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164 Cards in this Set

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Behavior

What are the tanner stages of development?
1. Childhood
2. pubic hair begins to develop, increase testes size, breast tissue elevation
3. increase penis width, darker scotal skin, development of glans, raised areola
5. adult, areola is no longer raised
Behavior

What is pathologic grief?
Pathologic grief includes extensively intense or prolonged grief or grief that is delayed, inhibited or denied.

May experience depressive symptoms, delusions, and hallucinations.
Behavior

What are the Kubler-Ross grief stages?
Denial, Anger, Bargaining, Grieving, Acceptance
(Death Arrives Bringing Grave Adjustments)

Stages do not have to occur in this order and > 1 stage can be present at a time
Behavior

What are the stress effects on our body processes?
Stress induces production of free fatty acids, 17-OH corticosteroids, lipids, cholesterol, catecholamines, affects water absorption, muscular tonicity, gastrocolic reflex, and mucosal circulation
Behavior

What is the differential diagnosis for sexual dysfunction?
1. drugs (antihypertensives, neuroleptics, SSRI's, ethanol)
2. diseases (depression, diabetes)
3. psychological (performance anxiety)
Behavior

What is the formula for BMI?
BMI is a measure of weight adjusted for height

BMI: weight in kg / (height in meters)squared
Behavior

What is a BMI for someone who is underweight, overweight, and obese?
Underweight: <18.5
Overweight: 25-29
Obese: >30
Behavior

What are the four mature ego defenses?
Mature ego defenses:
1. altruism
2. humor
3. sublimation
4. suppression

"Mature women wear a SASH: Sublimation, Altruism, Suppression, Humor"
Behavior

Ego defense:
Altruism?
Guilty feeling alleviated by unsolicited generosity towards others

(mafia boss makes large donations to charity)
Behavior

Ego defense:
Humor
Appreciating the amusing nature of an anxiety-provoking or adverse situation

(nervous medical student jokes about taking boards)
Behavior

Ego defense:
Sublimation
Sublimation:
Process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with ones value system.

(aggressive impulses used to suceed in business ventures)
Behavior

Ego defense:
Suppression
Voluntary (unlike repression) withholding of an idea or feeling from conscious awareness

(choosing not to think about the USMLE until the week of the exam)
Behavior

Immature ego defenses
Acting out
Unacceptable feelings and thoughts are expressed through actions

(tantrums)
Behavior

Immature ego defenses
Dissociation
Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress.

(extreme forms can result in multiple personalities (dissociative identity disorder))
Behavior

Immature ego defenses
Denial
Avoidance of awareness of some painful reality

A common reaction in newly diagnosed AIDS and cancer patients
Behavior

Immature ego defenses
Displacement
Process whereby avoided ideas and feelings are transferred to some neutral person or object

(mother yells at child because she is angry at her husband)
Behavior

Immature ego defenses
Fixation
Partially remaining at a more childish level of development

Men fixating on sports games
Behavior

Immature ego defenses
Identification
Modeling behavior after another person who is more powerful but not necessarily admired

(abused child becomes an abuser)
Behavior

Immature ego defenses
Isolation
Separation of feelings from ideas and events

(describing murder in graphic detail with no emotional response)
Behavior

Immature ego defenses
Projection
An unacceptable internal impulse is attributed to an external source

(a man who wants another woman thinks his wife is cheating on him)
Behavior

Immature ego defenses

Rationalization
Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame

(saying the job was not important anyway, after getting fired)
Behavior

Immature ego defenses
Reaction formation
Process whereby a warded-off idea of feeling is replaced by an (unconsciously derived) emphasis on its opposite.

