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171 Cards in this Set
- Front
- Back
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Withdrawal from this drug causes tremor, tachycardia, seizures, delirum tremens, agitations.
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Alcohol
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Pinpoint pupils and CNS depression are often in an overdose of?
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Opioids
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Euphoria, anxiety, paranoid delusions, impaired judgment and increased appetite are symptoms of what?
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Marijuana intoxication
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What are symptoms of Benzodiazepine withdrawal?
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Rebound anxiety, seizures, tremor, insomnia
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What are opioid antagonists that you can use for heroin overdose?
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Naloxone, Naltrexone
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What problems can acetylaldehyde specifically cause in the body?
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Forms adducts with proteins and nucleic acid, increases fatty acid synthesis leading to a fatty liver
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Delium tremens (autonomic hyperactivity, psychotic symptoms, and confusion) is treated with?
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Benzodiazepines
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What are manifestations of cirrohsis?
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jaundice, hypalbuminemia, coagulation factor deficiencies, peripheral edema, ascites, encephalopathy, asterixis, esophageal varices
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If you see confusion, ophthalmoplegia, and ataxia, think:
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Wernicke's encephalopathy
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Memory loss, confabulation, and personality change?
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Korsakoff's psychosis
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What is a possible deficiency in alchoholics?
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Thiamine (B1)
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Mallory-Weiss syndrome
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Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting
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What is the mean IQ?
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100
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What IQ is one of the criteria for mental retardation?
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less than 70
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What is classical conditioning?
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Learning in which a natural response is elicited through a learned stimulus that was presented earlier with an unconditioned stimulus (Pavlov's dogs)
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What is Negative reinforcement?
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removal of an aversive stimulus elicits behavior (mouses presses button to avoid shock) Part of operant conditioning
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A Reward received after a random number of responses is a?
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Variable ratio reinforcement schedule
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Countertransference is?
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Physician projects feelings about another person onto the patient
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The superego is the structure that controls what?
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Moral values, conscience
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What does the ego do?
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Mediator between the unconscious mind and external world
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What is dissociation?
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Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
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What is displacement?
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Ideas and feelings that are not being confronted are transferred to a neutral person or object.
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What is repression?
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Involuntary withholding of an idea or feeling from conscious awareness (the basic mechanism behind all others).
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What are some more mature ego defenses?
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Suppression (not same as repression), Altruism, Humor, Sublimation (S.A.S.H.)
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What can you use to treat depression with insomnia?
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Trazodone, Mirtazapine
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Mechanism of fluphenazine or haloperidol?
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D2 antagonists - block receptors of dopamine
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Antipsychotics are used to treat:
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schizophrenia, acute mania, Tourette's syndrome
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What are Extrapyramidal system side effects?
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Acute dystonia, akinesia, akathisia, tardive dyskinesia
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How do you treat neuroleptic malignant syndome?
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Dantrolene or dopamine agonists. (Symptoms of malignant syndrome include myoglobinuria and hyperpyrexia)
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Mechanism of atypcial antipsychotics?
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5-HT2 and D2 receptor antagonists
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What is the benefit of atypical antipsychotics over the typicals?
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Less EPS and anticholinergic SE's
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What side effect is worrisome with clozapine use?
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Agranulocytosis
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What are the side effects of lithium use?
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Movement (tremor), Nephrogenic diabetes insipidus, Hypothyroidism, tetratogenesis)
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Mechanism of buspirone?
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5-HT1a receptor agonist. Use for Generalized anxiety disorder, does not cause sedation or addiction
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What is serotonin syndrome?
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Using SSRI's in conjunction with MAOI's causes hyperthermia, muscle rigidity, and CV collapse
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Mechanism of TCA's?
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block reuptake of NE and serotonin
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Imipramine can be used to treat major depression and ?
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bedwetting
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Clomipramine can be used to treat major depression and ?
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OCD
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What are toxicity symptoms of TCA's?
