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522 Cards in this Set

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What are Piaget's cognitive developmental stages?
Sensorimotor: <2yo
Pre-operational: 2-6yo
Concrete operational: 7-11yo
Post-operational: >12yo
Describe the sensorimotor phase of Piaget's cognitive developmental stages.
1-4mo: Primary circular reactions [action & response both involve baby's own body i.e. sucking thumb]

4-12mo: Secondary circular reactions [action gets response from other person or object leading to repetition, i.e. cooing]

12-18mo: Tertiary circular reactions [action gets pleasing result leading to similar actions, i.e. stepping on sqeaky toy and attempt to get same response from another object]
Describe the pre-operational phase of Piaget's cognitive developmental stages.
Understands that objects are represented by words or images
Ability to pretend, Egocentric thought
Centering [can't understand more than one dimension at a time], Lacks conservation
Describe the concrete operational phase of Piaget's cognitive developmental stages.
Logical thinking about objects & events
Mental manipulation of objects and processes
Ability to consider more than one dimension at a time [decentrate]
Therefore: Understands CONSERVATION
Describe the post-operational phase of Piaget's cognitive developmental stages.
Abstract thinking, Hypothesizing, Higher order thinking [synthesizing, analyzing, evaluating]
What are the 5 leading causes of death in the U.S. in 1-4yo?
(1) Unintentional injuries [automobile, drowning, pedestrian]
(2) Birth defects
(3) Cancers
(4) Homicide
(5) Heart disease
What are the 5 leading causes of death in the U.S. in 5-9yo?
(1) Unintentional injuries [automobile, drowning, pedestrian]
(2) Cancers
(3) Birth defects
(4) Homicide
(5) Heart disease
What are the 3 leading causes of death in the U.S. in 12-18yo?
(1) Unintentional injuries
(2) Homicide [3-4X males, 7-8X Blacks]
(3) Suicide [higher for males]
What are the 5 leading causes of death in the U.S. in 25-44yo?
(1) Unintentional injuries
(2) Cancer
(3) Heart disease
(4) Suicide
(5) HIV/AIDS
What are the 5 leading causes of death in the U.S. in 45-64yo?
(1) Cancer
(2) Heart disease
(3) Unintentional injuries
(4) Stroke
(5) Chronic lower respiratory disease
What are the 5 leading causes of death in the U.S. in >= 65yo?
(1) Heart disease
(2) Cancer
(3) Stroke
(4) Chronic lower respiratory disease
(5) Influenza & pneumonia
What are the 7 leading causes of death in children <5yo worldwide
(1) Neonatal causes
(2) Acute respiratory infections
(3) Diarrheal
(4) Others, Including non-communicable diseases
(5) Malaria
(6) Measles
(7) Injuries & HIV/AIDS tied
Describe what the normal language of a 2-3 month old infant should be.
Cooing
Describe what the normal language of a 3-4 month old infant should be.
Babbling without intonation or discernible pattern
Describe what the normal language of a 10 month old infant should be.
Babbling household language [through imitating what they hear], jargon that has intonation
Describe what the normal language of a 1 year old toddler should be.
One-word stage
Describe what the normal language of a 2 year old toddler should be.
Two-word telegraphic stage
Describe what the normal language of a child > 2 year old should be.
Language develops rapidly into complete sentences
Describe how an infant/toddler less than 18 months old will play?
Solitary play [sensorimotor]
Describe how a toddler between 18 & 24 months old will play?
Parallel play [symbolic]. Child will play along side but not with others.
When do children start participating in cooperative [associative/imaginative] play?
Anywhere between 2 & 4 years old
What are Erik Erikson's psychosocial development stages?
List the EGO strengths & conflicts, & their corresponding ages?
In Erik Erickson's psychosocial development stages:
(1) Each stage has own psychosocial test [crisis that needs resolution] resulting in the development of an EGO STRENGTH
(2) Each builds on previous.
(3) With maturation new meaning given to lower stages.

Stages:
Infancy (Birth-1yo): Hope [Trust vs Mistrust]
Toddlerhood (1 to 3yo): Will [Autonomy vs Shame & Doubt]
Preschool (3-5yo): Purpose [Initiative vs Guilt]
Elementary School (6-Puberty): Competence [Competence vs Inferiority]
Adolescence (Teen-20's): Fidelity [Identity vs Role Confusion]
Young adulthood (20s-40s): Love [Intimacy vs Isolation]
Middle adulthood (40s-60s): Care [Generativity vs Stagnation]
Late adulthood (60s+): Wisdom [Integrity vs Despair]
Describe the age & conflict associated with developing Erik Erikson's ego strength of HOPE.
Infancy (Birth to 1yo)

Hope [Trust vs Mistrust]: If needs are dependably met, infants develop a sense of basic trust
Describe the age & conflict associated with developing Erik Erikson's ego strength of WILL.
Toddlerhood (1 to 3yo)

Will [Autonomy vs Shame & Doubt]: Toddlers learn to exercise will and do things for themselves, or they doubt their abilities
Describe the age & conflict associated with developing Erik Erikson's ego strength of PURPOSE.
Preschool (3-5yo)

Purpose [Initiative vs Guilt]: Learn to initiate tasks and carry out plans, or they feel guilty about efforts to be independent
Describe the age & conflict associated with developing Erik Erikson's ego strength of COMPETENCE.
Elementary School (6-Puberty)

Competence [Competence vs Inferiority]: Learn the pleasure of applying themselves to tasks, or they feel inferior
Describe the age & conflict associated with developing Erik Erikson's ego strength of FIDELITY.
Adolescence (Teen-20's)

Fidelity [Identity vs Role Confusion]: Teenagers work at refining a sense of self by testing roles and then integrating them to form a single identity, or they become confused about who they are
Describe the age & conflict associated with developing Erik Erikson's ego strength of LOVE.
Young adult (20s-40s)

Love [Intimacy vs Isolation]: Struggle to form close relationships and to gain the capacity for intimate love, or they feel socially isolated
Describe the age & conflict associated with developing Erik Erikson's ego strength of CARE.
Middle adult (40s-60s)

Care [Generativity vs Stagnation]: Discover a sense of contributing to the world, such as through family and work, or they may feel a lack of purpose
Describe the age & conflict associated with developing Erik Erikson's ego strength of WISDOM.
Late adult (60s+)

Wisdom [Integrity vs Despair]: When reflecting on his or her life, the older adult may feel a sense of satisfaction or failure
What is the leading cause of injury to 14-44yo women in the U.S.?
Domestic violence
Between what age are children most vulnerable to abuse?
7-12yo
What is conservation and when does it develop?
Understanding that the amount of a substance remains even when its form has changed [e.g. pour water from short glass into tall glass and understand there was the same amount of water in both].

Doesn't develop until a child is 6 years old and corresponds to Piaget's concrete operational stage [7-12yo].
What is object permanence and when does it develop?
Understanding that an object still exists even if you aren't interacting with it.

Doesn’t develop until an infant is 7-9 months.
What is the palmar grasp [grasping] reflex and at what age does it disappear?
If it fails to disappear what does that indicate?
The child's fingers grasp objects placed in the palm.

A reflex in competent newborns that disappears by 2mo.

Persistent fisting indicates neuromotor deficits
What is the Babinski reflex and at what age does it disappear?
If it fails to disappear what does that indicate?
The child's large toe dorsiflexes & the other toes fan in response to a scrape along the sole of their feet.

A reflex in competent newborns that disappears by 1 year.

Persistence of this reflex indicates a neuromotor deficit
What is the rooting reflex and at what age does it disappear?
If it fails to disappear what does that indicate?
The child's head turns in the direction of a stroke on the cheek when seeking a nipple to suck.

A reflex in competent newborns that disappears by 3mo.
What is the Moro reflex and at what age does it disappear?
What does it's absence of birth indicate?
Also known as the "startle" reflex. It is a response to unexpected loud noise or when the infant feels like it is falling that is characterized by (1) Startle (2) Spreading out arms [symmetric] (3) Unspreading arms [symmetric] (4) Crying.

A reflex in competent newborns that disappears by 3-4mo.

Deficiency or asymmetry in any except crying indicates profound disorder of motor system.
At what age does a child smile in response to a human face? (The "social smile")

If reflex is not developed by this time what might than indicate?
The "social smile" in response to the human face develop between 2-3 months.

Absent smile indicates visual loss attachment problems, maternal depression, or child abuse/neglect
When should a child be able to turn over on his own?
5 months
When should a child be able to sit unassisted?
6 months
When should a child be able to transfer toys from hand to hand?
10 months
When should a child be able to pick up toys and food using "pincer" (thumb and forefinger) grasp?
10 months
When should a child be able to walk unassisted?
Between 12-15 months
When does a child begin to show stranger anxiety?
6 months
What is the cause of reactive attachment disorder of infancy or early childhood?
What are the 2 types?
Grossly pathological care

The two types are:
(1) Inhibited type: Children are withdrawn and unresponsive
(2) Disinhibited type: Children approach and attach indiscriminately to strangers as though the strangers were familiar to them
By what age do the 9 dimensions of temperament described by Chess and Thomas stabilize?

What are the?
3 years old

Activity
Regularity
Initial reaction
Adaptability
Intensity
Mood
Distractibility
Persistence & attention span
Sensitivity
By what age do children have a sense of gender identity?
3 years old
What is encopresis and what is the earliest age it can be diagnosed in children?
It is soiling

Cannot be diagnosed until 4 years old
What is enuresis and what is the earliest age it can be diagnosed in children?
It is bed-wetting

Cannot be diagnosed until 6 years old
At what age do children start to read?
6 years old
What is rapprochement?
It is when a child moves away from and then returns to the mother for reassurance.

It is common during the 1st half of toddler hood [1-2yo]
At what age are children commonly over-concerned about physical injury?
4-5 years old
At what age do children tend to have romantic feelings about the opposite sex parent?
4-5 years old
By what age should a child be able to use 900 words and understand 3500 words?
3 years old
By what age should a child be able to use 250 words?
2 years old [generally speaks in 2-word sentences and uses pro-nouns e.g. "me do"]
By what age should a child be able to name body parts and objects?
2 years old
By what age should a child be able to speak in complete sentences?
3 years old
At what age do children start do develop the ability to think logically?
6 years old
By what age should a child be able to feed themselves with a fork and spoon?
2 years old
What are Elizabeth Kubler-Ross's stages of dying?
Denial: Resistance to reality of impending death, Search for other miracle cure, May withdraw from physician's care
Anger: (1) Why me (2) Hostility Resentment, & Envy at a variety of targets including the physician. Comments should not be taken personally
Bargaining: (1) Let's make a deal (2) Plea for extended life in exchange for something [e.g. change in behavior]
Depression: (1) Manifestations of illness become too serious or imposing to ignore or deny (2) Realization of unavoidable death (3) Immense sadness (4) Sense of great loss
Acceptance: (1) Resolute about impending death (2) End of struggle (3) Sincere preparations can begin
In normal grief how long does it take for SEVERE symptoms to resolve?
Within 2 months
In normal grief how long does it take for MODERATE symptoms to resolve?
Within 1 year
What is the average life expectancy in the U.S.?
What are the longest-lived and shortest-lived ethnicities currently in the United States?
76 years

Longest: Asians especially Chinese
Shortest: African American
Before how many weeks gestation is a birth classified as premature?
Less than 37 completed weeks gestation
Before how many weeks gestation is a birth classified as VERY premature?
Less than 32 completed weeks gestation
Before how many weeks gestation is fetal death classified as an abortion?
Less than 20 completed weeks gestation
What are the "baby blues"?
When do they start?
How long do they last?
Characteristics [incidence of 33-50%]:
(1) Exaggerated emotionality and tearfulness
(2) Interacting well with friends and family
(3) Good grooming

Starts within a few days after delivery

Lasts for up to 2 weeks
At what age is a child most likely to start developing separation anxiety when removed from their primary caregiver?
Towards the end of the first year of life
At what age is an infant able to lift head when lying prone?
2-3 months
After what age should a child be able to spend a few hours away from the mother and in the care of others with little problem?
3 years old
At what age do a child's sense of morality begin to be developed?
6 years old
Between what ages do children prefer to interact with children of the same sex?
7-11 (school age). Before the age of 6 children don't show any sexual preference.
What is seriation?
At what age is it developed?
The ability to arrange objects in order with respect to their sizes or other qualities

