Fa: Psychiatry - Psychology And Pathology

Front 1

What is classical conditioning?

Back 1

- Learning in which a natural response (salivation) is elicited by a conditioned, or learned, stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food)
- Usually deals with INVOLUNTARY responses

Front 2

What is operant conditioning?

Back 2

- Learning in which a particular action is elicited because it produces a punishment or reward
- Usually deals with VOLUNTARY responses

Front 3

What is the term for when a desired reward produces an action? Example?

Back 3

Positive Reinforcement - eg, mouse presses button to get food

Front 4

What is the term for when a target behavior (response) is followed by removal of an aversive stimulus? Example?

Back 4

Negative Reinforcement - eg, mouse presses button to turn of continuous loud noise

Front 5

What is the term for when repeated application of aversive stimulus extinguishes an unwanted behavior?

Back 5

Punishment

Front 6

What is the term for the discontinuation of reinforcement (positive or negative) eventually leading to elimination of behavior? When can this occur?

Back 6

Extinction
- Can occur in operant or classical conditioning

Front 7

What is "transference"?

Back 7

Patient projects feelings about formative or other important persons onto physician (eg, psychiatrist is seen as a parent)

Front 8

What is "countertransference"?

Back 8

Doctor projects feelings about formative or other important persons onto patient (eg, patient reminds physician of younger sibling)

Front 9

What are ego defenses?

Back 9

Unconscious, mental processes used to resolve conflict and prevent undesirable feelings (eg, anxiety or depression)

Front 10

What are the types of IMMATURE "ego defenses"?

Back 10

- Acting out
- Dissociation
- Denial
- Displacement
- Fixation
- Identification
- Isolation (of affect)
- Projection
- Rationalization
- Reaction formation
- Regression
- Repression
- Splitting

Front 11

What kind of ego defense is a "tantrum" an example of? Description?

Back 11

Acting Out (immature ego defense):
- Expressing unacceptable feelings and thoughts through actions

Front 12

What kind of ego defense is a "dissociative identity disorder (multiple personality disorder)" an example of? Description?

Back 12

Dissociation (immature ego defense):
- Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress

Front 13

What kind of ego defense is a "common reaction to a newly diagnosed AIDS or cancer patient" an example of? Description?

Back 13

Denial (immature ego defense):
- Avoiding the awareness of some painful reality

Front 14

What kind of ego defense is a "mother yelling at her child because her husband yelled at her" an example of? Description?

Back 14

Displacement (immature ego defense):
- Transferring avoided ideas and feelings to some neutral person or object (vs projection)

Front 15

What kind of ego defense is a "man fixated on sports games" an example of? Description?

Back 15

Fixation (immature ego defense):
- Partially remaining at a more childish level of development (vs regression)

Front 16

What kind of ego defense is an "abused child identifying with an abuser" an example of? Description?

Back 16

Identification (immature ego defense):
- Modeling behavior after another person who is more powerful (though not necessarily admired)

Front 17

What kind of ego defense is "describing a murder in graphic detail with no emotional response" an example of? Description?

Back 17

Isolation of Affect (immature ego defense):
- Separating feelings from ideas and events

Front 18

What kind of ego defense is a "man who wants another woman" experiencing if he "thinks his wife is cheating on him"? Description?

Back 18

Projection (immature ego defense):
- Attributing unacceptable internal impulse to an external source (vs displacement)

Front 19

What kind of ego defense is "after getting fired, claiming that the job was not important anyway" an example of? Description?

Back 19

Rationalization (immature ego defense):
- Proclaiming logical reasons for actions actually performed for other reasons
- Usually to avoid self-blame

Front 20

What kind of ego defense is a "patient with libidinous thoughts who enters a monastery" an example of? Description?

Back 20

Reaction Formation (immature ego defense):
- Replacing a warded off idea or feeling by an (unconsciously derived) emphasis on its opposite (vs sublimation)

Front 21

What kind of ego defense is "seen in children under stress, such as illness, punishment, or birth of a new sibling (eg, bedwetting in a previously toilet-trained child when hospitalized)" an example of? Description?

Back 21

Regression (immature ego defense):
- Turning back the maturational clock and going back to earlier modes of dealing with the world (vs fixation)

Front 22

What kind of ego defense is "not remembering a conflictual or traumatic experience by pressing bad thoughts into the unconscious" an example of? Description?

Back 22

Repression (immature ego defense):
- Involuntary withholding an idea or feeling from conscious awareness (vs suppression)

Front 23

What kind of ego defense is a "patient saying that all the nurses are cold and insensitive but that the doctors are warm and friendly" an example of? Description?

Back 23

Splitting (immature ego defense):
- Believing that people are either all good or all bad at different times due to intolerance of ambiguity
- Commonly seen in borderline personality disorder

Front 24

What are the types of MATURE "ego defenses"?

Back 24

- Altruism
- Humor
- Sublimation
- Suppression

Mature adults wear a SASH: Sublimation, Altruism, Suppression, Humor

Front 25

What kind of ego defense is a "mafia boss making large donations to charity" an example of? Description?

Back 25

Altruism (mature ego defense):
- Alleviating guilty feelings by unsolicited generosity toward others

Front 26

What kind of ego defense is a "nervous medical student making jokes about the boards" an example of? Description?

Back 26

Humor (mature ego defense):
- Appreciating the amusing nature of an anxiety-provoking or adverse situation

Front 27

What kind of ego defense is a "teenager's aggression toward his father that is redirected to perform well in sports" an example of? Description?

Back 27

Sublimation (mature ego defense):
- Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system (vs reaction formation)

Front 28

What kind of ego defense is "choosing to not worry about the big game until it is time to play" an example of? Description?

Back 28

Suppression (mature ego defense):
- Intentional withholding of an idea or feeling from conscious awareness (vs repression)

Front 29

What are the ego defenses that are related (__ vs __)?

Back 29

- Displacement vs Projection
- Fixation vs Regression
- Reaction Formation vs Sublimation
- Repression vs Suppression

Front 30

What is the similarity / difference between displacement and projection?

Back 30

- Displacement: transferring avoided ideas and feelings to some neutral person or object (eg, mother yells at her child because her husband yelled at her)
- Projection: attributing an unacceptable internal impulse to an external source (eg, a man who wants another woman thinks his wife is cheating on him)

Front 31

What is the similarity / difference between fixation and regression?