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Convulsions, coma, cardiotoxicitiy (TRI-C's); respiratory depression, confusion and hallucinations in elderly
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Mechanism of venlafaxine?
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SNRI - blocks serotonin, NE and dopamine reuptake. Use for severe depression and GAD
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What drug is helpful in smoking cessation?
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Buproprion. Contraindicated in patients prone to seizures (reduces threshold) and bulimia
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Mechanism of mirtazapine?
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A2 (alpha 2) anatagonist - increases release of NE and serotonin. Potent 5HT-2 and 5HT-3 anatagonist
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What do you have to worry about with MAOI use?
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Hypertensive crisis with tyramine ingestion.
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MAOI's can be used to treat:
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Atypical depression - (w/mood reactivity, hypersomnia, anxiety)
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What requirements are needed to diagnose schizophrenia?
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2 or more of the following symptoms (lasting > 6 months): a.Delusions (+ ) b. Hallucinations- often auditory (+) c. Disorganized thought- loose associations (+) d. Disorganized or catatonic behavior (+) e. Negative Symptoms- flat affect, social withdrawal, lack of motivation, lack of speech or thought
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What are the 5 subtypes of Schizophrenia?
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Disorganized (with regard to speech, behavior, and affect), Catatonic (automatisms), Paranoid (delusions), Undifferentiated, and Residual
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Define Schizoaffective Disorder?
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Schizophrenia plus a major depressive disorder, manic, or mixed episode (2 subtypes- bipolar or depressive)
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What are the symptoms of a manic episode?
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DIG FAST- Distractibility, Irresponsibility, Grandiosity, Flight of ideas, Activity increased (psychomotor Agitation), Sleep decreased, Talkativeness
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Define Hypomanic Episode
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Like manic episode but mood episodes are not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalizations (no psychotic features)
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What is disorder that is a milder form of bipolar lasting at least 2 years?
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Cyclothymic disorder
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What is the drug of choice in treating bipolar disorder?
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Bipolar disorder (contain combinations of manic -bipolar I, hypomanic- bipolar II, and depressed episodes. One manic or hyomanic episode defines bipolar disorder.)
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List 5 symptoms required to diagnose Major Depressive Episode
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SIG E CAPS- Sleep disturbance, Interest loss (anhedonia), Guilt or feelings of worthlessness, Energy loss, Concentration loss, Appetite/weight change, Psychomotor retartdation or agitation, Suicidal ideations (Need at least 5 symptoms for 2 weeks including anhedonia or depressed mood) (Disorder requires 2 or more episodes with a symptom free interval of 2 months)
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What is the lifetime prevalence of major depressive episode?
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5-12% Male, 10-25% Female
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What is milder form of depression lasting at least 2 years?
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Dysthymia
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What are the sleep patterns of depressed patients?
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decreased slow wave sleep, decreased REM latency, increased REM early in sleep cycle, Increased total REM sleep, repeated nighttime awakenings, early morning awakening
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What are the risk factors for suicide completion?
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SAD PERSONS- Sex (male), Age (teenager or elderly), Depression, Previous attempt, Ethanol or drug use, Rational thinking loss, Sickness (medical illness, 3 or more prescription medications), Organized plan, No spouse (divorced, widow, or single), Social support lacking.
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When is electroconvulsive therapy used?
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Treatment option for major depressive disorder refractory to other treatment (Produces painless seizure)
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What are the adverse effects of Electroconvulsive therapy (ECT)?
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Disorientation, anterograde, and retrograde amnesia
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Define a Panic Disorder.
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PANICS- Palpitations, Parethesias, Abdominal distress, Nausea, Intense fear of dying or losing control, lIghtheadedness, Chest pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of breath (Recurrent periods of intense fear and discomfort peaking in 10 minutes with 4 symptoms)
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Define Specific Phobia.
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Fear that is excessive or unreasonable and interferes with normal routine. Cued by presence or anticipation of a specific object or situation. Person recognizes fear is excessive (insight), yet exposure provokes an anxiety response. (Ex. Agoraphobia- fear of public places)
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How do you treat specific phobias?