Children are able do do this by the age of 6
What are the Tanner Stages of Sexual development in girls?
1: Genitalia and associated structures are the same as in childhood, Nipples (papillae) are slightly elevated
2: Scant, straight pubic hair, Slight elevation of breast tissue
3: Pubic hair increases over the pubis and becomes curly
4: Areola rises above the rest of the breast in girls
5: Genitalia are like adult, Pubic hair now is also on thighs, Areola is no longer elevated
What are the Tanner Stages of Sexual development in boys?
1: Genitalia and associated structures are the same as in childhood
2: Scant, straight pubic hair, Testes enlarge, Scrotum develops texture
3: Pubic hair increases over the pubis and becomes curly, Penis increases in length & testes enlarge
4: Penis increases in width, Glans develops, Scrotal skin darkens
5: Genitalia are like adult, Pubic hair now is also on thighs
In order to best reduce risk taking behavior in teenagers should you focus on long or short term risks?
Short term risks (e.g. "smoking will stain your teeth" rather than "smoking may give you cancer in 30 years")
During what period of adolescence is risk-taking behavior the highest?
Middle adolescence (14-17yo) by 17yo adolescents tend to have a more realistic appraisal of their own abilities
Between the ages of 15 months to 2.5 years old is a child more likely to fear separation from their parents or physical harm?
Separation
Between what ages do children have the greatest fear of bodily harm?
2.5yo to 6yo
At about what age do children begin to understand that children can also die and begin to fear their own death?
9 years old
At what age do children begin to understand the permanence of death?
6 years old
In what age do people possess the most power and authority?
Middle adulthood [40-65 years old]
What is climacterium?
The change in physiologic function that occurs during midlife
What is the most common psychiatric disorder in the elderly?
Depression
What is pseudodementia?
Depression may mimic and thus be misdiagnosed as Alzheimer disease. This misdiagnosed disorder is referred to as pseudodementia. There is:
(1) Moderate memory loss
(2) Other cognitive problems
(3) NO decrease in IQ
(4) Disruption of normal life
What is the "anniversary reaction"?
In grief when symptoms return on holidays or special occasions
What intellectual tasks do men tend to be better than women at?
Women better than men?
Men better than women: Spatial tasks [may have better developed right hemisphere]
Women better than men: Language [may not be related to language skills but women tend to have a larger corpus callosum and anterior commissure and appear to have better inter hemispheric communication]
What is Kluver-Bucy syndrome?
Due to a lesion in the amygdala [temporal lobe] and results in decreased aggression, increased sexual behavior, and hyperorality.
A lesion to the ventromedial nucleus of the hypothalamus may lead to what?
The ventromedial nucleus reduces hunger and thus a lesion may lead to excessive hunger and obesity.
A lesion to the lateral nucleus of the hypothalamus may lead to what?
The lateral nucleus icnreases hunger and thus a lesion may lead to reduced hunger and weight loss.
What region of the brain is most affected by Huntington's syndrome?
The caudate nucleus is affected the most but the putamen is also

Caudate + Putamen = Striatum
What region of the brain is most affected by Tourette syndrome syndrome?
Caudate nucleus
Describe which neurotransmitters are increased or decreased in depression.
Norepinephrine is decreased
Serotonin is decreased
Dopamine is decreased
Describe which neurotransmitters are increased or decreased in mania.
Dopamine is increased
Describe which neurotransmitters are increased or decreased in schizophrenia.
Dopamine is increased
Serotonin is increased
Glutamate ACTIVITY is DECREASED [cause unknown but might be due to hyposecretion OR hypo activity of NMDA receptors]
Describe which neurotransmitters are increased or decreased in anxiety.
GABA is decreased
Serotonin is decreased
Norepinephrine is increased
Describe which neurotransmitters are increased or decreased in Alzheimer's disease.
Acetylcholine is decreased
Glutamate is increased
What is 5-HIAA?
What might a decrease in it's levels indicate?
A serotonin metabolite

Severe depression, Attempted suicide, Aggressiveness and violence, Impulsiveness, Fire setting, Tourette syndrome, Alcohol abuse, Bulimia
What is the primary metabolite of serotonin?
5-HIAA (5-hydroxyindoleacetic acid)
What metabolite will you test for first in the urine or blood of an individual you suspect has pheochromocytoma?
Pheochromocytoma: Adrenal medulla tumor

Search for the norepinephrine metabolite vanillylmandelic acid (VMA)
What norepinephrine metabolite will be decreased in severe depression and attempted suicide?
MHPG (3-methyoxy-4-hydroxyphenylglycol)
A decrease of what NT metabolite would be expected in an individual with Parkinson's disease?
HVA (homovanillic acid) which is a metabolite of dopamine
An increase of what NT metabolite would be expected in an individual with Schizophrenia and other conditions involving psychosis?
HVA (homovanillic acid) which is a metabolite of dopamine
How does dopamine act on the tuberoinfundibular tract?
It inhibits the secretion of prolactin from acidophils (prolactin and GH) from the anterior pituitary.
Which NT is released onto the striatum from the nigrostriatal tract?
Dopamine
Hyperactivity or hypoactivity of which tract may be associated with the positive and negative symptoms of schizophrenia respectively?
Which NT is most important?
Mesolimbic-mesocoritcal tract

Dopamine
Where are most noradrenergic neurons of the CNS located?
Locus ceruleus
What enzyme converts dopamine into norepinephrine?
Dopamine beta-hydroxylase
Where are most serotonergic cell bodies in the brain located?
Dorsal raphe nuclei
What amino acid is the precursor for serotonin?
Tryptophan
What amino acid is the precursor for dopamine, norepinephrine, and epinephrine?
Tyrosine
What is fluoxetine (Prozac)?
A selective serotonin reuptake inhibitor
What do heterocyclic antidepressants work?
The inhibit the re-uptake of BOTH norepinephrine and dopamine
How is it thought that certain antipsychotics and tricyclic antidepressants produce side effects such as sedation and increased appetite causing weight gain?
Histamine receptor blockade
What are some common conditions that degeneration of cholinergic neurons of the CNS are associated with?
Alzheimer's disease
Down syndrome
Movement and sleep disorders
Where are most cholinergic cell bodies in the brain located?
Basal Nucleus of Meynert
Name some common drugs that block the action of acetylcholinesterase and are used to try and delay the progression of Alzheimer's disease.
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)
What is the major inhibitory NT of the CNS?
GABA
How do benzodiazepines work?
e.g. diazepam (Valium)

Increase the affinity of GABA for its binding site
How do barbiturates work?
e.g. secobarbital (Seconal)

Increase the duration that GABA channels are open for.
What is the major excitatory NT of the CNS?
Glutamate
What are some possible side effects of lithium therapy?
Hypothyroidism (sometimes hyperthyroidism)
Nephrogenic diabetes insipidus
Give some disease conditions in which the dexamethasone suppression test will give a positive result.
It is test in which positive findings are not specific.

Major depressive disorder (1/2 of patients)
Schizophrenia
Dementia
Cushing's
Pregnancy, Anorexia nervosa or severe weight loss, Endocrine disorders
Abuse
Withdrawal from alcohol and antianxiety agents
What is an evoked EEG used for?
Evaluate vision and hearing loss in infants
Brain responses in comatose and suspected brain-dead patients
How does an EEG differ between delirium and dementia?
Delirium: Abnormal EEG
Dementia: Often normal EEG
Describe the Folstein Mini-Mental State Examination.
It is a test of cognitive function

Scoring: <25 suggests cognitive problems, <20 suggest significant impairment

Orientation [10pts]: Person, Place, Time
Language [8pts]: Name the object that I am holding
Attention & Calculation [5pts] : Serial 7 subtraction from 100
Registration [3pts]: Repeat the names of three objects
Recall [3pts]: After 5 minutes, recall the names of these three objects
Construction [1pt]: Copy this design
Describe the Glasgow Coma Scale.
General Notes: Score of > 12 mild, 9-12 moderate, < 9 severe neurological impairment

Eye-opening response (E): 1: None 2: Opens to pain 3: Opens to command 4: Opens spontaneously

Verbal response (V): 1: None 2: Incomprehensible sounds 3: Speaks with inappropriate words 4: Confused verbal response 5: Oriented & can converse

Motor response (M): 1: None 2: Extension to pain 3: Flexion to pain 4: Withdrawal from pain 5: Localizes a source of pain 6: Obeys commands
What is the Amytal interview?
It is when a sedative such as amobarbital sodium is given prior to the clinical interview and may be useful in determining whether organic pathology is responsible for symptomatology in patients who exhibit certain psychiatric disorders or malingering.
What is IV sodium lactate administration used for?
It can provoke a panic attack in susceptible patients and can thus help identify individuals with panic disorder. Inhalation of carbon dioxide can produce the same effect.
What is acting out?
Defense mechanism

Avoiding personally unacceptable emotions by behaving in an attention-getting, often socially inappropriate manner
What is altruism?
Defense mechanism

Assisting others to avoid negative personal feelings (a relatively "mature" defense mechanism)
What is denial?
Defense mechanism

Not accepting aspects of reality that the person finds unbearable
What is displacement?
Defense mechanism

Moving emotions from a personally intolerable situation to one that is personally tolerable [e.g. a surgeon attending with unacknowledged anger toward his mother is abrasive to the female residents on his service]
What is dissociation?
Defense mechanism

Mentally separating part of one's consciousness from real life events or mentally distancing oneself from others [e.g. a teenager has no memory of a car accident in which he was driving and his girlfriend was killed]
What is humor?
Defense mechanism

Expressing personally uncomfortable feelings without causing emotional discomfort [a relatively "mature" defense mechanism]
What is identification (introjection)?
Defense mechanism

Unconsciously patterning one's behavior after that of someone more powerful [can be either positive or negative]
What is intellectualization?
Defense mechanism

Using the mind's higher functions to avoid experiencing emotion [e.g. a sailor whose boat is about to sink calmly explains the technical aspects of the hull damage in great detail to the other crew members]
What is isolation of affect?
Defense mechanism

Failing to experience the feelings associated with a stressful life event, although logically understanding the significance of the event [e.g. without showing any emotion, a woman tells her family the results of tests which indicate that her lung cancer has metastasized]
What is projection?
Defense mechanism

Attributing one's own personally unacceptable feelings to others. Associated with paranoid symptoms and prejudice. [e.g. a man with unconscious homosexual impulses begins to believe that his boss is homosexual]
What is rationalization?
Defense mechanism

Distorting one's perception of an event so that its negative out-come seems reasonable. [e.g. a man who loses an arm in an accident says the loss of his arm was good because it kept him from getting in trouble with the law]
What is reaction formation?
Defense mechanism

Adopting opposite attitudes to avoid personally unacceptable emotions [i.e. unconscious hypocrisy]
What is regression?
Defense mechanism

Reverting to behavior patterns like those seen in someone of a younger age.
What is splitting?
Defense mechanism

(1) Categorizing people or situations into categories of either "fabulous" or "dreadful" because of intolerance of ambiguity
(2) Seen in patients with borderline personality disorder

Example: A patient tells the doctor that while all of the doctors in the group practice are wonderful, all of the nurses and office help are unfriendly and curt
What is sublimation?
Defense mechanism

Expressing a personally unacceptable feeling (e.g. rage) in a socially useful way (a relatively "mature" defense mechanism)

Example: A man who got into fights as a teenager becomes a professional "prize fighter"
What is suppression?
A defense mechanism

Deliberately pushing personally unacceptable emotions out of conscious awareness (the only defense mechanism that includes some aspect of consciousness) (a relatively "mature" defense mechanism)

Example: A medical student taking a review course for the USMLE, mentally changes the subject when her mind wanders to the exam during a lecture
What is undoing?
A defense mechanism

Believing that one can magically revers past events caused by "incorrect" behavior by now adopting "correct" behavior
According to Freud what is primary process thinking?
Who is it seen in?
A type of thinking associated with primitive drives, wish fulfillment, and pleasure seeking and has NO logic or concept of time.

Children and psychotic adults
What are the components Freud's structural theory of the mind?
ID
Ego
Superego
What are the components of Freud's topographic theory of the mind?
Unconscious mind: Contains repressed thoughts & feelings that are not available to the conscious mind and uses primary thinking
Preconscious mind: Contains memories that, while not immediately available can be accessed easily
Conscious mind: Contains thoughts that a person is currently aware of. Operates closely with pre-conscious mind but can't access the unconscious. Uses secondary process thinking.
According to Freud what is secondary process thinking?
Thinking that is logical, mature, time-oriented and is capable of delaying gratification.
What is a defense mechanism?
An UNCONSCIOUS mental technique used by the ego to keep conflicts out of the conscious mind.
What is repression?
It is pushing unacceptable emotions into the unconscious and is the basic defense mechanism on which all others are based.
What is the Id?
What topographic level does it operate at?
At what age does it develop?
Part of Freud's structural theory of the mind that contains instinctive sexual and aggressive drives, operates by primary process thinking, and not influenced my external reality

Topographic level: Unconscious

Present at birth
What is the Ego?
What topographic level does it operate at?
At what age does it develop?
Part of Freud's structural theory of the mind that controls the expression of the id to adapt to the requirements of the external world primarily by the use of defense mechanisms.

Topographic level: Unconscious, Preconscious, and Conscious

Begins to develop immediately after birth
What is the Superego?
What topographic level does it operate at?
At what age does it develop?
Part of Freud's structural theory of the mind that is associated with moral values and conscience. It controls the expression of the id.

Topographic level: Unconscious, Preconscious, and Conscious

Begins to develop by about 6 years of age
What are the mature defense mechanisms?
Altruism
Humor
Sublimation
Suppression [the only defense mechanism that includes some aspect of consciousness]
What is transferance?
An unconscious mental attitude a patient has towards a doctor based on important past personal relationships and can be positive [e.g. engender confidence, over-idealization, sexualization] or negative [e.g. resentment, anger, etc.]
What is countertransferance?
The same as transferance but are unconscious mental attitudes a doctor has towards a patient.
What is a expansive mood?
Feelings of self-importance and generosity
What is a euthymic mood?
Normal mood, with no significant depression or elevation of mood
What is a dysphoric mood?
Subjectively unpleasant feeling
What is an anhedonic mood?
Inability to feel pleasure
What is a labile mood?
Mood swings, alterations between euphoric and dysphoric moodes
What is a restricted affect?
Decreased display of emotional responses
What is a blunted affect?
Strongly decreased display of emotional responses [same as restricted affect but more severe]
What is flat affect?
Complete lack of emotional response
What is labile affect?
Sudden alterations in emotional responses NOT related to environmental events
How is the psychophysiologic states of fear, anxiety, and free-floating anxiety defined?
Fear: Fright caused by real danger

Anxiety: Fright caused by imagined danger [danger is not known, not recognized, or inadequate to account for the symptoms]

Free floating anxiety: Fright not associated with any specific cause
Define clouded consciousness.
Inability to respond normally to external events
Define somnolence
Abnormal sleepiness
Define stupor
Responds only to shouting, shaking, or uncomfortable prodding
Define coma
Total unresponsiveness
What is habituation?
A simple form of learning in which repeated stimulation results in a DECREASED response.

