Term
| What is an idea of reference? |
|
Definition
| Belief that object, event, or person in one's environement has particular personal significance (Tv talking to you, Biblical passage meant for you alone) |
|
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Term
|
Definition
| Fixed, false belief. Can be bizarre (automatically qualifies for psychosis) or non-bizarre (alone, qualifies for delusional disorder) |
|
|
Term
|
Definition
| Misperception or misinterpretation of real external sensory stimuli. Black flecks on hospital ceiling turn into flies. |
|
|
Term
| What is a loose association? |
|
Definition
| Disturbance in continuity of thought -> expression of ideas that do not seem to be logically related |
|
|
Term
| What is circumstantiality? |
|
Definition
| Loss of goal-directed thought process. Pt. talks about related subjects/unnecessary details before eventually returning to original question/subject |
|
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Term
|
Definition
|
|
Term
|
Definition
| Response that persists even after a new stimulus is introduced. Pt. saying "No ifs ifs ifs ifs" during MMSE. Or, inability to change topics or giving same response to different questions. |
|
|
Term
|
Definition
| Rapid experession of thoughts with constant shifting from one idea to another. Seen in mania, psychosis. |
|
|
Term
| What is clang association? |
|
Definition
| Thoughts come out in a rhyming pattern. Pt says "voices tell me not to eat, any food would mean defeat" |
|
|
Term
|
Definition
| Pt. deviates from point of question and never returns to that line, unlike circumstantialy where pt. eventually returns to orginal topic and answers question. |
|
|
Term
|
Definition
| False sensory perception. |
|
|
Term
| Which type of hallucination is usually seen in psychosis? |
|
Definition
|
|
Term
|
Definition
| Sensation or hallucation caused by another sensation. Taste of chocolate leads to seeing roses. |
|
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Term
| Pt. presents with preoccupated with perfection, orderliness, that is ego-syntonic? |
|
Definition
| Obsessive compulsive personality disorder (ego syntonic) |
|
|
Term
| Pt. presents with obsession with doors being unlocked that causes anxiety until pt. checks all locks 5 times. Pt. realizes this is foolish? |
|
Definition
| Obsessive compulsive disorder (ego dystonic) |
|
|
Term
| Pt. presents with history of child abuse, instability of mood, relationships, and self-image. Pt. is impulsive and has scars on wrists? |
|
Definition
| Borderline personality disorder |
|
|
Term
| Pt. preferes to be alone. Pt has limited emotional range? |
|
Definition
| Schizoid personality disorder (does not want relationships) |
|
|
Term
| Pt. injects fecal matter into their skin to create abscess? |
|
Definition
| Factitious disorder. Pt. wants to play sick role (primary gain) |
|
|
Term
| What is concrete thinking? |
|
Definition
| No ability to form abstract concepts like metaphor. When asked what is similar about apple and orange? They say they are both round, as opposed to both fruit. Normal in children. |
|
|
Term
| What are risk factors for violent behavior? |
|
Definition
| Male, age 15-24, overt stressor present, low socioeconomic status, few social supports |
|
|
Term
| Pt. recently hospitalized comes in and out of consciousness during interview and does not know where he is. Pt. states he sees spirits in room and vampires are stealing his blood. Wife says he has never acted like this before. |
|
Definition
| Delirium, characterized by acute onset, caused by medical condition (fever, infection, withdrawal, trauma, metabolic abnormality) |
|
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Term
|
Definition
| Characterizing people and world as all good or all bad, seen in Borderline PErsonality disorder. |
|
|
Term
| Sudden appearance of neurological symptoms plus psychosocial stressor? |
|
Definition
| Conversion disorder, seen more frequently in women and low socioeconomic status. Always a DX of exclusion |
|
|
Term
| Persistent overwhelming fear of humiliation or embarassment in social or performance situation that causes physical symptoms of anxiety in those situations? |
|
Definition
| Social phobia. Tx- psychotherapy, propranolol |
|
|
Term
| What is thought blocking? |
|
Definition
| Pt. suddenly stops talking mid-sentence and can't complete sentence. Sx of psychosis. |
|
|
Term
| What is thought insertion? |
|
Definition
| Pt. believes thought being inserted into their mind. Sx of psychosis. |
|
|
Term
|
Definition
| Subjective sense that environment is strange or unreal |
|
|
Term
| What is depersonalization? |
|
Definition
| Feeling that one is falling apart or not one's self any longer. |
|
|
Term
| What is magical thinking? |
|
Definition
| Belief that one's thoughts or ideas have special powers |
|
|
Term
| What is thought broadcasting? |
|
Definition
| Pt. believes thoughts are being stolen or sent out to others. Sx of psychosis. |
|
|
Term
|
Definition
| Repetition of examiner's words or phrases by pt. |
|
|
Term
|
Definition
| Belief that one's self, others, or world are non-existent or coming to an end |
|
|
Term
| Intentional production of syptoms for secondary gain? |
|
Definition
|
|
Term
| Intentional production of symptoms for primary gain? |
|
Definition
|
|
Term
| Unconscious production of physical symptoms? |
|
Definition
|
|
Term
| Unconscious production of neuro sx? |
|
Definition
| Conversion disorder, seen more frequently in women and low socioeconomic status. Always a DX of exclusion |
|
|
Term
| Mimicking of examiner's body posture or movements? |
|
Definition
|
|
Term
| Shared delusion held by two or more people? |
|
Definition
| Folie a deux or shared delusional disorder. First step- interview alone. If hospitalized, keep away from eachother. |
|
|
Term
| Pt. takes on new identity after sudden stressor and travel, with no memory of old identity? |
|
Definition
| Dissociative fugue. Usually resolves with time. |
|
|
Term
| What is each axis for in psychiatric assessment? |
|
Definition
| Axis 1- psych x, Axis II- personality disorders, mental retardation, Axis III- medical dx, Axis IV- social stressors, Axis V- global assessment of function |
|
|
Term
| Difficulty temperment as infant may signal? |
|
Definition
| Increased risk of conduct problems in school |
|
|
Term
| Erikson stage 0-2 years old? |
|
Definition
|
|
Term
| Erikson stage 2-4 years old? |
|
Definition
| Autonomy vs Shame and Doubt |
|
|
Term
| Erikson stage 4-5 years old? |
|
Definition
|
|
Term
| Erikson Stage 5-12 years old? |
|
Definition
|
|
Term
| Erikson stage 13-19 years old? |
|
Definition
| Identity vs Role confusion |
|
|
Term
| Erikson stage 20-24 years old? |
|
Definition
|
|
Term
| Erikson stage 25-64 years old? |
|
Definition
| Generativity vs Stagnation |
|
|
Term
| Erikson stage 65 to death? |
|
Definition
|
|
Term
| Mahler infantile development, 0-2 months? |
|
Definition
| Autistic phase- no interest in interpersonal relationships |
|
|
Term
|
Definition
| Symbiosis- psychological fusion between mother and child |
|
|
Term
|
Definition
| Separation- individualization |
|
|
Term
|
Definition
| 6-10 mo- child realizes mother is separate person |
|
|
Term
|
Definition
| 10-16mo- practicing, exploration of enviroment |
|
|
Term
|
Definition
| 16-24 mo- rapproachment- need to know where mother is and refuel with contact |
|
|
Term
|
Definition
| 24-36mo- object constancy. integration of good and bad aspects of mother and child's self. Bad mother frustrates child's wishes. Good mother nurtures child. |
|
|
Term
| According to Heinz Kohutt, what does a child need to develop coherent stable sense of self? |
|
Definition
| Positive emphatic responses from caretakers. Without, child will grow up to have fragile self esteem and constant need for validation |
|
|
Term
|
Definition
| Sensorimotor- child focuses mostly on developing senses and motor skills |
|
|
Term
| Piaget stage 2-6 years old? |
|
Definition
| Pre-operational- child focuses on peforming physical tasks |
|
|
Term
|
Definition
| Concrete operational- child begins to think logical and reason through problems, unable to think abstractly |
|
|
Term
| Piaget stage 11 years and on? |
|
Definition
| Formal operational- child can think abstratively and use deductive reasoning |
|
|
Term
| What is a transitional object? |
|
Definition
| Comforting substitute for primary caregiver that allows child to tolerate separation w/o excessive anxiety (toy or blanket) |
|
|
Term
|
Definition
| Conscious awareness of painful reality is abolished (Pt with terminal cancer tells son that they are perfectly healthy) |
|
|
Term
|
Definition
| Acting as if unacceptable internal impulses are coming from external realm. Pt who wants to cheat on wife accuses wife of cheating on him. |
|
|
Term
| Pt. who is angry at father uses anger to perform better in football game? |
|
Definition
| Sublimation- transforming unacceptable social impulses into acceptable outlet in order to achieve impulse gratification |
|
|
Term
| Pt. who is angry/racist about imigrants in town volunteers to help imigrants find jobs? |
|
Definition
| Reaction formation- transforming unacceptable impulse into its opposite (must differentiate from altruism. In reaction formation, unacceptable impulse still present. In altruism, pt. gives freely of time. Doesn't have to be related to prior history, but question will probably be tricky) |
|
|
Term
| Pt. with history of alcohol dependence who has been sober for 12 years volunteers to teach kids at local school about substance abuse? |
|
Definition
| Altruism- service to others as way to gratify one's instincs (mature defense mechanism) |
|
|
Term
| according to Freud's structural theory, what are the three areas? |
|
Definition
|
|
Term
|
Definition
| Instinctual drives, mostly unconscious(devil on left shoulder) |
|
|
Term
|
Definition
| Agency that contains internalized parental and societal rules, mostly unconscious (angel on right shoulder) |
|
|
Term
|
Definition
| Agency that attempts to find equilibrium between Id and Superego to create preconscious and conscious functons |
|
|
Term
| Can emotional deprivation lead to failure to thrive in infant? |
|
Definition
|
|
Term
| Reshaping of external reality to suit one's inner needs? |
|
Definition
| Distortion- pt. remembers only positive feedback and ignores negative |
|
|
Term
| Pt can describe murder he witnessed with no emotion? |
|
Definition
| Isolation (of affect)- splitting an idea from the emotion accompanying it. |
|
|
Term
| What are narcisstic or primitive defense mechanism? |
|
Definition
| Denial, projection, distortion |
|
|
Term
| What are immature defense mechanisms? |
|
Definition
| Acting out, introjection, passive-aggressive, somatitization |
|
|
Term
| What are neurotic defense mechanisms? |
|
Definition
| Displacement, Externalization, Intellectualization, rationalization, inhibition, reaction formation, repression |
|
|
Term
| What are mature defensive mechanisms? |
|
Definition
| Sublimation, altruism, ascetism, anticipation, supression, humor |
|
|
Term
| Avoidance of personally unacceptable feelings by behaving in a socially inappropriate manner? |
|
Definition
|
|
Term
|
Definition
| Offering explanation in an attempt to justify attitudes, beliefs, or behavior that would otherwise be unacceptable. "I got fired because I drank tea and my boss was a coffee person." |
|
|
Term
| Adult acts like child in hospital? |
|
Definition
| Regression- pt. reverts to earlier developmental stage. Often brought on by significant stress. |
|
|
Term
| Compulsive act performed to negate or avoid consequences of fantasized action that is result of obsessive impulse? |
|
Definition
| Undoing- pt. fantasizes about detaching gas hose in basement so she keeps going downstairs to check that gas is hooked up |
|
|
Term
| What are three defensive mechanisms commonly seen in obsessive compulsive disorder? |