Back 31

- Fixation: partially remaining at a more childish level of development (eg, men fixating on sports games)
- Regression: turning back the maturational clock and going back to earlier modes of dealing with the world (eg, seen in children under stress such as illness, punishment, or birth of a new sibling - that starts to bedwet)

Front 32

What is the similarity / difference between reaction formation and sublimation?

Back 32

- Reaction Formation: replacing a warded off idea or feeling by an (unnecessarily derived) emphasis on its opposite (eg, patient with libidinous thoughts enters a monastery)
- Sublimation: replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system (eg, teenager's aggression toward father is redirected to perform will in sports)

Front 33

What is the similarity / difference between Repression and Suppression?

Back 33

- Repression: involuntary withholding an idea or feeling from conscious awareness (eg, not remembering a conflictual or traumatic experience, pressing bad thoughts into the unconscious)
- Suppression: intentional withholding of an idea or feeling from conscious awareness (eg, choosing not to worry about the big game until it is time to play)

Front 34

What are the long term effects of deprivation of affection on an infant?

Back 34

The 4 W's: Weak, Wordless, Wanting (socially), Wary
- ↓ Muscle tone
- Poor language skills
- Poor socialization skills
- Lack of basic trust
- Anaclitic depression (infant withdrawn/unresponsive)
- Weight loss
- Physical illness

Front 35

Infant deprivation of affection for how long can lead to irreversible changes?

Back 35

>6 months

Front 36

What can severe deprivation of an infant lead to?

Back 36

Infant death

Front 37

What are some examples of evidence of physical abuse of a child?

Back 37

- Healed fractures on x-ray (eg, spiral fractures)
- Burns (eg, cigarette, scalding)
- Subdural hematomas
- Pattern marks/bruising (eg, belts, electrical cords)
- Rib fractures
- Retinal hemorrhage or detachment

Front 38

Who is the most common physical abuser of a child?

Back 38

Usually biological mother

Front 39

How common is physical abuse of a child? How old of child?

Back 39

- ~3000 deaths / year in US
- 80% less than 3 years old

Front 40

What are some examples of evidence of sexual abuse of a child?

Back 40

- Genital, anal, or oral trauma
- STDs
- UTIs

Front 41

Who is the most common sexual abuser of a child?

Back 41

Known to victim, usually a male

Front 42

When is sexual abuse of a child more common?

Back 42

Peak incidence in 9-12 year olds

Front 43

What is the most common form of child maltreatment?

Back 43

Child neglect (failure to provide a child with adequate food, shelter, supervision, education, and/or affection)

Front 44

What are some examples of child neglect? Evidence?

Back 44

- Failure to provide a child with adequate food, shelter, supervision, education, and/or affection
- Evidence: poor hygiene, malnutrition, withdrawal, impaired social / emotional development, failure to thrive

Front 45

What do you need to do if you think a child is being abused or neglected?

Back 45

Must be reported to local child protective services

Front 46

What are the childhood and early onset disorders?

Back 46

- Attention-Deficit Hyperactivity Disorder
- Conduct Disorder
- Oppositional Defiant Disorder
- Tourette Syndrome
- Separation Anxiety Disorder

Front 47

What childhood disorder appears before age 12 with hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc)?

Back 47

Attention-Deficit Hyperactivity Disorder

Front 48

What are the problems associated with Attention-Deficit Hyperactivity Disorder?

Back 48

- Limited attention span
- Poor impulse control
- Hyperactivity
- Normal intelligence, but commonly coexists with difficulties in school

Front 49

Does Attention-Deficit Hyperactivity Disorder persist into adulthood?

Back 49

Continues in as many as 50% of individuals

Front 50

What brain changes are associated with Attention-Deficit Hyperactivity Disorder?

Back 50

↓ Frontal lobe volume / metabolism

Front 51

How do you treat Attention-Deficit Hyperactivity Disorder?

Back 51

- Methylphenidate
- Amphetamines
- Atomexetine
- Behavioral interventions (reinforcement, reward)

Front 52

What childhood disorder presents with repetitive and pervasive behaviors violating the basic rights of others (eg, physical aggression, destruction of property, theft)?

Back 52

Conduct Disorder

Front 53

What are the behaviors of a child with Conduct Disorder?

Back 53

Repetitive and pervasive behaviors violating the basic rights of others (eg, physical aggression, destruction of property, theft)

Front 54

What do many children with Conduct Disorder go onto develop in adulthood?

Back 54

Many will meet criteria for diagnosis of Antisocial Personality Disorder

Front 55

What childhood disorder is associated with an enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms?

Back 55

Oppositional Defiant Disorder

Front 56

What are the behaviors of a child with Oppositional Defiant Disorder?

Back 56

Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms

Front 57

What childhood disorder is associated with sudden, rapid, recurrent, non-rhythmic, sterotyped motor and vocal tics that persist for >1 year?

Back 57

Tourette Syndrome

Front 58

How do you diagnose Tourette Syndrome? How common is it?

Back 58

- Sudden, rapid, recurrent, non-rhythmic, sterotyped motor and vocal tics that persist for >1 year
- Lifetime prevalence: 0.1-1.0%
- Coprolalia (involuntary obscene speech) seen in 10-20% of patients

Front 59

What is Tourette Syndrome associated with?

Back 59

OCD and ADHD

Front 60

How do you treat Tourette Syndrome?

Back 60

- Anti-psychotics
- Behavioral therapy

Front 61

What childhood disorder is associated with an overwhelming fear of separation from home or loss of attachment figure, which may lead to factitious physical complaints to avoid going to or stay at school? When does it typically occur?

Back 61

Separation Anxiety Disorder (usually from 7-9 years)

Front 62

What are the characteristics of Separation Anxiety Disorder?

Back 62

- Overwhelming fear of separation from home or loss of attachment figure
- May lead to factitious physical complaints to avoid going to or stay at school
- Commonly from ages 7-9 years

Front 63

How do you treat a child with Separation Anxiety Disorder?

Back 63

- SSRIs
- Relaxation techniques / behavioral interventions

Front 64

What are the types of pervasive developmental disorders?

Back 64

- Autism spectrum disorder
- Rett disorder

Front 65

What are the characteristics of pervasive developmental disorders?

Back 65

Difficulties with language and failure to acquire or early loss of social skills

Front 66

Which developmental disorder is characterized by poor social interactions, communication deficits, repetitive / ritualized behaviors, and restricted interests?

Back 66

Autism Spectrum Disorder

Front 67

What are the characteristics of Autism Spectrum Disorder? When does it present?