Example: A child who receives weekly allergy injections cries less and less with each injection
What is sensitization?
A simple form of learning in which repeated stimulation results in an INCREASED response.

Example: Child who is afraid of spiders fells more anxiety each time he encounters a spider.
What is an unconditioned stimulus?
Something that automatically, without having to be learned produces a response.

Example: The odor of food
What is an unconditioned response?
A natural reflexive behavior that does not have to be learned

Example: Salivation in response to the odor of food
What is a conditioned stimulus?
Something that produces a response following learning

Example: The sound of the lunch bell
What is a conditioned response?
A behavior that is learned by an association made between conditioned stimulus and an unconditioned stimulus.

Example: Salivation in response to the lunch bell
What is the definition of acquisition in behavior learning?
When a conditioned response is learned
What is the definition of extinction in behavior learning?
When the conditioned response decreases if the conditioned stimulus (e.g. the sound of the bell) is never again paired with the unconditioned stimulus (e.g. the odor of food).

In operant conditioning it is the gradual disappearance of a learned behavior when reinforcement (reward) is withheld.
What is the definition of "stimulus generalization" in behavior learning?
When a new stimulus (e.g. a church bell) that resembles a conditioned stimulus (e.g. the lunch bell) causes a conditioned response (e.g. salivation)
What is aversive conditioning?
When an unwanted behavior (e.g. chewing your nails) is paired with a painful or aversive stimulus (e.g. a slap on the wrist). An association is created between the unwanted behavior and the aversive stimulus and the aversive behavior ceases.
What is learned helplessness?
When an animal learns that there is an association between an aversive stimulus and the inability to escape from that stimulus. Subsequently the animal makes no attempt to escape when faced with that stimulus and instead becomes hopeless and apathetic. It may be a model system for depression in humans.
What is imprinting in behavior learning?
The tendency of organisms to make an association with and the follow the first thing they see after birth or hatching (in birds)
What is the definition of positive reinforcement?
When the INTRODUCTION of a POSITIVE stimulus (reward) is introduced following an action that increases the rate of the behavior.
What is the definition of negative reinforcement?
When the REMOVAL of a NEGATIVE stimulus occurs following an action that increases the rate of the behavior.
What is the definition of punishment in learning behavior?
The introduction of an aversive stimulus aimed at reducing the rate of an unwanted behavior.
What is the definition of "shaping" in learning behavior?
It is rewarding closer and closer approximations of the wanted behavior until the correct behavior is achieved.
What is the definition of "modeling" in learning behavior?
It is a type of observational learning.

Example: Individual behaves in a manner similar to that of someone she admires.
Describe a "continuous" schedule of reinforcement and it's effect on behavior?
Reinforcement is presented after every action

Example: Getting gumballs from a machine.

Effect on behavior: Quickly learned and has little resistance to extinction [e.g. don't use machine again if no gumball comes aout]
Describe a "fixed ratio" schedule of reinforcement and it's effect on behavior?
Reinforcement is presented after a designated number of actions

Effect on Behavior: It results in a faster response rate [e.g. the person make widgets more quickly]
Describe a "fixed interval" schedule of reinforcement and it's effect on behavior?
Reinforcement is presented after a fixed time interval

Example: Having a quiz every Friday

Effect on behavior: The response rate increases towards the end of each interval [study more and more the closer a quiz comes]
Describe a "variable ratio" schedule of reinforcement and it's effect on behavior?
Reinforcement is presented after a random and unpredictable number of responses

Example: Gambling

Effect on Behavior: Harder to learn but extremely resistant to extinction [hard to leave the black jack table even if you haven't won any of the last 30 hands]
Describe a "variable interval" schedule of reinforcement and it's effect on behavior?
Reinforcement after a random and unpredictable amount of time

Example: Fishing

Effect on Behavior: Highly resistant to extinction [if you catch a fish early then you'll stay and tray and catch more even if you don't catch one for the next 8 hours]
What is "mental age" as defined by Alfred Binet?
It reflects a person's level of intellectual functioning regardless of what their chronological (actual) age is.
What is definition of the IQ?
How is it calculated?
Intelligence Quotient

IQ = (Mental Age/Chronological age) * 100
How does IQ change throughout life?
It is determined to a large extent by genetics (though poor nutrition and illness in childhood can negatively affect it) & as such is essentially the same in old age as in childhood.
What is a normal or average IQ?
What is the mean IQ?
How much is one standard deviation from the mean?
Normal/Average: 90-109
Mean: 100
Standard Deviation: 15
What IQ score indicates borderline intellectual functioning?
71-84
Below what IQ is an individual considered mentally retarded?
Less than 2 standard deviations below the mean which is 70 or less
Over what IQ is an individual said to have superior intelligence?
> 130 [more than 2 standard deviations above the mean]
In what age group is IQ generally tested?
<16yo
What IQ test is used most often to test intelligence in children 6-16.5 years old?
Wechsler Intelligence Scale for Children-Revised (WISC-R)
What IQ test is used most often to test intelligence in children 4-6.5 years old?
Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
What test is used to evaluate skills for daily living (e.g. dressing, using telephone, etc.) in mentally retarded and other challenged people (e.g. deaf or blind)
Vineland Social Maturity Scale
List the levels of mental retardation based on IQ and describe each.
Mild: 70-55 IQ [2-3 SD below mean] Educable: (1) Basic academic skills (2) Usually employable

Moderate: 55-40 IQ [3-4 SD below mean] Trainable: (1) Self-help skills (2) Can work under close supervision (3) Limited social skills

Severe: 40-25 IQ [4-5 SD below mean] (1) Limited language (2) Self-care w/ intensive training (3) Constant supervision

Profound: <25 IQ [6+ SD below mean]. (1) May not learn to talk (2) Total care
What is the difference between an objective and projective personality test?
Objective Personality Test: Based on questions that are easily scored and statistically analyzed

Projective Personality Test: Requires the subject to interpret the questions. Responses are assumed to be based on the subject's motivational state and defense mechanisms.
What is the Minnesota Multiphasic Personality Test (MMPI-2) used for?
Use: The MOST COMMONLY used OBJECTIVE personality test & is useful for primary care physicians because no training is required for administration.

Characteristics: 567 T/F questions with both clinical [depression, paranoia, etc.] and validity scales [identifying individuals trying to look ill or look well]
What is the Rorschach Test used for?
Uses: The MOST COMMONLY used PROJECTIVE personality test used to identify thought disorders and defense mechanisms.

Characteristics: Patients are asked to interpret 10 bilateral symmetrical ink blot designs
What is Thematic Apperception Test (TAT) used for?
Use: Projective tests in which stories are used to evaluate unconscious emotions and conflicts

Characteristics: Patients are asked to create verbal scenarios based on 30 drawings depicting ambiguous situations
What is the Sentence Completion Test (SCT) used for?
Use: Projective test used to identify worries and problems using verbal associations

Characteristics: Patients complete sentences started by the examiner (e.g. my mother ...)
What are the variables evaluated in the Mental Status Examination?
General Appearance: Appearance, Behavior, Attitude toward the interviewer, Level of consciousness
Cognition: Mini-mental status exam, Spatial, Abstraction (e.g. how are an orange and apple similar?), Speech
Mood and Affect: Mood and demonstrated affect, Match of emotions with current events
Though: Form or process of thought, Thought content (e.g. delusion)
Perception: Illusion, Hallucination
Judgment & Insight: Hypothetical questions (Find postmarked envelope on street. What do you do?
Reliability: The patients ability to reliably recount his health and history
Control of Aggressive and Sexual Impulses
Define substance abuse.
Define substance dependence.
Substance Abuse: A pattern of abnormal substance use that leads to impairment of occupational, physical, or social functioning.

Substance Dependence = Substance abuse + Withdrawal symptoms, Tolerance, or a Pattern of repetitive use
Define withdrawal.
Development of physical or psychological symptoms after the reduction or cessation of intake of a substance
Define tolerance.
The need for increased amounts of the substance to achieve the same positive psychological effect
Define cross-tolerance.
The development of tolerance to one substance to achieve the same positive psychological effect
In what demographic age group is the use of illegal substances most common?
Young adults 18-25yo
Twice as common in males
How much caffeine is in a cup of coffee?
Cup of tea?
Cup of soda?
Coffee: 125mg/cup
Tea: 65mg/cup
Soda: 40g/cup
What are two psychiatric conditions in which amphetamines are medically indicated for?
ADHD & Narcolepsy

Sometimes used to treat depression in the elderly and terminally ill, and depression and obesity in patients how do not respond to other treatments
What is the street name for methamphetamine?
"speed" or "ice"
What is the street name for methylene dioxymethamphetamine?
"ecstasy"
What is the difference "crack", "freebase", and "cocaine".
"crack" and "freebase" are cheap smokable forms of cocaine ; in expensive pure form cocaine is snorted
What symptoms are seen in newborns of mothers who used cocaine during pregnancy?
Hyperactivity & growth retardation
What is formication?
It is a hallucination in which the person believes there are bugs crawling on the skin
What is the primary manner in which cocaine causes it's psychological effects?
Inhibit the reuptake of dopamine
What is the primary manner in which amphetamines cause their psychological effects?
Stimulate dopamine release
How long does the elevation of mood typically last with cocaine use?
Typically 1 hour
What are the psychological effects of amphetamine & cocaine use?
Significant elevation of mood (lasting only 1 hour with cocaine)
Increased alertness and attention span
Aggressiveness, impaired judgement
Psychotic symptoms
Agitation and insomnia
What are the physiological effects of amphetamine & cocaine use?
Loss of appetite and weight
Pupil dilation
Increased energy
Tachycardia and other CVS effects
Seizures (particularly w/ cocaine)
Hypersexuality
What are the psychological effects of amphetamine and cocaine withdrawal?
Significant depression of mood
Strong pyschological craving (peaking a few days after the last dose)
Irritability
What are the physiological effects of amphetamine and cocaine withdrawal?
Hunger (particularly with amphetamines)
Pupil constriction
Fatigue
What is the primary way in which sedatives have their psychological effects?
Primarily by increasing the activity of GABA.
What are the CAGE questions and what are they used for?
To help identify people who have a problem with alcohol.

Do you ever?
C ... try to Cut down on your drinking?
A ... get Angry when someone comments on your drinking?
G ... feel Guilty about your drinking
E ... take a drink as an Eye-opener in the morning
At what BAL does coma occur in non-alcoholic individuals?
0.40-0.50%
What is the legal intoxication limit range in the U.S.?
0.08-0.15%
What is delirium tremens?
When do they occur?
Who does it occur in?
Is it life threatening?
Alcohol withdrawal delirium

May occur during the 1st week of withdrawal from alcohol (most common on the 3rd day of hospitalization)

It usually occurs in patients who have been drinking heavily for at least 5 years

It is life threatening with a mortality rate of about 20%
What drugs are most often taken to commit suicide?
Barbiturates
Why do barbiturates have a low safety margin?
Because they cause respiratory depression
What 4 major categories can most abused substances be classified into?
Stimulants
Sedatives (depressants)
Opioids
Hallucinogens and Related Agents
What is LSD?
How is it taken?
A hallucinogen called lysergic acid diethylamide and is ingested
What is PCP and it's street name?
How is it taken?
How does it work?
What amount may lead to convulsions, coma, and death?
A hallucinogen called phencyclidine or "angel dust" and is smoked

Binds with NMDA receptors of glutamate-gated ion channels

20mg
What is "Special K"?
Ketamine
What hallucinogen is extracted from mushrooms?
Psilocybin
What hallucinogen is extracted from cacti?
Mescaline
What are the physical effects of hallucinogen use?
Impairment of complex motor actvity
Cardiovascular symptoms
Sweating
Tremor
Nystagmus [vertical, horizontal, or rotational is an important diagnostic clue for PCP use]
What are the physiological and psychological withdrawal symptoms of hallucinogens?
There are few if any of either
Levels of what can be tested in bodily fluids (e.g. blood & urine) in nicotine use and for how long can it be detected?
Cotinine (a metabolite)
1-2 days
Levels of what can be tested in bodily fluids (e.g. blood & urine) in amphetamines use and for how long can it be detected?
Amphetamines themselves
1-2 days
Levels of what can be tested in bodily fluids (e.g. blood & urine) in cocaine use and for how long can it be detected?
Benzoylecgonine (a metabolite)
1-3 days in occasional use and 7-12 days in heavy users
Levels of what can be tested in bodily fluids (e.g. blood & urine) in alcohol use and for how long can it be detected?
Alcohol itself
7-12 hours
What is gamma-glutamyltransferase (GGT) a metabolite of and how long after use of the substance that it is metabolized from can it be detected in bodily fluids?
A metabolite of sedatives
7-12 hours
How long after use can specific barbiturates or benzodiazepine or their metabolites be found in bodily fluids?
1-3 days
How long after use can cannabinoid metabolites be detected in bodily fluids?
3-28 days
How long after use can PCP be detected in the bodily fluids of heavy users?
What are it's metabolites and how long after use can they be detected?
PCP: 7-14 days