(a pt with libidinous thoughts enter a monastery)
Behavior

Immature ego defenses
Regression
Turning back the maturational clock and going back to earlier modes of dealing with the world

Seen in children under stress (bed-wetting) and in patient on dialysis
Behavior

Immature ego defenses
Repression
Involuntary withholding of an idea or feeling from conscious awareness. The basic mechanism underlying all others.
Behavior

Immature ego defenses
Splitting
The belief that people are either good or bad

A patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly
Behavior

What is classical conditioning?
Learning in which a natural response (salivation) is elicited by a conditioned, or learned, stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food)
Behavior

Operant conditioning?
Pos and Neg reinforcement
Learning in which a particular action is elicited because it produces a reward.

Postive reinforcement: desired reward produces action (mouse presses button to get food)

Negative reinforcement: removal of adverse stimulus increases behavior (mouse presses button to avoid shock)

DO NOT CONFUSE WITH PUNISHMENT
(taking away something negative to reinforce an action)
Behavior

What are reinforcement schedules?
Pattern of reinforcement determines how quickly a behavoir is learned or extinguished
Behavior

What is a continuous reinforcement schedule
Reward received after every exposure causing the behavior be extinguished.

(think vending machine - stop using it if it does not deliver)
Behavior

What is variable ratio reinforcement schedule?
Reward recieved after random number of responses. Slowly extinguished.

Think slot machine, continue to play even if it rarely pays out.
Behavior

What is transference?
Patient projects feelings about formative or other important persons onto physician (eg psychiatrist = parent)
Behavior

What is countertransference?
Doctors project feelings about formative or other important persons onto patient.
Behavior

Freud's three (structural) theory of mind
Id: primal urges, sex, and aggression (I want it)

Ego: mediator between the unconscious mind and the external world. (deals with the conflict. take it and you will get in trouble)

Superego: moral values, conscience (you know you can't have it. taking is wrong)
Behavior

What are the three components of topographic theory of the mind?
Conscious: what you are aware of
Preconscious: what you are able to make conscious with effort (your phone number)

Unconscious: what you are not aware of; the central goal of Freudian psychoanalysis is to make the patient aware of what is hidden in his/her unconscious.
Behavior

Oedipus complex
Repressed sexual feelings of a child for the opposite-sex parent, accompanied by rivalry with same-sex parent.
Behavior

Narcolepsy
Disordered regulation of sleep-wake cycles. May include hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations.

The patients nocturnal and narcoleptic sleep episodes start off with REM sleep.
Behavior

What is cataplexy?
Loss of all muscle tone following a strong emotional stimulus.
It has a strong genetic component.
Treat with stimulants (amphetamines)
Behavior

What two things are correlated to IQ score?
Genetic factors and school achievement
Behavior

What type of tests are IQ tests?
Objective not projective
Behavior

What is the IQ criteria for diagnosis of mental retardation?
IQ < 70 (or 2 standard deviations below the mean) is one of the criteria for diagnosis of mental retardation.

IQ < 40 - severe MR
IQ < 20 - profound MR
Behavior

Standford-Binet test?
Test of IQ as mental age/chronilogical age x 100
Behavior

Wechsler Adult Intellegence scale
Uses 11 subtests (6 verbal, 5 performance)
Behavior

What is the mean of the IQ test and the standard deviation?
Mean 100
SD: 15
Behavior

What is REM sleep
REM sleep is like sex:
= increase pulse, penile/clitoral tumescence, decreases with age, increase BP

Occurs every 90 minutes and duration increases during the night.
Behavior

What is the primary neurotransmitter involved in REM sleep?
Acetylcholine
Behavior

Sleep stages and assoc wave forms:
Light sleep
Stage 1 (5%) and there are Theta wave forms on EEG
Behavior

Sleep stages and assoc wave forms:
Deeper sleep
Stage 2 (45%)
Sleep spindles and K complexes seen on EEG
Behavior

What sleep stage is assoc with delta EEG waveforms?
Deepest, non-REM sleep; sleepwalking; night terrors, bed-wetting (slow-wave sleep)

Delta: lowest frequency, highest amplitude
Behavior

What sleep stage involves dreaming?
REM (25% of sleep cycle)