Back 67

- Poor social interactions
- Communication deficits
- Repetitive / ritualized behaviors
- Restricted interests
- May or may not be associated with intellectual disability
- Rarely accompanied by unusual abilities (savants)

- Must present in early childhood, more commonly in boys

Front 68

What X-linked disorder is seen almost exclusively in girls with symptoms of regression: loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing?

Back 68

Rett Disorder

Front 69

What are the characteristics of Rett Disorder? In whom does it more commonly occur?

Back 69

- X-linked disorder
- Seen almost exclusively in girls, around ages 1-4
- Symptoms of regression: loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing

Front 70

How is Rett disorder obtained? How does it affect boys vs girls?

Back 70

X-linked disorder
- Usually seen in females
- Most affected males die in utero or shortly after birth

Front 71

What neurotransmitter changes are associated with Alzheimer Disease?

Back 71

↓ ACh

Front 72

What neurotransmitter changes are associated with Anxiety?

Back 72

↑ Norepinephrine
↓ GABA
↓ 5-HT

Front 73

What neurotransmitter changes are associated with Depression?

Back 73

↓ Norepinephrine
↓ 5-HT
↓ Dopamine

Front 74

What neurotransmitter changes are associated with Huntington Disease?

Back 74

↓ GABA
↓ ACh
↑ Dopamine

(opposite of Parkinson disease)

Front 75

What neurotransmitter changes are associated with Parkinson Disease?

Back 75

↓ Dopamine
↑ 5-HT
↑ ACh

(opposite of Huntington disease)

Front 76

What neurotransmitter changes are associated with Schizophrenia?

Back 76

↑ Dopamine

Front 77

When you are testing a patient's "orientation", what are you assessing?

Back 77

Ability to know:
- Who he or she is
- Where he or she is
- Date and time

Front 78

What is the usual order of loss of orientation? How do you document this?

Back 78

1st: time
2nd: place
3rd: person

Often abbreviated in medical charge as "alert and oriented x 3 (AOx3)"

Front 79

What are common causes of loss of orientation?

Back 79

- Alcohol
- Drugs
- Fluid / electrolyte imbalance
- Head trauma
- Hypoglycemia
- Infection
- Nutritional deficiencies

Front 80

What are the types of amnesias?

Back 80

- Retrograde amnesia
- Anterograde amnesia
- Korsakoff amnesia
- Dissociative amnesia

Front 81

What is the inability to remember things that occurred before a CNS insult?

Back 81

Retrograde Amnesia

Front 82

What is the inability to remember things that occurred after a CNS insult (no new memories)?

Back 82

Anterograde Amnesia

Front 83

What is the classic anterograde amnesia caused by thiamine deficiency? What happens in brain?

Back 83

Korsakoff Amnesia - associated with destruction of the mamillary bodies

Front 84

What type of memory is affected by Korsakoff Amnesia? Cause?

Back 84

- Classic anterograde amnesia
- May also include some retrograde amnesia
- Caused by thiamine deficiency and the associated destruction of the mammillary bodies
- Seen in alcoholics, and associated with confabulations

Front 85

What is the inability to recall important personal information, usually subsequent to severe trauma or stress?

Back 85

Dissociative Amnesia

Front 86

What type of memory is affected by Dissociative Amnesia?

Back 86

- Inability to recall important personal information, usually subsequent to severe trauma or stress
- May be accompanied by dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances)

Front 87

What is "dissociative fugue"?

Back 87

- Abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances
- May be a component of Dissociative Amnesia

Front 88

What is the definition of a cognitive disorder?

Back 88

Significant change in cognition (memory, attention, language, judgment) from previous level of functioning

Front 89

What are cognitive disorders associated with?

Back 89

- Abnormalities in CNS
- General medical conditions
- Medications
- Substance use

Includes:
- Delirium
- Dementia

Front 90

What are the components of cognition that can be significantly altered in a cognitive disorder?

Back 90

- Memory
- Attention
- Language
- Judgment

Front 91

What term is used for the "waxing and waning" level of consciousness with acute onset and a rapid decrease in attention span and level of arousal?

Back 91

Delirium

Front 92

What are the characteristic symptoms that may be seen in Delirium?

Back 92

- Disorganized thinking
- Hallucinations (often visual)
- Illusions
- Misperceptions
- Disturbance in sleep-wake cycle
- Cognitive dysfunction

Front 93

What is usually the cause of Delirium?

Back 93

Usually 2° to other illness, such as:
- CNS disease
- Infection
- Trauma
- Substance abuse / withdrawal
- Metabolic / electrolyte disturbances
- Hemorrhage
- Urinary / fecal retention
- Check for drugs with anti-cholinergic effects

Front 94

What is the most common presentation of altered mental status in an inpatient setting?

Back 94

Delirium

Front 95

Will the EEG be normal or abnormal in patients with Delirium?

Back 95

Abnormal

Front 96

How do you treat Delirium?

Back 96

- Identify and address underlying cause
- Optimize brain condition (O2, hydration, pain, etc)
- Anti-psychotics (mainly haloperidol)

* T-A-DA approach: Tolerate, Anticipate, Don't Agitate (helpful for management)

Front 97

Is the decreased level of consciousness associated with Delirium reversible?

Back 97

Often reversible

Front 98

What disorder is associated with a gradual decrease in intellectual ability or "cognition" without affecting the level of consciousness?

Back 98

Dementia

Front 99

What symptoms / changes is Dementia characterized by?

Back 99

* Memory deficits
- Aphasia (loss of ability to understand or express speech)
- Apraxia (inability to perform particular purposive actions)
- Agnosia (inability to interpret sensations and hence to recognize things)
- Loss of abstract thought
- Behavioral / personality changes
- Impaired judgment

Front 100

What does aphasia mean?

Back 100

Loss of ability to understand or express speech

Front 101

What does apraxia mean?

Back 101

Inability to perform particular purposive actions

Front 102

What does agnosia mean?

Back 102

Inability to interpret sensations and hence to recognize things

Front 103

How are dementia and delirium related?

Back 103

- Dementia: more gradual changes in cognition, specifically memory
- Delirium: rapid decrease in level of consciousness, attention span, and level of arousal

* A patient with dementia can develop delirium (eg, patient with Alzheimer disease who develops pneumonia is at ↑ risk for delirium)

Front 104

What are the irreversible causes of dementia?