Glutamic-oxaloacetic transaminas (SGOT) level and creatinine phosphokinase (CPK) can be detected more than 7 days after use
What immediate steps are taken in the detoxification from minor stimulants such as caffeine and nicotine?
Eliminate or taper from diet
Analgesics to control headache due to withdrawal
What immediate steps are taken in the detoxification from amphetamines and cocaine?
Benzodiazepines to decrease agitation
Antipsychotics to treat psychotic symptoms
Medical and psychological support
What immediate steps are taken in the detoxification from alcohol, benzodiazepines, barbiturates?
Hospitalization
Flumazenil (Mazicon) to reverse effects of benzodiazepines
Substitution of long-acting barbiturate or benzodiazepine in decreasing doses
IV diazepam of phenobarbital if seizures occur
Thiamine restoration in alcohol withdrawal
What immediate steps are taken in the detoxification from opioids?
Hospitalization and naloxone of overdose
Clonidine to stabilize the autonomic nervous system during withdrawal
Substitution of long-acting opioid (methadone) in decreasing doses to reduce withdrawal symptoms
What immediate steps are taken in the detoxification from hallucinogens?
Calming or "talking down" the patient
Benzodiazepines to decrease agitation
Antipsychotics to treat psychotic symptoms
What brain wakes indicate an awake state? When & where are they seen?
Alpha: Over occipital and parietal lobes are seen when a person relaxes with closed eyes

Beta: Over the frontal lobes with active mental concentration
What is a normal sleep latency?
Period of time from going to bed to falling asleep is normally less than 20 minutes
Does the longest REM period of sleep occur in the first half or second half of the sleep cycle?
2nd half
What stages of sleep decrease the most with age?
REM (50% in infancy to 5% in elderly)and Stage 3 & 4 non-REM (Delta sleep)
How do levels of ACh in the reticular formation affect sleep time?
Increased ACh levels increase both total and REM sleep. ACh is essential in the induction of REM sleep.
How do levels of dopamine affect sleep?
Increased levels of dopamine decrease total sleep time [treatment with antipsychotics which block dopamine receptors, may improve sleep in patients with psychotic symptoms.
How do levels of norepinephrine affect sleep?
Increased levels of NorE decrease both total & REM sleep
How do levels of serotonin affect sleep?
Increased levels of serotonin increase both total sleep time and delta sleep [non-REM 3 & 4]. Treatment with antidepressants, which increase serotonin availability can improve sleep in depressed patients.
What is the difference between a dyssomnia and a parasomnia?
Dyssomnia: Characterized by problems in the timing, quality, or amount of sleep

Parasomnia: Characterized by abnormalities in physiology or in behavior associated with sleep
What is bruxism?
How is it treated?
A parasomnia in which there is tooth grinding during sleep during stage 2 of non-REM sleep and can lead to tooth damage and jaw pain
Treated with dental appliance worn at night or corrective orthodontia
How does the DSM-IV define insomnia?
It is a dyssomnia
(1) Difficulty falling asleep or staying asleep that occurs 3 times a week for at least 1 month.
(2) Leads to sleepiness during the day or causes problems fulfilling social or occupational obligations

It is a very common disorder in at least 30% of the population
What is the most common sleep characteristic in depressed patients?
Terminal insomnia (waking too early)
What is sleep terror disorder?
During what part of sleep do they occur?
What might an onset in adolescence indicate?
Repetitive experiences of fright in which a person (usually a child) screams in fear during sleep during which the person cannot be awakened and has no memory of having a dream

Occurs during delta sleep [non-REM 3 & 4]

Temporal lobe epilepsy
What is nightmare disorder?
During what part of sleep do they occur?
Repetitive, frightening dreams that cause nighttime awakenings in which the person usually can recall the nightmare

Occurs during REM sleep
What is sleepwalking disorder?
During what part of sleep does it occur?
What is the usual age of onset?
Repetitive walking around during sleep with no memory of the episode on awakening

Occurs during delta [non-REM 3 & 4] sleep

Usually 4-8 years of age [childhood]
What is circadian rhythm sleep disorder?
What are the 3 different types?
Inability to sleep at appropriate times

Three types:
Delayed sleep phase type: Involves falling asleep and waking later than wanted
Jet Lag: Typically lasts 2-7 days after a change in time zones
Shift Work Type: For example residency
What is nocturnal myoclonus?
In what age group is this most common?
Repetitive, abrupt muscular contractions in the legs from toes to hips that cause nighttime awakenings

More common in the elderly
What is restless leg syndrome?
In what population is this most common?
Uncomfortable sensation in the legs necessitating frequent motion. Includes repetitive limb jerking during sleep. It causes difficulty falling asleep and nighttime awakenings.

More common in aging, pregnancy, and kidney disease
What is sleep drunkenness?
What other conditions must it be differentiated from?
What are predisposing conditions?
Difficulty awakening fully after adequate sleep

Rare and must be differentiated from substance abuse or other sleep disorders

Associated with genetic factors
What is REM sleep behavior disorder?
REM sleep without skeletal muscle paralysis. Patients can injure themselves or their sleeping partners
What is Kleine-Levin syndrome?
What age group is onset most common?
What is the course of the disease?
Kleine-Levin Syndrome (“KLS”) is a rare primary hypersomnia characterized by recurrent and unusually long episodes of hypersomnia, associated with behavioral/cognitive disturbances, megaphagia and more rarely sexual disinhibition. These serious episodes alternate with periods without any symptom, normal sleep and behavior typically lasting months to years

Primarily strikes adolescents

Is self-limiting; cessation of episodes typically occurs in early adult life
What is the definition of a primary hypersomnia?
Recurrent periods of excessive sleepiness occurring almost daily for at least 1 month and is not relieved by daytime naps
It is often accompanied by hyperphagia
What are the characteristics of sleep stages in depression?
Increased REM early in the sleep cycle and decreased REM later in the sleep cycle that may lead to waking too early [MOST COMMON]

Short REM latency (appearance of REM within 45 minutes of falling asleep)

Long first REM period and INCREASED TOTAL REM

Reduced delta [non-REM 1 & 2] sleep
What is obesity hypoventilation syndrome?
What is another name?
A condition that occurs in obese people, in which poor breathing leads to lower oxygen levels and higher carbon dioxide levels in the blood. It results in sleep apnea and chronic hypoxia

Pickwickian syndrome
What is central sleep apnea?
It is when little or no respiratory effort occurs resulting in less air reaching the lungs
What is obstructive sleep apnea?
What age group and sex is it most common in?
Respiratory effort occurs, but an airway obstruction prevents air from reaching the lungs.

40-60yo and males

PATIENTS OFTEN SNORE
What is the peak age of onset of schizophrenia in men?
Women?
Men: 15-25 years
Women: 25-35
What differences exist in how schizophrenics with positive and negative symptoms respond to anti-psychotics?
Positive: Respond well to most traditional AND atypical antipsychotic agents

Negative: Respond better to atypical than to traditional antipsychotics
What are the 3 phases of schizophrenia?
Prodromal: Signs and symptoms occur prior to the first psychotic episode, and include avoidance of social activities ; physical complains ; and new interest in religion, the occult or philosophy

Psychotic phase: The patient loses touch with reality. Disorders of perception, thought content, thought process, and form of though occur during an acute psychotic episode
Residual: Time period between psychotic episodes in which the patient IS in touch with reality but does not behave normally and is typically associated with NEGATIVE symptoms
What are factors improve prognosis and reduce suicide risk in schizophrenics?
Older age of onset, Has social relationships, Female, Employment, Few negative symptoms, Few relapses
Define illusion?
Hallucination?
They are both disorders of perception.

Illusion: Misperception of real external stimuli [e.g. interpreting the appearance of a coat in a dark closet as a man]
Hallucination: False sensory perception [e.g. hearing voices]
Give examples of disorders of perception?
Thought Content?
Thought Process?
Form of Thought?

What disease are all of these often present in?
Perception: Illusion, Hallucination
Thought Content: Delusion, Idea of Reference
Thought Process: Impaired abstraction ability, Magical thinking
Form of Thought: Loose associations, Neologisms, Tangentiality

Schizophrenia
Define delusions
Ideas of reference?
They are both disorders of thought content

Delusion: False belief not shared by others [e.g. feeling of being followed by FBI]

Idea of reference: False belief of being referred to by others [e.g. feeling of being discussed by someone on TV]
Define impaired abstraction ability?
Magical thinking?
They are both disorders of thought process.

Impaired abstraction ability: Problems discerning the essential qualities of objects or relationships [e.g. when asked what brought her to the emergency room the patient says "an ambulance"]

Magical thinking: Belief that thoughts affect the course of events [e.g. knock on wood]
Define loose associations?
Neologisms?
Tangentiality?
They are all disorders of form of thought.

Loose associations: Shift of ideas from one subject to another in an unrelated way

Neologisms: Inventing new words

Tengentiality: Getting further away form the point as speaking continues
Birth in what season of the year is associated with an increased incidence of schizophrenia?
Cold weather months [maybe viral influence?]
What are the anatomical differences in a schizophrenic brain?
(1) Abnormalities in frontal lobes [decreased glucose use demonstrated by PET scans]
(2) Lateral and third ventricle enlargement
(3) Decreased volume of limbic structures [e.g. amygdala, hippocampus]
Use of which drug mimics the psychotic symptoms of schizophrenia and why?
PCP [phencyclidine] b/c it is an NMDA receptor antagonist and one theory of schizophrenia states that symptoms might be attributable to a HYPO-functioning glutamate system. Certain NMDA agonists may help alleviate symptoms.
What is the approximate occurrence of schizophrenia in the
General population?
Person who has one parent or sibling with schizophrenia?
Person who has two parents with schizophrenia?
Person who has a monozygotic twin with schizophrenia?
General: 1%
Parent of sibling: 10%
Two parents: 40%
Monozygotic twin: 50%
What are the 5 DSM-IV subtypes of schizophrenia?
Disorganized
Catatonic
Paranoid
Undifferentiated
Residual
Describe the characteristics of the disorganized subtype of schizophrenia.
Poor grooming and disheveled appearance
Inappropriate emotional response [e.g. silliness]
Facial grimacing, Mirror gazing
Onset BEFORE 25 years of age
Describe the characteristics of the catatonic subtype of schizophrenia.
Stupor or agitation, lack of coherent speech
Bizarre posturing [wavy flexibility]
Rare since the introduction of anti-psychotic agents
Describe the characteristics of the paranoid subtype of schizophrenia.
Delusions of persecution
Better functioning and older age at onset than other subtypes
Describe the characteristics of the undifferentiated subtype of schizophrenia.
Characteristics of more than one subtype [Disorganized, Catatonic, Paranoid]
Describe the characteristics of the residual subtype of schizophrenia.
At least one previous psychotic episode
Subsequent residual symptoms but no current frank psychotic symptoms [residual phase?]
What time frame of symptoms are required to diagnose schizophrenia?
What is the prognosis?
Psychotic and residual symptoms lasting > 6 months

Lifelong social and occupational impairment
What time frame of symptoms are required to diagnose brief psychotic disorder?
What is the prognosis?
Psychotic symptoms lasting > 1 day but < 1 month that often occur with precipitating psychosocial factors

50-80% recover completely
What time frame of symptoms are required to diagnose schizophreniform disorder?
What is the prognosis?
Psychotic symptoms lasting > 1 month but < 6 months

33% recover completely
What is schizoaffective disorder?
What is the prognosis?
Symptoms of mood disorders AS WELL AS psychotic symptoms

Lifelong social and occupational impairment [somewhat higher over-all functioning than in schizophrenia]
What is delusional disorder?
What is the prognosis?
What are the different types?
Fixed, persistent, NON-bizzare, delusional system that persist for AT LEAST 1 month

50% recover completely ; many have relatively normal social and occupational functioning

Erotomanic type, Grandiose type, Jealous type, Persecutory type, Somatic type, Mixed type, Unspecified type
What is shared psychotic disorder [folie a deux]?
What is the prognosis?
Development of delusions in a person in a close relationship with someone with delusional disorder [the inducer]

10-40% recover completely when separated from the inducer
Define the Five Axes of the DSM-IV.
Axis I: Clinical disorders (most of psychiatry)
Axis II: Personality disorders, Mental retardation (essentially life-long problems) consisting of 3 clusters A, B, & C
Axis III: General Medical Conditions (all other biological illness)
Axis IV: Psychosocial, Environmental Problems (stressors)
Axis V: Global Assessment of Functioning
What are the 3 Clusters of DSM IV Axis II?
What are the characteristics of each cluster and the associated diseases?
Axis II --> Personality disorders, Mental retardation (essentially life-long problems) consisting of 3 clusters A, B, & C:
A:
(1) Avoids social relationships, is "peculiar" not not psychotic
(2) Paranoid, Schizoid, Schizotypal
B:
(1) Dramatic, emotional, inconsistent, Mood disorders, Substance abuse, and somatoform disorders
(2) Antisocial, Borderline, Histrionic, Narcissistic
C:
(1) Fearful, Anxious, Anxiety disorders
(2) Avoidant, Dependant, Obsessive-Compulsive
Define a major depressive episode according to DSM IV.
Requires at least 2 weeks of depressed mood or loss of interest accompanied by AT least 4 ADDITIONAL symptoms of depression
What is seasonal affective disorder?
What treatment might improve symptoms?
Subtype of major depressive disorder associated with the winter season and short days

