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231 Cards in this Set
- Front
- Back
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Classical Conditioning
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Natural response (salivation) elicited by a conditioned/learned stimulus (bell), previously presented in conjunction with an unconditioned stimulus (food); Pavlov's dogs
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Demonstrated by Pavlov's dogs
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Classical conditioning: Learning in which a natural response (salivation) is elicited by a conditioned, or learned, stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food)
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Operant Conditioning
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A particular action is elicited because it produces a reward
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Positive Reinforcement
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Desired reward produces an action
(Mouse presses a button to get food) |
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Negative Reinforcement
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Target behavior (response) is followed by removal of aversive stimulus (mouse presses button to turn off continuous loud noise)
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Punishment
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Repeated application of aversive stimulus extinguishing unwanted behavior
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Extinction
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Discontinuation of reinforcement (positive or negative) eventually eliminates behavior
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Transference
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Patient projects feelings about formative or other important persons onto physician (e.g., a psychiatrist is seen as a parent)
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Countertransference
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Doctor projects feelings about formative or other important persons onto the patient
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Acting out
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Unacceptable feelings & thoughts are expressed through actions. Example: Tantrums
Immature Defense |
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Dissociation
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Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress.
Example: Extreme forms can result in dissociative identity disorder (multiple personality disorder) Immature Defense |
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Denial
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Avoidance of awareness of some painful reality.
Example: Common reaction in newly diagnosed AIDS and cancer patients. Also, denial ain't just a river in Egypt. Immature Defense |
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Displacement
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Processes whereby avoided ideas and feelings are transferred to some neutral person or object (vs. projection).
Example: Mother yells at her child, because her husband yelled at her Immature Defense |
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Fixation
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Partially remaining at a more childish level of development (vs. regression).
Example: Men fixating on sports games Immature Defense |
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Identification
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Modeling behavior after another person who is more powerful (though not necessarily admired).
Example: Abused child identifies himself/herself with an abuser Immature Defense |
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Isolation (of affect)
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Separation of feelings from ideas and events.
Example: Describing murder in graphic detail with no emotional response Immature Defense |
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Projection
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An unacceptable internal impulse is attributed to an external source (vs. displacement).
Example: A man who wants another woman thinks his wife is cheating on him Immature Defense |
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Difference between Displacement and Projection
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Displacement: Avoided ideas/feelings transferred to neutral person/object (mom yells at child b/c husband yelled at her)
Projection: Unacceptable internal impulse attributed to an external source (man wants another woman thinks his wife is cheating on him) |
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Rationalization
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Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame. Example: After getting fired, claiming that the job was not important anyway
Immature Defense |
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Reaction formation
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Process whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite (vs. sublimation). Example: Patient with lustful thoughts enters a church
Immature Defense |
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Regression
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Turning back the maturational clock and going back to earlier modes of dealing with the world (vs. fixation).
Example: Seen in children under stress such as illness, punishment, or birth of a new sibling (e.g., bed-wetting in a previously toilet-trained child when hospitalized) Immature Defense |
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Difference between Fixation and Regression
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Fixation: Partially remaining childish (men and sports)
Regression: Reverting back to earlier ways of dealing with problems (previously potty-trained kid starts wetting bed again when new sibling arrives) |
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Repression
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Involuntary withholding of an idea or feeling from conscious awareness (vs. suppression).
Example: Not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconscious Immature Defense |
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Splitting
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Belief that people are either all good or all bad at different times due to intolerance of ambiguity. Seen in borderline personality disorder.
Example: Patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly Immature Defense |
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Ego defenses
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Unconscious mental processes used to resolve conflict and prevent undesirable feelings (e.g., anxiety, depression)
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Altruism
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Guilty feelings alleviated by unsolicited generosity toward others.
Example: Mafia boss makes large donation to charity Mature Defense |
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Humor
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Appreciating the amusing nature of an anxiety-provoking or adverse situation.
Example: Nervous medical student jokes about the boards Mature Defense |
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Sublimation
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One replaces 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).
Example: Teenager's aggression toward his father is redirected to perform well in sports Mature Defense |
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Difference between Reaction formation and Sublimation
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Reaction formation: Warded-off idea/feeling is replaced by an unconscious emphasis on the opposite (Lusty thoughts goes to church); Immature Defense
Sublimation: Replaces an unacceptable wish with a similar one that doesn't conflict with value system (Teenager aggressive towards father is redirected into sports); Mature Defense |
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Suppression
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Voluntary withholding of an idea or feeling from conscious awareness (vs. Repression).