Involves dreaming, loss of motor tone, possibly a memory processing function, erections, increase brain O2 use.
Behavior

Mneumonic for EEG waveforms
At night, BATS Drink Blood:

Beta (highest freq, lowest amp) - awake
Alpha (awake, eyes closed)
Theta
Sleep spindles and K complexes
Delta (lowest frequency, highest amplitude)
Beta (REM)
Behavior

What is key in initiating sleep?
Serotonergic predominance of raphe nucleus
Behavior

What neurotransmitter reduces REM sleep?
NE
Behavior

What are extraocular movements during REM caused by?
activity of PPRF (paramedian pontine reticular formation/conjugate gaze center)
Behavior

What drugs shorten sleep stages?
Other side effects
Benzodiazepines: shorten stage 4 sleep; thus useful for night terrors and sleepwalking
Behavior

What is imipramine used to treat?
Imipramine is used to treat enuresis because it decreases stage 4 sleep.
PSYCH

Bipolar disorder?
6 separate criteria sets exist for bipolar disorders with combinations of manic (bipolar I), hypomanic (bipolar II), and depressed episodes. 1 manic or hypomanic episode defines bipolar disorder. Lithium is drug of choice.
PSYCH

Cyclothymic disorder?
Cyclothymic disorder is a milder bipolar disorder lasting at least 2 years.
PSYCH

Major depressive episode?
SIG E CAPS.
Major depressive episode is characterized by at least 5 of the following for 2 weeks, including either depressed mood or anhedonia:
1. Sleep disturbance
2. Loss of Interest (anhedonia)
3. Guilt of feelings of worthlessness
4. Loss of Energy
5. Loss of Concentration
6. Change in Appetite/weight
7. Psychomotor retardation or agitation
8. Suicidal ideations
9. Depressed mood
Lifetime prevalence of major depressive episode-5-12% male, 10-25% female.
Major depressive disorder, recurrent - requires 2 or more episodes with symptom-free interval of 2 months.
PSYCH

What is Dysthymia?
Dysthymia is a milder form of depression lasting at least 2 years.
PSYCH

Risk factors for suicide completion?
SAD PERSONS.
Sex (male), Age (teenager or elderly), Depression, Previous attempt, Ethanol or drug use, loss of Rational thinking, Sickness (medical illness, 3 or more prescription medications), Organized plan, No spouse (divorced, widowed, or single, especially if childless), Social support lacking.
Women try more often; men succeed more often.
PSYCH

Sleep pattersn of depressed patients?
Patients with depression typically have the following changes in their sleep stages:
1. Decreased slow-wave sleep
2. Decreased REM latency
3. Increased REM early in sleep cycle
4. Increased total REM sleep
5. Repeated nightime awakenings
6. Early-morning awakening (important screening question)
PSYCH

What is Electroconvulsive therapy?
Treatment option for major depressive disorder refractory to other treatment. Produces a painless seizure. Major adverse effects of ECT are disorientation, anterograde and retrograde amnesia.
PSYCH

What is Panic disorder?
PANICS.
Recurrent periods of intense fear and discomfort peaking in 10 minutes with 4 of the following: Palpitations, Paresthesias, Abdominal discress, Nausea, Intense fear of dying or losing control, lIght-headedness, Chest pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of breath.
Panic is described in context of occurrence (e.g., panic disorder with agoraphobia). High incidence during Step 1 exam.
PSYCH

What is Specific phobia?
Fear that is excessive or unreasonable and interferes with normal routine. Cued by presence of anticipation of a specific object or situation. Person recognizes fear is excessive (insight), yet exposure provokes an anxiety response. Can treat with systematic desensitization. Examples include:
1. Gamophobia (gam = gamete)--fear of marriage
2. Algophobia (alg = pain)--fear of pain
3. Acrophobia (acro = height)--fear of heights
4. Agoraphobia (agora = open market)--fear of open places
PSYCH