Back 104

- Alzheimer disease
- Lewy body dementia
- Huntington disease
- Pick disease
- Cerebral infarcts
- Creutzfeldt-Jakob disease
- Chronic substance abuse (d/t neurotoxicity of drugs)

Front 105

What are the reversible causes of dementia?

Back 105

- NPH
- Vitamin B12 deficiency
- Hypothyroidism
- Neurosyphilis
- HIV (partially)

Front 106

How does the incidence of dementia change in different populations?

Back 106

Increased incidence with age

Front 107

Will the EEG be normal or abnormal in patients with Dementia?

Back 107

Usually normal

Front 108

How does dementia relate to depression?

Back 108

In elderly patients, depression may present like dementia (pseudo-dementia)

Front 109

What is the term for a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking?

Back 109

Psychosis

Front 110

What are the possible components of a psychosis?

Back 110

- Delusions
- Hallucinations
- Disorganized thinking

Front 111

Psychosis can occur in what kind of patients?

Back 111

- Patients with medical illnesses
- Patients with psychiatric illnesses
- Patients with both

Front 112

What is a hallucination?

Back 112

Perception in the absence of stimuli (eg, seeing a light that is not actually present)

Front 113

What is a delusion?

Back 113

Unique, false beliefs about oneself or others that persist despite the facts (eg, thinking aliens are communicating with you)

Front 114

What is disorganized speech?

Back 114

Words and ideas are strung together based on sounds, puns, or "loose associations"

Front 115

What are the types of hallucinations?

Back 115

- Visual
- Auditory
- Olfactory
- Gustatory
- Tactile
- Hypnagogic
- Hypnopompic

Front 116

What type of hallucination is more commonly a feature of MEDICAL illness (eg, drug intoxication) than psychiatric illness?

Back 116

Visual Hallucinations

Front 117

What type of hallucination is more commonly a feature of PSYCHIATRIC illness (eg, schizophrenia) than medical illness?

Back 117

Auditory Hallucinations

Front 118

What type of hallucination often occurs as an aura of psychomotor epilepsy?

Back 118

Olfactory Hallucinations

Front 119

What type of hallucination often occurs with brain tumors?

Back 119

Olfactory Hallucinations

Front 120

What type of hallucination is very rare?

Back 120

Gustatory Hallucinations

Front 121

What type of hallucination is common in alcohol withdrawal? Example?

Back 121

Tactile Hallucinations
- Eg, formication: the sensation of bugs crawling on one's skin)

Front 122

What type of hallucination is seen in cocaine abusers?

Back 122

Tactile Hallucinations
- "Cocaine crawlies"

Front 123

What type of hallucinations occur while going to sleep?

Back 123

HypnaGOgic (while GOing to sleep) Hallucinations

Front 124

What type of hallucinations occur while waking from sleep?

Back 124

HypnoPOMPic ("POMPous upon awakening") Hallucinations

Front 125

What mental disorder causes periods of psychosis, disturbed behavior and thought, and a decline in functioning that lasts >6 months?

Back 125

Schizophrenia

Front 126

How long must symptoms of Schizophrenia occur to make a diagnosis?

Back 126

6 months

Front 127

What brain changes are associated with Schizophrenia?

Back 127

- ↑ Dopaminergic activity
- ↓ Dendritic branching

Front 128

What is required to make a diagnosis of Schizophrenia?

Back 128

Requires 2 or more of the following:
- Delusions
- Hallucinations (often auditory)
- Disorganized speech (loose associations)
- Disorganized or catatonic behavior
- Negative symptoms: flat affect, social withdrawal, lack of motivation, lack of speech or thought

Front 129

What diagnosis would someone get if they are experiencing symptoms of schizophrenia, but for less than one month?

Back 129

Brief Psychotic Disorder (usually stress related)

Front 130

What diagnosis would someone get if they are experiencing symptoms of schizophrenia, but for only 1-6 months?

Back 130

Schizophreniform disorder

Front 131

What diagnosis would someone get if they have a stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episode, for at least two weeks? Types?

Back 131

Schizoaffective Disorder
- Bipolar type
- Depressive type

Front 132

What contributes to the etiology of schizophrenia?

Back 132

- Genetics
- Environment

Front 133

What is associated with psychosis / schizophrenia in teens?

Back 133

Frequent cannabis use

Front 134

What is the lifetime prevalence of schizophrenia? How does it compare in males vs females and whites vs blacks?

Back 134

1.5%
- Males = Females (but presents earlier in men - late teens to early 20s - vs in females - late 20s to early 30s)
- Blacks = Whites

Front 135

What are patients with Schizophrenia at increased risk for?

Back 135

Suicide

Front 136

What diagnosis would you give a patient who genuinely believes she is married to a celebrity when, in fact, she is not?

Back 136

Delusional Disorder

Front 137

How do you make a diagnosis of Delusional Disorder?

Back 137

-Fixed, persistent, untrue belief system lasting >1 month
- Functioning otherwise not impaired

Front 138

What are the types of dissociative disorders?

Back 138

- Dissociative Identity Disorder
- Depersonalization / Derealization Disorder

Front 139

What is the new name for "multiple personality disorder"?

Back 139

Dissociative Identity Disorder

Front 140

What is necessary to make a diagnosis of Dissociative Identity Disorder?

Back 140

Presence of 2 or more distinct identities or personality states

Front 141

Who is more likely to have Dissociative Identity Disorder? What is it associated with?

Back 141

- More common in females
- Associated with history of sexual abuse, PTSD, depression, substance abuse, borderline personality, and somatoform conditions

Front 142

What is necessary to make a diagnosis of Depersonalization / Derealization Disorder?

Back 142

Persistent feelings of detachment or estrangement from one's own body, thoughts, perceptions, and actions (depersonalization) or one's environment (derealization)

Front 143

What are the types of mood disorders?

Back 143

- Major depressive disorder
- Bipolar disorder
- Dysthymic disorder
- Cyclothymic disorder

Front 144

What are the characteristics of all mood disorders?

Back 144

- Abnormal range of moods or internal emotional states
- Loss of control of moods
- Severity of moods causes distress and impairment in social and occupational functioning

Front 145

Do mood disorders have psychotic features?

Back 145

Psychotic features (eg, delusions or hallucinations) may be present

Front 146

What is it the term for the distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy? How long does it have to last?

Back 146

Manic Episode - must last at least one week

Front 147

What does a diagnosis of a Manic episode require?