|
Definition
| Undoing, reaction formation, and isolation |
|
|
Term
| What are three phases of separation that child goes through? |
|
Definition
| Protest phase- 0-3 days after separation- child cries, calles for parent. Despair phase- child gives up hope after 3 days, transfers affection to another. Parent returns- child will initially be ambivalent. Does not return- child becomes hopeless. Detachment phase- bond with parent irreparably severed |
|
|
Term
| Freudian developmental stage 0-18 mo? |
|
Definition
| Oral stage- oral sensations give gratification, oral personality = dependent |
|
|
Term
| Freudian developmental stage 18-36mo? |
|
Definition
| Anal stage- excretion/retention of feces is main source of gratification. Anal personality = stubborn, frugal |
|
|
Term
| Freudian developmental stage 3-5 years? |
|
Definition
| Phallic stage- child looks outside him/herself for erotic object |
|
|
Term
|
Definition
| Also 3-5 years- after child achieves phallic stage. Boy loves mom, sees father as rival. Girl loves father, sees mother as rival. |
|
|
Term
| Freudian developmental stage 5-11/13 years? |
|
Definition
| Latent stage- sex drive quiescent. Focus on learning new skills and interacting with peers. |
|
|
Term
| Freudian developmental stage >11/13 years? |
|
Definition
| Genital stage- master instinctual drives, separate from parents, and establish genital sexuality |
|
|
Term
| What is freuds topographic model of mind? |
|
Definition
| Conscious, preconscious, and unconscious |
|
|
Term
| What is freuds structural model of mind? |
|
Definition
|
|
Term
|
Definition
| Process through which latent content is transformed into manifest content |
|
|
Term
| What is latent dream content? |
|
Definition
| Impulses, ideas unacceptable to conscious mind |
|
|
Term
| What is manifest dream content? |
|
Definition
| Images and sensations recalled by dreamer |
|
|
Term
|
Definition
| Combining different concepts or feelings into one image |
|
|
Term
| What is symbolic represenation? |
|
Definition
| Using neutral or innocent imagery to represent highly charged senses or impulses |
|
|
Term
|
Definition
| Divering feeling or energy associated with one object to another more acceptable to dreamer's superego |
|
|
Term
| What is secondary revision? |
|
Definition
| Ego intervenes at end of dreamwork to make manifest content more rational and acceptable to dreamer |
|
|
Term
|
Definition
| Sudden loss of muscle tone triggered by strong emotion or sensation, due to intrusion of REM sleep |
|
|
Term
| What is treatment of cataplexy? |
|
Definition
| Stimulant or antidepressant (antidep -> dec REM sleep) |
|
|
Term
|
Definition
| Immobile position constantly maintained (waxy flexibility seen in catatonic schizophrenia) |
|
|
Term
|
Definition
| Resistance to any attempt to have patient move |
|
|
Term
|
Definition
| Automatic performance of an act that may have symbolic meaning |
|
|
Term
| Repetitive and fixed pattern of behavior or speech? |
|
Definition
|
|
Term
| Pt can be molded into any position? |
|
Definition
|
|
Term
| In which sleep stage does one see decreased muscle tone, elevated BP and HR, erection? |
|
Definition
|
|
Term
| Spasmodic contractions of muscles of neck, trunk, tongue, face caused by antagonism of dopamine by neuroleptic? |
|
Definition
| Dystonia- tx- anticholinergic (benztropine, diphenhydramine trihexyphenidyl) |
|
|
Term
| What are the genes involved in inherited (early onset) Alzheimers? |
|
Definition
| Preseniline 1 gene on chromosome 14 (70-80%). Presenilin 2 gene on chromosome 1 (20-30%). Beta amyloid precursor protein gene (APP) on chromosome 21 (2-3%) |
|
|
Term
| What gene is involved in increased risk of late onset/non-inherited Alzheimer's? |
|
Definition
| ApoE gene- ApoE4 allele confers increased risk. |
|
|
Term
| Anterograde amnesia in alcoholic? |
|
Definition
| Korsakoff syndrome due to thiamine deficiency (hits mamillary bodies). Inability to form new memories (anterograde amnesia), with remote memory relatively spared) |
|
|
Term
| Where do 90% of partial complex seizures begin? |
|
Definition
|
|
Term
| Partial complex seizures are associated with what type of hallucination? |
|
Definition
| Olfactory. Odor comes from tip of temperaol- uncus. |
|
|
Term
| Low levels of what neurotransmitter lead to increased risk of suicide? |
|
Definition
|
|
Term
| Which neurotransmitter is associated with memory and cognitive function? |
|
Definition
|
|
Term
| Which neurotransmitter is associated with psychosis? |
|
Definition
|
|
Term
| Which neurotransmitter is associated with OCD, depression, and suicide? |
|
Definition
|
|
Term
| Which neurotransmitter is associated with anxiety disorders? |
|
Definition
|
|
Term
| Any anti-parkinsonian drug can cause? |
|
Definition
| Hallucinations due to increase in dopamine |
|
|
Term
| Nonfluent spontaneous speech, poor auditory comprehension, poor repition and poor naming? |
|
Definition
|
|
Term
| Fluent spontaneous speech, poor auditory comprehension, poor repetition, poor naming? |
|
Definition
| Wernicke (receptive) aphasia |
|
|
Term
| Nonfluent spontaneous speech, good audtiory comprehension, poor repetion, poor naming? |
|
Definition
| Broca (expressive) aphasia |
|
|
Term
| Fluent spontaneous speech, good auditory comprehension, poor repetion, poor naming? |
|
Definition
|
|
Term
| Where is broca's area of brain? |
|
Definition
| Brodman area 44 and 45- inferior frontal gyrus |
|
|
Term
| What is Wernicke's area of brain? |
|
Definition
| Brodman area 22- superior temporal gyrus |
|
|
Term
| Fluent spontaneous speech, good auditory comprehension, good repetion, and poor naming? |
|
Definition
|
|
Term
| What area of brain is involved in formation and storage of immediate and recent memories? |
|
Definition
|
|
Term
| Thiamine deficiency causes damage of? |
|
Definition
| Dorsal medial nucleus of thalamus and mamillary bodies |
|
|
Term
| Atrophy of caudate nucleus? |
|
Definition
| Huntingtons (choreiform movements) |
|
|
Term
| Lesion where causes euphoria, laughter, joking, and pun making? |
|
Definition
|
|
Term
| Lesion here causes depression and uncontrollable crying? |
|
Definition
|
|
Term
| Lesion here causes disinhibition, labile mood, iritability, eupohira, lack of remorse, poor insight/judgement? |
|
Definition
| Orbitofrontal area of frontal lobe |
|
|
Term
| Lesion here causes poor planning, decreased flexibility, decreased motivation, poor attention? |
|
Definition
| Dorsolateral region of frontal lobe |
|
|
Term
| Excessive motor activity, poor sustained attention, difficulty inhibiting impulses? |
|
Definition
|
|
Term
| How many settings must symptoms be seen in for dx of ADHD? |
|
Definition
| at least 2 (school, home) |
|
|
Term
| Onset of childhood disntegrative disorder? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Microcephaly, small eyes, long, smooth philtrum? |
|
Definition
| Fetal alchohol syndrome- causes IUGR, poor postnatal growth, microcephaly, developmental delay, ADHD later |
|
|
Term
| How old must child be for dx of nocturnal enuresis? |
|
Definition
|
|
Term
| Best treatment of nocturnal enuresis? |
|
Definition
| Bell-pad alarm. If unsuccessful, desmopressin, imipramine can be tried. |
|
|
Term
|
Definition
| alpha 2 agonist- clonidine, guafenacine. Typical antipsychotic- haloperidol or pimozide |
|
|
Term
| What is reactive attachment disorder? |
|
Definition
| Inability to relate to others and behavior problems caused by severely dysfunctional early relationship between caregiver and child (no stable attachment) |
|
|
Term
| Child only talks to parents/siblings at home? |
|
Definition
| Selective mutism- must differentiate from social phobia |
|
|
Term
| When do night terrors occur? |
|
Definition
| non-REM sleep- child does not rememeber in morning. Usually not treated. Can use benzo. |
|
|
Term
| When do nightmares occur? |
|
Definition
| REM sleep- child remembers. |
|
|
Term
| >6 mof of angry spiteful vindictive behavior in child? |
|
Definition
| Oppositional defiant disorder |
|
|
Term
| Disregard of rules, laws, and other's rights, violence toward animals, prior to age 18? |
|
Definition
| Conduct disorder- often becomes antisocial personality disorder after age 18 |
|
|
Term
| Impaired social interactions and impaired language development, usually dx prior to age 3 (or req to be dx prior to age 3) |
|
Definition
|
|
Term
| Impaired social interactions but normal language development? |
|
Definition
|
|
Term
| Progressive memory loss plus one of aphasia/anomia/apraxia? |
|
Definition
|
|
Term
| Inability to formulate or understand language? |
|
Definition
|
|
Term
| Inability to recal name of object? |
|
Definition
|
|
Term
| Inability to perform voluntary motor activity, but no evidence of motor or sensory deficit? |
|
Definition
|
|
Term
| Memory loss, psychosis, and personality change? |
|
Definition
| Frontotemporal dementia aka Pick disease (pick body- building of tau protein in neuron) |
|
|
Term
| Pt. presents with BMI of 17, amenorrhea? |
|
Definition
|
|
Term
| Repeated emesis leads to? |
|
Definition
| Hypokalemic hypochloremic metabolic acidosis |
|
|
Term
| How does repeated emesis cause hypokalemia? |
|
Definition
| H+ shift out of cells causes K+ to shift into cells. Aldosterone activated. Bicarbonated overflow in urine pulls positive K+ with it. |
|
|
Term
| Headache, intattention, memory loss, and drowsiness in elderly patient? |
|
Definition
| Chronic subdural hematoma- reversible cause of dementia- caused by tearing of bridging veins |
|
|
Term
| Altered consciousness, olfactory hallucinations, automatisms, and autonomic symptoms? |
|
Definition
| Partial complex seizure- automatism- spontaneous behavior- like tapping fingers- may march from fingers up arm to head |
|
|
Term
| Progressive cognitive decline, myoclonic jerks, rigidity, ataxia in 55 year old. EEG shows periodic burst activity? |
|
Definition
| Creutzfeld-Jakob disease- genetic (auto dom), consumption of contaminated meat, iatrogenic- corneal transplant, contaminted neurosurgery instruments. EEG can diagnose. Death within a year. |
|
|
Term
| Recurrent spontaneous anxiety attacks? |
|
Definition
|
|
Term
| Why are paresthesias common in anxiety/panic attacks? |
|
Definition
| Tachypnea causes respiratory alkalosis (inc. bicarb) -> decreased ionized calcium |
|
|
Term
| Excessive anxiety and worry for greater than 6mo, leads to physical symptoms? |
|
Definition
| Generalized anxiety disorder |
|
|
Term
| Why is dizziness and derealization common in anxiety/panic attacks? |
|
Definition
| Respiratory alkalosis and hypocapnia (low CO2) caused decreased cerebral perfusion |
|
|
Term
| Confusion, ataxia, and nystagmus, opthalmoplegia? |
|
Definition
| Wernicke encephalopathy- thiamine def, reversible |
|
|
Term
|
Definition
| Korsakoff syndrome due to thiamine deficiency (hits mamillary bodies). Inability to form new memories (anterograde amnesia), with remote memory relatively spared), usually irreversible |
|
|
Term
| Urinary incontinence, dementia, and ataxia? |
|
Definition
| Normal pressure hydrocephalus |
|
|
Term
| Treatment of normal pressure hydrocephalus? |
|
Definition
|
|
Term
| Hemorrhagic gastroenteritis, N/V, diarrhea, hypotension, seizures, coma. GARLIC smell on breath? |
|
Definition
| Acute Arsenic poisoning. But poisoning is usually chronic from drinking water. Can cause vit A def. -> night blindness. Tx- chelation with dimercaprol or succinic acid. |
|
|
Term
| Dopamine inhibits what in tuberoinfundibular path of brain? |
|
Definition
| Prolactin release. Antipsychotic inhibits dopamine and therefore increases prolactin. |
|
|
Term
| Recurrent fear that pt. has serious illness, can be temporarily reassured? |
|
Definition
| Hypochondriasis. Tx: regular followup with PCP |
|
|
Term
| What lab will be elevated for ~20-30 minutes after true generalized seizure? |
|
Definition
|
|
Term