Example: Choosing not to think about the USMLE until the week of the exam Mature Defense |
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Difference between Repression and Suppression
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Repression: Involuntary withholding an idea/feeling from conscious awareness (not remembering traumatic event); Immature Defense
Suppression: Voluntary withholding idea/feeling from conscious awareness (don't think about USMLE until week of test); Mature Defense |
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Mnemonic for Mature Defenses:
Mature adults wear a SASH |
Sublimation
Altruism Suppression Humor |
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Long-term deprivation of affection towards an infant results in:
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The 4 W's: Weak, Wordless, Wanting (socially), Wary
↓ muscle tone, weight loss Poor language & socialization skills Lack of basic trust Anaclitic depression (infant withdrawn/unresponsive) Physical illness Deprivation > 6 months can → irreversible changes Severe deprivation can result in infant death |
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Associated with the 4 W's: Weak, Wordless, Wanting (socially), Wary
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Long-term deprivation of affection towards an infant
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Child Abuse
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Healed fractures on x-ray, burns (e.g., cigarette, scalding), subdural hematomas, multiple bruises, retinal hemorrhage or detachment
Male caregiver; ~3,000 deaths/year in US, 80% < 3 years old |
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Sexual Abuse
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Genital, anal, or oral trauma; STIs; UTIs
Known to victim, usually Male Peak incidence is 9-12 years of age |
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Child Neglect
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Failure to provide adequate food, shelter, supervision, education, and/or affection; Most common form of child maltreatment
Evidence: Poor hygiene, malnutrition, withdrawal, impaired social/emotional development, failure to thrive |
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ADHD
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Onset < 7 years old; Continues into adulthood in 50%
Hyperactivity, impulsivity, limited attention span in multiple settings Normal intelligence, but commonly coexists with difficulties in school Associated with ↓ frontal lobe volumes Treatment: Methylphenidate, Amphetamines, Atomoxetine, Behavioral interventions (reinforcement, reward) |
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ADHD Treatment
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Methylphenidate, Amphetamines, Atomoxetine, Behavioral interventions (reinforcement, reward)
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Conduct Disorder
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Repetitive and pervasive behavior violating the basic rights of others (e.g., physical aggression, destruction of property, theft)
After 18 years old, many meet criteria for Antisocial Personality Disorder Childhood Disorder |
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Oppositional Defiant Disorder
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Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
Childhood Disorder |
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Tourette's Syndrome
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Onset < 18 years of age; Associated with OCD
Sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist > 1 year Coprolalia (involuntary obscene speech) in only 10-20% Treatment: Anti-psychotics and behavioral therapy Lifetime prevalence of 0.1-1% of general population Childhood Disorder |
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Coprolalia
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Involuntary obscene speech; found in only 10-20% of Tourette's Syndrome patients
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Separation Anxiety Disorder
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Onset 7-9 years old
Overwhelming fear of separation from home/loss of attachment figure May lead to factitious physical complaints to avoid going to or staying at school Treatment: SSRIs and relaxation techniques/behavioral interventions Childhood Disorder |
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Pervasive Developmental Disorders
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Characterized by difficulties with language and failure to acquire or early loss of social skills
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Autistic Disorder
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Severe language impairment, poor social interactions
Greater focus on objects than people Repetitive behavior and usually below-normal intelligence Rarely accompanied by unusual abilities (savants) Boys > Girls Treatment: behavioral and supportive therapy to improve communication and social skills; Medication when appropriate (i.e., disruptive/harmful behavior) |
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Asperger's Disorder
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Milder form of Autistm
All-absorbing interests, repetitive behavior, and problems with social relationships Children are normal intelligence and lack verbal or cognitive deficits No language impairment |
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Rett's Disorder
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X-linked
Almost exclusively in Girls (affected males not compatible with life) Onset of symptoms around 1-4 years old, including regression characterized by loss of development, loss of verbal abilities, mental retardation, ataxia, and stereotyped hand-wringing |
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Childhood Disintegrative Disorder
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Onset 3-4 years old; Boys > Girls
Marked regression in multiple areas of functioning after at least 2 years of apparently normal development Significant loss of expressive or receptive language skills, social skills or adaptive behavior, bowel or bladder control, play, or motor skills |
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Neurotransmitter changes in Anxiety
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↑ NE
↓ GABA, 5-HT |
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Neurotransmitter changes in Depression
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↓ NE, 5-HT, DA
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Neurotransmitter changes in Alzheimer's Dementia
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↓ ACh
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Neurotransmitter changes in Huntington's Disease
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↑ DA
↓ GABA, ACh |
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Neurotransmitter changes in Schizophrenia
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↑ DA
(also see ↓ dendritic branching) |
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Neurotransmitter changes in Parkinson's Disease
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↑ 5-HT, ACh
↓ DA |
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Neurotransmitter change:
↑ NE ↓ GABA, 5-HT |
Anxiety
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Neurotransmitter change:
↓ NE, 5-HT, DA |
Depression
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Neurotransmitter change:
↓ ACh (others all normal) |
Alzheimer's Dementia
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Neurotransmitter change:
↑ DA ↓ GABA, ACh |
Huntington's Disease
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Neurotransmitter change:
↑ DA |
Schizophrenia
(also see ↓ dendritic branching) |
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Neurotransmitter change:
↑ 5-HT, ACh ↓ DA |
Parkinson's Disease
