Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
113 Cards in this Set
- Front
- Back
5 axes of DSM-IV-TR
|
I: Clinical disorders
II: PD's and mental retardation III: General medical conditions IV: Psychosocial and environmental problems V: Global assessment of Functioning Scale |
|
The split mind of schizophrenia refers to
|
The nonrational divergence between behavior and thought content(laughing while afraid).
|
|
Hallmark of schizophrenia
|
Gross impairment of reality testing and is expressed by alterations in sensory perceptions, such as hallucinations, and abnormalities in thought processes such as delusions
|
|
"downward drift" hypothesis
|
Schizophrenic pts are often found in lower socioeconomic groups because of their social deficits.
|
|
Most common hallucinations
|
Auditory
|
|
Phases of schizophrenia
|
Prodromal: Pt avoids social activities and is quiet and passive. However, the pt may also by irritable. The pt may show a sudden interest in religion or cults. There may also be physical complaints. The pt is in touch with reality.
Psychotic: Loss of touch with reality, with hallucinations and delusions. Residual phase: Flat or inappropiate affect, peculiar thinking, eccentric behavior, and social withdrawal. However, the pt is in touch with reality |
|
Positive symptoms of schizophrenia
|
Delusions, hallucinations, agitation, and talkativeness.
|
|
Negative symtpoms of schizophrenia
|
Lack of motivation, social withdrawal, flat affect, poor grooming, cognitive disturbances, and poor speech content.
|
|
Criteria A for DSM-IV-TR diagnosis for schizophrenia
|
At least 2 of the following, each present for a significant portion of a 1-month period:
1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms |
|
Are schizophrenic pts oriented? How does this differ from pts with delirium or substance abuse?
|
They are oriented to place and time.
There is no clouding of consciousness and memory capacity is intact. |
|
Dopamine hypothesis
|
Increased dopamine activity associated with schizophrenia, psychosis states, and amphetamine induced psychotic states.
|
|
Brain abnormalities seen with schizophrenia
|
Frontal and prefrontal dysfunction, Ventricle enlargement, metabolic hypofunction(decreased glucose uptake) in frontal lobe.
|
|
Repeating the same words over and over
|
Perseveration
|
|
Beginning a response in a logical fashion but then getting further and further from the point
|
tangentiality
|
|
Uttering unrealated combinations of words or phrases
|
Word salad
|
|
Associating words by their sounds, not by their meanings
|
Echolalia: rhyming phrases
|
|
Misperceptions of real external stimuli. Pt believes the chair she's in is a time machine
|
illusions
|
|
Pt believes that her Dr. and his nurses are out to get her
|
Delusions
|
|
Concordance rate of schizophrenia in monzygotic twins
|
50%
Now thats scary... |
|
A pt stops talking although her lips continue to move and she seems to be concentrating on an inner stimulus
|
Thought blocking
|
|
The fact that schizophrenic pts are born more often during the winter months is attributed to?
|
Viral infections during the 2nd trimester of pregnancy
|
|
EEG's of schizophrenic pts often show?
|
Decreased alpha waves with increased beta and theta waves.
|
|
Besides dopamine what other neurotransmitters have been implicated in schizophrenia
|
Serotonin hyperactivity
Glutamate hyperactivity Norepi hyperactivity |
|
What occurs in almost 50% of schizophrenic pts
|
suicide attempt
|
|
25 y/o male pt believes that his cat and dog has been threatening to kill him. What subtype of schizophrenia
|
Paranoid
|
|
A 30 y/o Female pt is dirty with old makeup and unkempt hair. She is posturing and laughing while making incoherent speech.
|
Disorganized(hebephrenic)
|
|
Male pt is posturing in bizarre positions. He refuses to answer any questions and seems very agitated.
|
Catatonic
|
|
A 30 y/o female pt who had severe dellusion and auditory hallucinations 5 yrs ago appears with a flat affect and social withdrawal, but without any positive symptoms of schizophrenia
|
Residual:
At least 1 schizo episode Absence of positive symptoms Continuing negative symptoms |
|
Male pt presents disheveled and hearing voices. Pt also believes that he talks to God, who tells him to be a good person. There is no catatonia, or disorganized speech. There are no mood disturbances.