| Tumor where causes headache, papilledema, homonymous heminopsia (right or left side vision loss in both eyes), flashes of light/aura? |
|
Definition
|
|
Term
| Tumor where causes olfactory or gustatory hallucinations, mood lability, and behavior changes? |
|
Definition
|
|
Term
| New onset hallucinations, hypertension, tachycardia, fever occuring after 3 days of hospitalization? |
|
Definition
|
|
Term
|
Definition
| Chronic head trauma -> cognitive decline, Parkinsonian symptoms |
|
|
Term
| Lead pipe muscle rigidity, mutism, obtundation, fever, diaphoresis, tachycardia, hypertension. Pt. on antipsychotic? |
|
Definition
| Neuroleptic malignant syndrome |
|
|
Term
|
Definition
| Stop antipsychotic. Dantrolene -> binds ryanodine receptor, causes Ca repackaging in ER -> muscle relaxation. Bromocriptine -> increase dopamine. |
|
|
Term
| Schizophrenia findings on EEG? |
|
Definition
| Increased theta and delta activity, decreased alpha activity |
|
|
Term
| Schizophrenia findings on PET? |
|
Definition
| Increased D2 receptors in caudate |
|
|
Term
| Schizophrenia findings on CT? |
|
Definition
| Enlarged lateral and 3rd ventricles, decreased cortical volume |
|
|
Term
| What are indicators of good prognosis in schizophrenia? |
|
Definition
| Late onset, acute onset, obvious precipitating factor, good premorvid functioning, presenve of mood disorder, pt. married, family history, good support system, presence of psotive symptoms |
|
|
Term
| Treatment of acute psychosis and agitation? |
|
Definition
| Haloperidol and lorazepam |
|
|
Term
| Acute psychotic disorder length? |
|
Definition
|
|
Term
| Schizophreniform disorder length? |
|
Definition
|
|
Term
| Schizophrenia disorder length for dx? |
|
Definition
|
|
Term
| Nonbizarre delusion without deterioration of psychosocial function, no hallucinations? |
|
Definition
|
|
Term
| Types of delusional disorder? |
|
Definition
| Erotomanic (famous person loves pt.), Grandiose (believes he is pope), Jealous (spouse cheating), Persecutory (FBI tracking me, drones trying to blow me up), Somatic (infested with bug, have bad odor, AIDS) |
|
|
Term
|
Definition
| Paranoid, Disorganized, Catatonic,Schizoaffective, Residual, Mixed |
|
|
Term
| Schizophrenia with prominent hallucinations and delusions and relative preservation of cognitive functioning? |
|
Definition
|
|
Term
| Schizophrenia that has been treated for a while and has mostly negative symptoms now? |
|
Definition
|
|
Term
| Schizophrenia with disorganized speech and behavior, flat or inapp affect, functional impairment? |
|
Definition
| Disorganized- grimacing and silly behavior common. |
|
|
Term
| Schizophrenia with psychomotor disturbances, prolonged immobility, negativism, waxy flexibility, mutism, echolala/echopraxia? |
|
Definition
|
|
Term
| Schizophrenia with occasional mood disorder? |
|
Definition
| Schizoaffective (always psychotic, occasionally depressed/manic) |
|
|
Term
| Always depressed, occasionally psychotic? |
|
Definition
| Mood disorder with psychotic features |
|
|
Term
| Which illicit drugs most commonly cause psychosis? |
|
Definition
|
|
Term
| Schizophrenia with symptoms of paranoid and disorganized? |
|
Definition
|
|
Term
| Why might schizophrenic patient have hyponatremia with low urine Na concentration that resolves with water restriction? |
|
Definition
| Psychogenic polydipsia common in schizophrenia |
|
|
Term
| Visual hallucination of a transparent phantom of one's own body? |
|
Definition
|
|
Term
| What is Capgras Syndrome? |
|
Definition
| Delusion that familiar people have been replaced by identical imposters |
|
|
Term
|
Definition
| Perception of having lost everything |
|
|
Term
| What is eye movement densenitization and reprocessing? |
|
Definition
| Pt. focuses on lateral movement of therapists finger while maintaing a mental image of stressful event. Tx option for PTSD |
|
|
Term
|
Definition
| Projection of feelings, thoughts, attitudes once connected to important figure in pt.'s past to therapist (or another important figure). Pt. unconsciously re-enacts old script with new figure. |
|
|
Term
| What is counter-transference? |
|
Definition
| Projection of feelings, thoughts, attitudes once connected to therapist onto pt. |
|
|
Term
| Pairing feared stimulus with relaxation therapy? |
|
Definition
| Desensitization. Tx option for phobia- show picture of spider while undergoing deep muscle relaxation |
|
|
Term
| What are relative contraindications to hypnosis? |
|
Definition
| Paranoid delusions, history of trauma |
|
|
Term
|
Definition
| Explanatory statement made by therapist that links symptoms, feeling or behavior to its unconscious meaning |
|
|
Term
|
Definition
| Therapist points out behavior of pt and assigns meaning to it. |
|
|
Term
|
Definition
| Physiological functions like BP or HR are fed backt to pt. with the goal of allowing pt to control body responses |
|
|
Term
| What is habit reversal training? |
|
Definition
| When urge felt, perform action incompatible w/ action (hair pulling -> clench fist), then perform benign action to remove urge (brush hair). Used for impulse control disorders. |
|
|
Term
| What four areas does interpersonal therapy focus on? |
|
Definition
| Complicating mourning, interpersonal roles (conflicts with sig. others), role transition (changes in life status), interpersonal deficits (lack of social skills) |
|
|
Term
| What is the behavior therapy used for OCD? |
|
Definition
| Exposure and extinction- expose pt to feared stimulus then prevent neutralizing compulsion. Behavior progressively disappears (becomes extinct) when expected consequence does not occur. |
|
|
Term
| Can a diagnosis of major depression be made if substance or general medication condition could be cause? |
|
Definition
|
|
Term
|
Definition
| Mood stabilizer such as lithium, valproate, or carbamazepine |
|
|
Term
| If psychotic symptoms present? |
|
Definition
| Add atypical antipsychotic. |
|
|
Term
|
Definition
| Mood stabilizer or atypical antipsychotic |
|
|
Term
| Which mood stabilizer is excreted renally? |
|
Definition
|
|
Term
| Which mood stablizers are handled hepatically? |
|
Definition
| Valproate and carbamazepine |
|
|
Term
| Which drug causes atrialization of right ventricle in newborn? |
|
Definition
| Lithium (1/1000 chance if used during pregnancy) |
|
|
Term
| Which drugs cause neural tube defects, craniofacial abnormalities, and genital defects? |
|
Definition
| Valproate and carbamazepine increase risk of these problems in newborn if used during preg. |
|
|
Term
| Depressed mood, hyperphagic, hypersomnia during winter? |
|
Definition
| Seasonal affective disorder. Tx- light therapy, SSRI |
|
|
Term
| 2 or more years of alternating hypomania and mild depression (doesnt meed MDD)? |
|
Definition
|
|
Term
| 2 or more years of mild depression? |
|
Definition
|
|
Term
| Can you have major depression on top of dysthymia? |
|
Definition
|
|
Term
| 4 or more different mood episodes in 1 year? |
|
Definition
|
|
Term
| Headache, anxiety, depression in woman that comes and goes on monthly basis? |
|
Definition
| Premenstrual dysphoric disorder - occurs 1 week prior to menses. Also see edema, wt. gain, breast pain. |
|
|
Term
| What are ECT contraindications? |
|
Definition
| Recent MI, inc. ICP, aneurysm, bleeding disorder |
|
|
Term
| How does depression affect brain activity? |
|
Definition
| Decreased latency between periods of REM sleep, decreased activity in frontal lobe |
|
|
Term
| What are characteristics of atypical depression? |
|
Definition
| Mood reactivity- better mood with certain events (grandkids come over), diurnal- mood better in morning, appetite and sleep improve if pleasurable event occurs |
|
|
Term
| Abuse in childhood, now has memory gaps, changes in mannerisms, affect throughout day? |
|
Definition
| Dissociative identity disorder (mutl. personality disorder)- 2 or more personalities alternately take control of conscious mind recurrently |
|
|
Term
| Which endocrine conditions can cause anxiety like symptoms? |
|
Definition
| Pheochromocytoma, hyperthyroidism, hypercortisolism, and hyperparathyroidism |
|
|
Term
| Which metabolic conditions can cause anxiety-like symptoms? |
|
Definition
| Hypoxemia, hypercalcemia, and hypoglycemia |
|
|
Term
| Which neurologic conditions can cause anxiety-like symptoms? |
|
Definition
|
|
Term
| 4 pain symptoms, 2 GI symptoms, 1 sexual symptom, and 1 pseudoneurological sx? |
|
Definition
| Somatitization disoder, must be under 30 to dx. Unconscious production of symptoms. |
|
|
Term
| Treatment of panic disorder? |
|
Definition
| SSRI, can use benzo or propranolol for short term |
|
|
Term
|
Definition
|
|
Term
| Treatment of generalized anxiety disroder? |
|
Definition
|
|
Term
| Control of autonomic sx in social phobia? |
|
Definition
|
|
Term
| Treatment of sleepwalking? |
|
Definition
| Monitor and ensure safe environment |
|
|
Term
| "Magical" thinking, unusual perceptions, odd apperance, discomfort in close relationships? |
|
Definition
| Schizotypcal personality disorder |
|
|
Term
| REM sleep intrudes in daytime? |
|
Definition
|
|
Term
|
Definition
| Deficiency of orexin/hypocretin neurotransmitter |
|
|
Term
| Treatment of sex addiction? |
|
Definition
| SSRI can decrease sex drive and cause anorgasmia, medroxyprogesterone decreases libido |
|
|
Term
| Pattern of excessive emotionality and attention seeking, overly seductive, dramatic superfical speech? |
|
Definition
| Histrionic personality disorder |
|
|
Term
| Preoccupised with orderliness, perfection, has trouble completing tasks on time, forgoes social activities to work, stubborn? |
|
Definition
| Obsessive compulsive personality disorder |
|
|
Term
| Chronic excessive need to be taken care of, can't make decision on their own, must be in relationship? |
|
Definition
| Dependent personality disorder |
|
|
Term
| Chronic pattern of disregard for rights of others and laws, no remorse, charming? |
|
Definition
| Antisocial personality disorder |
|
|
Term
| Modafinil can be used to treat? |
|
Definition
| Narcolepsy, shift work disorder, daytime sleepiness caused by OSA. Increases monoamines and histamine. |
|
|
Term
| Chronic pattern of social inhibition, hypersensitivity to negative criticism, want friends but afraid of rejection? |
|
Definition
| Avoidant personality disorder |
|
|
Term
| PAttern of grandisosity and inflated perception of one's abilities, expect others to share their unrealsitic opinion of themselves and act accordingly? |
|
Definition
| Narcissistic personality disorder |
|
|
Term
| Wife complains that husband keeps kicking her at night? |
|
Definition
| Periodic limb movement disorder- nocturnal myoclonus. Causes unrefreshing sleep. |
|
|
Term
| When does withdrawal from heroin and morphine usually peak? |
|
Definition
|
|
Term
| Chronic meperidine use can cause? |
|
Definition
| Seizures due to buildup of toxic metabolite nomeperdine |
|
|
Term
| How long can PCP-induced psychosis last? |
|
Definition
|
|
Term
| Treatment of delirium tremens? |
|
Definition
| Lorazepam, folate, and thiamine |
|
|
Term
|
Definition
| Supportive, can use clonidine |
|
|
Term
| Violent behavior, exagerrated reactions to sensory stimuli, vertical nystagmus? |
|
Definition
|
|
Term
| How do amphetamines mediate action? |
|
Definition
| Cause release of stored monoamines |
|
|
Term
| How does cocaine mediate action? |
|
Definition
| Inhibits reuptake of neurotransmitters |
|
|
Term
|
Definition
| Allosterically increase frequency of GABA CL- channel opening |
|
|
Term
| How do barbiturates work? |
|
Definition
| Allosterically increase duration of GABA Cl- channel opening, at high dose can act as direct agonist |
|
|
Term
| How does PCP mediate action? |
|
Definition
| Activates NMDA glutamate receptors |
|
|
Term
| Which ilicit drug can cause coronary vasospasm, MI, and intracranial hemorrhage? |
|
Definition
|
|
Term
| Which ilicit drug can cause euphoria, mydriasis, and sensation that bugs on skin? |
