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244 Cards in this Set
- Front
- Back
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what are the kubler-ross grief stages?
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denial, anger, bargaining, grief, acceptance. not in order and can have >1 at a time
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what 5 enzymes are induced in stress?
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fatty acids, corticosteroids, lipids, cholesterol, catecholamines
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what 4 physical effects can be affected in stress?
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water absorption, muscle tonicity, gastrocolic reflex, and mucosal circulation
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what 5 diseases can be exacerbated by stress?
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irritable bowel syndrome, gastric ulcer disease, rheumatoid arthritis, diabetes, CHF
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name 4 drugs that can cause sexual dysfunction
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antihypertensives, SSRI, neuroleptics, ethanol
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name two diseases that can cause sexual dysfunction
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diabetes, depression
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what psychological problem can cause sexual dysfunction?
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performance anxiety
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what are the most famous tests for IQ?
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stanford-binet and wechsler
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how does the stanford-binet test work?
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calculates IQ as mental age/chronological age x 100
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how is the wechsler adult intelligence scale scored?
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11 subtests (6 verbal, 5 performance). mean 100, standard deviation 15
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name the IQ definitions for mental retardation, severe mental retardation, and profound mental retardation
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IQ <70 (2 standard devs below), IQ <40, IQ < 20
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what two factors are correlated with IQ scores?
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genetic factors, school performance
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define classical conditioning
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learning where natural response is elicited by conditioned response that previously was in conjunction with unconditioned stimulus
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what is the natural response in pavlov's experiments
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salivation
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what is the conditioned (learned) stimulus in pavlov's experiments
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bell
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what is the unconditioned stimulus in pavlov's experiments
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food
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define operant conditioning
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learning where certain action is done becuase you get reward
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give an example of positive reinforcement
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mouse presses button to get food
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give an example of negative reinforcement
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mouse presses button to avoid shock
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what is the difference between negative reinforcement and punishment
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negative reinforcement - being nice to younger brother to avoid being scolded (active). punishment: decreasing behavior after being scolded (passive)
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define reinforcement schedule
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pattern of reinforcement determines how quickly behavior is learned or extinguished
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give an example of continuous reinforcement
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like vending machine: stop using if doesn't deliver (rapidly extinguished)
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give an example of variable ratio?
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slot machine - continue to play even if it rarely rewards. slowly extinguished.
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define transference
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patient proejcts feelings about important person onto physician (physician=parent)
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define countertransference
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doctor projects feelings about important person onto patient (patient=child)
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what are Frued's 3 structures of the mind?
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id, superego ego
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define Id
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primal urges, sex, aggression ( I want it)
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define superego
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moral values, conscience (you know you can't have it)
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define ego
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mediator between unconscious mind and external world (deals with conflict)
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define conscious
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what you are aware of
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define preconscious
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what you are able to make conscious with effort (phone number)
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define unconscious
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what you are not aware of (goal of Freudian psychoanalysis)
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define oedipus complex
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repressed sexual feelings of child for opposite-sex parent, acompanied by rivalry with same-sex parent
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what are automatic and unconscious reactions to psychological stress?
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ego defenses
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ego defense: mafia boss makes large donation to charity
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altruism
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ego defense: nervous medical student jokes about the boards
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humor
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ego defense: aggressive impulses used to succeed in business
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sublimation
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ego defense: choosing not to think about USMLE until week before test (conscious)
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suppression
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is suppression conscious or unconscious?
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conscious (and voluntary)
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what are mature responses?
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sublimation, altruism, humor, suppression (mature women wear a SASH)
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ego defense: tantrums
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acting out
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temporary, drastic changes in personality, memory, consciousness, motor behavior to avoid stress
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dissociation
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avoidance of awareness of painful reality
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denial (subconscious)
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ego defense: mother yells at child because she is angry at husband
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displacement
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partially at more childish level of development (men and sports)
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fixation
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abused child becomes abuser
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identification
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describes murder in graphic detail with no emotional response
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isolation
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man who wants another woman think his wife is cheating on him
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projection
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saying the job was not important anyway after getting fired
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rationalization
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patient with sexual thoughts enters monastery
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reaction formation
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patient crying in dialysis, child bed-wetting in stress
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regression
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involuntary withholding of an idea or feeling from conscious
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repression
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what is the basic mechanism underlying all other ego defenses?