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Orientation
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Patient's ability to know who they are, where they are, and the date and time; Chart: Alert and oriented x 3 (AOx3)
Order of Loss: Time → Place → Person Common causes of loss of orientation: Alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional deficiencies |
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Common causes of loss of orientation
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Alcohol
Drugs Fluid/electrolyte imbalance Head trauma Hypoglycemia Nutritional deficiencies Orientation: patient's ability to know who & where they are, date and time |
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Order of orientation loss
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Lost 1st: Time
2nd: Place Last: Person |
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Retrograde Amnesia
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Inability to remember things occurring before the CNS insult
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Anterograde Amnesia
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Inability to remember things occurring after the CNS insult (no new memory)
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Korsakoff's Amnesia
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Classic Anterograde Amnesia
Caused: Thiamine deficiency and destruction of mammillary bodies May also include some Retrograde amnesia Seen in alcoholics Associated with Confabulations (Medical Dictionary: The unconscious filling of gaps in one's memory by fabrications that one accepts as facts) |
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Dissociative Amnesia
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Inability to recall important personal information, usually subsequent to severe trauma or stress
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Cognitive Disorder
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Significant change in cognition (memory, attention, language, judgement) from previous level of functioning
Associated with CNS abnormalities, a general medical condition, medications, or substance use Includes Delirium and Dementia |
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Delirium
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Delirium = changes in Sensorium
Acute; Waxing and waning level of consciousness Rapid ↓ in attention span and level of arousal Disorganized thinking, hallucinations (often visual), illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction; Abnormal EEG MC inpatient presentation of altered mental status; often reversible Usually secondary (e.g., CNS disease, infection, trauma, substance abuse/withdrawal); Check for drugs with anticholinergic effects |
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Treatment for Delirium
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Identify and address the underlying cause
Optimize brain condition (O2, hydration, pain, etc.) Antipsychotics (mostly Haloperidol) T-A-DA approach (Tolerate, Anticipate, Don't Agitate) helpful for management |
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Dementia
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Gradual ↓ in intellectual ability/cognition w/o affecting level of consciousness
Memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement Dementia can → Delirium (e.g., an Alzheimer's patient who develops pneumonia is at higher risk for delirium) Irreversible; Incidence ↑ with age (in elderly, depression may present like dementia = Pseudodementia) Causes: Alzheimer's disease, cerebral vascular infarcts, HIV, Pick's disease, chronic substance abuse (due to neurotoxicity of drugs), Creutzfeldt-Jakob disease, Normal Pressure Hydrocephalus |
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Causes of Dementia
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Alzheimer's disease
Cerebral vascular infarcts HIV Pick's disease Chronic substance abuse (due to neurotoxicity of drugs) Creutzfeldt-Jakob disease Normal Pressure Hydrocephalus |
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Symptoms: Gradual ↓ in intellectual ability, memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement
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Dementia
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Symptoms: Acute waxing and waning level of consciousness, rapid ↓ in attention span and level of arousal, disorganized thinking, visual hallucinations, illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction, abnormal EEG
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Delirium
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Psychotic Disorder
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Distorted perception of reality (psychosis) characterized by delusions, hallucinations, and/or disorganized thinking
Psychosis can occur in patients with medical illness, psychiatric illness, or both |
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Signs of Psychosis
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Hallucinations
Delusions Disorganized speech |
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Hallucinations
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Perceptions in absence of external stimuli (e.g., seeing a light that is not actually present)
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Delusions
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False beliefs about oneself or others that persist despite the facts (e.g., thinking the CIA is spying on you...hmm...)
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Disorganized speech
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Words and ideas are strung together based on sounds, puns, or "loose associations"
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Difference between Visual and Auditory Hallucinations
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Visual: More commonly a features of medical illness (e.g., drug intoxication) than psychiatric illness
Auditory: More commonly a feature of psychiatric illness (e.g., Schizophrenia) than medical illness |
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Olfactory Hallucination
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Often occur as an aura of psychomotor epilepsy and in brain tumors
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Tactile Hallucination
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Common in alcohol withdrawal (e.g., formication - the sensation of bugs crawling on one's skin)
Also seen in cocaine abusers ("cocaine crawlies") |
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Formication
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Sensation of bugs crawling on skin
Tactile hallucination seen in alcohol withdrawal and cocaine abusers |
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Hypnagogic Hallucination
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Occurs while going to sleep
HypnaGOgic - GOing to sleep |
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Hypnopompic Hallucination
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Occurs while waking from sleep
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Schizophrenia
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Chronic w/ periods of psychosis, disturbed behavior & thought, and decline in functioning that lasts > 6 months
Associated w/ ↑ DA and ↓ dendritic branching Genetics and environment contribute; ↑ risk of suicide Teens: Frequent cannabis use assoc. w/ psychosis/schizophrenia M = F, blacks = whites; Men present late teens-early 20s; late 20s-early 30s in women; 1.5% lifetime prevalence Subtypes: Paranoid, Disorganized, Catatonic, Undifferentiated, Residual |
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Diagnosis of Schizophrenia
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Requires 2 or more of the following:
Delusions (+ symptom) Hallucinations - often auditory (+ symptom) Disorganized speech (loose associations) (+ symptom) Disorganized catatonic behavior (+ symptom) Flat affect (- symptom) Social withdrawal (- symptom) Lack of motivation (- symptom) Lack of speech or thought (- symptom) |
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Brief Psychotic Disorder
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< 1 month, usually stress related
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Schizophreniform Disorder
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1-6 months
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Schizoaffective Disorder
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At least 2 weeks of:
Stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episode 2 subtypes: Bipolar or Depressive |
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5 Subtypes of Schizophrenia
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Paranoid (delusions)
Disorganized (with regard to speech, behavior, and affect) Catatonic (automatisms) Undifferentiated (elements of all types) Residual |
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Delusional Disorder
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Fixed, persistent, nonbizarre belief system lasting > 1 month
Functioning otherwise not impaired Example: a woman who genuinely believes she is married to a celebrity, when she's not Shared psychotic disorder (folie a deux): development of delusions in a person in a close relationship with someone with delusional disorder; often resolves upon separation |
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Shared Psychotic Disorder
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aka: folie a deux
Development of delusions in a person in a close relationship with someone with delusional disorder; often resolves upon separation |
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Dissociative Identity Disorder
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Formerly known as Multiple Personality Disorder (We like the old name better)
Presence of 2 or more distinct identities or personality states F > M Associated with history of sexual abuse |
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Depersonalization Disorder
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Persistent feelings of detachment or estrangement from one's own body, a social situation, or the environment
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Dissociative Fugue
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Abrupt change in geographic location with inability to recall the past, confusion about personal identity, or assumption of a new identity
Associated with traumatic circumstances (e.g., natural disasters, wartime, trauma) Leads to significant distress or impairment (unless you're Jason Bourne) Not the result of substance abuse or general medical condition |
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Mood Disorder
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Abnormal range of moods/internal emotional states & loss of control over them; Severity of moods → distress and impairment in social and occupational functioning; Psychotic features may be present
Includes: Major Depressive Disorder Bipolar Disorder Dysthymic Disorder Cyclothymic Disorder |
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Manic Episode
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Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 1 week. Often disturbing to patient
Dx requires hospitalization or at least 3 of: (manics DIG FAST): Distractibility, Irresponsibility, Grandiosity, Flight of ideas, ↑ in goal-directed Activity/psychomotor Agitation, ↓ need for Sleep, Talkativeness or pressured speech |
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Diagnosis of a Manic episode
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Dx requires hospitalization or at least 3 of (manics DIG FAST):
Distractibility Irresponsibility - seeks pleasure, consequence ignored (hedonistic) Grandiosity - inflated self-esteem Flight of ideas - racing thoughts ↑ in goal-direct Activity/psychomotor Agitation ↓ need for Sleep Talkativeness or pressured speech |
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Mnemonic: DIG FAST
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Dx of manic episode requires hospitalization or at least 3 of:
Distractibility Irresponsibility - seeks pleasure, consequence ignored (hedonistic) Grandiosity - inflated self-esteem Flight of ideas - racing thoughts ↑ in goal-direct Activity/psychomotor Agitation ↓ need for Sleep Talkativeness or pressured speech |
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Hypomanic episode
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Like manic episode except mood disturbance is not severe enough to caused marked impairment in social and/or occupational functioning or to necessitate hospitalization. No psychotic features
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Bipolar disorder
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Defintion: 1+ episodes of manic (bipolar I) or hypomanic (bipolar II)
→ depression eventually. Mood/functioning normal b/w episodes Use of antidepressants can lead to ↑ mania High suicide risk Treatment: Mood stabilizers (e.g., Lithium, Valproic Acid, Carbamazepine), atypical antipsychotics |
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Cyclothymic disorder
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Dysthymia and hypomania - a milder form of bipolar disorder lasting at least 2 years
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Treatment of Bipolar disorder
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Mood stabilizers (e.g., Lithium, Valproic Acid, Carbamazepine), atypical antipsychotics
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Atypical Depression
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Characterized by mood reactivity (can experience improved mood in response to positive events), "reversed" vegetative symptoms (hypersomnia, weight gain), leaden paralysis (heavy feeling in arms and legs), & long-standing interpersonal rejection sensitivity
MC subtype of depression; Treatment: MAOIs, SSRIs |
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Major Depressive Disorder
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Self-limited, major depressive episodes usually lasting 6-12 months
Episodes characterized by at least 5/9 symptoms for 2 or more weeks (Sx must include patient-reported depressed mood or anhedonia and occur more frequently as the disorder progresses): SIG E CAPS: Sleep disturbance; loss of Interest (anhedonia); Guilt or feelings of worthlessness loss of Energy loss of Concentration; Appetite/weight changes; Psychomotor retardation or agitation; Suicidal ideations Lifetime prevalence of MD episode: 5-12% male, 10-25% female |
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Dysthymia
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Milder form of depression lasting at least 2 years
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Seasonal Affective Disorder
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Symptoms associated with winter season; improves in response to full-spectrum bright-light exposure
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SIG E CAPS
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Sleep disturbance, loss of Interest (anhedonia), Guilt or feelings of worthlessness
loss of Energy loss of Concentration, Appetite/weight changes, Psychomotor retardation or agitation, Suicidal ideations Commonly used mnemonic for depression screening. Historically used in prescription writing: SIG is short for signatura (Latin for 'directions'); & depressed patients prescribed Energy CAPsules |
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LICE! GASPS!
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My awesome mnemonic for MDD screening. Surely you would gasp if you had lice...or maybe not if you have anhedonia. Anyway...