What is Post-traumatic stress disorder?
Persistent reexperiencing of a previous traumatic event in the life of the patient as nightmares of flashbacks. Response involves intense fear, helplessness, or horror. Leads to avoidance of stimuli assoc'd with the trauma and persistently increased arousal. Disturbance lasts >1 month and causes distress or social/occupational impairment. PTSD often follows accute stress disorder, which lasts up to 2-4 weeks.
PSYCH

What is Adjustment disorder?
Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, moving) and lasting < 6 months.
PSYCH

What is Generalized anxiety disorder?
Uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event. Sleep disturbance, fatigue, and difficulty concentrating are common.
PSYCH

Describe malingering?`
Patient consciously fakes or claims to have a disorder in order to attain a specific gain (e.g., avoiding work, obtaining drugs).
PSYCH

Factitious disorder?
Consciously creates symptoms in order to assume "sick role" and to get medical attention.
Manifested by a chronic history of multiple hospital admissions and willingness to receive invasive procedures. Mynchausen's syndrome by proxy is seen when illness in a child is caused by the parent. Motivation is unconscious. Is a form of child abuse and must be reported.
PSYCH

Somatoform disorders?
Both illness production & motivation are unconscious drives. More common in women. Several types:
1. Conversion - motor or sensory symptoms (e.g., paralysis, pseudoseizure) that suggest neurologic or physical disorder, but tests & physical exam are negative; often follows an acute stressor; patient may be unconcerned about symptoms
2. Somatoform pain disorder- prolonged pain that is not explained completely by illness
3. Hypochondriasis - preoccupation with & fear of having a serious illness in spite of medical reassurance
4. Somatization disorder - variety of complaints in multiple organ systems with no identifiable underlying physical findings
5. Body dysmorphic disorder - preoccupation with minor or imagined physical flaws; patients often seek cosmetic surgery
6. Pseudocyesis - false belief of being pregnant assoc'd with objective physical signs of pregnancy
PSYCH

Patient-Disease Assoc's:

Describe a 'primary gain':
Primary gain - is what the symptom does for the patient's internal psychic economy.
PSYCH

Patient-Disease Assoc's:

Describe a 'secondary gain':
Secondary gain - is what the symptom gest the patient (sympathy, attention).
PSYCH

Patient-Disease Assoc's:

Describe a 'tertiary gain':
Tertiary gain - is what the caretake gets (like an MD on an interesting case).
PSYCH

Personality trait - Describe:
Personality trait - is an enduring pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide rage of important social and personal contexts.
PSYCH

Personality disorder - Describe:
Personality disorder - is when these patterns become inflexible and maladaptive, causing impairment in social or occupational functioning or subjective distress; person is usually not aware of problem. Disordered patterns must be stable by early adulthood; not usually diagnosed in children.
PSYCH

What are Cluster A personality disorders?
"Weird."
Odd or eccentric; cannot develop meaningful social relationships. No psychosis; genetic association with schizophrenia.
Types:
1. Paranoid
2. Schizoid
3. Schizotypal
PSYCH

What Cluster disorder is:

Schizotypal
Cluster A
'Schizotypal':interpersonal awkwardness, odd beliefs or magical thinking, eccentric appearance
PSYCH

What Cluster disorder is:

Paranoid
Cluster A
'Paranoid': distrust and suspiciousness; projection is main defense mechanism
PSYCH

What Cluster disorder is:

Schizoid
Cluster A
'Schizoid': voluntary social withdrawal, limited emotional expression, content with social isolation, unlike avoidant
PSYCH

What are Cluster B personality disorders?
"Wild".
Dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse.
1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic
PSYCH

What Cluster disorder is:

Antisocial
Cluster B
Antisocial: disregard for and violation of rights of others, criminality; males>females; conduct disorder if <18 years
PSYCH

What Cluster disorder is:

Borderline
Cluster B
Borderline: unstable modd and interpersonal relationships, impulsiveness, sense of emptiness; females > males
PSYCH

What Cluster disorder is:

Histrionic
Cluster B
Hystrionic: excessive emotionality, attention seeking, sexually provocative
PSYCH

What Cluster disorder is:

Narcissistic
Cluster B
Narcissistic: grandiosity, sense of entitlement; may react to criticism with rage; may demand "top" physician / best health care
PSYCH

What are Cluster C personality disorders?
"Worried".
Anxious or fearful; genetic association with anxiety disorders.
Types:
1. Avoidant
2. Obsessive-compulsive
3. Dependent
PSYCH

What Cluster disorder is:

Avoidant?
Cluster C
Avoidant: sensitive to rejection, socially inhibited, timid, feelings of inadequacy
PSYCH

What Cluster disorder is:

Obsessive-compulsive?
Cluster C
Obsessive-compulsive: preoccupation with order, perfectionism, and control
PSYCH

What Cluster disorder is:

Dependent?
Cluster C
Dependent: submissive and clinging, excessive need to be taken care of, low self-confidence
PSYCH

Eating disorders:

What is Anorexia nervosa?
Anorexia nervosa: abnormal eating habits (excessive dieting), body image distortion, and increased exercise. Severe weight loss, amenorrhea, anemia, and electrolyte disturbances can follow. Seen primarily in adolescent girls. Commonly coexists with depression.
PSYCH

Eating disorders:

What is Bulimia nervosa?
Bulimia nervosa: binge eating followed by self-induced vomiting or use of laxatives. Body weight is normal. Parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting.
PSYCH

What are substance dependence requirements?
Maladaptive pattern of substance use difined as 3 or more of the following signs in 1 year:
1. Tolerance-need more to achieve same effect.
2. Withdrawal
3. Substance taken in larger amounts or over longer time than desired
4. Persistent desire to attempts to cut down
5. Significant energy spent obtaining, using, or recovering from substance
6. Important social, occupational, or recreational activities reduced because of substance use
7. Continued use in spite of knowing the problems that it causes
PSYCH

What are substance abuse requirements?
Maladaptive pattern leading to clinically significant impairment or distress. Substance dependance plus 1 or more of the following in 1 year:
1. Recurrent use resulting in failure to fulfill major obligations at work, school, or home
2. Recurrent use in physically hazardous situations
3. Recurrent substance-related legal problems
4. Continued use in spite of persistent problems caused by use
Psych

Person demands only the best and most famous doctor in town.

What is the personality disorder?
Cluster B
Narcissitic
Psych

Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C protein.

What is the dx?
Factitious disorder from self-scripted insulin
Psych

55yo business man complains of lack of successful sexual contacts with women and lack of ability to reach full erection. Two years ago he had a heart attack.

What might be the cause of his problem?
Fear of sudden death during intercourse
Psych

15yo girl of normal height and weight for her age has enlarged parotid glands but no other complaints. The mother confides that she found laxatives in the daughter's closet.

Dx?
Bullemia
Psych

Man on several medications, including antidepressants and antihypertensives, has mydriasis and becomes constipated.

What is the cause of his symptoms?
Tricyclic antidepressants
Psych

Women on MAO inhibitor has hypertensive crisis after a meal.

What did she ingest?
Tyramine (wine or cheese)
Psych

Seven signs of long term deprivation of affection in an infant:
1. decreased muscle tone
2. poor language skills
3. poor socialization skills
4. lack of basic trust
5. anaclitic depression
6. weight loss
7. physical illness

"The 4 W's: Weak, Wordless, Wanting (socially), Wary"
Psych

Are the signs of infant deprivation reversible?
Yes but only up until 6mths
Psych

Anaclitic depression
Depression in an infant owing to continued separation from caregiver - can result in failure to thrive.
Infant becomes withdrawn and unresponsive.
Psych

Regression in children is caused by:
Children regress to younger behavior under stress such as:
physical illness
punishment
birth of new sibling
tiredness

ex. bedwetting in a previously toliet-trained child when hospitalized
Psych

Autistic disorder
These children have severe communication problems and difficulty forming relationships.