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repression
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patient says that all nurses are insensitive but all doctors are nice
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splitting
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what is the difference between substance abuse and substance dependence?
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substance abuse = impairement symptoms (i.e. recurrent use in physically hazardous situations) vs substance dependence (attempts to cut back, energy spent getting substance)
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characteristics of substance abuse (1 or more in 1 year)
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recurrent use results in failure to fulfill major obligations, recurrent use in physically hazardous situations, recurrent substance-related legal problems, continued use despite personal problems
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drug intoxication that causes disinhibition, slurred speech
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alcohol
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what is the best enzyme test for alcohol intoxication?
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GGT
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drug withdrawal that causes tachycardia, delirium tremons, hallucinations
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alcohol
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drug intoxication that causes cns depression, nausea/vomiting, pinpoint pupils
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opioids
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what drug withdrawal causes piloerection, flulike symptoms, dilated pupils
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opioids
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intoxication includes pupillary dilation, euphoria, prolonged wakefulness and attention
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amphetamines
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withdrawal leads to post-use crash including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
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amphetamines
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intoxication leads to euphoria, tactile hallucination, paranoid, sudden cardiac death
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cocaine
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withdrawal leads to severe depression, severe psychological carving
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cocaine
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intoxication: belligerence, nystagmus, psychosis
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PCP
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withdrawal: recurrence of intoxication symptoms due to reabsorption in GI tract: sudden onset of severe, random, homicidal violence
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PCP
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intoxication: marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupil dilation
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LSD
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intoxication: paranoid, slowed time, dry mouth
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marijuana
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intoxication: low safety margin, respiratory depressoin
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barbituates
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withdrawal: delirium, anxiety, life-threatening cardiovascular collapse
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barbituates
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intoxication: somnolence, minor respiratory depression, ataxia
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benzodiazepines
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withdrawal: rebound anxiety, insomnia, tremors
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benzodiazepines
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intoxication: increased diuresis, restlessness, muscle twitching
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caffeine
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withdrawal: headache, lethargy, depression, weight gain
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caffeine
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intoxication: restlessness, insomnia, anxiety, arrythmias
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nicotine
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withdrawal: irritability, headache, anxiety, weight gain, craving
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nicotine
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treatment for alcoholism
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disulfiram to condition patient to abstain, supportive treatment of systemic problems, peer support groups
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life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink
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delirium tremens
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what is the order of appearance of DT symptoms
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first autonomic hyperactivity (tachycardia, anxiety), then psychotic symptoms (hallucinations, delusions) then confusion
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what is the treatment for delirium tremens?
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benzodiazepines
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alcoholic hepatitis/cirrhosis, pancreatitis, dilated cardiomyopathy, peripheral neuropathy, cerebellar degeneration, wernicke-korsakoff, testicular atrophy + hyperestrinism, mallory-weiss are complications of what?
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alcoholism
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name 4 late consequences of alcoholic cirrhosis
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peirpheral edema/ascites, encephalopathy, asterixis (flapping of hands), esophageal varices
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name 4 symptoms of alcoholic cirrhosis
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jaundice, hypoalbuminemia, coagulation factor deficiencies, portal hypertension
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deficiency of what causes Wernicke-Korsakoff syndrome?
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thiamine (B1)
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what is the classic triad of Wernickes's encephalopathy
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confusion, ophthalmoplegia, ataxia
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what are 3 symptoms of korsakoff's psychosis?
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memory loss, confabulatoin, personality change
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is korsakoff's reversible or irreversible
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irreversible
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what is the anatomical defect in the brain in wernicke-korsakoff syndrome?
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periventricular hemorrahge/necrosis particularly in mamillary bodies
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what is the treatment of wernicke-korsakoff?
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IV thiamine
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what distinguished mallory-weiss from esophageal varices?
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pain
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longitudinal lacerations at gastroesophageal junction caused by excessive vomiting
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mallory-weiss syndrome
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name two competitive inhibitor for opioids
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naloxone and naltrexone
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what is used for heroin detoxification or long-term maintenance?
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methadone (long acting oral opiate)
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name 6 risks in heroin addiction?
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hepatitis, abscess, overdose, hemorrhoids, AIDS, right-sided endocarditis
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rapid decrease in attention span and level of arousal -disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction
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delirium
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2 keys to diagnosing delirium
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waxing/waning consciousness, rapid development
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2 causes of delirium
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substance abuse, medical illness
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is delirium reversible or irreversible?