|
Definition
|
|
Term
| What percentage of Asians lack acetaldehyde dehydrogenase? |
|
Definition
| 10%. Without it, get symptoms of alcohol intoxication w/ very small ingestion. |
|
|
Term
| What are side effects of inhalants? |
|
Definition
| Hearing loss, peripheral neuritis, parasthesias, cerebellar signs, motor impairment, rhabdomyolysis, renal/hepatic damage, GI bleed |
|
|
Term
| Does LSD act as a stimulant or depressant? |
|
Definition
| Usually stimulant- tachycardia, hypertension, mydriasis, along with hallucinations |
|
|
Term
| Which illicit causes feelings of empathy and closeness to others? |
|
Definition
|
|
Term
| Which illicit can cause bruxism? |
|
Definition
|
|
Term
| Why do TCAs have so many side effects? |
|
Definition
| They block cholinergic (dry mouth), adrenergic (ortho hypotension, and histaminergic (sedation) receptors |
|
|
Term
|
Definition
|
|
Term
| Which TCA is used for treatment of OCD? |
|
Definition
|
|
Term
| Which TCA is used for treatment of enuresis? |
|
Definition
|
|
Term
|
Definition
| Melatonin agonist with half life of 1-2.5 hours. Good for decreasing time to sleep onset, but will not keep asleep. |
|
|
Term
| Which mood stabilizer can cause aplastic anemia? |
|
Definition
|
|
Term
| Which SSRI is best for pt worried about wt? |
|
Definition
|
|
Term
| Muscle rigidity, hyperthermia, autonomic instability? |
|
Definition
| NMS (antipsychotic) or serotonin syndrome (MAOI +SSRI) |
|
|
Term
| Pt on MAOI (such as phenelzine or selegiline) eats aged cheese? |
|
Definition
| Monitor BP for hypertensive crisis |
|
|
Term
|
Definition
| Propranolol, anticholinergic |
|
|
Term
|
Definition
| Anticholinergic- benztropine, diphenhydramine |
|
|
Term
| How many treatments are usually used in ECT? |
|
Definition
|
|
Term
| Is ECT shock applied bilaterally or unilaterally? |
|
Definition
| Unilaterally, to decrease memory loss |
|
|
Term
| Treatment options for narcolepsy? |
|
Definition
| Stimulant- methylphenidate, modafinil. SSRI- decrease REM |
|
|
Term
| Which drug is best for psychosis in parkinson's? |
|
Definition
| Clozapine- spares nigrostrial dopaminergic and does not have anticholinergic side effects |
|
|
Term
| Treatment of hyperarousal in PTSD? |
|
Definition
|
|
Term
|
Definition
| REM attack during day-> loss of muscle tone. |
|
|
Term
| What is tardive dyskinesia? |
|
Definition
| Choreiform movements, usually orofacial, subsequent to treatment with antipsychotic, usually occurs after 1-6mo of treatment. May be permanent. D/c antipsychotic, anticholinergic. |
|
|
Term
|
Definition
| Intermittent muscle spasms involving head and neck (torticollis- neck spasm, occulogyric crisis- eyes forced into upward gaze). Tx: anticholinergic |
|
|
Term
|
Definition
| Restless legs, feels like ants in pants. Tx: propranolol or antichol. |
|
|
Term
| What must be present to prove malpractice? |
|
Definition
| 4 D's: 1. Duty existed toward pt. on part of physician. 2. Deviation from standard practice occurred. 3. Direct causal relationship between deviation and untoward outcome. 4. Damages occurred as a result. |
|
|
Term
| What are criteria for involuntary admission? |
|
Definition
| One of: Evidence of mental illness, risk of harming self or others, or pt unable to provide for his/her basic needs. |
|
|
Term
| Are physicians required to warn potential victims if pt. reveals homicidal plan? |
|
Definition
|
|
Term
| Which antipsychotic can be used for irritability in autism, ages 5-16 years old? |
|
Definition
|
|
Term
| What causes positive symptoms of psychosis? |
|
Definition
| increased dopamine in mesolimbic pathway |
|
|
Term
| What causes negative symptoms of psychosis? |
|
Definition
| Alterations in serotonin receptors in pre-frontal cortex |
|
|
Term
| Which other neurotransmitter plays role? |
|
Definition
|
|
Term
| What are four dopaminergic pathways important in schizophrenia and its treatment? |
|
Definition
| Mesolimbic- midbrain to nucleus accumbens, Mesocortical- midbrain to limbic cortex. Nigrostriatal- substantia nigra to basal ganglia, Tuberoinfundibular- hypothalamus to pitutiary |
|
|
Term
| What is significance of mesolimbic pathway? |
|
Definition
| Responsible for salience, euphoria, delusions, and hallucinations- positive symptoms of psychosis due to inc dopamine here |
|
|
Term
| What is significance of mesocortical pathway? |
|
Definition
| Responsible for cognition. Too little dopamine here in schizophrenia and too much block can cause slowing. |
|
|
Term
| What is significance of nigrostriatal pathway? |
|
Definition
| Responsible for movement control. Too much block causes movement disorders (dystonia, tardive dyskinesea) |
|
|
Term
| What is significance of tuberinfundibular pathway? |
|
Definition
| Dopamine here inhibts prolactin release. Blocking causes increased prolactin -> dec. libido, galactorrhea. |
|
|
Term
| Changes in these pathways in schizophrenia? |
|
Definition
| Too much dopamine in mesolimbic, too little in mesocortical. |
|
|
Term
| What is the relationship between acetylcholine and dopamine in nigrostriatal pathway? |
|
Definition
| Reciprocal- decreasing dopamine leads to increasing acetylcholine (so tx of dystonia is anticholinergic as antipsychotic causes decreased dopamine and therefore an increase in cholinergic activity) |
|
|
Term
| What is relationship between serotonin and dopamine in nigorstriatal and tuberinfundibular? |
|
Definition
| Reciprocal- increased serotonin causes decreased dopamine, so blocking serotonin as atypicals allegedly do will cause increased dopamine levels and reduced likelihood of EPS symptoms |
|
|
Term
| How are antipsychotics metabolized? |
|
Definition
|
|
Term
| At what level of occupation of dopamine recepetors is a clinical effect in psychosis seen? |
|
Definition
|
|
Term
| How does nicotine affect metabolism of antipsychotics? |
|
Definition
| Increases metabolism, therefore if a patient stops smoking, they may need to decrease dosage otherwise side fx could ensure |
|
|
Term
| What are symptoms of hyperprolactinemia? |
|
Definition
| Sexual dysfunction- dec libido, erectile dysfunction, amenorrhea, gallactorhea, gynecomastia |
|
|
Term
| Which drugs are least likely to cause hyperprolactinemia? |
|
Definition
| Quetiapine and aripiprazole |
|
|
Term
|
Definition
| Sustained involuntary muscle contraction, usually occurs in first 1-5 days of tx |
|
|
Term
|
Definition
| Subjective muscle restlessness, fidgetiness, restless legs |
|
|
Term
|
Definition
| Tremor, bradykinesia, Rabbit syndrome (rhythmic tremor of mouth), occurs more in females |
|
|
Term
| What is tardive dyskinesia? |
|
Definition
| Spontaneous choreiform movements, late onset |
|
|
Term
| Which drug is least likely to cause EPS? |
|
Definition
| Clozapine- spares nigrostriatal dopamine receptors |
|
|
Term
| What are anticholinergic side effects seen from antipsychotics? |
|
Definition
| Central- agitation, hallucinations, seizures. Peripheral- dry mouth, dilated pupils ->blurred vision, constipation, urinary retention |
|
|
Term
| Which antipsychotic caues retinitis pigmentosa? |
|
Definition
|
|
Term
| Which antipsychotic can cause cataracts, at least in beagles? |
|
Definition
|
|
Term
| Which antipsychotic can decrease ejaculation? |
|
Definition
|
|
Term
| How do antipsychotics increase drooling? |
|
Definition
| Increase salivary muscarinic activity and decrease salivary adrenergic activity |
|
|
Term
| What are cardiac side effects? |
|
Definition
| QT prolongation and Torsades |
|
|
Term
| What are biggest culprits of QT prolong? |
|
Definition
| IV haloperidol (but not oral) and ziprasidone |
|
|
Term
| Which antipsychotics cause the most weight gain? |
|
Definition
| Clozapine, olanzipine, thioridazine |
|
|
Term
| Which antipsychotic may actually cause weight loss? |
|
Definition
|
|
Term
| What is neuroleptic malignant syndrome? |
|
Definition
| Rigidity, elevated HR, BP, fever, delirium, rhabdomyolysis -> myoglobinuria |
|
|
Term
| What are examples of high potency typical antipsychotics? |
|
Definition
| Haloperidol , fluphenazine (more EPS, less anticholinergic) |
|
|
Term
| Examples of middle potency? |
|
Definition
|
|
Term
|
Definition
| Chlorpromazine, thioridazine (less EPS, more anticholinergic) |
|
|
Term
| Atypicals target which receptor in addition to D2? |
|
Definition
|
|
Term
| Which is the only atypical that is a mixed DA agonist/antagonist? |
|
Definition
|
|
Term
| Which antipsychotic is the last line despite perhaps being the most effective? |
|
Definition
|
|
Term
|
Definition
| Can cause agranulocytosis- monitor weekly for 6 mo, biweekly for next 6 mo, then every 4 weeks indefinitely via CBC and absolute neutrophil count |
|
|
Term
| What other unique side effect does clozapine have? |
|
Definition
|
|
Term
| Which atypical has increased incidence of EPS, hyperprolactinemia, and HYPOTENSION? |
|
Definition
|
|
Term
| Which antipsychotic is well known for causing weight gain, and insulin resistance? |
|
Definition
|
|
Term
| Which antipsychotic is know for being very sedating? |
|
Definition
|
|
Term
| Which atypical is known for QT prolongation? |
|
Definition
|
|
Term
| This is the only side effect with increased incidence in aripiprazole? |
|
Definition
|
|
Term
| A delusion consisting of aliens from the planet Zedulia who have a magical pirate ship able to time travel would qualify a patient for? |
|
Definition
| Schizoprenia, as it is bizarre (always check duration of delusion to classify appropriately) |
|
|
Term
| Sometimes has mood symptoms without psychosis? |
|
Definition
| Mood disorder with psychotic features |
|
|
Term
| Sometimes has psychosis/schizophrenia without mood symptoms? |
|
Definition
|
|
Term
| A delusion consisting of Tom Cruise being in love with me? |
|
Definition
| Delusional disorder, this is within the realm of possibility therefore not bizarre |
|
|
Term
| What are diagnostic criteria for major depressive episode? |
|
Definition
| 2 weeks of depressed mood leading to impairment plus 5 of: SIG E CAPS: Sleep change Interest decrease GUILT Energy decrease, Concentration decrease, Appetite change, Psychomotor retardation, Suicidal |
|
|
Term
| What are diagnostic criteria for manic episode? |
|
Definition
| 1 week of elevated/agitated mood leading to impairment plus mixture of DIG FAST: Distractiability, Insomnia, Grandiosity, Flight of ideas, Agitation, Speech (pressured), Thoughtlessness (inc. high risk activities) |
|
|
Term
| What is difference between mania and hypomania? |
|
Definition
| Hypomania- 4 days not 7 days, no hospitalization, no psychotic symptoms |
|
|
Term
| What are medical causes of depression? |
|
Definition
| CVD, hypo/hyperthyroid, Cushings, Addison's, hypo/hyperglycemia, hypo/hypercalcemia, Parkinson's, mononucleosis, viral illness, Carcinoid, Lupus, Cancer |
|
|
Term
| Which two types of cancer are most likely to cause depression? |
|
Definition
|
|
Term
| What are medical causes of mania? |
|
Definition
| Hyperthyroidism, Temporal lobe seizure, Multiple sclerosis, Glioblastoma, brain tumor, Syphilis, Lyme disease |
|
|
Term
| What is chance of 2nd depressive episode after one? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How long should an episode be treated? |
|
Definition
| 6-9 months than may taper |
|
|
Term
| What if they feel better after 1 month? |
|
Definition
| Still shoot for 6-9 months |
|
|
Term
| Serotonin syndrome characterized by? |
|
Definition
| Fever, Autonomic instability, and Seizures |
|
|
Term
| Serotonin syndrome caused by? |
|
Definition
| SSRI + MAOI or combination of drugs that increase serotonin |
|
|
Term
|
Definition
| Depressed mood for at least 2 years, no asymptomatic period longer than 2 months, and 2 of CHASES: Concentration decrease, Hopelessness, Appetite change, Sleep change, Energy decrease, Self esteem decrease |
|
|
Term
| What are the symptoms of a panic attack? |
|
Definition