Loss of... Interest Energy Concentration Guilt/worthlessness Appetite/weight changes Sleep disturbances Psychomotor retardation/agitation Suicidal ideation |
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Maternal (postpartum) "blues"
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50-85% incidence rate
Characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery Usually resolves within 10-14 days Tx: Supportive; follow-up to assess possible postpartum depression |
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Postpartum Depression
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10-15% incidence
Characterized by depressed affect, anxiety, poor concentration starting within 4 weeks after delivery Lasts 2 weeks to a year or more Tx: Antidepressants, psychotherapy |
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Postpartum Psychosis
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0.1-0.2% incidence
Characterized by delusions, hallucinations, confusion, unusual behavior, and possible homicidal/suicidal ideations or attempts Usually lasts days to 4-6 weeks Tx: Antipsychotics, antidepressants, possible inpatient hospitalization |
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Electroconvulsive Therapy
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Tx option for MDD refractory to o/ Tx & for pregnant women w/ MDD
Also considered when immediate response is necessary (acute suicidality), in depression with psychotic features, and for catatonia Produces a painless seizure in an anesthetized patient Major adverse effects are disorientation and temporary anterograde/retrograde amnesia usually fulling resolving in 6 months |
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Risk Factors for Suicide Completion
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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, widowed, or single, especially if childless) Social support lacking Women try more often; men succeed more often |
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SAD PERSONS
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Risk factors for suicide completion
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, widowed, or single, especially if childless) Social support lacking |
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Anxiety disorder
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Inappropriate experience of fear/worry and its physical manifestations (anxiety) when 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 Lifetime prevalence of 30% in women and 19% in men Includes: Panic disorder, Phobias, OCD, PTSD, GAD |
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Panic disorder
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Defined by presence of recurrent periods of intense fear and discomfort peaking in 10 minutes with at least 4 of (PANICS):
Palpitations/Parasthesias Abdominal distress Nausea Intense fear of dying or losing control/lIghtheadedness Chest pain/Chills/Choking, disConnectedness Sweating/Shaking/Shortness of breath Described in context of occurrence (e.g., panic disorder w/ agoraphobia); Have persistent fear of having another attack; Sx are the systemic manifestations of fear; Strong genetic component; Tx: Cognitive behavioral therapy (CBT), SSRIs, Venlafaxine, Benzodiazepines (risk of tolerance, physical dependence) |
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Treatment for Panic Disorders
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Cognitive behavioral therapy (CBT)
SSRIs Venlafaxine Benzodiazepines (risk of tolerance, physical dependence) |
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Mnemonic for Panic Disorder: PANICS
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Palpitations/Parasthesias
Abdominal distress Nausea Intense fear of dying or losing control/lIghtheadedness Chest pain/Chills/Choking, disConnectedness Sweating/Shaking/Shortness of breath |
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Specific phobia
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Excessive or unreasonable fear, interferes w/ normal function
Cued by presence of anticipation of a specific object or situation Person recognizes fear is excessive Treat with systematic desensitization |
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Social phobia
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Social Anxiety Disorder
Exaggerated fear of embarrassment in social situations (e.g., public speaking, using public restrooms) Treatment: SSRIs |
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Obsessive-Compulsive Disorder
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Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions (compulsions); Associated w/ Tourette's disorder
Treatment: SSRIs, Clomipramine Ego dystonic: behavior inconsistent with one's own beliefs and attitudes (vs. obsessive-compulsive personality disorder) |
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Treatment for OCD
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SSRIs, Clomipramine
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Ego dystonic
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Behavior inconsistent with one's own beliefs and attitudes (vs. obsessive-compulsive personality disorder)
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Post-Traumatic Stress Disorder
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Persistent re-experiencing 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 assoc. w/ the trauma & persistently ↑ arousal
Disturbance lasts > 1 month, w/ onset of symptoms beginning any time after event, causes significant distress &/or impaired function Treatment: Psychotherapy, SSRIs Acute stress disorder - lasts between 2 days and 1 month |
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Acute Stress Disorder
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Lasts between 2 days and 1 month
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Malingering
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Patient consciously fakes or claims to have a disorder in order to attain a specific secondary gain (avoiding work, obtaining drugs)
Poor compliance with treatment or follow-up of diagnostic tests Complaints cease after gain (vs. factitious disorder) |
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Factitious disorder
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Patient consciously creates physical and/or psychological symptoms in order to assume "sick role" and to get medical attention (primary gain)
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Munchausen's Syndrome
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Chronic factitious disorder w/ predominantly physical signs and Sx
Characterized by a history of multiple hospital admissions and willingness to receive inpatient procedures |
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Munchausen's Syndrome by proxy
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When illness in a child or elderly patient is caused by the caregiver.