Back 147

- Lasts at least one week

Diagnosis requires hospitalization or at least 3 of the following (manics DIG FAST):
- Distractibility
- Irresponsibility
- Grandiosity

- Flight of ideas
- ↑ Activity (goal directed) / Agitation
- ↓ Sleep
- Talkativeness (or pressured sleep)

Front 148

What is the definition of a hypomanic episode?

Back 148

- Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization.
- No psychotic features.
- Lasts at least 4 consecutive days.

Front 149

What is Bipolar I disorder?

Back 149

Presence of at least 1 manic episode with or without a hypomanic or depressive episode.

Front 150

What is Bipolar II disorder?

Back 150

Presence of a hypomanic and a depressive episode.

Front 151

What happens to a patient's mood and functioning between manic and depressive episodes in bipolar disorder?

Back 151

Mood and functioning usually return to normal between episodes.

Front 152

What happens in a patient with bipolar disorder who takes anti-depressants?

Back 152

Can lead to increased mania

Front 153

What is there risk of in bipolar disorder?

Back 153

High suicide risk

Front 154

How do you treat bipolar disorder?

Back 154

- Mood stabilizers (eg, lithium, valproic acid, carbamazepine)
- Atypical anti-psychotics

Front 155

What is the term for dysthymia and hypomania? How long does it have to last for a diagnosis?

Back 155

Cyclothymic disorder (milder form of bipolar disorder); lasting at least 2 years

Front 156

How long do major depressive episodes usually last?

Back 156

Usually last 6–12 months (self-limited)

Front 157

How many symptoms and for how long must they be present to be diagnosed with Major Depressive Disorder?

Back 157

- At least 5 of 9 symptoms
- 2 or more weeks

* Must include patient-reported depressed mood or anhedonia
* Must occur more frequently as disorder progresses

Front 158

What are the 9 symptoms used to diagnose Major Depressive Disorder?

Back 158

SIG E CAPS:
- Sleep disturbance
- Loss of Interest (anhedonia)
- Guilt or feelings of worthlessness

- Energy loss and fatigue

- Concentration problems
- Appetite/weight changes
- Psychomotor retardation or agitation
- Suicidal ideations

- Depressed mood

Front 159

What happens to the sleep stages in patients with Major Depressive Disorder?

Back 159

- ↓ Slow-wave sleep
- ↓ REM latency
- ↑ REM early in sleep cycle
- ↑ Total REM sleep
- Repeated nighttime awakenings
- Early-morning awakening (important screening question)

Front 160

What is the term for a milder depression that lasts at least 2 years?

Back 160

Persistent Depressive Disorder (Dysthymia)

Front 161

What is the term for the depressive symptoms that are associated with the winter season? How can it be improved?

Back 161

Seasonal Affective Disorder
- Improves in response to full-spectrum bright-light exposure

Front 162

What is the most common subtype of depression?

Back 162

Atypical Depression

Front 163

What are the characteristics of atypical depression?

Back 163

- Differs from classical forms of depression

Characterized by:
- Mood reactivity (being able to experience improved mood in response to positive events, albeit briefly)
- “Reversed” vegetative symptoms (hypersomnia and weight gain)
- Leaden paralysis (heavy feeling in arms and legs)
- Long-standing interpersonal rejection sensitivity

Front 164

How do you treat atypical depression?

Back 164

- MAO inhibitors
- SSRIs

Front 165

What are the types of postpartum mood disturbances?

Back 165

- Maternal (postpartum) "blues"
- Postpartum depression
- Postpartum psychosis

Front 166

How common are maternal (postpartum) blues?

Back 166

50-85% incidence

Front 167

Characteristics / criteria for maternal (postpartum) blues?

Back 167

- Depressed affect, tearfulness, and fatigue
- Starting 2-3 days after delivery
- Usually resolves within 10 days

Front 168

How do you treat a patient with maternal (postpartum) blues?

Back 168

- Supportive treatment
- Follow-up to assess for possible postpartum depression

Front 169

How common is postpartum depression?

Back 169

10-15% incidence

Front 170

Characteristics / criteria for postpartum depression?

Back 170

- Depressed affect, anxiety, and poor concentration starting within 4 weeks after delivery
- Lasts 2 weeks to a year or more

Front 171

How do you treat a patient with postpartum depression?

Back 171

- Antidepressants
- Psychotherapy

Front 172

How common is postpartum psychosis?

Back 172

0.1 - 0.2% incidence

Front 173

Characteristics / criteria for postpartum psychosis?

Back 173

- Delusions, hallucinations, confusion, unusual behavior, and possible homicidal/suicidal ideation or attempts
- Usually lasts 4-6 weeks

Front 174

How do you treat a patient with postpartum psychosis?

Back 174

- Anti-psychotics
- Anti-depressants
- Possible inpatient hospitalization
- Assessment of child safety

Front 175

What are the characteristics of normal bereavement?

Back 175

- Shock
- Denial
- Guilt
- Somatic symptoms
- May experience simple hallucinations (eg, hearing name called)

Front 176

What is the timeline of normal bereavement?

Back 176

6-12 months

Front 177

What are the characteristics of pathologic grief?

Back 177

- Excessively intense grief
- Grief that is delayed, inhibited, or denied
- May experience depressive symptoms, delusions, and hallucinations

Front 178

What is the timeline of pathologic grief?

Back 178

> 6-12 months

Front 179

What treatment can be given for major depressive disorder refractory to other treatment?

Back 179

Electroconvulsive therapy

Front 180

What treatment can be given for pregnant women with major depressive disorder?

Back 180

Electroconvulsive therapy

Front 181

When is Electroconvulsive therapy indicated?

Back 181

- Major depressive disorder refractory to other treatment
- Pregnant women with major depressive disorder
- Considered when immediate response is necessary (acute suicidality)
- In depression with psychotic features
- Catatonia

Front 182

What does electroconvulsive therapy cause? Adverse effects?

Back 182

- Relatively painless seizure in an anesthetized patient
- Disorientation, temporary headache, and partial anterograde/retrograde amnesia usually fully resolving in 6 months

Front 183

What kind of amnesia may be caused by electroconvulsive therapy? How long does it last?

Back 183

Partial Anterograde / Retrograde Amnesia - fully resolves in 6 months

Front 184

What are the risk factors for suicide completion?

Back 184

SAD PERSONS are more likely to complete suicide:
- Sex (male)
- Age (teenager or elderly)
- Ethanol or drug use
- loss of Rational thinking
- Sickness (medical illness, ≥3 prescriptions)
- Organized plan
- No spouse (divorced, widowed, or single, especially if childless)
- Social support lacking

Front 185

Who attempts suicide more often?