The disorder is characterized by repetitive behavior. They are children of normal intelligence and lack social or cognitive deficits
Psych

Asperger disorder
A milder form of autism involving problems with social relationships and repetitive behavior.
Children are of normal intelligence and lack social or cognitive deficits.
Psych

Rett disorder
x-linked disorder seen only in girls (affected males die in utero). Characterized by loss of development and mental retardation appearing at approximately age 4.
Sterotyped hand-wringing
Psych

ADHD
Limited attention spam and hyperactivity.
Children are emotionally liable, impulsive, and prone to accidents.
Normal intellegence

Treatment: methylphenidate (Ritalin)
Psych

Conduct disorders
Continued behavior violating social norms.
At > 18yrs of age, diagnosed as antisocial personality disorder.
Psych

Oppositional defiant disorder?
Child is noncomplaint in the absence of criminality
Psych

Tourette's syndrome
Motor/vocal tics and involuntary profanity.

Onset < 18 yrs.

Treatment: haloperidol
Psych

Separation anxiety disorder
Fear of loss of attachment figure leading to factitious physical complaints to avoid going to school.

Common onset age: 7-8
Psych

What is the peak incidence of child sexual abuse?
9-12yo
Psych
Neurotransmitter changes with:

Anxiety
increase NE
decrease GABA
decrease serotonin
Psych
Neurotransmitter changes with:

Depression
decrease NE
decrease serotonin
Psych
Neurotransmitter changes with:

Alzheimer's dementia
decrease ACh
Psych
Neurotransmitter changes with:

Huntington's disease
decrease GABA
decreased ACh
Psych
Neurotransmitter changes with:

Schizophrenia
increase dopamine
Psych
Neurotransmitter changes with:

Parkinson's dz
decrease dopamine
Psych

In what order do patients most commonly lose their orientation to things?
Lose time first, place second, and person (name, ex) last.
Psych

Anosognosia
Unaware that one is ill
Psych

Autotopagnosia
Unable to locate one's own body parts
Psych

Depersonalization
Body seems unreal or dissociated
Psych

Anterograde amnesia
Inability to remember things that occurred after a CNS insult (no new memory).
Behavior

Korsakoff's amnesia
Classic anterograde amnesia that is caused by thiamine deficiency (bilateral destruction of mammillary bodies), is seen in alcoholics, and associated with confabulations.
Behavior

Retrograde amnesia
Inability to remember things that occurred before a CNS insult
Behavior

What is the most common psychiatric illness on medical and surgical floors?
Delirium
Behavior

Describe an episode of delirium:
Cause?
EEG?
Waxing and waning level of consciousness;
rapid decreases in attention span and level of arousal;

Disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction.

Often due to substance use/abuse or medical illness.
Abnormal EEG
Behavior

Describe dementia:
Gradual decrease in cognition
Memory deficits (deMEMtia = MEMory)
Aphasia
Apraxia
Agnosia
Loss of abstract thought
Behavioral/personality changes
Impaired judgement

Patient is alert, no change in level of consciousness (change in consciousness in delirium)

More often than not there is a gradual onset.

Normal EEG
Behavior

Hallucinations
Perceptions in the absence of external stimuli

(MOW: you make up the presence of an external stimulus)
Behavior

Illusions
Misinterpretation of actual external stimuli
Behavior

Delusions
False beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary
Behavior

Loose associations
Disorders in the thoughts are formed
(MOW: tie ideas together wrong)
Behavior

What are the 6 types of hallucinations?
Hallucinations
1. visual/auditory: common in schizophrenia
2. olfactory: often an aura of a psychomotor epilepsy
3. Gustatory: rare
4. Tactile: ex. feeling bugs on you (common in delerium tremins and cocaine use)
5. hypnaGOgic: occurs while GOing to sleep
6. hypnopompic: occurs while waking from sleep
Behavior