|
Undifferentiated
|
|
Traditional antipsychotics such as haldol and thorazine are no longer 1st line txmt for schizo because?
|
They cause parkinsonian like termors and tardive dyskinesia
|
|
1st line drug therapy for schizo
|
atypical antipsychotics:
resperidol, clozapine, olanzapine(Zyprexa), Quetiapine (seroquel), aripiprazole(Abilify) |
|
Disorder in which psychotic and residual symptoms last from 1-6 months w/o evidence of prominent mood symptoms, but then resolve. Same symptoms for less than a month.
|
Schizophreniform disorder
Brief psychotic disorder |
|
dissheveled female presents with feelings of sadness, guilt and weight loss lasting more than 3 months. She also has been unable to sleep and has trouble concentrating. Upon further discourse, pt admits to hearing her dead husbands voice and feels her children are stealing her money. Disorder?
|
Schizoaffective disorder:
Psychotic and MDD |
|
Voluntary social withdrawal w/o evidence of psychosis
|
Schizoid PD
|
|
Negative symptoms, bizzare behavior, odd thought patterns, but without psychosis
|
Schizotypal PD
|
|
Extreme mood swings with uncotrollable anger and suicidal thoughts, but psychotic episodes only last minutes
|
Borderline PD
|
|
Major identifying symptom of atypical depression
|
Weight gain and somnolence
|
|
Masked depression
|
Up to 50% of pts of depressed seem unaware of or deny that they are depressed; instead they report vague physical symptoms
|
|
DSM-IV-TR for MDD
|
At least 5 of the following symptoms over a 2 week period. At least one of these must be symptom 1 or 2:
1. Sadness, hopelessness 2. Decreased pleasure or interest in activities 3. Change in appetite 4. Insomnia or somnolence 5. Agitation or retardation 6. Daily fatigue or loss of energy 7. Guilt 8. Problems concentrating or thinking 9. Thoughts of death/suicide |
|
Seasonal affective disorder. Txmt?
|
MDD during the winter months
Full spectrum light exposure |
|
Significant risk factor for MDD
|
Being female
|
|
Neurotransmitters implicated in mood disorder
|
Dysregulation of catecholamines and indolamine
|
|
High levels of corticosteroids increase the risk for
|
mood disorders
|
|
Without txmt, most episodes of depression are...
|
Self-limiting and last 6-12 months
|
|
1st line txmt agents of MDD
|
SSRI's
|
|
Discreet episodes of both depression and mania
|
Bipolar disorder I
|
|
Episodes of depression and hypomania
|
Bipolar disorder II
|
|
DSM-IV-TR criteria for Mania
|
Criterion A:
A distinct period of abnoramlly and persistently elevated, expansive, or irritable mood lasting at least 1 week. Criterion B: At least 3 1. Inflated self-esteem/grandiosity 2. Decreased need for sleep 3. talkativeness or pressured sleep 4. Flight of ideas 5. Increased Agitation 6. Distractibility 7. Engagement in activites with negative consequences |
|
How is sexual interest and modesty affected in those with manic episodes
|
decreased modesty and increased sexual interest
|
|
Symptoms of mania for a 4 day period, but without sever social or occupational impairment and psychotic symptoms
|
Hypomania
|
|
Psychotic symptoms can occur in any major mood disorder but are more common in?
|
Bipolar I disorder:
Usually delusions Mostly occur during manic episodes Themes of power and influence |
|
Most likely etiology factor for bipolar disorder. Are psychosocial factors involved?
|
Genetics
No, this is opposite to MDD |
|
What can happen to a bipolar pt if given anti-depressants
|
Can provoke a hypomaniac or full blown manic episode
|
|
The txmt of choice for the maintenance of bipolar disorder. What can be given in its place for those who its contraindicated or show rapid-cycling bipolar episodes
|
Lithium: may cause renal problems and hypothyroidism
Anticonvulsants: Depakote and carbamazepine |
|
Disorder characterized by anhedonia, neurovegative symptoms, and unreactive mood.