| At least 4 of PANICSS: Palpitations Abdominal distress Numbness (paresthesias) Intense fear of death, Choking/Chills/Chest Pain, Sweating, Shortness of Breath |
|
|
Term
| What makes it a panic disorder? |
|
Definition
| Panic atack plus consistent worry about having another attack |
|
|
Term
|
Definition
|
|
Term
| What neurotransmitter changes are involved in panic attack? |
|
Definition
| Inc NE and decreased GABA, decreased serotonin |
|
|
Term
| OCD is ego dystonic or syntonic? |
|
Definition
|
|
Term
| OCPD is ego dystonic or syntonic? |
|
Definition
|
|
Term
|
Definition
| SSRI or clomipramine, exposure/response prevention |
|
|
Term
| Experienced traumatic event now persistently re-experience with symptoms of hypervigilance? |
|
Definition
| PTSD if symptoms >1 month. Acute stress disorder if symptoms less than 1 month. |
|
|
Term
| Depression or anxiety after stressful event, occuring within 3 months of stressor and ending within 6months of stressor ending? |
|
Definition
|
|
Term
| If stressor continues, can adjustment disorder continue longer than 6mo? |
|
Definition
| Yes, chronic stressor -> chronic adjustment disorder |
|
|
Term
| What is primary therapy for adjustment disorder? |
|
Definition
| Supportive Psychotherapy is PRIMARY. Pharmacotherapy is ADJUNCTIVE. |
|
|
Term
| What are the cluster A personality disorders? |
|
Definition
| Schizoid, Schizotypal, and Paranoid (weird people) |
|
|
Term
| General distrust of others, perceives personal attacks and counters quickly? |
|
Definition
|
|
Term
| Voluntary social withdrawal, restricted affect, no interest in sex? |
|
Definition
|
|
Term
| Odd beliefs, magical thinking, few close friends, social anxiety? |
|
Definition
|
|
Term
| What are the cluster B personality disorders? |
|
Definition
| Borderline, Antisocial, Narcissistic, Histrionic (bad) |
|
|
Term
| Disregard for others and violation of their rights, no remorse, charming at first, h/o conduct disorder as child? |
|
Definition
|
|
Term
| Impulsive, unstable self image/relationships, frequent suicidal gestures, self mutilation? |
|
Definition
|
|
Term
| Attention seeking, sexual, excessive emotion? |
|
Definition
|
|
Term
| Sense of superiority, believe they are special, sense of entitlement, takes advtange of others for their own gain? |
|
Definition
|
|
Term
| What are the cluster C personality disorders? |
|
Definition
| Avoidant, Dependent, Obsessive Compulsive |
|
|
Term
| Pattern of social inhibition, fear of rejection, believe they are soccially inept, want relationships but want to know they are liked before engaging? |
|
Definition
|
|
Term
| Require others to make decisions for them, usually has one person they give responsibility of their life to, urgently seeks a new relationship after one ends? |
|
Definition
|
|
Term
| Preoccupation with control and perfectionism, want every detail right at expense of efficiency, choose work over everything else, miserly? |
|
Definition
| Obsessive-compulsive pers. disorder |
|
|
Term
| What are examples of personality disorders NOS? |
|
Definition
| Depressive, Sadomasochistic, Sadistic, Passive-Aggressive |
|
|
Term
| This person makes excuses all the time, alternate between compliance and defiance, inefficient procrastinator, try to manipulate others to do their work, and complains about their misfortunes all the time? |
|
Definition
| Passive-Aggressive Personality Disorder |
|
|
Term
| What is the definition of substance abuse? |
|
Definition
| 1. Causes impairment. 2. Use in dangerous situations. 3. Recurrent use despite legal problems 4. continued use despite social or relationship problems 5. Lasts at least 1 year |
|
|
Term
| What is the definition of substance dependence? |
|
Definition
| 1. Causes impairment 2. Evidence of tolerance 3. Evidence of withdrawal 4. use substance more than intended 5. Persistent use despite efforts to abstain 6. Significant time spent trying to get drug 7. Decreased social activities, work 8. Continued use despite physical or psychological problems due to substance |
|
|
Term
| What are the two biggest factors in dependence? |
|
Definition
| Tolerance (need more of substance to get same effect) and Withdrawal (stopping drug use leads to adverse symptoms) |
|
|
Term
| What are alcohol's effects on neurotransmitters? |
|
Definition
| Increases serotonin and GABA activity, decreases glutamate activity |
|
|
Term
| What is the legal limit for alcohol in blood? |
|
Definition
|
|
Term
| What are symptoms of mild alcohol withdrawal? |
|
Definition
| Irritability, tremor, insomina |
|
|
Term
| What are symptoms of moderate alcohol withdrawal? |
|
Definition
| Diaphoreseis, fever, disorientation |
|
|
Term
| What are symptoms of severe alcohol withdrawal? |
|
Definition
| Delirium tremens- visual/tactile hallucinations, delirium, seizures (gen. tonic-clonic), autonomic instability |
|
|
Term
| What is mortality of delirium tremens if untreated? |
|
Definition
|
|
Term
| What is treatment of delirium tremens? |
|
Definition
| Benzo, thiamine, folate. Can give haloperidol for hallucinations and agitation |
|
|
Term
| Long term alcohol use causes deficiency of? |
|
Definition
|
|
Term
| Thiamine deficiency causes? |
|
Definition
| Wernicke encephalopathy and Korsakoff syndrome |
|
|
Term
| Ataxia, confusion, nystagmus and gaze palsies indicate? |
|
Definition
|
|
Term
|
Definition
| Yes, with thiamine supplementation |
|
|
Term
| Impaired recent memory, anterograde amnesia, confabulation indicate? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| It inhibits dopamine and norepinephrine re-uptake. Indirect sympathomimetic. |
|
|
Term
| How long will cocaine show up on UDS? |
|
Definition
| 3 days, longer in heavy user |
|
|
Term
| What are examples of amphetamines? |
|
Definition
| Dextroamphetamine, methylphenidate (ritalin), Methamphetamine, MDMA (ectasy), MDEA (eve) |
|
|
Term
| How do amphetamines work? |
|
Definition
| Cause dopamine, serotonin, NE release -> indirect sympathomimetic. Can cause hallucinations. |
|
|
Term
| How long will amphetamines show up on UDS? |
|
Definition
| 1-2 days, but may not catch all amphetamines |
|
|
Term
| How should cocaine and amphetamine intoxication be treated? |
|
Definition
| Symptomatically. Agitation -> benzo. Psychosis -> haloperidol. Control BP, HR as needed. |
|
|
Term
| What drug should not be given to pt. on cocaine? |
|
Definition
|
|
Term
| What is treatment for cocaine or amphetamine withdrawal? |
|
Definition
| Supportive. Generally not life-threatening. |
|
|
Term
| How do benzodiazepines work? |
|
Definition
| Increase frequency of GABA channel opening |
|
|
Term
| How do barbiturates work? |
|
Definition
| Increase duration of GABA channel opening, at high doses, act as direct agonist |
|
|
Term
| How long will UDS be positive for benzo/barbiturates? |
|
Definition
|
|
Term
| How is intoxication with benzo treated? |
|
Definition
| Charcoal can be useful. Flumazenil. Be careful not to over do it -> withdrawal -> seizure |
|
|
Term
| How is intoxication with barbiturate treated? |
|
Definition
| Charcoal cane be useful. Alkanization of urine with sodium bicarbonate increases excretion |
|
|
Term
| Can benzo tx be stopped abruptly? |
|
Definition
| No, that can cause life-threatening withdrawal Must taper |
|
|
Term
| What are symptoms of benzo withdrawal? |
|
Definition
| Delirum, hallucinations, seizures, tachycardia, hypertension, diaphoresis |
|
|
Term
| What is treatment of benzo withdrawal? |
|
Definition
| Long-acting benzo (diazepam), taper gradually |
|
|
Term
| In general, is withdrawal from sedating drug life-threatening? |
|
Definition
|
|
Term
| In general, is withdrawal from stimulant or hallucinogenic life-threatening? |
|
Definition
| No, that can cause life-threatening withdrawal Must taper |
|
|
Term
| What receptors do opiods act on? |
|
Definition
| Mu, Kappa, Delta receptors |
|
|
Term
| Miosis, Respiratory Depression, and Altered mental status indicate? |
|
Definition
|
|
Term
| What is treatment for opiod intoxication? |
|
Definition
|
|
Term
| Which opiod antagonist has longer half life? |
|
Definition
| Naltrexone (4.5 hrs) > Naloxone (1.5 hours) |
|
|
Term
| What is treatment for opiod dependence? |
|
Definition
|
|
Term
| What are symptoms of opiod withdrawal? |
|
Definition
| SLUDGE - Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis (also mydriasis, piloerection, rhinorhea) |
|
|
Term
| Do hallucinogens cause physical dependence? |
|
Definition
| No (therefore no withdrawal from LSD, mescaline, mushrooms, etc) |
|
|
Term
| How do PCP and ketamine act? |
|
Definition
| Activated NMDA glutamate receptors and dopamine neurons, also act as analgesics |
|
|
Term
| What are symptoms of PCP intoxication? |
|
Definition
| Violent behavior, hyperreactivity to stimuli, nystagmus, poor judgement, and muscle rigidity |
|
|
Term
| What are treatments for PCP intoxication? |
|
Definition
| Quiet room. Acidify urine with ammonium chloride. |
|
|
Term
| How long will UDS be positive for PCP? |
|
Definition
|
|
Term
|
Definition
| Acitivates cannabinoid receptor which inhibits adenylate cyclase -> decreased cAMP |
|
|
Term
| What are signs/symptoms of marijuane intoxication? |
|
Definition
| Euphoria, inc. appetite, dry mouth, conjunctival injection |
|
|
Term
| Can one develop dependence on marijuana? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Overdose of inhalant can cause? |
|
Definition
| Respiratory depression, arrhythmias |
|
|
Term
| Long term effects of inhalants? |
|
Definition
|
|
Term
| Surprise someone intoxicated on inhalant? |
|
Definition
| Can cause sudden sniffing death syndrome |
|
|
Term
|
Definition
| Antagonizes adenosine -> increased adenylate cyclase activity -> increased cAMP |
|
|
Term
| What are signs/symptoms of caffiene intoxication? |
|
Definition
| Insomnia, anxiety, restlessness, flushed face, diuresis, rambling speech |
|
|
Term
| When does intoxication typically occur? |
|
Definition
| Greater than 250mg of caffiene ingested |
|
|
Term
| How much caffiene is in typical coffee cup? |
|
Definition
|
|
Term
| How much caffiene is in typical tea cup? |
|
Definition
|
|
Term
| What are signs/symptoms of caffiene withdrawal? |
|
Definition
| Headache, nausea/vomiting |
|
|
Term
|
Definition
| Stimulates nicotinic receptors |
|
|
Term
| What are effects of nicotine? |
|
Definition
| CNS stimulation -> restlessness, insomnia, anxiety, inc. attention, inc. mood, decreased tension |
|
|
Term
| What are symptoms of nicotine withdrawal? |
|
Definition
| Intense craving, increased appetite, irritability, dysphoria |
|
|
Term
| What are pharmacologic treatments for nicotine withdrawal/quitting? |
|
Definition
| Nicotine replacement, bupropion, varenecylcine |
|
|
Term
| Memory loss that is progressive and irreversible with normal level of consciousness? |
|
Definition
|
|
Term
| What percentage of dementia is reversible? |
|
Definition
|
|
Term
| What are causes of reversible dementia? |
|
Definition
| Hypothyroidism, Folate/B12 deficiency, neurosyphilis, normal pressure hydrocephalus, Wilson's disease, among others |
|
|
Term
| What are standard battery of tests to rule out reversible causes? |
|
Definition
| CBC, CMP, TSH, VDRL/RPR, B12, Folate, CT or MRI |
|
|
Term
| What are top 3 causes of dementia? |
|
Definition
| Alzheimer's, Vascular, and Pseudodementia (depression) |
|
|
Term
| Diagnosis of Alzheimer's requires? |
|
Definition
| Memory impairment plus 1 of aphasia (impaired language or understanding), apraxia (inability to perform purposeful movement), agnosia ( inability to interpret sensations correctly or name object), or decreased executive functioning. Plus rule out everything else. |
|
|
Term
| What will CT show in Alzheimer's? |
|
Definition
| Diffuse atrophy with enlarged ventricles |
|
|
Term
| What will microscope show in Alzheimer/s? |
|
Definition
| Amyloid plaques, Tau protein neurofibrillary tangles |
|
|
Term
| What is treatment for Alzheimer's? |
