyspareunia and vaginismus)

299
Q

Which differential diagnosis are included in sexual dysfunction?

A

Drugs
Diseases
Psychological (performance anxiety)

300
Q

Which drugs may be related to sexual dysfunction?

A

Antihypertensives, neuroleptics, SSRIs, ethanol

301
Q

Which diseases are related to sexual dysfunction?

A

Depression, diabetes, STDs

302
Q

Periods of terror with screaming in the middle of the night

A

Sleep terror disorder

303
Q

When does sleep terror disorder happens?

A

During slow wave sleep

304
Q

In whom is Sleep terror disorder more common?

A

Most common in children

305
Q

In which phase of sleep does Sleep terror disorder occurs?

A

Occurs during non REM sleep (no memoty of arousal) as opposed to nightmares that occur during REM sleep (memory of a scary dream)

306
Q

When do nightmares occur?

A

During REM sleep

307
Q

Which are the causes of sleep terror disorder?

A

Cause unknown, but triggers may include emotional stress, fever, or lack of sleep

308
Q

Which is the treatment for sleep terrors?

A

Usually self limited

309
Q

Disordered regulation of sleep-wake cycles

A

Narcolepsy

310
Q

Which is the primary characteristic of Narcolepsy?

A

Is excessive daytime sleepiness

311
Q

What causes narcolepsy?

A

By ↓ orexin production in lateral hypothalamus

312
Q

What is also associated to Narcolepsy?

A

Hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations
Nocturnal and narcoleptic sleep episodes that start off with REM sleep
Cataplexy in some patients

313
Q

What is cataplexy?

A

Loss of all muscle tone following a strong emotional stimulus, such as laughter

314
Q

Does genetics play a role in narcolepsy?

A

Yes, strong genetic component

315
Q

Treatment for narcolepsy

A

Daytime stimulants (eg. amphetamines, modafinil) and nighttime sodium oxybate (GHB)

316
Q

How is maladaptative pattern of substance use is defined?

A

As 2 or more of the following signs in 1 year:
Tolerance- need more to achieve same effect
Withdrawal
Substance taken in larger amounts, or over longer time, than desired
Persistent desire or unsuccessful attempts to cut down
Significant energy spent obtaining, using, or recovering from substance
Important social, occupational, or recreational activities reduced because of substance use
Continued use in spite of knowing the problems that it causes
Craving
Recurrent use in physically dangerous situations
Failure to fulfill major obligations at work, school or home due to use
Social or interpersonal conflicts related to substance use

317
Q

Stages of Change in overcoming substance addiction

A
  1. Precontemplation
  2. Contemplation
  3. Preparation / determination
  4. Action/ willpower
  5. Maintenance
  6. Relapse
318
Q

What happens in precontemplation?

A

Not yet acknowledging that there is a problem

319
Q

Acknowledging that there is a problem, but not yet ready or willing to make a change

A

Contemplation

320
Q

What happens in preparation/ determination

A

Getting ready to change behavior

321
Q

Changing behaviors

A

Action/willpower

322
Q

Maintaining behavior change

A

Maintenance

323
Q

What is the Relapse?

A

Returning to old behaviors and abandoning new changes

324
Q

How are Psychoactive drugs classified?

A

Depressants
Stimulants
Hallucinogens

325
Q

Which drugs are Drepressants?

A

Alcohol
Opioids
Barbiturates
Benzodiazepines

326
Q

Effect of depressant drugs

A

Nonspecific: Mood elevation, ↓ anxiety, sedation, behavioral disinhibition, respiratory depression

327
Q

Withdrawal effects of Depressant drugs

A

Nonspecific: anxiety, tremor, seizures, insomnia

328
Q

Clinical effect of Alcohol

A

Emotional lability, slurred speech, ataxia, coma, blackouts

329
Q

Sensitive indicator of alcohol abuse

A

Serum γ glutamyltransferase (GGT)

330
Q

Which liver enzyme is altered?