Back 185

Women

Front 186

Who succeeds at suicide more often?

Back 186

Men

Front 187

What are the characteristics of anxiety disorder?

Back 187

- Inappropriate experience of fear/worry and its physical manifestations (anxiety)
- The source of the fear/worry is either not real or insufficient to account for the severity of the symptoms
- Symptoms interfere with daily functioning

Front 188

How common is anxiety disorder by gender?

Back 188

30% in women, 19% in men

Front 189

What are the types of anxiety disorder?

Back 189

- Panic disorder
- Phobias
- Generalized anxiety disorder

Front 190

What are the characteristics (symptoms) of panic disorder?

Back 190

Defined by the presence of recurrent panic attacks (periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following):
- Palpitations
- Paresthesias
- Abdominal distress
- Nausea
- Intense fear of dying or losing control
- lIght-headedness
- Chest pain
- Chills
- Choking
- disConnectedness
- Sweating
- Shaking
- Shortness of breath

Front 191

What is panic disorder associated with?

Back 191

Strong genetic relationship

Front 192

How do you treat panic disorder?

Back 192

- Cognitive behavioral therapy
- SSRIs
- Venlafaxine
- Benzodiazepines (risk of tolerance, physical dependence)

Front 193

What is necessary for a diagnosis of panic disorder?

Back 193

Attack followed by 1 month (or more) of 1 (or more) of following:
- Persistent concern of additional attacks
- Worrying about consequences of attack
- Behavioral change related to attacks

Front 194

What causes the symptoms in panic disorder?

Back 194

Symptoms are the systemic manifestations of fear

Front 195

What is a specific phobia? How do you treat?

Back 195

- Fear that is excessive or unreasonable and interferes with normal function
- Cued by presence or anticipation of a specific object or situation
- Person recognizes fear is excessive
- Can treat with systematic desensitization

Front 196

What are the characteristics of a social anxiety disorder? How do you treat?

Back 196

- Exaggerated fear of embarrassment in social situations (e.g., public speaking, using public restrooms)
- Treatment: SSRIs

Front 197

What are the characteristics of agoraphobia?

Back 197

Exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone

Front 198

What are the criteria for Generalized Anxiety Disorder?

Back 198

- Pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event.
- Associated with sleep disturbance, fatigue, GI disturbance, and difficulty concentrating.

Front 199

How do you treat Generalized Anxiety Disorder?

Back 199

- SSRIs
- SNRIs
- Buspirone
- Cognitive Behavioral Therapy

Front 200

What is the term diagnosis for emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, illness)? How long must it last for a diagnosis?

Back 200

Adjustment Disorder
- Lasts <6 months
- >6 months in presence of chronic stressor

Front 201

What is the diagnosis for recurring intrusive thoughts, feelings, or sensations that cause severe distress, relieved in part by performance of repetitive actions?

Back 201

Obsessive-Compulsive Disorder

Front 202

What is an "obsession" in Obsessive-Compulsive Disorder?

Back 202

Recurring intrusive thoughts, feelings, or sensations that cause severe distress

Front 203

What is a "compulsion" in Obsessive-Compulsive Disorder?

Back 203

Performance of repetitive actions that partially relieve distress of obsessions

Front 204

What does the term "ego dystonic" mean regarding Obsessive-Compulsive Disorder?

Back 204

Behavior is inconsistent with one's own beliefs and attitudes (unlike in obsessive-compulsive personality disorder)

Front 205

What is Obsessive-Compulsive Disorder associated with?

Back 205

Tourette Disorder

Front 206

How do you treat Obsessive-Compulsive Disorder?

Back 206

- SSRIs
- Clomipramine

Front 207

What is the diagnosis for the preoccupation with minor or imagined defects in appearance, leading to significant emotional distress or impaired functioning?

Back 207

Body Dysmorphic Disorder

Front 208

How do patients with Body Dysmorphic Disorder present to the doctor?

Back 208

Repeatedly seeking cosmetic surgery

Front 209

What are the symptoms of Post-Traumatic Stress Disorder?

Back 209

- Persistent reexperiencing of a previous traumatic event (e.g., war, rape, robbery, serious accident, fire)
- May involve nightmares or flashbacks, intense fear, helplessness, or horror
- Leads to avoidance of stimuli associated with the trauma and persistently ↑ arousal
- Disturbance lasts > 1 month, with onset of symptoms beginning anytime after event, and causes significant distress, negative cognitive alterations, and/or impaired functioning.

Front 210

How long must the disturbance last for a diagnosis of Post-Traumatic Stress Disorder?

Back 210

> 1 month

Front 211

How do you treat Post-Traumatic Stress Disorder?

Back 211

- Psychotherapy
- SSRIs

Front 212

What is the term for the symptoms of Post-Traumatic Stress Disorder that last <1 month?

Back 212

Acute Stress Disorder (lasts between 3 days and 1 month)

Front 213

What is the diagnosis in a patient who consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary / external gain?

Back 213

Malingering

Front 214

What does a patient with Malingering do?

Back 214

Consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary / external gain (eg, avoiding work, obtaining compensation)

Front 215

What do malingering patients do regarding treatment / follow-up?

Back 215

- Poor compliance with treatment
- Poor compliance with follow-up of diagnostic tests

Front 216

What happens to a patient with malingering when they get when they wanted?

Back 216

Complaints cease

Front 217

What is the diagnosis in a patient with unexplained symptoms or complaints that are not consciously made up to deceive?

Back 217

Somatoform Disorder

Front 218

What is the diagnosis in a patient with unexplained symptoms or complaints that are consciously made up to deceive with the chief goal being psychological gain?

Back 218

Factitious Disorder

Front 219

What is the diagnosis in a patient with unexplained symptoms or complaints that are consciously made up to deceive with the chief goal being external gain?

Back 219

Malingering

Front 220

What are the types of factitious disorders? Purpose?

Back 220

Done for primary / psychological gain
- Munchausen syndrome
- Munchausen syndrome by proxy

Front 221

What does a patient with a factitious disorder do?

Back 221

Consciously creates physical and/or psychological symptoms in order to assume "sick role" and to get medical attention (1° [internal] gain)

Front 222

What is the chronic factitious disorder with predominantly physical signs and symptoms, characterized by a history of multiple hospital admissions and willingness to receive invasive procedures?