Many patients improve in response to full-spectrum light exposure
What are the top 5 risk factor for suicide from highest to lowest?
1) Serious prior suicide attempt
2) Older than 45yo
3) Alcohol dependence
4) History of rage and violent behavior
5) Male
Which gender is more likely to commit suicide?
Female: 3 times more likely to attempt
Male: 3 times more likely to succeed
What does the DSM IV require to diagnose bipolar I disorder?
Bipolar II disorder?
Bipolar I: Mania and depression [requires only 1 episode of mania for diagnosis b/c there is no pure mania]

Bipolar II: Hypomania and depression [hypomania plus one episdoe of major depression]
How do periods between episodes compare between people with mood disorders [e.g. bipolar] and schizophrenia or schizoaffective disorder?
Schizophrenics and people w/ schizoaffective disorder are CHRONICALLY impaired with residual symptoms between episodes while functioning in those with mood disorders usually returns to normal between episodes
What is dysthymic disorder?
What is cyclothymic disorder?
Compare them to major depressive disorder and bipolar disorder.
Dysthymic: Dysthmia continuing over a 2-year period with NO discrete episode of illness

Cyclothymic: Periods of hypomania and dysthmia occurring over a 2-year period with NO descrete episodes of illness

Dysthmic and cyclothymic disorders are LESS SEVERE, NON-EPISODIC, CHRONIC, and NEVER associated with psychosis
When is the use of electroconvulsive therapy indicated?
The primary indication is MAJOR DEPRESSIVE DISORDER
(1) Symptoms don't respond to antidepressant medications
(2) Antidepressant medications are too dangerous or have intolerable side effects [ECT may be particularly useful in elderly]
(3) RAPID RESOLUTION of symptoms is necessary (e.g. acutely suicidal)
(4) There are psychotic features
Why aren't benzodiazepines used for long term treatment of anxiety disorders?
Benzodiazepienes carry a high risk of dependence and addiction and are therefor usually used only to treat acute anxiety symptoms [e.g. panic attack]
How does DSM IV define panic disorder [it may occur with or without agoraphobia]?
Episodic [about twice weekly] periods of intense anxiety [panic attacks]
Cardiac and respiratory symptoms and the conviction that one is about to die
Sudden onset of symptoms, increasing in intensity over a period of approx 10min and lasting about 30 min [attacks rarely follow a fixed pattern]
Attacks can be induced by administration of sodium lactate or CO2
More common in young women in their 20s
What is agoraphobia?
Fear being in places where it may be difficult or embarrassing to get out quickly or where you may have a panic attack and can't get help. Because of your fears, you avoid places where you think you may have a panic attack or panic-like symptoms.
What event in childhood or childhood disorder is panic disorder with agoraphobia in an adult is associated with?
Separation anxiety disorder
How does DSM IV define phobias?
What is the difference between specific and social phobias?
Specific: Irrational fear of certain things
Social: Exaggerated fear of embarrassment in social situations

Because of the fear, the patient avoids the object or situation with avoidance leading to social and occupational problems
How does DSM IV define obsessive-compulsive disorder?
Recurring, intrusive feelings, thoughts, and images [obsessions] that cause anxiety
Anxiety is relieved in part by performing repetitive actions [compulsions]
A common obsession is avoidance of hand contamination and compulsive need to wash hands after touching things
Repeated checking (e.g. gas jets on stove) are common
Patients usually have INSIGHT (understand thoughts and behaviors are irrational and want to eliminate them)
What is the most common age of onset of obsessive-compulsive disorder?
What factors are involved in it's development?
Usually young adulthood [may start in childhood]

Genetic factors are involved
Increased incidence in 1st degree relatives of Tourette disorder patients
How does DSM IV define generalized anxiety disorder?
Persistent anxiety symptoms including hyperarousal and worrying lasting 6 months or more
Gastrointestinal symptoms are common
Symptoms are not related to a specific person or situation [the anxiety is "free floating"]
What is the most common age of onset of generalized anxiety disorder?
Commonly during early 20's
What is the cause of post traumatic stress disorder (PTSD) and acute stress disorder (ASD)?
Symptoms in both occur after a catastrophic life-threatening or potentially fatal event affecting the patient or a close friend or relative of the patient
What are the four classifications of symptoms in post traumatic stress disorder (PTSD) and acute stress disorder (ASD)?
(1) Re-experiencing: Intrusive memories of the even such as flashbacks or nightmares
(2) Hyperarousal: Anxiety, increased startle response, impaired sleep, hypervigilance
(3) Emotional numbing: e.g. difficulty connecting with others
(4) Avoidance: e.g. survivor's guilt, dissociation, and social withdrawal
How do post traumatic stress disorder (PTSD) and acute stress disorder differ in their onset and duration?
PTSD: Symptoms last for more than 1 month (sometimes years) and may have a delayed onset
ASD: Symptoms last only between 2 days and 4 weeks
What are the DSM IV diagnostic criteria for adjustment disorders?
(1) The development of emotional or behavioral symptoms in response to an identifiable stressor(s) that occur within 3 months of the onset of stressor(s)
(2) These symptoms or behaviors are clinically significant through impairment of function
(3) The stress-related disturbance does not meed the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder
(4) These symptoms do NOT represent bereavement
(5) Once the stressor or its consequences have terminated the symptoms do not persist for more than an additional 6 months
What are the subtypes of adjustment disorders?
(1) With depressed mood
(2) With anxiety
(3) With mixed anxiety & depressed mood
(4) With disturbance of conduct
(5) With mixed disturbance of emotions and conduct
(6) Unspecified
What are somatoform disorders characterized by?
Which sex are they more common in?
Characterized by physical symptoms without sufficient organic cause.

Most are more common in women although hypochondriasis occurs equally in both sexes
What are factitious disorders and malingering characterized by and how do they differ from somatoform disorders?
Individuals with somatoform disorders truly believe they are ill while those with factitious disorders or malingering feign or induce symptoms for psychological (factitious disorder) or tangible (malingering) gain.
How does DSM-IV classify somatization disorder?
What is the usual onset?
History over years of wide ranging physical complaints including at least two GI symptoms (e.g. nausea), four pain symptoms, one sexual symptom (e.g. menstrual problems), and one psuedoneurological symptom (e.g. paralysis)

Before 30yo
How does DSM-IV classify hypochondriasis?
What is the usual onset?
Exaggerated concern with health and illness lasting at least 6 months
Concern persists despite medical evaluation and reassurance
Goes to many different doctors seeking help (doctor shopping)

More common in middle and old age
How does DSM-IV classify conversion disorder?
What is the usual onset?
Sudden, dramatic loss of sensory or motor function (e.g. blindness, paralysis) often associated with a stressful life event
Patients appear relatively unworried "la bell indifference"

More common in unsophisticated adolescents and young adults
How does DSM-IV classify body dysmorphic disorder?
What is the usual onset?
Excessive focus on a minor or imagined physical defect
Symptoms not accounted for by anorexia nervosa

Usually in late teens
How does DSM-IV classify pain disorder?
What is the usual onset?
Intense acute or chronic pain not explained completely by physical disease

Usually 30's and 40's
What are the most commonly feigned symptoms in factitious disorder and malingering?
Abdominal pain
Fever (by heating thermometer)
Hematuria (adding blood from a needle stick)
Induction of tachycardia (drugs)
Skin lesions (injuring easily reached areas)
Seizures
How does DSM-IV classify factitious disorder [formerly Munchausen syndrome]?
Conscious simulation of physical or psychiatric illness to gain attention from medical personnel
Undergoes unnecessary medical and surgical procedures
Has a "grid abdomen" --> Multiple crossed scars from repeated surgeries
How does DSM-IV classify factitious disorder by proxy?
Conscious simulation of illness in another person, typically in a child by a parent, to obtain attention from medical personnel
Is a form of child abuse because the child undergoes unnecessary medical and surgical procedures
Must be reported to child welfare authorities
How does DSM-IV classify malingering?
Conscious simulation or exaggeration of physical or psychiatric illness for financial or other obvious gain
Avoids treatment by medical personnel
Health complaints stop as soon as the desired gain is obtained
What is the hallmark of delirium?
Dementia?
Amnestic disorder?
Delirium: Impaired consciousness
Dementia: Loss of memory and intellectual abilities
Amenstic disorder: Loss of memory with few other cognitive disorders
People with amnestic disorder commonly have a history of what?
Alcohol abuse (thiamine deficiency leading to destruction of mamillary bodies)

May also be due to temporal lobe trauma due to vascular disease or infection such as Herpes
How do the physical findings of delirium, dementia, and amnestic disorder differ?
Delirium:
(1) Acute medical illness
(2) Autonomic dysfunction
(3) Abnormal EEG (fast wave activity or generalized slowing)
Dementia and Amnestic Disorder:
(1) No medical illness
(2) Little autonomic dysfunction
(3) Normal EEG
How do the psychological findings of delirium, dementia, and amnestic disorder differ?
Delirium:
(1) Impaired consciousness
(2) Illusions or hallucination (often visual and disorganized)
(3) Anxiety with psychomotor agitation
(4) "Sundowning" (symptoms much worse at night)
(5) Acute onset & is reversible
Dementia & Amenstic disorder
(1) Normal consciousness (sensorium)
(2) No psychotic symptoms in early stages
(3) Depressed mood
(4) Little diurnal variability
(5) Confabulation
(6) Progressive disease
What is confabulation?
Untruths told to hide memory loss in amnestic disorder
What are the genetic associations with Alzheimer's disease?
Amyloid Precurosor Protein: Chromosome 21 [Alzheimer's is inevitable in patients with down syndrome if they live into their 40's]
Presenilin 1 [chr 14] & II [chr 1]: Involved in the processing in A-beta
Apoliprotein E3 [Chr 19]
What are the characteristics of personality disorders?
What is required for DSM-IV-TR diagnosis of personality disorder?
Characteristics:
(1) Chronic, lifelong, rigid, unsuitable patterns of relating to others that cause social and occupational problems
(2) Persons with PD's are generally not aware that they are the cause of their own problems, do NOT have frank psychotic symptoms, and do not seek psychiatric help

PD must be present by early adulthood. Antisocial PD cannot be diagnosed until age 18 ; prior to this age, the diagnosis is conduct disorder
What are the characteristics of dissociative disorders?
What is the treatment?
Characteristics:
(1) Abrupt but temporary amnesia or loss of identity, or by feelings of detachment owing to psychological factors
(2) Commonly related to disturbing emotional experiences in the patient's recent or remote past

Treatment: Hypnosis, Amobarbital sodium interview, Long-term psychoanalytical oriented psychotherapy to recover "lost" memories of disturbing emotional experiences
What are the DSM-IV diagnostic criteria for paranoid personality disorder?
[BRS does not have all details]
Cluster A: A pervasive distrust and suspiciousness of other such that their motives are interpreted as malevolent, and is indicated by at least 4 out of the following 7:
(1) Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
(2) Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
(3) Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
(4) Reads hidden, demeaning, or threatening meanings into benign remarks or events
(5) Persistently bears grudges
(6) Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
(7) Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
What are the DSM-IV diagnostic criteria for schizoid personality disorder?
[BRS does not have all details]
Cluster A: Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings and is indicated by at least 4 of the following 7:
(1) Neither desires nor enjoys close relationships, including being part of a family
(2) Almost always chooses solitary activities
(3) Little, if any interest in having sexual experiences with another person
(4) Takes pleasure in few, if any activities
(5) Lacks close friends or confidants other than 1st degree relative
(6) Appears indifferent to the praise or criticism of others
(7) Shows emotional coldness , detachment, of flattened affectivity
What are the DSM-IV diagnostic criteria for schiztypal personality disorder?
[BRS does not have all details]
Cluster A: A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior that is indicated by at least 5 of the following 9:
(1) Ideas of reference
(2) Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms
(3) Unusual perceptual experiences, including bodily illusions
(4) Odd thinking and speech
(5) Suspiciousness or paranoid ideation
(6) Inappropriate constricted affect
(7) Behavior or appearance that is odd, eccentric, or peculiar
(8) Lack of close friends or confidants other than first-degree relatives
(9) Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
What are the DSM-IV diagnostic criteria for antisocial personality disorder?
[BRS does not have all details]
Cluster B: There is a pervasive pattern of disregard for and violation of the rights of others occurring SINCE AGE 15 but the current age of the patient most be AT least 18 (otherwise conduct disorder) and is indicated by at least 3 of the following 7:
(1) Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
(2) Deceitfulness, as indicted by repeated lying, use of aliases, or conning others for personal profit or pleasure
(3) Impulsivity of failure to plan ahead
(4) Irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) Reckless disregard for safety of self or others
(6) Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
(7) Lack of remorse, as indicated by being indifferent to or rationalizing having, hurt, mistreated, or stolen from another
What are the DSM-IV diagnostic criteria for borderline personality disorder?
[BRS does not have all details]
Cluster B: Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity and is indicated by at least 5 of the following 9:
(1) Frantic efforts to avoid real or imagined abandonment (do not include suicidal or self0mutilating behavior covered in criterion 5)
(2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) Identify disturbance: markedly and persistently unstable self-image or sense of self
(4) Impulsivity in at least TWO areas that are potentially self-damaging (e.g. spending, sex, etc.)
(5) Recurrent suicidal behavior, gestures, or threats, self-mutilating behavior
(6) Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) Chronic feelings of emptiness
(8) Inappropriate, intense anger or difficulty controlling anger
(9) Transient, stress-related paranoid ideation r severe dissociative symptoms
What are the DSM-IV diagnostic criteria for histrionic personality disorder?
[BRS does not have all details]
Cluster B: Pervasive pattern of excessive emotionally and attention seeking, and is indicated by 5 or more of the following 8:
(1) Is uncomfortable in situations in which he or she is not the center of attention
(2) Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
(3) Displays rapidly shifting and shallow expression of emotions
(4) Consistently uses physical appearance to draw attention to self
(5) Has a style of speech that is excessively impressionistic and lacking in detail
(6) Shows self-dramatization, theatrically, and exaggerated expression of emotion
(7) Is suggestible (easily influenced by others or circumstances)
(8) Considers relationships to be more intimate than they actually are
What are the DSM-IV diagnostic criteria for narcissistic personality disorder?
[BRS does not have all details]
Cluster B: Pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy and is indicated by 5 or more of the following 9:
(1) Has a grandiose sense of self-importance
(2) Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
(3) Believes that he or she is "special" and unique and can only be understood by, or should associated with, other special or high-status people (or institutions)
(4) Requires excessive admiration
(5) Has a sense of entitlement
(6) Is interpersonally exploitive
(7) Lacks empathy: Unwilling to recognize of identify with the feelings or needs of others
(8) Often envies others or believes that others are envious of him/her
(9) Shows arrogant, haughty behavior or attitudes
What are the DSM-IV diagnostic criteria for dependent personality disorder?
[BRS does not have all details]
Cluster C: Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation and is indicated by at least 5 of the following 8:
(1) Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
(2) Needs others to assume responsibility for most major areas of his or her life
(3) Has difficulty expressing with others because of fear of loss of support for approval [DO NOT include realistic fears of retribution]
(4) Has difficulty initiating projects or doing things on his or her own [because of lack of self-confidence rather than lack of motivation]
(5) Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
(6) Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for him/herself
(7) Urgently seeks another relationship as a source of are and support when a close relationship ends
(8) Is unrealistically preoccupied with fears of being left to take care of himself or herself
What are the DSM-IV diagnostic criteria for avoidant personality disorder?
[BRS does not have all details]
Cluster C: Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation and is indicated by at least 4 of the following 7:
(1) Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
(2) Is unwilling to get involved with people unless certain of being liked
(3) Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
(4) Is preoccupied with being criticized or rejected in social situations
(5) Is inhibited in new interpersonal situations because of feelings of inadequacy
(6) Views self as socially inept, personally unappealing, or inferior to others
(7) Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrasing
What are the DSM-IV diagnostic criteria for obsessive-compulsive personality disorder?
[BRS does not have all details]
Cluster C: Pervasive pattern f preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency and is indicated by 4 or more of the following 8:
(1) Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
(2) Shows perfectionism that interferes with task completion
(3) Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
(4) Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values
(5) Is unable to discard worn-out or worthless objects even when they have no sentimental value
(6) Is reluctant to delegate tasks or to work with others unless they submit to exactly his/her way of doing things
(7) Adopts a miserly spending style toward both self and others ; money is viewed as something to be hoarded for future catastrophes
(8) Shows rigidity and stubborness
What does the code for adult antisocial behavior denote?
Denotes antisocial (e.g. criminal) behavior NOT due to an Axis I or II mental disorder