Motivation is to assume a sick role by proxy. Form of child/elder abuse |
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Difference between Malingering and Factitious disorder
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Malingering - Secondary gain; fakes disorder to obtain drugs, miss work, whatever
Factitious disorder - Primary gain, patient creates fake symptoms to assume "sick role" to get medical attention |
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Somatoform Disorders
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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. F > M
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Somatization Disorder
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Variety of complaints in multiple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over a period of years, developing before 30 years old
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Conversion
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Sudden loss of sensory or motor function (e.g., paralysis, blindness, mutism), often following an acute stressor; patient is aware of but sometimes indifferent toward symptoms ("la belle indifference"); MC in adolescents, & young adults, F > M
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Hypochondriasis
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Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance
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Body Dysmorphic Disorder
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Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning; patients often repeatedly seek cosmetic surgery
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Pain disorder
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Prolonged pain with no physical findings; pain is the predominant focus of clinical presentation and psychological factors play an important role in severity, exacerbation, or maintenance of the pain
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Personality trait
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An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself
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Personality disorder
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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
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Cluster A Personality Disorders
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Odd or eccentric; inability to develop meaningful social relationships. No psychosis; genetic association with Schizophrenia
"Weird" (Accusatory, Aloof, Awkward) Paranoid Schizoid Schizotypal |
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Paranoid
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Pervasive distrust and suspiciousness; projection is the major defense mechanism
Cluster A Personality Disorder |
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Schizoid
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Voluntary social withdrawal, limited emotional expression, content with social isolation (vs. avoidant)
Cluster A Personality Disorder SchizoiD = Distant |
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Schizotypal
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Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
Cluster A Personality Disorder SchizoTypal = magical Thinking |
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Cluster B Personality Disorders
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Dramatic, emotional, or erratic; genetic assoc. w/ mood disorders & substance abuse; "Wild" (Bad to the Bone)
Antisocial Borderline Histrionic Narcissistic |
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Antisocial
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Disregard for and violation of rights of others, criminality
M > F Conduct Disorder if < 18 years old Cluster B Personality Disorder |
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Borderline
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Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, boredom, sense of emptiness
F > M Splitting is a major defense mechanism Cluster B Personality Disorder |
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Histrionic
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Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance
Cluster B Personality Disorder |
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Narcissistic
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Grandiosity, sense of entitlement; lacks empathy and requires excessive admiration; often demands the "best" and reacts to criticism with rage
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Cluster C Personality Disorders
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Anxious or fearful; genetic association with anxiety disorders
"Worried" (Cowardly, Compulsive, Clingy) Avoidant Obsessive-Compulsive Dependent |
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Avoidant
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Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. Schizoid - voluntary social withdrawal, content with social isolation, limited emotional expression)
Cluster C Personality Disorder |
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Difference between Avoidant and Schizoid
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Avoidant: Type C personality disorder; Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others
Schizoid: Type A personality disorder; voluntary social withdrawal, content with social isolation, limited emotional expression |
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Obsessive-compulsive
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Preoccupation with order, perfectionism, and control; ego-syntonic: behavior consistent with one's own beliefs and attitudes (vs. OCD)
Cluster C Personality Disorder |
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Dependent
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Submissive and clinging, excessive need to be taken care of, low self-confidence
Cluster C Personality Disorder |
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Difference between OCD and Obsessive-compulsive
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OCD: Ego-Dystonic ( Behavior INconsistent with ones own beliefs and attitudes); Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by repetitive actions (compulsions)
Obsessive-compulsive: Ego-Syntonic (behavior consistent with one's own beliefs and attitudes); Preoccupation with order, perfectionism, and control; Cluster C Personality Disorder |
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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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Difference between: Schizoid, Schizotypal, Schizophrenic, and Schizoaffective
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Schizoid
Schizotypal = Schizoid + Odd thinking Schizophrenic = Greater odd thinking than schizotypal Schizoaffective = Schizophrenic psychotic symptoms + Bipolar or Depressive Mood Disorder |
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Anorexia Nervosa
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Excessive dieting +/- purging
Intense fear of gaining weight, body image distortion, and ↑ exercise, leading to body weight < 85% of ideal body weight Associated with ↓ bone density Severe weight loss, metatarsal stress fractures, amenorrhea, anemia, and electrolyte disturbances Seen primarily in adolescent girls Commonly coexists with depression |
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Bulimia Nervosa
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Binge eating +/- purging; often followed by self-induced vomiting or use of laxatives, diuretics, or emetics
Body weight often maintained within normal range Parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from induced vomiting (Russell's sign) Seen predominantly in adolescent girls |
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Russell's Sign
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Dorsal hand calluses seen in Bulimia Nervosa from induced vomiting
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Gender Identity Disorder
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Strong, persistent cross-gender identification