|
Meloncholic
|
|
Disorder characterized by the presence of low self-esteem and decreased productivity for at least 2 yrs
|
dysthymia
|
|
Disorder in which pt has episodes of hypomania and depression w/o MDD, that lasts for 2 yrs. No psychosis
|
Cyclothymic disorder:
NO Substance Abuse |
|
Common symptoms with anxiety
|
Shakiness, sweating, mydriasis, tachycardia, hyperventilation, GI symptoms
|
|
All anxiety disorders are characterized by symptoms of?
|
Fear w/o adequate cause
For 6 months |
|
GAD is comorbid with what conditions? Onset usually occurs at what time?
|
MDD
Childhood or early adoloscence |
|
30 y/o pt complains of her heart racing and tachycardia w/ SOB. She states that she is often worried over little things and feels a need to control most aspects of her life. Condition? Is this situational or free-floating anxiety?
|
Generalized anxiety disorder
Free-floating |
|
Rates of anxiety disorders between men and women
|
Women are 2-3x more likely to have panic disorder, 2x as likely to develop PTSD when exposed to an extreme stressor and slightly more likely to have a GAD
|
|
Neurotransmitters implicated in anxiety disorders
|
Decreased GABA, decreased Serotonin, and Increased Norepi
|
|
Organic Differential Diagnoses associated with symptoms of anxiety
|
Excessive Caffeine
Hyperthyroidism Substance abuse/withdrawal B12 Deficiency Pheochromocytoma Adrenal medullary tumor |
|
Episodes of panic, with intense anxiety tha last for 30 min. and commonly occur 2x a week. Common symptoms?
|
Panic disorder:
Cardiac and respiratory symptoms that give the feeling of dying |
|
Panic attacks associated with fear and avoidance of public places or situations where escape is impossible or help is unavailable
|
Panic disorder w/ agoraphobia
|
|
Compared with the general population, adults who have panic disorder w/ agoraphobia are more likely to have...?
|
Experienced seperation anxiety disorder
|
|
An exaggerated fear of embarrassing oneself in a social or performance setting such as while giving a speech, eating in public, or using a public restroom.
|
Social phobia/social anxiety disorder
|
|
Irrational fear of things such as snakes...
|
Specific phobia
|
|
Condition of recurrent, unwanted, intrusive feelings, thoughts, and anxiety. How is it relieved initially?
|
OCD
By repetitive actions |
|
OCD is genetically related to what condition, with a high correspondance rate in 1st degree relatives
|
Tourette's
|
|
Symptoms of ASD and PTSD
|
Re-experiencing episodes
Hyperarousal Emotional numbing Avoidance |
|
Difference between ASD and PTSD
|
ASD lasts 2 days to 4 weeks
PTSD lasts more than 1 month |
|
Disorder characterized by emotional symptoms that cause social, work, and school occuring within 3 months and lasting less than 6 months after a serious life-stressor
|
adjustment disorder
|
|
1st line emergency txmt of anxiety
|
Benzo's: clonazepam, alprazolam, diazepam, and lorazepam
|
|
Long term txmt of anxiety
|
SSRI's: paroxetine, fluoxetine, sertraline
|
|
Most effective form of txmt for phobias
|
Cognitive behavioral therapy and systematic desensitization
|
|
Condition of sleep apnea, cardiovascular problems, alveolar hypoventilation and obesity
|
Pickwickian syndrome
|
|
Does the prevalence of obesity vary by ethnic group in men
|
NO! but it does vary by women
|
|
Obesity in children is currently highest in what ethnic group?
|
Mexican American and African Americans
|
|
How does insurance define obesity
|
20% over ideal bodyweight based on standard height and weight
|
|
For most people, maintenance of weight loss is best achieved by?