A

GGT

AST value is twice ALT value

331
Q

Symptoms caused by mild alcohol withdrawal

A

Symptoms similar to other depressants

332
Q

Several alcohol withdrawal consequences

A

Can cause autonomic hyperactivity and Delirium tremens (5-15% mortality rate)

333
Q

Which is the treatment for delirium tremens?

A

Benzodiazepines

334
Q

Example of opiods

A

Morphine, heroin, methadone

335
Q

Intoxication symptoms of Opiods

A

Euphoria, respiratory and CNS depression, ↓ gag reflez, pupillary constriction (pinpoints pupils), seizures (overdose)

336
Q

Treatment for Opiods abuse

A

Naloxone, naltrexone

337
Q

Symptoms of Opiods withdrawal

A

Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (flu-like symptoms)

338
Q

Treatment for withdrawal from opiods

A

Long term support, methadone, buprenorphine

339
Q

Toxic effects of Barbiturates

A

Low safety margin, marked respiratory depression

340
Q

What is the treatment for barbiturates intoxication?

A

Symptom management (assis respiration, ↑ BP)

341
Q

Withdrawal effects of Barbiturates

A

Delirium, life threatening cardiovascular collapse

342
Q

Which depressant drugs have greater safety margin?

A

Benzodiazepines

343
Q

Intoxication symptoms of Benzodiazepines

A

Ataxia, minor respiratory depression

344
Q

Treatment for Benzodiazepines

A

Suportive care; consider flumazenil

345
Q

Competitive banzodiazepine antagonist

A

Flumazenil

346
Q

Withdrawal effects of Benzodiazepines

A

Sleep disturbance, depression, rebound anxiety, seizure (can be triggered by reveal with flumazenil)

347
Q

Stimulants drugs

A

Amphetamines
Cocaine
Caffeine
Nicotine

348
Q

Effect of intoxication by stimulant drugs

A

Nonspecific: mood elevation, psychomotor agitation, insomnia, cardiac arrhytmias, tachycardia, anxiety

349
Q

Withdrawal efects of stimulant drugs

A

Nonspecific: post use “crash”, including depression, lethargy, weight gain, headache

350
Q

Which are findings of amphetamine intoxication?

A

Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and atention, hypertension, tachycardia, anorexia, paranoia, fever

351
Q

Severe toxic intoxication by amphetamines

A

Cardiac arrest, seizures

352
Q

Withdrawal effects of Amphetamines

A

Anhedonia, ↑ appetite, hypersomnolence, existential crisis

353
Q

Toxice effects of Cocaine

A

Impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death

354
Q

Treatment for cocaine intoxication

A

Benzodiazepines

355
Q

Withdrawal effect of Cocaine

A

Hypersomnolence, malaise, severe psychological craving, depression/ suicidality

356
Q

Caffeine toxic effects

A

Restlessness, ↑ diureses, muscle twithcing

357
Q

Withdrawal effects of caffeine

A

Lack of concetration, headache

358
Q

Most common effect of Nicotine intoxication

A

Restlessness

359
Q

Withdrawal effect of nicotine

A

Irritability, anxiety, craving

360
Q

Treatment for Nicotine Withdrawl

A

Nicotine patch, gum, or lozenges; bupropion/ varenicline

361
Q

Hallucinogen drugs

A

PCP (Phencyclidine), LSD (Lysergic acid diethylamide), Marijuana (cannabiboid)

362
Q

Toxic effects of PCP (Phencyclidine)

A

Belligerence, impulsiveness, fever, psychomotor agitation, analgesia, verical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures

363
Q

Treatment of PCP (Phencyclidine) intoxication

A

Benzodiazepines, rapid acting antipsychotic

364
Q

Withdrawal effects of PCP (Phencyclidine)

A

Depression, anxiety, irritability, restlessness

365
Q

Intoxication effects of LSD

A

Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks

366
Q

Marijuana is a…

A

Cannabinoid

367
Q

Toxic effects of Marijuana

A

Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, ↑ appetite, dry mouth, conjunctival injection, hallucinations

368
Q

Prescription form of marijuana (cannabinoid)

A

Dronabinol (tetrahydrocannabinol isomer)

369
Q

Which is the clinical use for dronabinol?