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reversible
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what is the characteristic of drugs that can cause delirium?
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anticholinergic
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what is the most common psychiatric illness on medical/surgical floors?
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delirium
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gradual decrease in cognition: memory deficits, aphasia, apraxia, agonsia, loss of abstract thought, behavior/personality changes, impaired judgement
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dementia
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name 3 keys to diagnosing dementia?
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patient is alert, no change in level of consciousness, more gradual
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what condition can present like dementia in the elderly?
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depression
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is dementia irreversible or reversible?
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irreversible
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sleep disturbance, loss of interest, guilty, loss of energy, loss of concentratoin, change in appetite, psychomotor retardation, suicidal ideations
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major depressive disorder
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are males or females more likely to get major depressive disorder?
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females
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define intervals of major depressive disorder
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2 or more episodes with symptom-free interval of 2 months
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what is a mild form of depression lasting at least 2 years?
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dysthymia
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name 3 sleep patterns of depressed patients
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decreased slow-wave sleep, decrease REM latency, early moring awakening
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what is the most important sleep screening question for depressed patients?
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early morning awakening
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these are risk factors for what condition: male, teenaged/elderly, depressed, previous atempt, drugs, loss of rational thinking, sickness, organized plan, no spouse, no social support
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suicide completion
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what is the gender difference between suicide?
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women try more, men succeed more often
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what is a treatment option for refractory major depressive disorder
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electroconvulsive therapy
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is ECT painful or painless?
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painless
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what response does ECT provoke?
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seizure
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what are the 3 major adverse affects of ECT?
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disorientation, anterograde amnesia, retrograde amnesia
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what causes complications of ECT?
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anesthesia
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distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week
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manic episode
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distractibility, irresponsibiliy, grandiosity, flight of ideas, agitation, goal directed activity, decreased sleep, talkativeness
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manic episode
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what are 3 differences between hypomania and mania?
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hypomania not severe enough to cause marked impairment in functioning or hospitalization and also no psychotic features
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combination manic and depressed episodes
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bipolar I
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combination of hypomanic and depressed episodes
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bipolar II
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how many manic episodes do you need to define bipolar disorder?
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1
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what is the treatment of choice for bipolar disorder
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lithium
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what is a mild form of bipolar disorder lasting two years?
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cyclothymic disorder
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patient consciously fakes to have a disorder for specific gain
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malingering
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patient consciously creates symptoms to assume sick role and get medical attention
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factitious disorder
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chronic history of multiple hospital admissions and willingness to receive invasive procedures
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Munchausen's syndrome
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illness in child is caused by parent, motivation is unconscious. child abuse
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munchausen's syndrome by proxy
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is somatoform disorder more common in men or women?
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women
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is illness production/motivation of somatoform disorder conscious or unconscious?
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unconscious
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motor or sensory symptoms that suggest neurological/physical disoder but tests negative, acute stressor, patient unconcerned about symptoms
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conversion
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prolonged pain that is not explained by illness
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somatoform pain disorder
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preoccupation with and fear of getting sick despite medical reassurance
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hypochondriasis
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variety of complaints in multiple organ systems with no identifiable underlying physicial finding
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somatization disorder
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preoccupation with minor or imagined physical flaws, patients seek cosmetic surgery
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body dysmorphic disorder
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false belief of being pregnant
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pseudocyesis
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define primary gain
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what symptom does for patient's psyche (nothing to do w/ what get from other people)
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define secondary gain
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what the symptoms gets patient from other people(sympathy, attention)
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define tertiary gain
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what the caretaker gets (MD on interesting case)
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recurrent periods of fear/discomfort with palpitations, paresthesias, abdominal distress, nausea, intense fear of dying, light-headedness, chest pain, chills, choking, disconnectedness, sweating, shakng, shortness of breath
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panic disorder
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how do you describe panic disorder?
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in context of occurence (i.e. panic disorder with agoraphobia)
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fear that is excessive or unreasonable, cued by specific object or situation. exposure provokes anxiety response
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specific phobia
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is a phobia unconscious or does the patient recognize that fear is excessive?