Before using this diagnosis, the diagnosis of Conduct disorder, Antisocial personality disorder, and Impulse control disorders should be considered
What are the DSM-IV diagnostic criteria for dissociative amnesia?
Failure to remember important information about oneself
Amnesia usually resolves in minutes or days but may last years
What are the DSM-IV diagnostic criteria for dissociative fugue?
Amnesia combined with sudden wandering from home
Adoption of a different identity
What are the DSM-IV diagnostic criteria for dissociative identity disorder (formerly multiple personality disorder)?
At least 2 distinct personalities ("alters") in an individual
More common in women (particularly those sexually abused in childhood)
In a forensic (e.g. jail) setting, malingering and alcohol abuse must be considered and excluded
What are the DSM-IV diagnostic criteria for depersonalization disorder?
Recurrent, persistent feelings of detachment from one's own body, the social situation, or environment (derealization)
Understanding that these perceptions are only feelings (i.e. normal reality testing)
People on commercial dieting and weight loss programs generally regain the weight in how much time?
Within a 5-year period
What is orlistat?
Pancreatic lipase inhibitor used to aid weight loss?
What is sibutramine hydrochloride?
Monoamine reputake inhibitor, which thereby increases feelings of satiety
What are the DSM IV criteria for anorexia?
What are some of the physical characteristics of an individual w/ anorexia?
DSM IV:
(1) Extreme weight loss (15% or more below normal weight) w/ refusal to maintain normal weight
(2) Amenorrhea for >3 mo
(3) Distortion of body image
(4) Fear of becoming fat

PHYSICAL CHARACTERISTICS:
Metabolic acidosis
Hypokalemia
Hypercholesterolemia
Mild anemia and leukopenia
Lanugo (body hair on the trunk)
Osteoporosis
Cold intolerance
Syncope
What is malanosis coli?
Blackened area of the colon if there is laxative abuse
What are the DSM IV criteria & physical characteristics of an individual w/ bulimia?
DSM IV:
(1) Binge eating followed by compensatory behavior to prevent weight gain
(2) Behavior 2 times a week for at least 3 months
(3) If meets DSM IV for anorexia than anorexia is diagnosed

PHYSICAL CHARACTERISTICS
Relatively normal body weight
Esophageal varices caused by repeated vomiting
Tooth enamel erosion due to gastric acid in the mouth
Swelling or infection of the parotid glands
Metacarpal-phalangeal calluses (Russell's sign) from the teeth because the hand is used to induce gagging
Electrolyte disturbances
Menstrual irregularities
What is Russel's sign
Metacarpal-phalangeal calluses from the teeth because the hand is used to induce gagging in bulimia
What are the stages of Rett's syndrome?
Stage 1: Signs and symptoms are subtle & easily overlooked . Starts between 6 and 18 months of age. May show less eye contact & start to lose interest in toys. They may also have delays in sitting or crawling.

Stage II: Starts between 1 and 4yo. Gradually lose ability to speak and to use their hands purposefully. Repetitive, purposeless hand movements — wringing, washing, clapping or tapping — begin during this stage. Some hold their breath or hyperventilate and may scream or cry without provocation. Often difficult for them to initiate movement. Slowing of head growth usually is noted during this stage.

Stage 3: Plateau that usually begins between 2 and 10yo and can last for years. Although problems with mobility continue, behavior may improve. Often cry less, aren't as irritable, and may show improvement in alertness, attention span and nonverbal communication skills. Many remain in stage III for the rest of their lives.

Stage 4: Last stage. Marked by reduced mobility, muscle weakness and scoliosis. Understanding, communication and hand skills generally don't decline further during this stage. In fact, repetitive hand movements may decrease. Although sudden death in sleep can occur, most live into their 40s or 50s. They usually need care and assistance throughout life.
What is the cause of Rett's syndrome?
Most cases of Rett syndrome are caused by mutations in the MECP2 gene.

It is an X-linked dominant inheritance.

Primarily a disease of females with most males having the mutation dying before birth.
At what age is autism usually diagnosed?
What is the latest it is usually diagnosed?
What diseases must be excluded for diagnosis?
Usual diagnosis: 1yo
Latest diagnosis: 3yo
Exclude: Rett's or CDD
What social symptoms do autistic children generally exhibit?
* Fails to respond to his or her name
* Has poor eye contact
* Appears not to hear you at times
* Resists cuddling and holding
* Appears unaware of others' feelings
* Seems to prefer playing alone — retreats into his or her "own world"
What language symptoms do autistic children generally exhibit?
* Starts talking later than other children
* Loses previously acquired ability to say words or sentences
* Does not make eye contact when making requests
* Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
* Can't start a conversation or keep one going
* May repeat words or phrases verbatim, but doesn't understand how to use them
What language behavioral do autistic children generally exhibit?
* Performs repetitive movements, such as rocking, spinning or hand-flapping
* Develops specific routines or rituals
* Becomes disturbed at the slightest change in routines or rituals
* Moves constantly
* May be fascinated by parts of an object, such as the spinning wheels of a toy car
* May be unusually sensitive to light, sound and touch and yet oblivious to pain
What are language pragmatics?
Social rules around language (e.g. how loud to speak)
What is language prosody?
Intonation and stress points in language
How does the onset of Asperger's syndrome compare to autism?
The onset is generally later
What are the signs and symptoms of Autism?
* Engaging in one-sided, long-winded conversations, without noticing if the listener is listening or trying to change the subject
* Displaying unusual nonverbal communication, such as lack of eye contact, few facial expressions, or awkward body postures and gestures
* Showing an intense obsession with one or two specific, narrow subjects, such as baseball statistics, train schedules, weather or snakes
* Appearing not to understand, empathize with, or be sensitive to others' feelings
* Having a hard time "reading" other people or understanding humor
* Speaking in a voice that is monotonous, rigid or unusually fast, marked deficits in pragmatics and prosody of language
* Moving clumsily, with poor coordination
* Having an odd posture or a rigid gait
* Generally normal intelligence
The autism spectrum of disorders is more common in what sex?
4-5 more common in males
What is the onset of childhood disintegrative disorder (aka Heller's syndrome)?
After 2 years old but before 10yo.

Development of the child is completely normal up until this time.
In what are the areas do children with childhood disintegrative disorder experience loss of previously learned skills?
Significant loss in at least two of the following areas before the age to 10yo:
* Ability to say words or sentences (expressive language)
* Ability to understand verbal and nonverbal communication (receptive language)
* Social skills and self-care skills (adaptive behavior)
* Bowel and bladder control
* Play skills
* Motor skills (ability to voluntarily move the body in a purposeful way)
What are the DSM-IV criteria for the diagnosis so ADHD?
(1) 6 or more specific symptoms of inattention or 6 or more specific symptoms of hyperactivity-impulsivity have persisted for AT LEAST 6 months to a degree that is maladaptive and inconsistent with the developmental level
(2) Some hyperactive-impulsive or inattentive symptoms that caused impairment were present BEFORE age 7
(3) Some impairment from the symptoms is present in TWO OR MORE settings
(4) There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning
(5) The symptoms DO NOT OCCUR exclusively as during the course of some other pervasive developmental disorder
What are the 3 categories of ADHD?
(1) Combined Type
(2) Predominantly Inattentive Type
(3) Predominantly Hyperactive-Impulsive Type
What are the 9 specific symptoms of inattention?
6 of the 9 are required for ADHD diagnosis
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.
What are the 9 specific symptoms of hyperactivity-impulsivity?
6 of the 9 are required for ADHD diagnosis
Hyperactivity:
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.

Impulsivity:
7. Often blurts out answers before questions have been finished.
8. Often has trouble waiting one's turn.
9. Often interrupts or intrudes on others (e.g., butts into conversations or games).
What is the prognosis of ADHD?
Most children show remission by adulthood with usually being the 1st symptom to disappear as the child reaches adolescence the
What is the DSM-IV criteria for the diagnosis of conduct disorder?
A repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms are violated as manifested by 3 OR MORE of the following criteria in the past 12 months and a LEAST one present in the past 6 months.
(1) Aggression to people and animals
(2) Destruction of property
(3) Deceitfulness or theft
(4) Serious violation of rules

The disturbance in behavior MUST cause clinically signification impairment in social, academic, or occupational functioning

If the individual is 18 years or older then criteria for antisocial personality disorder must not be met

Onset can be in childhood [at least 1 criteria prior 10yo] or adolescent [absence of any criteria prior to age 10]
What is the prognosis for conduct disorder?
There is a risk for criminal behavior, antisocial personality disorder, substance abuse, and mood disorders in adulthood

Most children show remission by adulthood
What are the characteristics of oppositional defiant disorder?
What is the usual age of onset?
Behavior that, while defiant, negative, and non-compliant, does not grossly violate social norms

Gradual onset, usually before age 8
What is the prognosis of oppositional defiant disorder?
A significant # of cases progress to conduct disorder.

Most children show remission by adulthood
What are the characteristics and symptom of Tourrette disorder?
Characterized by involuntary movements and vocalizations (tics), which may include the involuntary use of profanity. Whiles these behaviors can be controlled briefly, they must ultimately be expresed.
At what age is the normal onset of Tourrette disorder and what is the course of the disease?
What sex is it more common in?
What are the predisposing factors?
Usually begins before 18yo, most commonly between the ages of 7 & 8 with a motor tic (e.g. facial grimacing)

3 times more common in males

Strong genetic component & genetic relationships with both ADHD and obsessive compulsive disorder
What is thought to be the cause of Tourrette disorder?
What are the most effective treatments?
Believed to involve dysfunctional regulation of dopamine in the caudate nucleus.

Haloperidol and atypical antipsychotic agents
What is separation anxiety disorder characterized by?
How does it present?
What are these children at risk for in adulthood?
Overwhelming fear of loss of a major attachment figure, particularly the mother

Child often complains of physical symptoms to avoid going to school and leaving mother

Anxiety disorders in adulthood especially agoraphobia
What is selective mutism?
What sex is it more common in?
Children with this rare disorder speak in some social situations but not in others. The child may whisper or communicate in hand gestures.