|
Definition
| Cholinesterase inhibitors such as donepizil. Benzo for anxiety. Antipsychotic for agitation/psychosis |
|
|
Term
| Memory impairment, aphasia/apraxia/agnosia plus focal neuro symptoms? |
|
Definition
|
|
Term
| What is course of vascular dementia? |
|
Definition
| Step-wise. Abrupt drops in functioning then stabilization |
|
|
Term
| How do you diagnose vascular dementia? |
|
Definition
|
|
Term
| Personality changes are hallmark of what type of dementia? |
|
Definition
| Pick's Demnita (frontotemporal dementia) |
|
|
Term
| What would you see on microscopy of brain of pt. w/ Pick's? |
|
Definition
| Pick bodies - intraneuronal inclusion body |
|
|
Term
| Autosomal dominant disorder due to hyperexpansion of gene on chromosome 4? |
|
Definition
|
|
Term
| When does onset of Huntington's typically occur? |
|
Definition
|
|
Term
| What are symptoms of Huntingtons? |
|
Definition
| Progressive dementia, Choreiform movements (snake-like), Muscular hypertonicity, Depression (very common), Psychosis |
|
|
Term
| How is huntington's diagnosed? |
|
Definition
|
|
Term
| Loss of dopamine neurons in substantia nigra? |
|
Definition
|
|
Term
|
Definition
| Bradykinsea, resting tremor, mask-like face, shuffling gait, shrinking handwriting, dysarthria, dementia (30% of pt) |
|
|
Term
|
Definition
| Levodopa/carbidopa (often reserved until late in course), amantadine, anticholinergics, MAOIs (selegiline)- dec. breakdown of dopamine, Surgery (electro-stimulation) |
|
|
Term
| Rapidly progressive dementia, myoclonus, ataxia, cortical blindness? |
|
Definition
|
|
Term
| What are microscopic changes in Creutzfeld-Jakob? |
|
Definition
| Spongiform changes in cortex |
|
|
Term
| What is life expectancy for pt. with Creutzfeld-Jakob disease? |
|
Definition
|
|
Term
| When is average age on onset for Creutzfeld-Jakob? |
|
Definition
|
|
Term
| What are characteristics of delirium? |
|
Definition
| Rapid onset, flucuates throughout day w/ lucid intervals, altered consciousness, and hallucinations |
|
|
Term
| Always ask about what in elderly pt with memory loss? |
|
Definition
|
|
Term
| Common answer to questioning in depressed patient? |
|
Definition
| "I don't know". Depressed pt. will guess or confabulate |
|
|
Term
| What happens to REM sleep as you age? |
|
Definition
| Increased REM cycles, decreased REM duration -> net loss of total REM sleep |
|
|
Term
| What happens to stage 1 and 2 sleep as you age? |
|
Definition
| Increased stage 1 and 2 sleep |
|
|
Term
| What happens to stage 3 and 4 sleep as you age? |
|
Definition
| Decreased stage 3 and 4 sleep (increased night time awakenings) |
|
|
Term
| IQ < 70 with onset prior to age 18? |
|
Definition
| Mental retardation. Mild IQ 50-70. Moderate IQ 40-50. Severe 25-40. Profound <25. |
|
|
Term
| What is most common cause of mental retardation? |
|
Definition
|
|
Term
| What is most common inherited cause of mental retardation? |
|
Definition
|
|
Term
| What are prenatal causes of mental retardation? |
|
Definition
| TORCH - toxoplasmosis Other (AIDS, syphilis, alcohol, drugs) Rubella CMV HSV. |
|
|
Term
| What are perinatal causes of mental retardation? |
|
Definition
|
|
Term
| What are postnatal causes of mental retardation? |
|
Definition
| Hypothyroidism, Malnutrition, Toxin exposure (Lead), and Trauma |
|
|
Term
| What percentage of conduct disorder pt. are diagnosed with anti-social PD? |
|
Definition
|
|
Term
| What percentage of ADHD pt have conduct or oppositional defiant disorder? |
|
Definition
|
|
Term
|
Definition
| Symptoms of hyperactivity and/or inattentiveness plus onset prior to age 7 |
|
|
Term
| Impaired language development, poor social skills, get very interested in one topic, focus on part of object? |
|
Definition
|
|
Term
|
Definition
| Almost always prior to age 3 |
|
|
Term
| What percentage of autistic children are mentally retarded? |
|
Definition
|
|
Term
| What percentage of autistic children can function indepently as adults? |
|
Definition
|
|
Term
| Which drug is useful for aggression in autistic child? |
|
Definition
|
|
Term
| Impaired social skills, but normal language and cognitive development? |
|
Definition
|
|
Term
| Normal development until 6mo then loss of developmental milestones, decreased head circ, handwringing? |
|
Definition
| Rett disorder- only in girls, boys die in utero. Never progress past 1 year of cognitive skills |
|
|
Term
| Childhood disintegration syndrome? |
|
Definition
| Normal development until ~2 years then regression. Occurs in girls and boys. |
|
|
Term
| Diagnosis of tourettes requires? |
|
Definition
| Motor AND vocal tics almost every day for at least 1 year. No tic free period greater than 3 months |
|
|
Term
|
Definition
| Impaired dopamine regulation |
|
|
Term
| What is treatment of tourettes? |
|
Definition
|
|
Term
| How old must child be for diagnosis of nocturnal enuresis? |
|
Definition
|
|
Term
| What are treatments of nocturnal enuresis? |
|
Definition
| Bell-pad, desmopressin, imipramine |
|
|
Term
| What is required for diagnosis of somatitization disorder? |
|
Definition
| 2 GI symptoms, 1 sexual symptom, 1 neuro symptom, 4 pain symptoms. Onset prior to age 30 |
|
|
Term
| What is treatment of somatitization disorder? |
|
Definition
| Regular appointments and avoidance of unnecessary tests/procedures |
|
|
Term
| Stressor leads to pseudoneurological disorder? |
|
Definition
|
|
Term
| Who is most likely to suffer from conversion disorder? |
|
Definition
| Young ,female, lower socioeconomic status |
|
|
Term
| Are symptoms of conversion disorder consciously produced? |
|
Definition
|
|
Term
| Are symptoms of somatization disorder consciously produced? |
|
Definition
|
|
Term
| Are symptoms of malingering and factictious disorder consciously produced?" |
|
Definition
|
|
Term
| Which is the only somatoform disorder in which men are affected as much as women? |
|
Definition
|
|
Term
| Prolonged severe discomfort w/ no medical diagnosis? |
|
Definition
| Pain disorder. May be related to old injury, but not caused by, i.e. minor ankle sprain or back strain |
|
|
Term
| Intentional production of symptoms for primary gain? |
|
Definition
|
|
Term
| Feigning symptoms for secondary gain? |
|
Definition
|
|
Term
| Failure to resist aggressive impulses, Aggressiveness out of proportion to triggering event? |
|
Definition
| Intermittent Explosive Disorder. Men >women |
|
|
Term
| Treatment of intermittent explosive disorder? |
|
Definition
|
|
Term
| What percentage of bulimia pt. have kleptomania? |
|
Definition
|
|
Term
| Recurrent pulling out of one's hair? |
|
Definition
|
|
Term
| What is clue that pt. has trichotillomania and not a hair loss disorder? |
|
Definition
| In trichotillomania, you often see hair of different lengths in patches of hair loss. In hair loss disorder, hair usually falls out all at once. |
|
|
Term
| treatment of trichotillomania? |
|
Definition
|
|
Term
|
Definition
| Amenorrhea (missed 3 periods) +15% below normal weight (or BMI <18.5) |
|
|
Term
| What are common sequalae of anorexia? |
|
Definition
| Hypochloremic hypokalemic alkalosis. Hypercholesterolemia. Arrythmia, cardiac arrest, lanugo (fine body hair), melanosis coli (darkened area of colon- prolonged laxative use), leukopenia, osteoporosis |
|
|
Term
| Binging-compensation behavior must occur how often for diagnosis of bulemia? |
|
Definition
| At least 2x per week for 3 months |
|
|
Term
| What is weight requirement for bulemia? |
|
Definition
| No wt. requirment. Can be underweight, normal weight, or overweight. |
|
|
Term
| What are two types of bulimia? |
|
Definition
| Purging type- vomit, laxative, or diuretic use. Non-purging- excessive exercise or fasting |
|
|
Term
| Common sequelae of bulimia? (may overlap with anorexia) |
|
Definition
| Hypochloremic hypokalemic metabolic alkalosis, Esophagitis, Dental Erosion, Calloused Knuckles, and Salivary gland hypertrophy |
|
|
Term
| Pt. binges 2x/week for at least 6 months, eats rapidly, eats until uncomfortable full, eats alone due to embarassment, and eats when not hungry? |
|
Definition
|
|
Term
| Treatment of binge-eating disorder? |
|
Definition
| Psychotherapy or behavioral therapy |
|
|
Term
| Increases in which neurotransmitters will decrease total sleep time? |
|
Definition
| Dopamine and norepinephrine |
|
|
Term
| Increase in which neurotransmitter will increase total sleep time and increase REM? |
|
Definition
|
|
Term
| Increase in which neurotransmitter will increase total sleep time and increase delta wave sleep? |
|
Definition
|
|
Term
|
Definition
| Disturbance in amount, quality, or timing of sleep |
|
|
Term
|
Definition
| Abnormal behavior or physiology during sleep |
|
|
Term
| What are stages of sleep cycle? |
|
Definition
| Stage 0 - awake, eyes open- beta waves. Stage 0- awake ,eyes close- alpha waves. Stage 1- light sleep -theta waves. Stage 2- medium sleep- theta with sleep spindles (beta) and k complexes (delta). Stage 3,4- deep sleep (delta waves). REM- beta waves |
|
|
Term
| How often do REM cycles occur? |
|
Definition
| Every 90 minutes, but as sleep progress, REM latency decreases and approaches 60 minutes. |
|
|
Term
| How long does each REM cycle occur? |
|
Definition
|
|
Term
| What are 4 cardinal symptoms of narcolepsy? |
|
Definition
| Excessive daytime sleepiness, Cataplexy, Sleep Paralysis, Hypnogogic/hypnapompic hallucinations |
|
|
Term
|
Definition
| Abrupt loss of muscle tone often caused by strong emotion |
|
|
Term
|
Definition
| Symptom of catatonic schizophrenia - waxy flexibility |
|
|
Term
| What is cause of narcolepsy? |
|
Definition
| Hypocretin/orexin deficiency (these are neurotransmitters) |
|
|
Term
|
Definition
| Sleepiness- naps, stimulants (modafinil, ritalin). Cataplexy- SSRI to decrease REM sleep |
|
|
Term
| What are characteristics of a nightmare? |
|
Definition
| Occurs during REM, fully awake afterward and remember dream |
|
|
Term
| What are characteristics of night terror? |
|
Definition
| Occurs during deep sleep (non-REM, stage 3 or 4), do not fully awaken, do not remember dream |
|
|
Term
| During what stage of sleep does sleepwalking occur? |
|
Definition
|
|
Term
| What is treatment of sleepwalking? |
|
Definition
|
|
Term
| What is technical term for talking in sleep? |
|
Definition
|
|
Term
| What are the stages of sexual response? |
|
Definition
| DEPOR - Desire Excitement Plateau Orgasm Resolution |
|
|
Term
| What occurs in desire stage? |
|
Definition
| interest in sexual activity |
|
|
Term
| What occurs in excitement stage? |
|
Definition
| Begins with fantasy or physical contact. Men- erection. Women- vaginal lubrication, clitoral erection, labial swelling, elevation of uterus. Both- nipple erection, inc. BP and HR |
|
|
Term
| What occurs in plateau stage? |
|
Definition
| Men- swelling of testicles, tightening of scrotal sac, secretion of seminal fluid. Women - contraction of outer third of vagina. Enlargement of upper third of vagina. Both- facial flushing, inc. HR, BP, RR |
|
|
Term
| What occurs in orgasm stage? |
|
Definition
| Men- ejaculation. Women- contraction of uterus and lower 1/3 of vagina. |
|
|
Term
| What occurs in resolution stage? |
|
Definition
| Both- muscles relax, BP and HR return to baseline. Men- refractory perioid. Women- little or no refractory period. |
|
|
Term
| What are effects of aging on sex in men? |
|
Definition
| Increased time to ejaculate, requires more direct stimulation of genitals to get erection. |
|
|
Term
| What are effects of aging on sex in women? |
|
Definition
| After menopause, vaginal dryness |
|
|
Term
| Which drug classes cause sexual dysfunction? |
|
Definition
| Anti-hypertensives, anti-cholinergics, anti-depressants, and anti-psychotics |
|
|
Term
| How do alcohol and marijuane affect libido? |
|
Definition
| Increase libido by decreasing inhibition |
|
|
Term
| How do cocaine and amphetamines affect libido? |
|
Definition