Characterized by persistent discomfort with one's sex, causing significant distress and/or impaired functioning TransSEXualism - Desire to live as the opposite SEX, often through surgery or hormone treatment TransVESTism - Paraphilia; wearing clothes (e.g., VEST) of the opposite sex (cross-dressing) |
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Difference between Transsexualism and Transvestism
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TransSEXualism - Desire to live as the opposite SEX, often through surgery or hormone treatment
TransVESTism - Paraphilia; wearing clothes (e.g., VEST) of the opposite sex (cross-dressing) |
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Substance Dependence
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Maladaptive pattern of use defined as 3+ of the following in 1 year:
Tolerance - need more to achieve same effect Withdrawal Substance taken in larger amounts, or over longer time, than desired Persistent desire or unsuccessful attempts to cut down Significant energy spent obtaining, using, or recovering from it Important social, occupational, or recreational activities ↓ b/c of use Continued use in spite of knowing the problems that it causes |
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Substance Abuse
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Maladaptive pattern → clinically significant impairment or distress
Recurrent use resulting in failure to fulfill major obligations at work, school, or home Recurrent use in physically hazardous situations Recurrent substance-related legal problems Continued use in spite of persistent problems caused by use |
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Stages of change in overcoming addition
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1. Precontemplation - not yet acknowledging that there is a problem
2. Contemplation - acknowledge, but not yet ready/willing to change 3. Preparation/determination - getting ready to change behavior 4. Action/willpower - changing behaviors 5. Maintenance - maintaining the behavior choice 6. Relapse - returning to old behaviors & abandoning new changes |
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Depressants
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Intoxication: Nonspecific - mood elevation, ↓ anxiety, sedation, behavioral disinhibition, respiratory depression
Withdrawal: Nonspecific - anxiety, tremor, seizures, insomnia |
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Opioids
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Depressant; Examples: Heroin, morphine, methadone
Intoxication: Euphoria, respiratory and CNS depression, ↓ gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose). Treatment: Naloxone, Naltrexone Withdrawal: Sweating, dilated pupils, piloerection ("cold turkey"), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea ("flu-like" Sx). Tx: long-term support, Methadone, Buprenorphine |
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Alcohol
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Depressant
Intoxication: Emotional lability, slurred speech, ataxia, coma, blackouts. Serum γ-glutamyltransferase (GGT) - sensitive indicator of alcohol use. Lab AST value is twice ALT value. Mild withdrawal: Sx similar to other depressants; Severe withdrawal: Autonomic hyperactivity and DTs. Tx: Benzodiazepines |
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Barbiturates
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Depressant
Intoxication: Low safety margin, marked respiratory depression. Treatment: Symptom management (assist respiration, ↑ BP) Withdrawal: Life-threatening cardiovascular collapse |
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Benzodiazepines
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Depressant
Intoxication: Greater safety margin. Ataxia, minor respiratory depression. Tx: Flumazenil (competitive benzodiazepine antagonist) Withdrawal: Sleep disturbance, depression, rebound anxiety, seizure (severe) |
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Stimulants
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Intoxication: Nonspecific - mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
Withdrawal: Nonspecific - post-use "crash," including depression, lethargy, weight gain, headache |
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Amphetamines
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Stimulant
Intoxication: Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever. Severe: cardiac arrest, seizure Withdrawal: Anhedonia, ↑ appetite, hypersomnolence, existential crisis |
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Cocaine
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Stimulant
Intoxication: Impaired judgement, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death. Treatment: Benzodiazepines Withdrawal: Hypersomnolence, malaise, severe psychological craving, depression/suicidality |
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Caffeine
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Stimulant
Intoxication: Restlessness, ↑ diuresis, muscle twitching Withdrawal: Lack of concentration, headache |
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Nicotine
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Stimulant
Intoxication: Restlessness Withdrawal: Irritability, anxiety, craving. Treatment: nicotine patch, gum, or lozenges; Bupropion/Varenicline |
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PCP
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Hallucinogen
Intoxication: Belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures. Treatment: benzodiazepines, rapid-acting antipsychotic Withdrawal: Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep |
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LSD
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Hallucinogen
Intoxication: Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks |
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Marijuana
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Hallucinogen; Cannabinoid
Intoxication: Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, ↑ appetite, dry mouth, conjunctival injection, hallucinations. Prescription form is dronabinol (tetrahydrocannabinol isomer): used as antiemetic (chemotherapy) and appetite stimulant (in AIDS) Withdrawal: Irritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hours and last for 5-7 days. Generally detectable in urine for 4-10 days |
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Heroin addiction
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Users at ↑ risk for hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis. Look for track marks (needle sticks in veins)
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Methadone
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Long-acting oral opiate; used for heroin detoxification or long-term maintenance
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Naloxone + Buprenorphine
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Partial agonist; long-acting with fewer withdrawal symptoms than methadone. Naloxone is not active when taken orally, so withdrawal symptoms occur only if injected (lower abuse potential)
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Alcoholism
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Physiologic tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs) when intake is interrupted
Complications: alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy |
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Wernicke-Korsakoff Syndrome
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Caused by thiamine deficiency. Triad of Confusion, Opthalamoplegia, and ataxia (Wernicke's encephalopathy)
May progress to irreversible memory loss, confabulation, personality change (Korsakoff's psychosis). Assoc. w/ periventricular hemorrhage/mammillary body necrosis Treatment: IV Vitamin B1 (thiamine) |
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Mallory-Weiss Syndrome
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Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting. Often presents with hematemesis. Associated with pain (vs. esophageal varices)
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Delirium tremens (DTs)
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Life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink. Symptoms in order of appearance:
Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) → Psychotic symptoms (hallucinations, delusions) → Confusion Treatment: Benzodiazepines |