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patient recognizes fear is excessive
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treatment for phobia
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systemic desensitization
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fear of marriage
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gamophobia (gam in gamete)
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fear of pain
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algophobia (alg=pain)
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fear of heights
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acrophobia (acro=height)
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fear of being unable to escape from a place
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agoraphobia
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person witnessed traumatic event. response is intense fear, helplesness, horror. persistent flashbacks and person avoids stimuli associated with trauma
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post-traumatic stress disroder
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how long does PTSD last?
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> 1 month, usually less than 3 months
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what does PTSD usually follow and how long does that last
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acute stress disorder, 2-4 weeks
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emotional symptoms causing impairment following an identifiable stressor and lasting <6 months
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adjustment disorder
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uncontrollable anxiety for at least 6 months that is unrelated to specific thing. sleep disturbance, fatigue, difficulty concentrating
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generalized anxiety disorder
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patient with severe communicaiton problems and difficulty forming relationships. repetitive behavior, unusual abilites, below-normal intelligence
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autistic disorder
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treatment for autistic disorder
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increase communciation and social skills
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mild autisim with problems in social relationships and repetitive behavior
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asperger's disorder
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autism with normal intelligence and lack of social/cognitive defects
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asperger's disorder
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x-linked disorer in girls. loss of development and mental retardation by age 4. stereotyped hand-wringing
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Rett disorder
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limited attention span and hyperactivity. emotionally labile, impulsive, prone to accidents. normal intelligence
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ADHD
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treatment for ADHD
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methylphenidate (ritalin)
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continued behavior violating social norms. < 18 years old
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conduct disorder
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child noncompliant in absence of criminality
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oppositional defiant disorder
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motor/vocal tics and involuntary profanity. onset < 18 years old
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Tourette's syndrome
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treatment for tourette's
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haloperidol
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fear of loss of attachment figure leading to factitious physical complaints to avoid going to school. onset 7-8 years old
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separation anxiety disorder
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abnormal eating habits, body image distortion, increased exercise, severe weight loss, amenorrhea, anemia, electrolyte disturbances, adolescent girls, coexist with depression
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anorexia nervosa
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bing eating followed by self-induced vomiting/laxatives. normal body weight. parotitis, enamel erosion, electrolyte disturbances, dorsal hand calluses from induced vomiting
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bulimia nervosa
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perceptions in the absence of external stimuli
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hallucinations
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misinterpretations of actual external stimuli
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illusions
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false beliefs not shared by others that are firmly maintained despite obvious proof to contrary
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delusion
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delusion vs loose association
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delusion = disorder in actual idea, loose association - way ideas tied together
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common schizophrenia hallucinations
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visual/auditory
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aura of psychomotor epilepsy
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olfactory hallucination
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is gustatory hallucination common or rare?
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rare
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two groups that see tactile hallucination
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cocaine users, alcohol users (DTs)
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hallucination while going to sleep
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hypnagogic
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hallucination while waking from sleep
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hypnopompic
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person stops breathing for at least 10 seconds repeatedly during sleep
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sleep anea
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sleep apnea with no respiratory effort
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central
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sleep apnea with effort against obstruction
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obstructive
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treatment for sleep apnea
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weight loss, continuous positive airway pressure, surgery
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condition associated with obesity, loud snoring, hypertension, arryhtmias, sudden death, chronic tiredness
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sleep apnea
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disordered regulation of sleep-wake cycles with strong genetic component
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narcolepsy
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what stage does narcoleptic sleep episodes start with
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REM
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loss of all muscle tone following strone emotional stimulus
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cataplexy
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treatment for narcolepsy
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stimulants (amphetamines)
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period of psychosis and distubed behavior with decline in function > 6 months
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schizophrenia
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period of psychosis and distubed behavior with decline in function 1-6 months
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schizophreniform
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period of psychosis and distubed behavior with decline in function < 1 month. stress related
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brief psychotic disorder
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delusions, hallucinations, loose associations, disorganized behavior
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positive symptoms of schizophrenia
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flat affect, social withdrawal, lack of motivation, lack of speech/thought
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negative symptoms schizophrenia
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are genetic or environmental factors more important in schizophrenia
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genetic factors
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what group is more likely to get schizophrenia?