Selective mutism must be distinguished from normal shyness
What does electroconvulsive therapy do?
What is done prior to administration of ECT?
Induces a generalized seizure, lasting 25-60 seconds by passing an electrical current ACROSS the brain

Prior to seizure induction patient is pre-medicated with atropine, then a short-acting general anesthesia (e.g. methohexital) and a muscle relaxant (e.g. succinylcholine) to prevent injury during seizure
What are the different ways in which electrodes can be placed in electro convulsive therapy?
What are the differences?
Unilateral: Two electrodes in the NON-dominant hemisphere
Bilateral: One electrode placed on each temple
Bifrontal: One electrode placed above the end of each eyebrow

With unilateral and bilateral ECT, there are fewer side effects but less efficacy than with bilateral ECT
What are the problems associated with electro convulsive therapy?
Major adverse effects are memory problems that include:
(1) Acute confusional state after treatment that lasts about 30 minutes and then remits
(2) Anterograde amnesia (inability to make new memories): Resolves within a few weeks
(3) Retrograde amnesia: Inability to remember events occurring up to 2 months prior to ECT [these memories rarely return]
What are the major contraindications of electro convulsive therapy?
What is the mortality rate?
Increased ICP
Recent (2 weeks) myocardial infarction

Very low and is comparable to that associated with induction of general anesthesia
What are psychoanalysis and related therapies based on?
What is the central strategy of these techniques?
Freud's concepts of the unconscious mind defense mechanism and transference reactions

To uncover experiences that are repressed in the unconscious mind and integrate them into the person's conscious mind and personality
What is free association?
How does the therapy differ in psychoanalysis and related therapies?
Patient says whatever comes to mind

Psychoanalysis: Patient lies on couch facing away from therapist
Related therapies: Person sits in chair and faces the therapist
Aside from free association what are 2 other techniques used to recover repressed experiences in psychoanalysis and related therapies?
Dream analysis
Analysis of transference reactions
What are the characteristics of a person that is appropriate for receiving psychoanalysis or related therapies?
(1) Younger than 40 years old
(2) Intelligent and not psychotic
(3) Have good relationships with others
(4) Have a stable life situation (e.g. not in midst of divorce)
(5) Have the time and money to spend on treatment
How does the frequency and the time course of therapy sessions in psychoanalysis compare with related therapies?
Psychoanalysis: Treatment 4-5 times weekly for 3-4 years
Related therapies: Briefer and more direct
What are behavioral and cognitive-behavioral therapies based on?
Learning theory [symptoms are relieved by unlearning maladaptive behavior patterns and altering negative thinking patterns]

Unconscious conflicts are IRRELEVANT and thus are not examined
Who is the target population for group therapy?
How do groups with therapists differ from groups without?
People with a common problems [e.g. rape victims]
People with personality disorders or other interpersonal problems
People who have trouble interacting with therapists as authority figures in individual therapy

With therapist: Members of the group provide the opportunity to express feelings as well as feedback, support, and friendship to eachother. Therapist has LITTLE input. He/she facilitates and observes the members' interpersonal interactions
Without: These groups are LEADERLESS. Members of the group provide support and practical help for a shared problem (e.g. Narcotics, Overeaters, and Alcoholics Anonymous are built on this model.
When developing a strategy in family therapy what are useful things to identify about the functioning of the family unit?
Dyads: Subsystems between two family members
Triangles: Dysfunctional alliances between two family members against a 3rd member
Boundaries: Barriers between subsystems that may be too rigid or too permeable
What is the goal of supportive therapy?
NOT aimed at insight into problems but rather at helping people feel protected and supported during a life crisis.

It is also used over many years for chronically ill people such as the mentally retarded.
What is the basis of interpersonal therapy?
How many sessions per week?
Based on the idea that psychiatric problems such as anxiety and depression are based on difficulties in dealing with others and aims to develop interpersonal skills.

12-16 weekly sessions.
What is systemic desensitization?
What is it's most common use?
(1) In the past, through classical conditioning, the person associated an innocuous object with a fear-provoking stimulus, until the innocuous object became frightening
(2) As part of therapy increasing doses of fear-provoking stimulus are paired with a relaxing stimulus to induce a relaxation response (since fear and relaxation are reciprocally inhibited less anxiety occurs when exposed to the fear-provoking stimulus in the future)

Most common use: Treatment of phobias
What is aversive conditioning?
What is it's most common use?
(1) Classical conditioning is used to pair a maladaptive but pleasurable stimulus with an aversive or painful stimulus (e.g. a shock) so the two become associated.
(2) The person ultimately stops engaging in the maladaptive response because it automatically provokes an unpleasant response

Most Common Use: Treatment of paraphilias or addictions
What are flooding & implosion?
What are their most common uses?
(1) The person is exposed to an actual (flooding) or imagined (implosion) overwhelming does of the feared stimuls
(2) Through the process of habituation the person becomes accustomed to the stimulus and is no longer afraid

Most Common Use: Treatment of phobias
What is a token economy?
What is it's most common use?
(1) Through the process of operant conditioning, desirable behavior is reinforced by a reward or positive reinforcement
(2) The person increases the desirable behavior to gain the reward

Most Common Use: To increase positive behavior in a person who is severely disorganized (psychotic) autistic, or mentally retarded
What is biofeedback?
What is it's most common use?
(1) Through the process of operant conditioning, the person is given ongoing physiologic information (e.g. blood pressure), which acts as a reinforcement
(2) The person uses this information along with relaxation techniques to control visceral changes (e.g. heart rate, BP, smooth muscle tone)

Most Common Use: To treat hypertension, Raynaud disease, migraine and tension headaches, chronic pain, fecal incontinence, and temporomandibular joint pain
What is cognitive therapy?
What is it's most common use?
(1) Weekly, for 15-25 weeks, the person is helped to identify distorted, negative thoughts about himself or herself
(2) The person replaces these negative thoughts with positive, self-assuring thoughts and symptoms improve

Most Common Use: To treat mild to moderate depression somatoform disorders, eating disorders
What is the difference between, sole, joint residential, and split custody?
Sole: Child lives with one parent while the other has visitation rights
Joint residential: Child spends some time living with each parent
Split: Each parent has custody of at least one child
With whom do most elderly Americans live with?
Most spend their last years living on their own

Only about 20% live with family members and about 5% live in nursing homes
What is culture shock?
A strong emotional response, which may involve psychiatric symptoms, related geographic relocation and the need to adapt to unfamiliar social and cultural surroundings. Culture shock is reduced when groups of immigrants of a particular culture live in the same geographic area
Who is at the highest risk form culture shock?
Why?
Young men

Because lose the most status on leaving their culture of origin and unlike others in the group who can stay at home among familiar people, young men often must get out into the new culture and earn a living
What is gender identity disorder?
What is the presumed cause?
Also known as transsexuality. Individuals that have a pervasive psychological felling of being born into the body of the wrong sex despite a body form normal for their physiological sex.

Associated with altered prenatal brain exposure to sex hormones
What is the difference between gender identity and gender role?
Gender identity: Sense of self as being male or female
Gender role: Expression of one's gender identity in society
What role does estrogen play in sex drive?
Testosterone?
Estrogen: Only minimally involved in libido, so menopause and aging do not reduce sex drive if a woman's general health is good
Testosterone: Believed to play an important role in sex drive in BOTH men and women
What are the 4 states in the four-stage model for sexual response developed by Masters and Johnson?
Excitement (min-hours)
Plateau (30-180 seconds)
Orgasm (3-15 seconds)
Resolution (10-15 minutes)
What are the characteristics of Masters and Johnson's four-stages of sexual response that are exclusive to men?
Excitement: Penile erection
Plateau: Increased size and upward movement of testes, Secretion of a few drops of sperm-containing fluid
Orgasm: Forcible expulsion of seminal fluid
Resolution: Refractory, or resting, period (length varies by age and physical condition) when restimulation is not possible
What are the characteristics of the four-stages of sexual response that are exclusive to women?
Excitement: Clitoral erection, Labial swelling, Vaginal lubrication, Tenting effect (rising of uterus in the pelvic cavity)
Plateau: Contraction of the outer one-third of the vaina, forming the orgasmic platform (enlargement of the upper one third of the vagina)
Orgasm: Contractions of the uterus and vagina
Resolution: Little or no refractory period
What are the characteristics of the four-stages of sexual response in both men and women?
Excitement: Increased BP and respiration
Plateau: Further increase in BP and respiration, Flushing of the chest and face ("sex flush")
Orgasm: Contractions of the anal sphincter, Further increase in BP and respiration
Resolution: Muscle relaxation, Return of the sexual and cardiovascular systems to the prestimulated state over 10-15 minutes
What findings in a male complaining of erectile dysfunction would tend to point to psychological rather than physiological causes?
Presence of morning erections
Erections during REM sleep
What are the characteristics of hypoactive sexual desire disorder?
Decreased interest in sexual activity
What are the characteristics of hypoactive sexual aversion disorder?
Aversion to and avoidance of sexual activity
What are the characteristics of hypoactive female sexual arousal disorder?
Inability to maintain vaginal lubrication until the sex act is completed, despite adequate physical stimulation (reported in as many as 20% of women)
What are the different types of and characteristics of hypoactive male erectile disorder (impotence)?
Lifelong/primary: RARE, Has never had an erection sufficient for penetration
Acquired/Secondary: MOST COMMON males sexual disorder, Currently unable to maintain erections despite normal erections in the past
Situational: COMMON, Has difficulty maintaining erections in some sexual situations but not others
What are the different types of and characteristics of orgasmic disorder?
A disorder of male OR female (more common)

Lifelong/Primary: Has never had an orgasm
Acquired: Currently unable to achieve orgasm despite adequate genital stimulation and normal orgasms in the past
What are the characteristics of premature ejaculation?
Ejaculation before the MAN would like it to occur
Plateau phase of the sexual cycle is short or absent
Is usually accompanied by anxiety
Is the second most common male sexual disorder
What are the characteristics of vaginismus?
Painful spasms occur in the outer one-third of the vagina, which makes intercourse or pelvic examination difficult
What are the characteristics of dyspareunia?
Persistent pain occurs in association with sexual intercourse without pelvic pathology (functional dyspareunia)
Can also be caused by pelvic pathology e.g. pelvic inflammatory disease (PID) due to chlamydiosis (most common) or gonorrhea (most serious)
Occurs much more commonly in women; can occur in men
The disturbance is not caused by lack of lubrication or by vaginismus
What are sensate-focus exercises and what are they used for?
They are used to treat sexual desire, arousal, and orgasmic disorders

In these exercises the individual's awareness of touch, sight, smell, and sound stimuli are increased during sexual activity, and psychological pressure to achieve an erection or orgasm is decreased
What is the squeeze technique and what is it used for?
It is used to treat premature ejaculation

Man is taught to identify the sensation that occurs just before emission of semen and at this moment, the man asks his partner to exert pressure on the coronal ridge of the glans on both sides of the penis until the erection subsides, thereby delaying ejaculation
What drugs are used to treat premature ejaculation?
What are some treatments for erectile dysfunction?
Premature ejaculation: SSRI's because they delay orgasm

Erectile dysfunction: Oral or intracorporeal injection of vasodilators, Implantation of prosthetic devices
What is the DSM-IV definition of paraphilias?
In what sex are they most common?
What are some pharmacologic treatments?
Paraphilias involve the preferential use of unusual objects of sexual desire or engagement in unusual sexual activity. To fit DSM-IV criteria the behavior must continue over a period of at least 6 months, and cause impairment in occupational or social functioning.

Almost exclusively men

Pharmcalogic treatment: Antiandrogens and female sex hormones for paraphilias that are characterized by hypersexuality
How do exhibitionists derive sexual pleasure?
Revealing one's genitals to unsuspecting women so that they will be shocked
How do individuals with fetishism derive sexual pleasure?
Using inanimate objects
How do individuals with transvestic fetishism derive sexual pleasure?
Wearing women's clothing, particularly underclothing (exclusive to HETEROSEXUAL men)
How do individuals with frotteurism derive sexual pleasure?
Rubbing the penis against clothed woman who is not consenting and not aware (e.g. crowded subway)
How do individuals with necrophilia derive sexual pleasure?
Engaging in sexual activity with dead bodies
How do individuals with pedophelia derive sexual pleasure?
Engaging in fantasies or actual behaviors with children under age 14 years, of the opposite or same sex

THE MOST COMMON PARAPHILIA
How do individuals with sexual sadism or masochism derive sexual pleasure?
Giving (sadism) or receiving (masochism) physical pain or humiliation
How do individuals with telephone scatologia derive sexual pleasure?
Making telephone calls to unsuspecting women and engaging them in conversation of a sexual nature (obscene phone calls)
How do individuals with voyeurism derive sexual pleasure?
Secretly watching other people (often by using binoculars) undressing or engaging in sexual activity
What guideline is generally used to see if an individual is healthy enough for sexual activity following an myocardial infarction?
If exercise that raises the heart rate to 110-130 beats/minute (e.g. exertion equal to climbing two flights of stairs) can be tolerated without severe shortness of breath or chest pain

Sexual positions that produce the least exertion in the patient (e.g. the PARTNER in the superior position) are the safest after MI
What is the major cause of erectile dysfunction in diabetics?
1/4 to 1/3 of all diabetic men (more commonly older patients) have erectile dysfunction while orgasm and ejaculation are less likely to be affected

Main causes are vascular changes and diabetic neuropathy
How do spinal cord injuries affect male sexual function and reproduction?
Female?
Male: Cause erectile dysfunction, Orgasmic dysfunction, Retrograde ejaculation (into bladder), Reduced testosterone levels, Decreased fertility

Female: Problems of vaginal lubrication, pelvic vasoconstriction, and orgasm. Fertility is NOT usually adversely affected
What are the physical alterations that occur in sexual function in males with age?
Females?
Males: Slower erection, Diminished intensity of ejaculation, Longer refractory period, Need for more direct stimulation