A

Used as antiemetic (chemotherapy) and appetite stimulant (in AIDS)

370
Q

Withdrawal effect of Marijuana

A

Irritability, depression, insomina, nausea, anorexia

371
Q

When do most symptoms peak in Marijuana withdrawal? and how much do they last?

A

In 48 hours, and last for 5-7 days

372
Q

For how many days can marijuana be detected in urine?

A

Generally detectable in urine for 4-10 days

373
Q

Which risks do Heroin users have?

A

Users at ↑ risk for Hepatitis, absecess, overdose, hemorroids, AIDS, and right sided endocarditis

374
Q

What do we need to look for when suspectic of Heroin addiction?

A

For track marks (needle sticks in veins)

375
Q

Mediactions treatment for Heroin users

A

Methadone
Naloxone + buprenorphine
Naltrexone

376
Q

Long acting oral opiate

A

Methadone

377
Q

How does Methadone in Heroin users?

A

Used for heroin detoxification or long term maintenance

378
Q

What are Naloxone + Buprenorphine?

A

Partial agonist

379
Q

Which are the benefit of Naloxone + Buprenorphine compared to Methadone in Heroin users?

A

Longacting with fewer withdrawal symptoms compared to methadone

380
Q

For Heroin users which is the way of Naloxone + Buprenorphine adminsitration?

A

Naloxone is not active when taken orally, so withdrawal symptoms occur only if injected (lower abuse potential)

381
Q

Long acting opiod antagonist used for relapse prevention once detoxified in Heroin users

A

Naltrexone

382
Q

Characteristics of Alcoholism

A

Physiologic tolerance and dependence with symptoms of withdrawal when intake is interrupted

383
Q

Withdrwal symptosm of alcohol

A

Tremor, tachycardia, hypertension, malaise, nausea, delirium tremens

384
Q

Complications of alcoholism

A

Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy

385
Q

Treatment for alcoholism

A

Disulfiram, naltrexone, suportive care

Alcoholics Anonymous and other peer support groups are helpful in sustaining abstinence

386
Q

What is the point of administering Disulfiram in alcoholics?

A

To condition the patient to abstain from alcohol use

387
Q

Which pathology is caused by Thiamine deficiency?

A

Wernicke Korsakoff syndrome

388
Q

Which si the triad of Wernicke Korsakoff syndrome?

A

Confusion
Ophthalmoplegia
Ataxia (Wernicke encephalopathy)

389
Q

Which may be te progression of Wernicke Korsakoff syndrome?

A

May progress to irreversible memory loss, confabulation, personality change (Korsakoff psychosis)

390
Q

What is associated to Wernicke Korsakoff syndrome?

A

Periventricular hemorrhage/necrosis of mamillary bodies

391
Q

Which is the treatment for Wernicke Korsakoff syndrome?

A

IV vitamin B1 (thiamine)

392
Q

Longitudinal partial thickness tear at the gastroesophageal junction caused by excessive vomiting

A

Mallory Weiss syndrome

393
Q

How is Mallory Weiss syndrome presented?

A

With hematemesis

394
Q

What is associated to Mallory Weiss syndrome?

A

With pain

395
Q

Differential diangosis of Mallory Weiss syndrome

A

Esophageal varices

396
Q

What is Delirium Tremens?

A

Life threatening alcohol withdrawal syndrome

397
Q

When does Delirium tremens happens?

A

Peaks after 2-5 days after last drink

398
Q

Symptoms in order of appearance of delirium tremens

A

Autonominc system hyperactivity (tachycardia, tremors, anxiety, seizures)
Psychotic symptoms (hallucinations, delusions)
Confusion

399
Q

Which is the treatment for Delirium Tremens?

A

Benzodiazepines

PSYCHIATRY (3 decks)

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