Give a general description of schizophrenia:

Compare to schizophreniform and brief psychotic disorder:
Schizophrenia: periods of psychosis and disturbed behavior with a decline in functioning lasting > 6mths

Schizophreniform: 1-6mths of same symptoms

Brief psychotic disorder: < 1mth (usually stress related)
Behavior

What does the diagnosis of schizophrenia require?
Requires two or more of the following: (note 1-4 are positive symptoms)
1. delusions
2. hallucinations (often auditory)
3. disorganized thought (loose associations)
4. disorganized or catatonic behavior
5. "negative symptoms" - flat affect, social withdrawal, lack of motivation, lack of speech or thought.
Behavior

What are the five subtypes of schizophrenia?
1. disorganized
2. catatonic
3. paranoid
4. undifferentiated
5. residual
Behavior

What is schizoaffective disorder?
A combination of schizophrenia and a mood disorder
Behavior

It is said that genetic and environmental factors cause Schizophrenia: is there one that is a greater component?
Genetics outweight environmental
Behavior

What is the lifetime prevalence of schizophrenia?

How does it differ between males and females and whites and blacks?
Lifetime prevalence = 1.5%

males=females (presents earlier in men)
blacks=whites
Behavior

Hypomanic episode
Like manic episode except mood disturbance not severe enough to cause marked impairment in social and/or occupational functioning or to neccessitate hospitalization.

There are NO psychotic features.
Behavior

What is a manic episode?
A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week.
Behavior

During a manic episode what must be present?
3 or more of the following must be present:
DIG FAST

Distractibility
Irresponsibility-seeks pleasure without regard to consequences (hedonistic)
Grandiosity: inflated self-esteem
Flight of ideas: racing thoughts
ncrease in goal-directed Activity/psychomotor Agitation
Sleepless (decreased need for sleep)
Talkative or pressured speech
Behavior

Bipolar disorder
Rx?
6 separate criteria sets exists for bipolar disorders with combinations of manic (bipolar I), hypomanic (bipolar II), and depressed episodes.

1 manic or hypomanic episode defines bipolar disorder.

Lithium is the DOC
Behavior
Describe intoxication and Withdrawl from:

Alcohol
Alcohol intox:
disinhibition, emotional liability, slurred speech, ataxia, coma, blackouts.

Serum gamma-glutamyltransferase (GGT)-sensitive indicator of alcohol use.

Withdrawl:
Tremor, tachycardia, HTN, malaise, nausea, seizures, delirium tremens (DTs),
tremulousness, agitation, hallucinations.
Behavior
Describe intoxication and Withdrawl from:

Opiods
Intox:
CNS depression, nausea and vomiting, constipation, pupillary constriction (pinpoint pupils), seizures (overdose is life-threatening)

Withdrawl:
anxiety, insomnia, anorexia, sweating, dilated pupils, pilorection ("cold turkey"_, fever rhinorrhea, nausea, stomach cramps, diarrhea
(flulike symptoms), and yawning.
Behavior
Describe intoxication and Withdrawl from:

Amphetamines
Intox:
Psychomotor agitation, impaired judgement, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefullness and attention, cardiac arrhythmias, delusions, hallucinations, fever.

Withdrawal:
Post-use "crash", including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence.
Behavior
Describe intoxication and Withdrawl from:

Cocaine
Intox:
Euphoria, psychomotor agitation, impaired judgement, tachycardia, pupillary dilation, HTN, hallucination (including tactile), paranoid ideations, angina, sudden cardiac death.

Withdrawal
Post-use "crash", including severe depression and suicidality, hypersomnolence, fatigue, malaise, and severe psychological craving.
Behavior
Describe intoxication and Withdrawl from:

PCP
Intox:
Belligerence, impulsiveness, fever, psychomotor agitation, veritcal and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirum.