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Systemic desensitization
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How long must a person have symptoms of Post traumatic stress disorder (nightmares or flashbacks of event) before being diagnosed?
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> 1 month
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Define Adjustment Disorder?
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Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g. divorce, moving) and lasting < 6 months.
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What are the symptoms of Generalized Anxiety Disorder?
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uncontrollable anxiety for at least 6 months unrelated to person, situation or event, sleep disturbance, fatigue, and difficulty concentration
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What do you call a patient that consciously fakes or claims to have a disorder in order to attain a specific secondary gain
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Malingering (complaints cease after gain)
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Name the disorder in which a patient consciously creates symptoms in order to assume the sick role and to get medical attention
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Factitious Disorder
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Define Munchausen's syndrome
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Syndrome manifested by a chronic history of multiple hospital admissions and willingness to receive invasive procedures. (Seen when illness in a child is caused by the parent)
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What are the 6 somatoform disorders?
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Conversion, Pain disorder, Hypochondriasis, Somatization disorder, Body dysmorphic disorder, and Pseudocyesis (false belief of being pregnant)
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What is the conversion somatoform disorder?
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Motor or sensory symptoms (e.g. paralysis) that suggest neurologic or physical disorder, but tests and physical exam are negative; often follows an acute stressor; patient may be unconcerned about symptoms.
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What is a pain somatoform disorder?
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Prolonged pain that is not explained completely by illness
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What type of gain is defined by what the symptom does for the patient's internal psychic economy?
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Primary
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What is secondary gain?
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What the symptom gets the patient (sympathy, attention)
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Define tertiary gain
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What the caretaker gets (like an MD on an interesting case)
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Define personality trait
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enduring pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts
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What is a personality disorder?
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When patterns of a personality trait become inflexible and maladaptive, causing impairment in social or occupational functioning or subjective distress; person is usually not aware of problem (not diagnosed in children)
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What personality disorders make up Cluster A?
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Paranoid, Schizoid, Schizotypal (Odd or eccentric, cannot develop meaningful social relationships. No psychosis; genetic association with schizophrenia)
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What are the symptoms of paranoid personality disorder?
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Distrust and suspiciousness; projection is main defense mechanism
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What are the symptoms of Schizoid personality disorder?
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voluntary social withdrawal, limited emotional expression, content with isolation, unlike avoidant
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How do you define Schizotypal personality disorder?
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interpersonal awkardness, odd beliefs or magical thinking, eccentric appearance
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In what cluster would you find Antisocial, Borderline, Histrionic, and Narcissistic personality disorders?
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Cluster B (dramatic, emotional, or erratic- genetic association with mood disorders and substance abuse)
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Define Antisocial personality disorder
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disregard for and violation of rights of others, criminality; males > females; conduct disorders if < 18 years
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What characterizes Borderline personality disorders?
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unstable mood and interpersonal relationships, impulsiveness, sense of emptiness; females > males; splitting is a major defense mechanism
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What are the symptoms of Histrionic personality disorder?
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excessive emotionality, attention seeking, sexually provacative, overly concerned with appearance.
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Define Narcissistic personality disorder
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grandiosity, sense of entitlement; may react to criticism with rage; may demand top physician/best health care
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What personality disorders make up Cluster C?
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Avoidant, Obsessive-Compulsive, Dependent (Anxious or fearful; genetic association with anxiety disorders)
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Define Avoidant personality disorder
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sensitive to rejection, socially inhibited, timid, feelings of inadequacy
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What defines Obsessive-Compulsive personality disorder?
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preoccupation with order, perfectionism, and control
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What personality disorder is defined by submissive, clinging, excessive need to be taken care of, and low self confidence?
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Dependent personality disorder
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What is the schizophrenia time course?