Women: Vaginal thinning, Shortening of vaginal length, Vaginal dryness
How does sexual interest change with age?
Does NOT usually change significantly with increasing age
What type of intercourse is the riskiest in the transmission of HIV?
What is the physician's role in informing the partner of a HIV positive patient?
Anal intercourse because of the likelihood of tissue tearing leading to contact with the blood supply

Patients how are HIV-positive MUST protect their sexual partners from infection. If they fail to do so (e.g. do not use a condom) and the physician has knowledge of such a failure, the physician MUST ensure that the threatened partner is informed
Of the following drugs ; alcohol, cocaine, amphetamines, and PCP. Which are associated with increased aggressiveness.
Alcohol in LOW doses inhibits aggression but facilitates it in HIGH doses

Cocaine, amphetamines and PCP all increase aggression

Heroin user show LITTLE aggression
Which neurotransmitters are associated with increased & decreased aggression?
Serotonin and GABA inhibit aggression

Dopamine and norepinephrine fascilitate it
Low levels of what neurotransmitter is associated with impulsive aggression?
Serotonin
What is the usual age of sexual abuse?
1/3 are between 8-13yo and 25% are younger than 8yo
What percentage of sexual abusers are known to the child?
Percent men?
Percent relatives?
Known to child: 70-90% (50% of these are relatives while the other 50% are family acquaintances)
Men: 90%
What are the 3 phases of physical and sexual abuse of domestic partners?
(1) Buildup of tension in the abuser
(2) Abusive behavior (battering)
(3) Apologetic and loving behavior by the abuser to the victim
What is the responsibility of the physician when child or elder abuse is suspected?
What responsibilities if any does the physician have to the abuser?
Abuse MUST be reported to the appropriate agency BEFORE or in conjunction with treatment of patient. Even if there was NO intention to injury a cultural remedy such as "coining" ALSO MUST be reported

Physician does NOT have to tell the suspected abuser of the child or impaired elder that he or she suspects abuse
Physician does NOT need family consent to hospitalize the abused child or elderly person for protection or treatmetn
What is the responsibility of the physician when domestic partner abuse is suspected?
Direct reporting by the physician is NOT appropriate because the victim is usually a competent adult. The physician who suspects abuse should:
(1) Document the abuse
(2) Ensure the safety of the abused person
(3) Develop an emergency escape plan for the abused
(4) Provide emotional support
(5) Refer the abused person to an appropriate shelter or program
(6) Encourage the abused person to report the case to law-enforcement officials
What is the definition of sodomy?
Insertion of penis into the oral or anal orifice
What are the usualy characteristics of rapists (age, race with respect to victim)?
Rape victims (age, where rape occurred, presence of vaginal injures)?
Rapists: <25yo, Same race as victim, Known to victim, Often use alcohol
Victim: 16-24yo, Most commonly occurs in victim's home
What should the physical setting for a medical interview be?
As private as possible
Ideally, there should be no desk or other obstacle between the physician and patient
Participants should interact at eye level (both should be seated)
What is the Social Readjustment Rating Scale created by Homes and Rahe?
This scale ranks the effects of life events

Events with the highest scores require people to make the most social readjustment in their lives
What types of thoughts or actions in patients prior to entering surgery predispose them to the greatest psychological and medical risk?
Patients that believe that they won't survive surgery
Patients who do not admit that they are worried before surgery
What is the time period that defines chronic pain?
Pain lasting at least 6 months
What is the APGAR score?
General notes: Measures physical functioning in premature and full-term newborns and can be sued to predict the likelihood of IMMEDIATE survival. It is evaluated at 1 minute and either 5 or 10 minutes after birth. A score >7 indicates no imminent survival threat while one <4 indicates an imminent survival threat.

A ppearance [Color]: 0 (Both body and extremities pale or blue), 1 (Pink body, blue extremities) 2 (Pink body, Pink extremities)

P ulse [Heartbeat]: 0 (Absent) 1 (Slow [<100/min]) 2 (Rapid [>100/min])

G rimace [Reflexes e.g. heel prick / nasal tickle]: 0 (Absent) 1 (Grimace) 2 (Foot withdrawal, Cry, Sneeze, Cough)

A ctivity [Muscle tone]: 0 (Flaccid, Limp) 1 (Weak, Inactive) 2 (Strong, Active)

R espiration: 0 (Absent) 1 (Irregular, Slow) 2 (Good, Crying)
What is the definition of "latent learning" in learning behavior?
Occurs without immediate reinforcement, and what is learned is not exhibited until some time later when reinforcement is available.
What is the definition of "discrimination training" in learning behavior?
Involves the use of reinforcement and extinction to establish behavioral contingencies and obtain precise stimulus control.
What is the definition of "spontaneous recovery" in learning behavior?
The reappearance of a conditioned response after extinction.
What is the definition of "stimulus discrimination" in learning behavior?
Responding to one stimulus but not to a stimulus which is similar.
What are Freud's stages of childhood development?
(1) Oral (birth-1yo): Id satisfied through mouth
(2) Anal (1-2yo): Id satisfied through anus
(3) Phallic (3-5yo): When a boy typically resolves to overcome Oedipal feelings of incestuous love for his mother by incorporating his perceptions of his father's traits. In doing so, he obviates the need to fear his father's wrath, Castration anxiety, Electra complex, Penis envy
(4) Latency (6-11yo): Child becomes more involved w/ outside world, gaining social and technical skills and, upon adolescence, experiencing new stirrings of his or her own sexuality
(5) Genital (adolescence-adulthood): Makes up the final 2 stages of personality development along with the latency stage
Describe how the stability of personality in each of the following periods?
(1) Infancy
(2) Adolescence
(3) Young adulthood
(4) Middle adulthood
(5) Later adulthood
(1) Infancy: Temperament at about 3mo is a good predictor of temperament at about age 10
(2) Adolescence: Personality traits tend to remain stable during this period but outward behavior associated with these traits tend to become more socially acceptable
(3) Young adulthood: Least amount of personality stability
(4) Middle adulthood: Where stability of personality highest
(5) Later adulthood: As activity declines with age there is a tendency to become more accepting of the way things are and to challenge and risk less often than they did previously
What is the Bender Visual Motor Gestalt Test?
An expressive technique designed to detect brain damage by observing visual motor coordination and behavioral tests as the patient copies test designs.
What is the Omnibus Personality Inventory?
It was designed to assess effective functioning in college students by measuring values, interest, attitudes, and social and emotional adjustment.
What is astereognosia?
Inability to recognize objects by touch.
What is asomatognosia?
Inability to recognize bodily states.
What is spatial agnosia?
Deficit in stereoscopic vision and ability to relate objects in space.
What is autotopagnosia?
Inability to name or localize body parts.
What is prosopagnosia?
Inability to recognize faces.
What are the stages of sleep and what is seen in an electroencephalogram in each phase?
Normal Sleep Cycle: 90minutes w/ 20-25% in REM during adulthood
(1) non-REM 1: Characterized by vertex sharp waves in the beginning, the disappearance of occipital α-waves, the appearance of θ-waves, and slow rolling eye movements. Characterized by 3-7 cycles/second. It is the lightest stage of sleep characterized by peacefulness, slowed pulse and respiration, decreased BP, & episodic body movements.
(2) non-REM 2: 12-14 cycles/second, Slower θ-waves, K-complexes [high-amplitude, slow tri-phasic waves that are smaller than 4 cycles/second]
(3) non-REM 3: Increasing appearance of δ-waves [high amplitude, slow waves, smaller than 4 cycles/second]
(4) non-REM 4: characterized by 50% of waves being δ-waves
(5) REM: Rapid eye movement, Intermittent saw-toothed waves [4-7 cycles/second], Occipital α-waves, Ocular & middle ear muscles active while rest are paralyzed, Low responsiveness to external stimuli
How do benzodiazepines affect sleep stages & in what sleep disorders are these changes useful?
Benzodiazepines shorten non-REM 4 (delta sleep).

This is the period during which night terrors, sleepwalking, & bed wetting occur and thus are useful in the treatment of these conditions.
What are the characteristics of expressive language disorder?
Associated with childhood onset & typically involves limitations in the linguistic features of language.
What is troilism?
Engaging in sexual interaction with another person in the presence of a third person.
What are the DSM-IV diagnostic criteria for nicotine withdrawal?
Dysphoric mood, Insomnia, Irritation, Frustration, Anger, Difficulty concentrating, Restlessness, Increased appetite, Weight gain, & Decreased heart rate
What is the difference between gender role & identity?
Identity --> Inward perception of "maleness" or "femaleness"

Role --> Outward perception of "maleness" or "femaleness"
What are the six categories of sexual dysfunction?
(1) Sexual desire disorders
(2) Sexual arousal disorders
(3) Orgasm disorders
(4) Sexual pain disorder
(5) Sexual dysfunction "not otherwise specified"
(6) "Other" sexual disorders
What is Peyronie's disease?
Connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting as many as 1-4% of men. Specifically the fibrosing process occurs in the tunica albuginea, a fibrous envelope surrounding the penile corpora cavernosa causing an abnormal upward curvature of the penis.

The disease may cause pain, hardened, cord-like lesions (scar tissue known as "plaques"), or abnormal curvature of the penis when erect. In addition, narrowing and or shortening of the penis may occur. Pain felt in the early stages of the disease often resolves in twelve to eighteen months. Erectile dysfunction, in varying degrees, often accompanies these symptoms in the later stages of the disease process. The condition may also make sexual intercourse painful and/or difficult, though many men report satisfactory intercourse in spite of the disease. Although it can affect men of any race and age, it is most commonly seen in caucasian males above the age of 40.
What is sexual (orgasmic) anhedonia?
Sexual anhedonia is known as 'ejaculatory anhedonia'. This rare condition means that the person will ejaculate with no accompanying sense of pleasure. This condition is most frequently found in males, but women can suffer from lack of pleasure when the body goes through the orgasm process as well.
What is the definition of anhedonia?
What conditions is this common in?
Anhedonia is an inability to experience pleasure from normally pleasurable life events such as eating, exercise, and social or sexual interaction.

Anhedonia is recognized as one of the key symptoms of the mood disorder depression according to both the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) and the International Statistical Classification of Diseases and Related Health Problems (ICD). Other than anhedonia, the DSM considers only depressed mood to be a key symptom.[citation needed] The ICD lists both depressed mood and fatigue or loss of energy as the other key symptoms. Anhedonia is also seen in schizophrenia, schizoid personality disorder and other mental disorders.
What is the definition of perseveration?
Perseveration is the uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder.
What are the 4 situations in which information about a patient can be disclosed without consent?
(1) Child or elder abuse
(2) Gunshot or stabbing
(3) Reportable communicable disease
(4) Threatens to kill or harm themselves or others with reasonable ability to do so
Describe the following interviewing technique:
Empathy
It requires the patient to try and put themselves in the patient's shoes and vicariously experience their feelings, thoughts, and actions. It differs from support in that it requires the physician to project him/herself into the patient's experience.

Example: "I can imagine ..."
Describe the following interviewing technique:
Reflection
When the patient repeats what the patient told him/her for example by summarizing

Example: "So you are telling me that ..."
Describe the following interviewing technique:
Confrontation
When a physician points out discrepancies in a patient's responses.
Describe the following interviewing technique:
Support
When a physician expresses concern and interest in the patient. This differs from empathy in that physician does not attempt to project him or herself into the patients experience.
Describe the following interviewing technique:
Facilitation
When a physician encourages a patient to talk more about an experience.

Example: "Then what happened?"
What is the female athlete triad?
(1) Eating disorder
(2) Amenorrhea
(2) Osteoporosis
What is a hypnagogic hallucination?
A hallucination that occurs when falling asleep

Most often brief & simple such as hearing a bell ring or name called but can be complex.
What is a hypnopompic hallucination?
A hallucination that occurs on waking

Most often brief & simple such as hearing a bell ring or name called but can be complex.
What are the common psychiatric co-morbidities of OCD?
Tic disorders
What are the common psychiatric co-morbidities of eating disorders?
Body dysmorphic disorder
What are the common psychiatric co-morbidities of panic disorder?
Depression, Simple phobias, PTSD
Obsessive compulsive disorder is associated with increased activity in which part of the brain?
Caudate nucleus
What is the tonic neck reflex and at what age does it disappear?
Extension of the ipsilateral leg and flexion of the of the contralateral leg when the head is turned.

It is a reflex in competent infants that disappears between 7 & 8 months.
What is deja vu?
What is it commonly associated with?
When the experience of an event, person, or thing is seen as familiar, even though it has never previously been experienced before.

It is commonly associated with the aura preceding complex partial siezures [especially in temporal lobe epilepsy]
What is jamais vu?
When a patient fails to recognize familiar events that have been encountered before.
What is the Halstead-Reitan Battery of tests?
A group of tests that reflect the basic & higher level neuro-sensory functioning of the entire brain, & can be used in a serial fashion with little learning effect being present.
What is the Stanford Binet Intelligence test used for?
Used in adults and mainly reflects verbal skills.
What is the only defense mechanism that includes some aspect of the consciousness?
Suppression
What is the defense mechanism on which all other defense mechanisms are based?
Repression
What are the "stages of change" in a patient's motivation to change his or her health risk behaviors (e.g. smoking)?
Precontemplation (denial, minimization)
Contemplation (musing or thinking about doing something)
Preparation (actually getting ready to do something)
Action (implementing concrete actions to deal with the problem)
Maintenance (acting to ensure that the changes are maintained)