Withdraw:
recurrence of intox symptoms due to reabsorption in GI tract; sudden onset of severe, random, homicidal violence.
Behavior
Describe intoxication and Withdrawl from:

LSD
Intox:
Marked anxiety or depression
delusions
visual hallucinations
flashbacks
pupil dilation

No withdrawl effects
Behavior
Describe intoxication and Withdrawl from:

Marijuana
Intox:
Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawl, increased appetite, dry mouth, hallucinations

No withdrawl symptoms
Behavior
Describe intoxication and Withdrawl from:

Barbiturates
Intox
Low safety margin, resp depression

Withdrawal
Anxiety, seizures, delirium, life-threatening cardiovascular collapse
Behavior
Describe intoxication and Withdrawl from:

Benzodiazepines
Benzo's intox:
Greater safety margin than barbiturates.
Amnesia, ataxia, somnolence, minor respiratory depression.
Addicitive effects with alcohol

Withdrawl:
rebound anxiety, seizures, tremor, insomnia.
Behavior
Describe intoxication and Withdrawl from:

Caffeine
Intoxication:
Restlessness, insomnia, increased diuresis, muscle twitching, cardiac arrhythmias

Withdrawl:
Headache, lethargy, depression, weight gain
Psych
Describe intoxication and Withdrawl from:

Nicotine
Nicotine intox:
restlessness, insomnia, anxiety, arrhythmias

Withdrawal
Irritability, headache, anxiety, weightgain, craving
Psych

Number of heroin addicts:
How to ID?
500,000 in US

Look for "track marks"
Psych

What six things are heroin users at risk for?
Hepatitis
Abscesses
Overdose
hemorrhoids
AIDS
right-sided endocarditis
Psych

What two drugs competitively inhibit opioids?
Naloxone and naltrexone
Psych

What does methadone do?
It is a long-acting oral opiate used for heroin detoxification or long-term maintence.
Psych

Delirium tremens
Rx?
Life-threatening alcohol withdrawl syndrome that peaks 2-5 days after last drink.

In order of appearance: autonomic system hyperactivity (tacycardia, tremors, anxiety) --> psychotic symptoms (hallucinations, delusions) --> confusion

Rx: benzodiazepines
Psych

Wernicke-Korsakoff syndrome
Caused by vitamin B1 (thiamine) deficiency; common in malnourished alcoholics.

Triad of confusion, ophthalmoplegia, and ataxia (Wernicke's encephalopathy).
May progres to memory loss, confabulation, personality change (Korsakoff's psychosis; irreversible).

Associated with periventricular hemorrhage/necrosis, especially in mammillary bodies

Rx: IV Vit B12
Psych

Neurleptic malignant syndrome
Cause?
Rx?
Adverse effect of antipsychotics(thioridazine, haloperidol, fluphenazine, chlorpromazine --> all block D2 receptors since excess dopamine effects are assoc with schizophrenia)

This syndrome is associated with: ridgity, myoglobinuria, autonomic instability, hyperpyrexia (extreme fever).

Rx: dantrolene and dopamine agonists
Psych

Tardive dyskinesia

Cause?
Side effect of antipsychotics (thioridazine, haloperidol, fluphenazine, chlorpromazine --> all block D2 receptors since excess dopamine effects are assoc with schizophrenia)

Tardive dyskinesia: stereotypic oral-facial movements probably due to dopamine receptor sensitization; results of longterm antipsychotic use.
Psych

Describe the evolution of extrapyramidal side effects seen with antipsychotic medication use:
Within 4hrs: acute dytonia (sustained m. contraction)
4d: akinesia (can't initiate movement)
4wk: akathisia: inner restlessness - can't sit still
4mo: tardive dyskinesida (often irreversible!)
Psych

Side effect of atypical antipsychotic CLOZAPINE?
Agranulocytosis
Psych

Side effects of Lithium (MOA)?
MOA: not known

Side effects:
LMNOP

Lithium side effects:
Movement (tremor)
Nephrogenic diabetes insipidus
hypOthyroidism
Pregnancy problems