Back 222

Munchausen Syndrome

Front 223

What is the factitious disorder where a child or elderly patient's illness is caused by the caregiver; motivation is to assume a sick role by proxy?

Back 223

Munchausen Syndrome by Proxy (form of child / elder abuse)

Front 224

What are the types of somatoform disorders? Purpose?

Back 224

Physical symptoms with no identifiable physical cause:
- Somatic symptom disorder
- Conversion disorder
- Illness anxiety disorder (hypochondriasis)

Front 225

What are the characteristics of Somatic Symptom and Related Disorders?

Back 225

- Category of disorders characterized by physical symptoms with no identifiable physical cause
- Both illness production and motivation are unconscious drives
- Symptoms not intentionally produced or feigned
- More common in women

Front 226

What disorder causes a variety of complaints in one or more organ systems lasting for months to years? What is it associated with?

Back 226

Somatic Symptom Disorder
- Associated with excessive, persistent thoughts and anxiety about symptoms
- May co-occur with medical illness

Front 227

What disorder causes a sudden loss of sensory or motor function often following an acute stressor?

Back 227

Conversion Disorder (somatoform disorder)

Front 228

What are the symptoms of Conversion Disorder?

Back 228

- Sudden loss of sensory or motor function often following an acute stressor
- Eg, paralysis, blindness, mutism
- Patient is aware of but sometimes indifferent towards symptoms ("la belle indifférence")

Front 229

In whom is Conversion Disorder most common in?

Back 229

- Females
- Adolescents and young adults

Front 230

What disorder is associated with a preoccupation with and fear of having a serious illness despite medical evaluation and reassurance?

Back 230

Illness Anxiety Disorder (Hypochondriasis)

Front 231

What is a personality trait?

Back 231

Enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself

Front 232

What is a personality disorder? By when does it present?

Back 232

- Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/ or impaired functioning; person is usually not aware of problem
- Usually presents by early adulthood

Front 233

How do you remember the three clusters of personality disorders?

Back 233

A, B, and C:
- Weird (paranoid, schizoid, schizotypal)
- Wild (antisocial, borderline, histrionic, narcissistic)
- Worried (avoidant, obsessive-compulsant, dependent)

Front 234

What are the Cluster A personality disorders characterized by? Associated with?

Back 234

Weird: Accusatory, Aloof, Awkward
- Odd or eccentric
- Inability to develop meaningful social relationships
- No psychosis
- Genetic association w/ schizophrenia

Front 235

What are the types of Cluster A personality disorders?

Back 235

- Paranoid
- Schizoid
- Schizotypal

Front 236

What are the Cluster B personality disorders characterized by? Associated with?

Back 236

Wild: Bad to the Bone
- Dramatic, emotional, or erratic
- Genetic association with mood disorders and substance abuse

Front 237

What are the types of Cluster B personality disorders?

Back 237

- Anti-social
- Borderline
- Histrionic
- Narcissistic

Front 238

What are the Cluster C personality disorders characterized by? Associated with?

Back 238

Worried: Cowardly, Compulsive, Clingy
- Anxious or fearful
- Genetic association with anxiety disorders

Front 239

What are the types of Cluster C personality disorders?

Back 239

- Avoidant
- Obsessive-Compulsive
- Dependent

Front 240

Which personality disorder causes pervasive distrust and suspiciousness; projection is the major defense mechanism?

Back 240

Paranoid (Cluster A)

Front 241

Which personality disorder causes voluntary social withdrawal, limited emotional expression, and a contentness with social isolation?

Back 241

Schizoid (Cluster A)

Front 242

Which personality disorder causes eccentric appearance, odd beliefs or magical thinking, and interpersonal awkwardness?

Back 242

Schizotypal (Cluster A)

Front 243

Which personality disorder causes a disregard for and violation of rights of others, criminality, and impulsivity?

Back 243

Antisocial (Cluster B) (if >18 years old)

Conduct Disorder (if <18 years old)

Front 244

In whom is Antisocial Personality Disorder more common?

Back 244

- Males > Females
- Must be >18 yo w/ history of conduct disorder before age 15

Front 245

Which personality disorder causes unstable mood and interpersonal relationships, impulsiveness, self-mutliation, boredom, and a sense of emptiness?

Back 245

Borderline (Cluster B)

Front 246

In whom is Borderline Personality Disorder more common?

Back 246

Females > Males

Front 247

In what personality disorder is splitting a major defense mechanism?

Back 247

Borderline (Cluster B)

Front 248

Which personality disorder causes excessive emotionality and excitability, attention seeking, sexually proactive, and overly concerned with appearance?

Back 248

Histrionic (Cluster B)

Front 249

Which personality disorder causes grandiosity, sense of entitlement, lack of empathy, requires excessive admiration, and often demands the "best" and reacts to criticism with rage?

Back 249

Narcissistic (Cluster B)

Front 250

Which personality disorder causes hypersensitivity to rejection, social inhibition, timid, feelings of inadequacy, and a desire to have relationships with others?

Back 250

Avoidant (Cluster C)

Front 251

Which personality disorder causes a preoccupation with order, perfectionism, and control?

Back 251

Obsessive-Compulsive (Cluster C)
- Ego-syntonic: behavior is consistent with one's own beliefs and attitudes (vs OCD)

Front 252

Which personality disorder causes submissiveness, clinginess, excessive need to be taken care of, and low self-confidence?

Back 252

Dependent (Cluster C)

Front 253

What are the types of "Schizo" disorders? Severity?

Back 253

Schizoid < Schizotypal < Schizophrenic < Schizoaffective

Front 254

What are the characteristics of Schizotypal compared to Schizoid?

Back 254

Schizotypal = Schizoid + Odd thinking

Front 255

What are the characteristics of Schizophrenia compared to Schizotypal?

Back 255

Schizophrenic has greater odd thinking than Schizotypal

Front 256

What are the characteristics of Schizoaffective disorder compared to Schizophrenia?

Back 256

Schizoaffective = Schizophrenic psychotic symptoms + Bipolar or Depressive mood disorder

Front 257

What is the diagnosis for symptoms of schizophrenia that last for less than 1 month?

Back 257

Brief psychotic disorder, usually stress related

Front 258

What is the diagnosis for symptoms of schizophrenia that last for 1-6 months?

Back 258

Schizophreniform disorder

Front 259

What is the diagnosis for symptoms of schizophrenia that last for greater than 6 months?