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none. men=females, black=whites
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a combination of schizophrenia and mood disorder
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schizoaffective disorder
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5 subtypes of schizophrenia
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disorganized, catatonic, paranoid, undifferentiated, residual
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enduring pattern of perceiving, relating to, and thinking about the environment and onself that is exhibited in a wide range of important and personal contexts
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personality
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pattersn become inflexible, causing impairment in social functioning, patient not aware of problem.
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personality disorder
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are personality disorders diagnosed usually in early adulthood or childhood?
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early adulthood
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personality disorder: odd/eccentric, no meaningful social relationships, no psychosis, genetic association with schizophrenia
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Cluster A personality disorders
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distrust and suspiciousness, projection is main defense mechanism
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paranoid
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voluntary social withdrawal, limited emotional expression
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schizoid
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interpersonal awkwardness, odd beliefs or magical thinking, eccentric appearance
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schizotypal
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personaliy cluster: dramatic, emotional, erratic: genetic association with mood disorders and substance abuse
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cluster B personality disorders
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disregard for and violation of rights of others, crimality, males > females, > 18
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antisocial
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unstable mood and interpersonal relationships, impulsive, sense of emptiness, more females than males
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borderline
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excessive emotions, attention seeking, sexually provocative
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histrionic
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grandiosity, sense of entitlement, react to criticism with rage
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narcissistic
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perosnality cluster that is anxious or fearful, genetic association with anxiety disorders
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cluster C personality disorders
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sensitive to rejection, socially inhibited, feelings of inadequacy
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avoidant
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preoccupation with order, perfectionism, control
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obsessive-compulsive
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submissive and clinging, excessive need to be taken care of, low self-confidence
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dependent
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Test that reflects basic and higher level cognition and neuro-sensory functioning of the entire brain
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halstead-reitan battery
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test that is primarily verbal skills
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stanford-binet intelligence test
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developmental and social functioning test
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vineland adaptive behavior scale
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intelligence assessment test, not aphasia or neuro-sensory skill
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wechsler adult intelligence test
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academic achievement only test
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wide range achievement test
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how to address patient when first meet
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leveling: if physician wants title, need to address patient w/ title also
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If needle stick from patient occurs, is an AIDS test on the patient a violation of confidentiality?
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no, because there is threat to self or others
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if you make a mistake with drugs in patient, what do you do?
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always admit mistake. this strengthens the patient-physician relationship
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do patients with avoidant personality disorder want relationships?
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yes they dislike their isolation but fear rejection
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therapy for phobia that guides patient through progressive steps
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desensitization
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change response by denying reward that has maintained that response
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extinction
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encouraging patient to confront feared object without gradual exposure
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flooding
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what is the criteria for emancipated minors under 18 (4)
|
self-supporting, military, married, children
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when should you refer patients to others?
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NEVER
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who do you report an impaired resident to?
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person directly in charge of the physician
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who do you report an impaired licensed physiican to?
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state licensing board
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can a patient involuntarily confined in a mental health hospital deny treatment?
|
yes
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under what conditions can organs be harvested after death?
|
signed donor card (doesn't matter if expired) or informed surrogate
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is it ethical and legal for a patient to refuse treatment to HIV positive patient
|
not ethical but legal
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does a pregnant woman have the right to refuse life-saving intervention for the fetus?
|
yes
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do you still need informed consent if you find unexpected non-emergency finding in surgery?
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yes
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do you still need consent if an unexpected emergency finding is found in surgery?
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no
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what do you do if parents refuse life saving treatment for dying child?
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court order to save life
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what conditions can you treat a child without parental consent?
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emergency, STD, prenatal care, drug abuse, contraceptive prescription
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3 facets of legal informed consent
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discuss risks, benefits, alternatives/patient agrees to care/no coercion
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4 exceptions to informed consent
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1. patient lacks decision-making capabiliy
2. emergency 3. withold information that would severly harm patient 4. patient waives informed consent |
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5 facets of decision making capability
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1. patient makes and communicate s choice
2. patient is informed 3. decision remains stable 4. decision consistent with patient's values and goals 5. decision is not result of delusions/hallucination |
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algorithmn for ethics questions:
rank priorities in questions for patients |
1. introduction. 2. come to diagnosis. 3. talk about diagnosis. 4. talk about treatment.
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how to treat regression in sibling of patient?
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tell parents to spend more time with child.
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term for inability to recognize faces
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prosopagnosia
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deficit in cognition about one's illness
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anosagnosia
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