| Increase libido by increasing dopamine |
|
|
Term
| How does testosterone affect libido? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Absence or deficiency of sexual desire or fantasies? |
|
Definition
| Hypoactive sexual desire disorder |
|
|
Term
| Avoidance of any genital contact with sexual partner? |
|
Definition
|
|
Term
| Inability to maintain lubrication in female? |
|
Definition
| Female sexual arousal disorder |
|
|
Term
| Genital pain before, during, or after sexual intercourse? |
|
Definition
|
|
Term
| Involuntary contraction of outer 1/3 of vagina during insertion of penis, tampon, and/or speculum? |
|
Definition
|
|
Term
| In what populations is vaginismus more common? |
|
Definition
| Higher socioeconomic and religious |
|
|
Term
|
Definition
| Pedophilia, Voyeurism, Exhibitionism, Fetishism, Transvestic fetishism, Froteurism, Masochism, Sadism, Necrophilia, Telephone scatologia |
|
|
Term
| Watching unsuspecting nude individuals? |
|
Definition
|
|
Term
| Sexual pleasure from rubbing gentials against unsuspecting person? |
|
Definition
|
|
Term
| Exposure of genitals to strangers? |
|
Definition
|
|
Term
| Sexual preference for inanimate objects? |
|
Definition
|
|
Term
| Sexual gratification in men from wearing women's clothing? |
|
Definition
|
|
Term
| Sexual excitement from being humiliated, beaten? |
|
Definition
|
|
Term
| Sexual excitement from hurting another? |
|
Definition
|
|
Term
| Calling unsuspecting women and talking dirty? |
|
Definition
|
|
Term
| What is gender identity disorder? |
|
Definition
| Feeling that one was born the wrong sex |
|
|
Term
| What are mature defense mechanisms? |
|
Definition
| Altruism, Humor, Sublimation, Suppression |
|
|
Term
| What are neurotic defense mechanisms? |
|
Definition
| Controlling, Displacement, Intellectualization, Isolation of affect, Rationalization, Reaction formation, Repression |
|
|
Term
| What are immature defense mechanisms? |
|
Definition
| Acting out, Denial, Regression, Projection |
|
|
Term
|
Definition
| Defense mechanism seen in Borderline PD in which pt. sees world/groups of people as all good or all bad |
|
|
Term
| What therapeutic technique involves resolving unconscious conflicts by bring repressed experiences and feelings to awareness and integrateing them into personality? |
|
Definition
| Psychoanalysis. Pt. lies on cough with therapist out of view. |
|
|
Term
| What techniques are used in psychoanalysis? |
|
Definition
| Free association- pt. says whatever comes to mind. Dream interpretation. |
|
|
Term
| What concepts are important to remember for pscyhoanalysis |
|
Definition
| Transference (pt -> therapist) and Counter-transference (therapist -> pt.) |
|
|
Term
| What are common behavioral therapy techniques? |
|
Definition
| Systemic desensitization, Flooding, Implosion, Aversion, Token economy, Biofeedback |
|
|
Term
| What is systemic desensization? |
|
Definition
| Performing relaxation techniques while being exposed to anxiety-provoking stimulus |
|
|
Term
|
Definition
| Expose pt to anxiety provoking stimulus and preventing withdrawal |
|
|
Term
|
Definition
| Asking pt. to imagine stimulus |
|
|
Term
| What is aversion therapy? |
|
Definition
| Negative stimulus (shock) is paired with behavior to condition pt. to stop behavior (disulfiram is example) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Monitoring vital signs and asking pt. to mentally control. Could do while exposing pt. to stimulus |
|
|
Term
| Identifying negative or maladaptive thoughts and replacing them with positive ones is what kind of therapy? |
|
Definition
| Cognitive therapy. Good for depression and anxiety. |
|
|
Term
| What disorders is group therapy effective for? |
|
Definition
| Substance abuse, adjustment disorder, and personality disorders |
|
|
Term
| How do tricyclic anti-depressants work? |
|
Definition
| Inhibition of serotonin and NE re-uptake |
|
|
Term
| What causes large side effect profile of tricyclic anti-depressants? |
|
Definition
| They are anti-histaminergic (sedation), anti-adrenergeric (orthostatic hypotension), and anti-muscarinic (dry mouth, urinary retention) |
|
|
Term
| Overdose on TCA can cause? |
|
Definition
| cardiotoxicity, arrhythmias, coma, seizures |
|
|
Term
| How do monoamine oxidase inhibitors work? |
|
Definition
| They prevent degradation of norepinephrine, epinephrine, dopamine, serotonin, and tyramine by monoamine oxidase |
|
|
Term
| Are MAOIs reversible inhibitors? |
|
Definition
|
|
Term
| Which neurotransmitters does MAO-A degrade? |
|
Definition
| Serotonin, dopamine, and tyramine |
|
|
Term
| Which neurotransmitters does MAO-B degrade? |
|
Definition
| Norepinephrine, epinephrine, dopamine, tyramine |
|
|
Term
| Which SSRI has the least sexual side effects? |
|
Definition
|
|
Term
| Which atypical anti-depressant lowers seizure threshold? |
|
Definition
|
|
Term
| Would an SSRI be good for depression with insomnia? |
|
Definition
| No, SSRI can cause/worsen insomnia |
|
|
Term
| Do SSRIs cause weight gain or loss? |
|
Definition
| Usually weight gain, but debated |
|
|
Term
| Would trazodone be good for depression with insomnia? |
|
Definition
| Yes, it is heavily sedating |
|
|
Term
| Would trazodone be good for depressed 25 year old male? |
|
Definition
| Bo, side effect of priapism |
|
|
Term
| Which anti-depressant would be useful in anorexia? |
|
Definition
| Mirtazepine, causes wt. gain |
|
|
Term
| Fever, autonomic instability, muscle rigidity after starting anti-psychotic? |
|
Definition
| Neuroleptic malignant syndrome - FALTER - Fever, Autonomic instability, Leukocytosis, Tremor, Elevated CPK, Rigidity |
|
|
Term
| What are side effects of lithium? |
|
Definition
| Tremor, hypothyroidism, nephrogenic diabetes insipidus |
|
|
Term
| What are side effects of carbamazepine? |
|
Definition
| Agranulocytosis, thrombocytopenia, leukopenia |
|
|
Term
| What are side effects of valproate? |
|
Definition
| hepatotoxicity, thrombocytopenia |
|
|
Term
| What birth defect is lithium associated with? |
|
Definition
| Ebstein's anomaly- atrialization of right ventricle |
|
|
Term
| What birth defect are carbamazepine and valproate associated with? |
|
Definition
| Neural tube defects, craniofacial anomalies |
|
|
Term
| Which benzodiazepines have short half-life? |
|
Definition
|
|
Term
| Which benzodiazepines have intermediate half-life? |
|
Definition
| Alprazolam, Clonazepam, Lorazepam |
|
|
Term
| Which benzodiazepines have long half-life? |
|
Definition
| Chlordiazepoxide, Diazepam, Flurazepam |
|
|
Term
| Requirement for involuntary admission? |
|
Definition
| Two physicians find that pt. is potentially harmful to self or others |
|
|
Term
| What must pt. demonstrate for informed consent? |
|
Definition
| Know name of treatment, alternatives to treatment, risks and benefits of treatment, consequences of refusing treatment, and pt. must have capacity to make decision |
|
|
Term
| Which kinds of care may minor receive without consent from parent? |
|
Definition
| STD, obstetric care, and treatment of substance abuse |
|
|
Term
| What can make a minor emancipated? |
|
Definition
| In military, married, have children, or self-supporting |
|
|
Term
|
Definition
| Legal term that judge determines |
|
|
Term
|
Definition
| Clinical term, must meet 4 criteria |
|
|
Term
| What four criteria must be met for capacity? |
|
Definition
| Can communicate choice, understands purpose, risk/benefits, and alternatives, appreciates situation and consequnces, and can logically understand situation and reach rational conclusions |
|
|
Term
| To stand trial, one must be? |
|
Definition
|
|
Term
| What criteria must be met to be found "not guilty by reason of insanity"? |
|
Definition
| 1. Must have mental illness. 2. Not understand right from wrong. 3. Did not understand consequences of actions at time act committed 4. Must meet statutory criteria (varies) |
|
|
Term
| What must be established to prove malpractice? |
|
Definition
| 1. Established standard of care 2. Physician breached responsbility to plantiff 3. Breach led to injury/damage to plaintiff |
|
|
Term
| What is compensatory damage? |
|
Definition
| Reimbursement of medical expenses, lost salary, and physical suffering |
|
|
Term
|
Definition
| Awarded to patient to punish doctor for gross negligence |
|
|
Term
| Which SSRI is pregnancy category D? |
|
Definition
|
|
Term
| All other SSRIs are what category? |
|
Definition
|
|
Term
| What are examples of SNRIs? |
|
Definition
| Venlafaxine, Duloxetine, and Desvenlafaxine |
|
|
Term
| Duloxetine is also used for? |
|
Definition
| Fibromyalgia and diabetic neuropathy |
|
|
Term
| What are examples of NDRIs? |
|
Definition
| Bupropion (less sexual side effects, no wt. gain) |
|
|
Term
| Which two antidepressants are known for sedation? |
|
Definition
| Trazodone and mirtazepine |
|
|
Term
| Which anti-depressant increases appetite? |
|
Definition
|
|
Term
| What are chances of 2nd episode of depression after 1? |
|
Definition
|
|
Term
| What are chances of 3rd episode after 2 episodes? |
|
Definition
|
|
Term
| What are chances of 4th episode after 3 episodes |
|
Definition
|
|
Term
| Can anti-depressants be discontinued abruptly? |
|
Definition
|
|
Term
| Which anti-depressants are most known for causing discontinutation syndrome? |
|
Definition
| Paroxetine and venlafaxine |
|
|
Term
| Are benzos a long term treatment option? |
|
Definition
| No, only for extremely short term due to addictive potential and withdrawal effects |
|
|
Term
|
Definition
| Generalized anxiety disorder |
|
|
Term
| What is buspirone's mechanism of action? |
|
Definition
| Partial serotonin agonist |
|
|
Term
| Which drug may decrease nightmares? |
|
Definition
|
|
Term
| Which two drugs are commonly used for psychotic agitation? |
|
Definition
| Haloperidol plus lorazepam |
|
|
Term
| Vertigo but no hearing loss after URI? |
|
Definition
|
|
Term
| Vertio and hearing loss after URI? |
|
Definition
|
|
Term
| Headache, diplopia, and papilledema in young woman? |
|
Definition
|
|
Term
| Upper respiratory +lower respiratory symptoms and kidney sx (hematuria)? |
|
Definition
|
|
Term
| What are important considerations in investigation of erectile dysfunction? |
|
Definition
| 1. Look at medications. 2. Lower neuro exam to rule out spinal stenosis, cauda equina syndrome 3. CV exam for vascular disease. 4. Diabetes -neuropathy 5. Testosterone level 6. Nocturnal erection - psych |
|
|
Term
| How does hemochromatosis cause ED? |
|
Definition
| Iron deposition in pituitary -> decreased LH and FSH -> hypogonadrotropic hypogonadism |
|
|
Term
| How is anti-psychotic related dystonia treated? |
|
Definition
| Anticholinergic drug such as benztroping, diphenhydramine, or trihexyphenidyl |
|
|
Term
| How is anti-psychotic related akasthisia treated? |
|
Definition
| Propranolol, benzodiazepine |
|
|
Term
| How is anti-psychotic realted parkinsonism treated? |
|
Definition
|
|
Term
| What are benzodiazepines with long half life? |
|
Definition
| Diazepam, Clonazepam, Chlordiazepoxide, Lorazepam (long or intermediate) |
|
|
Term
| What are benzodiazepines with intermediate half life? |
|
Definition
| Alprazolam, Oxazepam, Temazepam, Lorazepam (long or intermediate) |
|
|
Term
| What are benzodiazepines with short half life? |
|
Definition
| Midazolam (versed), triazolam |
|
|
Term
| Which anti-psychotic could cause decrease in night vision? |
|
Definition
| Thioridazine -> retinitis pigmentosa -> dec. night vision |
|
|
Term
| Treatment of priapism due to trazodone? |
|
Definition
| Injection of epinephrine into penis |
|
|
Term
| Treatment of lithium toxicity with seizure or coma? |
|
Definition
|
|
Term
| Anticholinergic side fx of TCA? |
|
Definition
| Blurry vision, dry mouth, urinary retention |
|
|
Term
| Antihistaminergic side fx of TCA? |
|
Definition
|
|
Term
| Anti-adrenergic side fx of TCA? |
|
Definition
|
|
Term
| Lethal side effect of TCA? |
|
Definition