Back 259

Schizophrenia

Front 260

What disorder is signified by excessive dieting +/- purging with an intense fear of gaining weight, body image distortion, and increased exercise, leading to a body weight well below the ideal?

Back 260

Anorexia Nervosa

Front 261

What is the BMI required for a diagnosis of Anorexia Nervosa?

Back 261

BMI < 18.5 kg/m2

Front 262

What is Anorexia Nervosa associated with?

Back 262

- ↓ Bone density
- Severe weight loss
- Metatarsal stress fractures
- Amenorrhea
- Languo (fine body hair)
- Anemia
- Electrolyte disturbances
- Commonly coexists with depression

Front 263

What causes osteoporosis in Anorexia Nervosa?

Back 263

Decreased estrogen over time

Front 264

What disorder is signified by binge eating +/- purging, often followed by self-induced vomiting or use of laxatives, diuretics, or emetics; with a normal body weight?

Back 264

Bulimia Nervosa

Front 265

What is Bulimia Nervosa associated with?

Back 265

- Parotitis
- Enamel erosion
- Electrolyte disturbances
- Alkalosis
- Dorsal hand calluses from induced vomiting (Russell sign)

Front 266

What is the term for a strong, persistent cross-gender identification with persistent discomfort with one's sex assigned at birth, causing significant distress and/or impaired functioning?

Back 266

Gender Dysphoria

Front 267

What is the term for people with gender dysphoria?

Back 267

Transgender

Front 268

What is the term for people who desire to live as the opposite sex, often through surgery or hormone treatment?

Back 268

Transsexualism

Front 269

What is the term for people who wear clothes of the opposite sex (cross-dressing), not gender dysphoria?

Back 269

Transvestism

Front 270

What are the types of sexual dysfunction disorders?

Back 270

- Sexual desire disorders
- Sexual arousal disorders
- Orgasmic disorders
- Sexual pain disorders

Front 271

What are the types of sexual desire disorders?

Back 271

- Hypoactive sexual desire disorder
- Sexual aversion disorder

Front 272

What are the types of sexual arousal disorders?

Back 272

Erectile Dysfunction

Front 273

What are the types of orgasmic disorders?

Back 273

- Anorgasmia
- Premature ejaculation

Front 274

What are the types of sexual pain disorders?

Back 274

- Dyspareunia
- Vaginismus

Front 275

What is the differential diagnosis for sexual dysfunction?

Back 275

- Drugs
- Diseases
- Psychological

Front 276

What drugs can cause sexual dysfunction?

Back 276

- Anti-hypertensives
- Neuroleptics
- SSRIs
- Ethanol

Front 277

What diseases can cause sexual dysfunction?

Back 277

- Depression
- Diabetes
- STDs

Front 278

What psychological factors can cause sexual dysfunction?

Back 278

Performance anxiety

Front 279

What is the diagnosis for patients with periods of terror with screaming in the middle of the night? What part of the sleep cycle does this occur during?

Back 279

Sleep Terror Disorder
- Occurs during slow-wave sleep (non-REM sleep)

Front 280

Who is more likely to get Sleep Terror Disorder? How do you treat?

Back 280

Children - usually self-limited

Front 281

What is the difference between nightmares and sleep terrors?

Back 281

- Nightmares: REM sleep, w/ memory of scary dream
- Sleep Terrors: non-REM sleep, w/ no memory of arousal

Front 282

What causes / triggers sleep terrors?

Back 282

- Cause unknown

Triggers:
- Emotional stress
- Fever
- Lack of sleep

Front 283

What disease causes disordered regulation of the sleep-wake cycles?

Back 283

Narcolepsy

Front 284

What causes Narcolepsy?

Back 284

↓ Orexin production in lateral hypothalamus

Front 285

What are the symptoms of Narcolepsy?

Back 285

- Primary characteristic: excessive daytime sleepiness
- Hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations
- Nocturnal and narcoleptic sleep episodes that start off with REM sleep
- Cataplexy (loss of all muscle tone following a strong emotional stimulus, such as laughter) in some patients

Front 286

What is "hypnagogic" refer to?

Back 286

Hallucinations that occur just before SLEEP in patients with narcolepsy

GOing to sleep

Front 287

What is "hypnopompic" refer to?

Back 287

Hallucinations that occur just before AWAKENING in patients with narcolepsy

POst-sleep

Front 288

How is the sleep cycle affected by Narcolepsy?

Back 288

Nocturnal and narcoleptic sleep episodes start off with REM sleep

Front 289

What is cataplexy?

Back 289

Loss of all muscle tone following a strong emotional stimulus, such as laughter

Front 290

What is associated with Narcolepsy?

Back 290

Strong genetic component

Front 291

How do you treat Narcolepsy?

Back 291

- Daytime stimulants: amphetamines, modafinil
- Nighttime sodium oxybate (GHB)

Front 292

What are the criteria for a substance use disorder?

Back 292

Maladaptive pattern of substance use defined as 2 or more of the following signs in 1 year:
- Tolerance
- Withdrawal
- Substance taken in larger amounts, or over longer time, than desired
- Persistent desire or unsuccessful attempt to cut down
- Significant energy spent obtaining, using, or recovering from substance
- Important social, occupational, or recreational activities reduced because of substance use
- Continued use in spite of knowing the problems that it causes
- Craving
- Recurrent use in physically dangerous situations
- Failure to fulfill major obligations at work, school, or home due to use
- Social or interpersonal conflicts related to substance use

Front 293

What are the stages of change in overcoming substance addiction?

Back 293

1. Precontemplation
2. Contemplation
3. Preparation / determination
4. Action / willpower
5. Maintenance
6. Relapse

Front 294

What is the first stage in overcoming a substance addiction?

Back 294

Pre-contemplation: not yet acknowledging that there is a problem

Front 295

What is the second stage in overcoming a substance addiction, after pre-contemplation?

Back 295

Contemplation: acknowledging that there is a problem, but not yet ready or willing to make a change

Front 296

What is the third stage in overcoming a substance addiction, after contemplation?

Back 296

Preparation / Determination: getting ready to change behavior

Front 297

What is the fourth stage in overcoming a substance addiction, after preparation / determination?

Back 297

Action / Willpower: changing behaviors

Front 298

What is the fifth stage in overcoming a substance addiction, after action / willpower?

Back 298

Maintenance: maintaining the behavior change

Front 299

What is the sixth stage in overcoming a substance addiction, after maintenance?

Back 299

Relapse: returning to old behaviors and abandoning new changes