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< 1 month- brief psychotic disorder, usually stress related, 1-6 months- schizophreniform disorder, > 6 months- schizophrenia
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Define Anorexia nervosa
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abnormal eating habits (excessive dieting), body image distortion, and increase exercise. Severe weight loss, metatarsal stress fractures, amenorrhea, anemia, and electrolyte disturbances can follow. Seen primarily in adolescent girls. (Seen with depression)
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What are the symptoms of Bulimia nervosa?
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Parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting (Russel's sign)
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Define Bulimia nervosa.
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binge eating followed by self-induced vomiting or use of laxatives. (body weight is usually normal)
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IQ at which you are deemed severely mentally retarded?
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<40
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IQ for diagnosis of mental retardation?
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<70
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Stanford-Binet test is used for what purpose?
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calculate IQ as mental age/chronological age x 100.
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In simple learning, define habituation.
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repeated stimulation leads to decreased response
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In simple learning, describe sensitization.
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repeated stimulation leads to increased response
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What is classical conditioning?
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learning in which a natural response is elicited by a conditioned stimulus, that was previously presented in conjunction with an unconditioned stimulus (Pavlov's dog)
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What is operant conditioning?
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Learning in which an action is elicited because it produces a reward.
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What is positive reinforcement?
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desired reward causes action (mouse presses button to get food)
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What is negative reinforcement?
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removal of aversive stimulus causes action (mouse presses button to avoid shock)
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What is punishment in the context of operant conditioning?
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application of aversive stimulus extinguishes unwanted behavior.
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What is extinction in the context of operant conditioning?
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discontinuation of reinforcement eliminates behavior.
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Describe continuous reinforcement.
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reward received after every response, rapidly extinguished
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Describe variable ratio reinforcement
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reward received after random number of responses, slowly extinguished.
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What is transference?
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a patient projection feelings abou other persons onto the physician
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What is countertransferance?
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Physician projecting feelings about other persons onto patient.
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In Freud's structural theory of the mind, what is the Id?
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The Id is the primal urges, food, sex, and aggression drives.
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In Freud's structural theory of the mind, what is the Ego?
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The Ego is the mediator between the unconscious and the external world.
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In Freud's structural theory of the mind, what is the Superego?
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The superego is the moral values and conscience.
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Describe conscious.
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What you are aware of.
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Describe preconscious.
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What you are able to make conscious with effort, i.e. your phone number
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Describe unconscious
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What you are not aware of
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Oedipus complex
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repressed sexual feelings of a child for the opposite sex parent, accompanied by rivalry with the same-sex parent.
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In Social Learning, what is shaping?
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behavior achieved following reward through closer and closer approximatinos of desired behavior.
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In Social Learning, what is modeling?
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behavior acquired by watching others and assimilating actions into one's own repertoire.
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Ego Defense: Acting Out
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Unacceptable feelings and thoughts expressed as actions
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Ego Defense: Dissociation
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temporary, drastic change in personality, memeory, consciousness, or motor behavior to avoid emotional stress
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Ego Defense: Denial
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Avoidance of awareness of some painful reality.
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Ego Defense: Displacement
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process where avoided ideas and feelings are transferred to a neutral person or object
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Ego Defense: Fixation
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Partially remaining at a more childish level of development
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Ego Defense: Identification
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Modeling behavior after another person who is more powerful
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Ego Defense: Isolation of affect
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separation of feelings from ideas or events
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Ego Defense: Projection
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An unacceptable internal impulse attributed to an external source
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Ego Defense: Rationalization
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Giving logical reasons for actions actually performed for other reasons.
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Ego Defense: Reaction formation
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Process of replacing a warded-off idea or feeling with an emphasis on its opposite
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Ego Defense: Regression
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Reverting to earlier stages of maturation to deal with the world.
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Ego Defense: Repression
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Involuntary witholding of an idea from conscious awareness
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Ego Defense: Splitting
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Belief that people are all good or all bad at different times.
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Ego Defense: Altruism
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Guilty feelings alleviated by unsolicited generosity toward others.
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Ego Defense: Humor
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Appreciating the amusing nature of an anxiety-provoking or adverse situation
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Ego Defense: Sublimation
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Replacing an unacceptable impulse with a similar impulse that is acceptable but does not conflict with one's value system.