|
|
Term
|
Definition
| GI upset and sexual (anorgasmia, dec. libido) |
|
|
Term
| Where are the majority of serotonin receptors in body? |
|
Definition
|
|
Term
| How long do post-partum blues usually last? |
|
Definition
|
|
Term
| What are common symptoms of post-partum blues? |
|
Definition
| Sadness, feelings of dependency, frequent crying spells, dysphoria |
|
|
Term
| How long should you continue anti-depressant when treating depression? |
|
Definition
| At least 6 months, regardless of improvement. Taper when discontinuing. |
|
|
Term
| What are negative symptoms of schizophrenia? |
|
Definition
| Flat affect, Alogia (diminished flow and spontaneity of speech), Avolition (lack of initiative and goals) |
|
|
Term
| What are positive symptoms of schizophrenia? |
|
Definition
| Ideas of reference (false beliefs that news broadcaster is talking to you or Bible passage written just for you), Disorganized speech or behavior, Delusions, Hallucinations |
|
|
Term
| What percentage of schizophrenics attempt suicide? |
|
Definition
|
|
Term
| What percentage of schizophrenics complete suicide? |
|
Definition
|
|
Term
| A stroke in which area is most likely to cause subsequent depression? |
|
Definition
| Left frontal- would classify as mood disorder caused by general medical condition |
|
|
Term
| Treatment of mania without psychosis? |
|
Definition
| Monotherapy with lithium, divalproex, or carbamazepin |
|
|
Term
| Treatment of mania with psychosis? |
|
Definition
| Dual therapy- add an atypical antipsychotic such as olanzapine |
|
|
Term
| How does bipolar disorder present in adolescents? |
|
Definition
| Multiple intense mood swings per day w/ short periods of euphoria, long periods of irritability |
|
|
Term
| Treatment of major depression with psychosis? |
|
Definition
| SSRI and anti-psychotic or ECT |
|
|
Term
| Treatment of social phobia? |
|
Definition
| Psychotherapy and behavioral therapy. Benzo or propranolol can be given for extremely short term (before flight or speech) |
|
|
Term
| Pt. presents with nystagmus, hyperacusis, and increased muscle strength? |
|
Definition
|
|
Term
| Treatment of generalized anxiety disorder? |
|
Definition
|
|
Term
| In what population is buspirone less effective in? |
|
Definition
| Pt. who has used benzo before |
|
|
Term
|
Definition
| Exposure/prevention therapy plus SSRI |
|
|
Term
| Encephalopathy, ataxia, opthalmogplegia in alcoholic? |
|
Definition
|
|
Term
| Female carriers of fragile X disorder are more likely to have which psychiatric disorder? |
|
Definition
| Schizotypal personality disorder (also increased incidence in those with family history of schizophrenia) |
|
|
Term
| How long does cocaine stay detectable on UDS? |
|
Definition
|
|
Term
| Characteristic EEG finding in delirium? |
|
Definition
|
|
Term
| Characteristic EEG finding in hepatic encephalopathy? |
|
Definition
|
|
Term
|
Definition
| Detect and correct underlying abnormality. Atypical antipsychotic and benzo can be given. Items to orient patient: tv/radio, window, pictures, visitors |
|
|
Term
| Agression toward people or animals, destruction of property, theft in child? |
|
Definition
|
|
Term
| Treatment of conduct disoder? |
|
Definition
| Allow natural consequences of actions (jail), multi-system approach (school, home, parent-child), observe for and tread ADHD, atypical antipsychotic |
|
|
Term
| Does Obsessive-Compulsive Personality Disorder cause impairment of function? |
|
Definition
| Yes, if not then dx is obs-compulsive traits |
|
|
Term
| PTSD is often accompanied by? |
|
Definition
| Depression and risk of substance abuse |
|
|
Term
| What is treatment of PTSD? |
|
Definition
| SSRI and cognitive behavioral therapy (exposure and reframing of associated thoughts) |
|
|
Term
| Depressed mood + 2 other symptoms for 2 years with no symptom free period longer than 2 mo? |
|
Definition
|
|
Term
|
Definition
| Dysthymia and hypomania for at least 2 years |
|
|
Term
| What is rapid cycling disorder? |
|
Definition
| Greater than 4 episodes of mania and major depression in 1 year |
|
|
Term
| Fear of having serious illness, misintepretation of physical signs/symptoms? |
|
Definition
|
|
Term
| Numerous physical complaints, unconsciously produced, that have no medical dx? |
|
Definition
|
|
Term
| Which types of hallucinations are more likely caused by medical condition? |
|
Definition
| Tactile, olfactory, gustatory |
|
|
Term
| Criteria for ADHD diagnosis? |
|
Definition
| Symptoms of hyperactivity, impulsivity, and inattention, onset prior to age 7, duration > 6months |
|
|
Term
|
Definition
| Stimulant- methylphenidate (ritalin), ampheatmine salts (adderall), atemoxetine |
|
|
Term
| Repetitive emesis as in bulimia causes? |
|
Definition
| Hypochloremic hypokalemic metabolic alkalosis, hypomagnesmia, elevated amylase, dental caries, and enlarged parotid glands |
|
|
Term
| What is treatment of bulimia? |
|
Definition
| Cognitive behavioral therapy, nutritional rehab, SSRI |
|
|
Term
| What is timeline for diagnosis of acute stress disorder? |
|
Definition
|
|
Term
| What is treatment of acute stress disorder? |
|
Definition
| Social support- can prevent development of PTSD |
|
|
Term
| How long must symptoms last to classify as PTSD? |
|
Definition
|
|
Term
| What is goal of supportive psychotherapy? |
|
Definition
| Maintain pt. intrapsychic functioning |
|
|
Term
| What is goal of insight-oriented psychotherapy? |
|
Definition
| Improve pt. intrapsychic functioning |
|
|
Term
| What defense mechanisms are commonly used in histrionic personality disorder? |
|
Definition
| Repression and dissociation |
|
|
Term
| What are criteria for adjustment disorder? |
|
Definition
| Occurs within 3 mo. of stressor and lasts up to 6 mo after stressor ends. Can have anxiety and/or depressive symptoms. |
|
|
Term
| Depression in children often presents as? |
|
Definition
|
|
Term
| Motivation and fabrication of symptoms are conscious in which disorders? |
|
Definition
| Malingering and factitious disorder |
|
|
Term
| Motivation and fabrication of symptoms are unconscious in which disorders? |
|
Definition
| Conversion, somatitization disorder |
|
|
Term
| A dysomnia is a problem with? |
|
Definition
| Duration or type of sleep |
|
|
Term
| What are examples of dysomnias? |
|
Definition
| Narcolepsy, Obstructive sleep apnea, poor sleep hygiene, circadian rhythm disorder |
|
|
Term
| A parasomnia is a problem with? |
|
Definition
|
|
Term
| What are examples of parasomnias? |
|
Definition
| Nightmare, night terror, bruxism, nocturnal enuresis, periodic limb movement disorder |
|
|
Term
| Difficulty falling asleep and multiple night time awakenings for at least 1 month that causes impairment? |
|
Definition
|
|
Term
|
Definition
| Sleep hygiene, can try 2 week course of zaleplon, zolpidem, or benzo - no longer than 2 weeks- can develop addiction |
|
|
Term
| What is good sleep hygiene practice? |
|
Definition
| Eat at regular times (not late at night), Hot bath near bedtime, Warm milk near bedtime, Avoid daytime naps, Get up/go to bed at same time each day, Avoid caffiene, alcohol, or nicotine, Exercise, Avoid evening stimulation |
|
|
Term
| Multiple symptoms in multiple organ systems with no medical cause that begin prior to age 30? |
|
Definition
|
|
Term
| Which anti-depressants are best for depression in breastfeeding mother? |
|
Definition
| Sertraline or paroxetine. They have the least amount of transfer in breastmilk. |
|
|
Term
| Visual hallucinations 2 weeks after using LSD? |
|
Definition
| Hallucinogen Persisting Perception Disorder- continued sensory perception dysfunction after usage of hallucinogen, may be worsened by stress, marijuane or sensory deprivation (monotonous driving) |
|
|
Term
| Single motor OR vocal tic? |
|
Definition
|
|
Term
| Muttiple motor AND vocal tics, occurs longer than 1 year? |
|
Definition
|
|
Term
| Which tic usually appears first in Tourette's? |
|
Definition
|
|
Term
|
Definition
| Haloperidol, or clonidine or guanifescine |
|
|
Term
| Which defense mechanisms is common in Avoidant personality disorder? |
|
Definition
| Displacement- transferring a feeling about one object to another- yell at kids instead of boss. Projection- individual attributes feelings they have about themselves to others |
|
|
Term
| Anxiety about separation from home or caretaker, occurs longer than 4 weeks? |
|
Definition
| Separation Anxiety Disorder |
|
|
Term
| What often precipitates development of separation anxiety disorder? |
|
Definition
| Life-threatening disease or accident involving parent |
|
|
Term
| What often develops in patient with separation anxiety disorder? |
|
Definition
| Somatic complaints- headache, stomach ache |
|
|
Term
|
Definition
| Family therapy, inc. school support, SRRI |
|
|
Term
| Risk of what is increased in pt. with separation anxiety? |
|
Definition
|
|
Term
| What is dissociative fugue? |
|
Definition
| Overwhelming stress, traumatic event, sudden travel -> pt. forgets identity-> creates new identity |
|
|
Term
| Is dissociate fugue usually chronic? |
|
Definition
| No, usually resolves quickly |
|
|
Term
| What is dissociative amnesia? |
|
Definition
| Inability to recal specific info. about one's identity, usually caused by trauma/stress. Does not involve travel or creation of new identity |
|
|
Term
| What is dissociative identity disorder? |
|
Definition
| Trauma, abuse in childhood -> creation of multiple personalities that recurrently take control of behavior |
|
|
Term
| Can you diagnose mood symptoms in pt. who is actively intoxicated or withdrawing? |
|
Definition
|
|
Term
| Difficulty balancing work and relationships, lifelong problems with work and love that cause anxiety? |
|
Definition
|
|
Term
| Is neurosis ego-syntonic or ego-dystonic? |
|
Definition
| Ego-dystonic- pt. understands problem is with themselves |
|
|
Term
| What is timeline for alcohol withdrawal? |
|
Definition
| Tremor@ 6-8hours, Psychosis@ 8-12 hours, Seizures@12-24 hours, DTs@24-72 hours |
|
|
Term
| What is best benzo for alcohol withdrawal? |
|
Definition
| Lorazepam- metabolized by glucuronidation, which is not dependent on liver function |
|
|
Term
| Pt. feels as if they should have been born a member of opposite sex? |
|
Definition
|
|
Term
| What is treatment of gender identity disorder? |
|
Definition
| Psychotherapy for social ostracism, Hormonal Therapy, Surgical sexual reassignment |
|
|
Term
| Hormonal and surgical treatment is most successful if pt. does what? |
|
Definition
| Lives as opposite sex in community for 3 months prior to hormones and 12 months prior to surgery (9 on hormones) |
|
|
Term
| A mildly retarded pt. IQ 55-70 can do what? |
|
Definition
| Can live and work independetly, can hold a job. |
|
|
Term
| A moderately retarded pt IQ 40-55 can do what? |
|
Definition
| Some self care, but will need supervision |
|
|
Term
| A severely retarded pt IQ 25-40? |
|
Definition
| Is not independent, will need to live with someone else |
|
|
Term
| A profoundly retarded pt IQ < 25 will need? |
|
Definition
| Nursing care throughout life |
|
|
Term
| Motor or neurologic symptoms unconsciously produced after new stressor? |
|
Definition
|
|
Term
| What populations is conversion disorder seen more often? |
|
Definition
| Lower socioeconomic and less educated |
|
|
Term
| What is la belle indifference? |
|
Definition
| Pt. with conversion disorder show indifference or lack of concern about symptoms |
|
|
Term
| What is treatment of conversion disoder? |
|
Definition
| Reassurance that pt. will get better with time |
|
|
Term
| What are symptoms of amphetamine intoxication? |
|
Definition
| Dec. need for sleep, agitation, tachycardia, hypertension, mydriasis, diaphoresis, hallucinations (psychosis) |
|
|
Term
| What is optimal treatment for Borderline Personality disorder? |
|
Definition
| Dialectical Behavior Therapy- helps pt. confront and manage volatile emotions and impulses |
|
|