|
A combo of sensible dieting and exercise tailored to the persons needs.
|
|
What is melanosis coli? How does it happen?
|
Laxative abuse leads to a blackened area of mucosa identified during exam of the colon.
|
|
Hypergymnasia
|
Pts with eating disorders tend to engage excessively in sports and strenuous exercise
|
|
Do pts with anorexia or bulimia have appetite problems
|
No
|
|
16 female pt presents w/ Syncope episode and significantly low bodyweight. She states she has not had a period in months, and is cold all the time. She denies any problems. What major conditions should you be aware of?
|
Anorexia nervosa:
Malnutrition can lead to metabolic acidosis and elctrolyte disturbances such as hypokalemia. This may lead to cardiac arrhythmias and brain deterioration/coma. |
|
20 y/o female dancer presents with signs of bulimia. What are you looking for on physical exam
|
-Relatively normal weight
-Menstrual irregularities -Hypokalemia/metabolic abnormalities -Esophageal varices -Enamel erosion/Dental Caries -Infection of the parotid glands Russel's sign |
|
What is Russel's sign?
|
Calluses on the Metacarpal-phalangeal joint do to induced gagging with bulimia
|
|
Difference in Psychological characteristics of anorexia and bulimia
|
Anorexia:
Intense fear of obesity Denial of disorder No sexual interest Denies depression SSRI's may not work Bulimia: Worry about gaining weight Distress about having disorder Normal sexual function Reports Depression SSRI's may work |
|
Bodyweight to qualify for anorexia diagnosis
|
less than 85% ideal bodyweight
BMI less than 17.5 |
|
First stage of txmt for anorexia
|
Restore bodyweight and save pts life. 2nd stage is to prevent relapse.
|
|
Most effective form of psychotherapy in anorexia
|
Family therapy
|
|
Etiology of anorexia nervosa
|
Family difficulties such as marital problems or an overcontrolling mother
|
|
Most effective therapy for bulimia
|
Antidepressants w/ psychotherapy
|
|
Bulimia diagnosis requires what?
|
Recurrent episodes of binge eating couple with feeling out of control.
|
|
A syndrome of cognitive impairment that results from central nervous system dysfunction. It is hallmarked by impaired and clouding of consciousness. Are these pts oriented?
|
Delirium
No; they know person, but not place or time. |
|
Most common psychiatric syndrome seen in hospitalized pts, particularly those in intensive care units and nursing homes.
|
Delirium
|
|
Common causes of delirium
|
meningitis and encephalitis, substance abuse, systemic illnesses
|
|
Gradual loss of memory and intellectual ability without impairment of consciousness
|
Dementia
|
|
Most common form of dementia
|
Alzheimers
|
|
Common microscopic finding in alzheimers
|
neurofibrillary tangles and amyloid plaques
|
|
Alzheimers usually affects what part of the cortex
|
Begins in the temporal lobes and spread to the frontal and parietal.
|
|
Txmt that slows alzheimers in 25% of pts
|
cholinesterase inhibitors
|
|
Form of dementia that is caused by multiple, small cerebral infarctions resulting from atherosclerosis.
|
Vascular:
Sudden onset Abrupt loss of function w/ each infarct |
|
Unique symptoms of Lewy body dementia
|
Positive symptoms that have adverse responses to anti-psychotic meds
|
|
Fabrication of forgotten information to cover up memory loss
|
Confabulation
|
|
Is there normal level of consciousness with amnesia
|
Yes
|
|
Primary cause of amnestic disorder
|
Thiamine deficiency as a result of long term alcohol abuse
|
|
Differential diagnosis for dissociative disorders
|
PTSD
|
|
Syndrome in which one forgets pertinent personal info and wanders from home adopting a new identity. Major cause?
|
Dissociative fugue
|
|
Failure to remember personal info
|
Dissociative amnesia
|
|
Recurrent feelings of detachment and unreality about ones own body, the social situation, or the environment
|
Depersonalization disorder
|
|
Dissociative disoders are the result of
|
emotional factors
|