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Ego Defense: Suppression
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Voluntary witholding of an idea from conscious awareness.
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Effects of long term deprivation on infants
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4 W's: Weak, Wordless, Wanting (socially), Wary. Also:anaclitic depression, weight loss, physical illness and death.
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Anaclitic depression
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infant depression due to separation from caregiver, reversible, but can cause developmental disturbances
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Attention-deficit hyperactivity disorder (ADHD)
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decreased attention span and poor impulse control. Normal intellignece with hyperactivity, motor impairment and emotional lability.
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Pharmocological treatment for ADHD
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methylphenidate, amphetamines
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Conduct Disorder
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behavior violating social norms (aggression, theft) <18 yo
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Antisocial personality disorder
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behavior violating social norms (aggression, theft) >18 yo
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Oppositional defiant disorder
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pattern of hostile, defiant behavior toward authority figures, w/o violations of social norms
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Tourette's syndrome
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lifelong disorder with motor and vocal tics. Associated with OCD, onset <18 yo
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Treatment of Tourette's syndrome
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antipsychotics (haloperidol)
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Separation Anxiety Disorder
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Overwhelming fear of separation from home or person, onset 7-8 yo
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Autistic Disorder
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severe langueage impairment and poor social interaction, repetitive behavior and below normal intelligence, more common in boys
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Treatment of Autistic Disorder
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behavioral and suupportive therapy to improve communication and social skills
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Asperger's
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milder form of autism. Restricted interests, repetitive behavior, and problems with social relationships. Normal intelligence.
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Rett's Disorder
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X-linked disorder seen in girls. Progressive loss of development, retardation and stereotyped hand writing.
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Childhood Disintegrative Disorder
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marked regression in functioning after 2 years of normal development, onset between 3-4 yo, common in boys
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Evidence of child abuse
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healed fractures, cigarette burns, bruises, genital/anal trauma, STDs, UTIs
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Child Abusers
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Usually female and the primary caregiver, known to victim (usually male)
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Change of neurotransmitters in anxiety
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increase: NE decrease: GABA, 5-HT
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Change of neurotransmitters in depression
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decrease: NE, 5-HT, dopamine
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Change of neurotransmitters in alzheimers
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decrease: Ach
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Change of neurotransmitters in Huntington's
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decrease: GABA, Ach
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Change of neurotransmitters in Schizophrenia
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increase: dopamine
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Change of neurotransmitters in Parkinson's
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decrease: dopamine, increase: Ach
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Mental Orientation
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ability to know who he or she is, what date and time it is and what the present circumstances are
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Retrograde Amnesia
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inability to remember things that occurred before a CNS insult
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Anterograde Amnesia
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inability to remember things that occurred after a CNS insult
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Korsakoff's amnesia
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anterograde amnesia cuased by thiamine deficiency. Caused by bilateral destruction of mammillary bodies.
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Dissociative amnesia
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inability to recall important personal information due to trauma or stress
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The most common psychiatric illness on medical and surgical floors?
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delirium
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Delirium
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variable level of consciousness, decrease in attention span/arousal, disorganized thinking, hallucinations, illusions, cognitive dysfunction
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Dementia
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gradual decrease in cognition, memory deficits, loss of abstract thought, no change in consciousness
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Differences between Hallucinations, Illusions, Delusions and Loose Associations
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Hallucinations are perceptions in the absence of external stimuli. Illusions are misinterpretations of stimuli. Delusions are false beliefs not shared by others and Loose associations are disorders in the way ideas are tied together.
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Type of hallucination common in delirium
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visual
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Type of hallucination common in schizophrenia
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auditory
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Type of hallucination common in psychomotor epilepsy
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olfactory
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Type of hallucination common in alcohol withdrawal
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tactile (bugs crawling)
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Type of hallucination common in falling asleep
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hypnagogic
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Type of hallucination common in waking up from sleep
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hypnopomic
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