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Treatment for Alcohol withdrawal
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Benzodiazepines
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Treatment for Anxiety
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SSRIs, SNRIs, Buspirone
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Treatment for ADHD
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Methylphenidate, amphetamies
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Treatment for Bipolar Disorder
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"Mood stabilizers" (e.g., Lithium, Valproic acid, Carbamazepine), atypical antipsychotics
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Treatment for Bulimia
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SSRIs
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Treatment for Depression
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SSRIs, SNRIs, TCAs, Buspirone, Mirtazapine (especially with insomnia)
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Treatment for OCD
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SSRIs, Clomipramine
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Treatment for Panic disorder
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SSRIs, Venlafaxine, Benzodiazepines
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Treatment for PTSD
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SSRIs
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Treatment for Social phobias
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SSRIs
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Treatment for Schizophrenia
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Antipsychotics
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Treatment for Tourette's syndrome
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Antipsychotics (e.g., Haloperidol, Risperidone)
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CNS Stimulants
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Methylphenidate, Dextroamphetamine, Methamphetamine
Mechanism: ↑ catecholamines at the synaptic cleft, especially NE and DA Use: ADHD, narcolepsy, appetite control |
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Antipsychotics
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Neuroleptics
Halperidol, Trifluoperazine, Fluphenazine, Thioridazine, Chlorpromazine (haloperidol + the "-azines") MOA: All typical antypsychotics block DA D2 receptors (↑ [cAMP]) Use: Schizophrenia (primarily + symptoms), psychosis, acute mania, Tourette's syndrome Toxicity: Hard to remove from body, Endocrine S/Es, NMS, TD, EPS |
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Neuroleptic Malignant Syndrome
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Associated with Antipsychotics
Rigidity Myoglobinuria Autonomic instability Hyperpyrexia Treatment: Dantrolene, D2 agonists (e.g., bromocriptine) |
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Tardive Dyskinesia
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Sterotypic oral-facial movements as a result of long-term antipsychotic use. Often irreversible
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Side Effects of Antipsychotics
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Highly lipid soluble and stored in the body as fat → very slow to be removed from body
Extrapyramidal System (EPS) side effects (e.g., dyskinesias) Endocrine side effects (e.g., DA receptor antagonism → hyperprolactinemia → galactrorrhea Side effects from blocking muscarinic (dry mouth, constipation), α1 (hypotension), and histamine (sedation) receptors Neuroleptic Malignant Syndrome Tardive Dyskinesia |
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High potency Antipsychotics
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Trifluoperazine
Fluphenazine Haloperidol "Try to Fly High" Neurologic side effects (extrapyramidal system) |
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Low potency Antipsychotics
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Chlorpromazine
Thioridazine "Cheating Thieves are low" Non-neurologic side effects (anticholinergic, antihistamine, and α1-blockade effects) |
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Chlorpromazine vs. Thioridazine side effects
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Chlorpromazine - Corneal deposits
Thioridazine - reTinal deposits |
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Haloperidol side effects
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Neuroleptic Malignant Syndrome
Tardive Dyskinesia |
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Neuroleptic Malignant Syndrome mnemonic: FEVER
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Fever
Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles (Rigidity, myoglobinuria, autonomic instability, hyperpyrexia) |
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Atypical antipsychotics mnemonic
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OLanzapine
CLOZapine QUETIiapine RISPERidone Aripiprazole Ziprasidone It's Atypical for OLd CLOZets to QUIETly RISPER from A to Z or... ZOLA RISPERs QUIETly CLOZE |
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Atypical antipsychotics
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MOA: Varied effects on 5-HT2, DA, and α- and H1-receptors
Use: Schizophrenia - both + and - Sx. Also for Bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette's syndrome Toxicity: Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics |
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Atypical antipsychotics causing significant weight gain
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Olanzapine
Clozapine |
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Clozapine side effects
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Significant weight gain
Agranulocytosis (requires weekly WBC monitoring) Seizure |
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Ziprasidone side effects
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Prolonged QT interval
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Lithium
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MOA: Possibly related to inhibition of Phosphoinositol cascade
Use: Mood stabilizer for bipolar disorder; blocks relapse and acute manic effects; SIADH Toxicity: Tremor, sedation, edema, heart block, hypothyroidism, polyuria (nephrogenic diabetes insipidus), teratogenesis, fetal cardiac defects (Ebstein anomaly & malformation of great vessels) Narrow therapeutic window requires close monitoring of serum levels. Almost exclusively excreted by kidneys; most reabsorbed at proximal convoluted tubules following NA+ reabsorption |
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Lithium Side effects
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LMNOP
Lithium side effects Movement (tremor) Nephrogenic diabetes insipidus hypOthyroidism Pregnancy problems |
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Lithium Toxicity
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(LMNOP)
Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist → nephrogenic diabetes insipidus), teratogenesis Fetal cardiac defects: Ebstein anomaly and Malformation of the great vessels |
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Buspirone
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MOA: Stimulates 5-HT1A receptors
Use: Generalized anxiety disorder No sedation, addiction, or tolerance; Takes 1-2 weeks of take effect; Does not interact w/ alcohol (vs. barbiturates, benzodiazepines) I'm always anxious if the BUS will be ON time, so I take BUSpirONe |
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SSRIs mnenonic
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FLashbacks PARalize SEnior CITizens
Fluoxetine Paroxetine Sertraline Citalopram |
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SSRIs
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MOA: Serotonin-specific reuptake inhibitors. Takes antidepressants 4-8 weeks to have an effect
Use: Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD Toxicity: Fewer than TCAs. GI distress, sexual dysfunction (anorgasmia and ↓ libido); Serotonin Syndrome |
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Serotonin Syndrome
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SS w/ any drug that ↑ 5-HT: MAOIs, SNRIs, SSRIs, TCAs
Hyperthermia Confusion Myoclonus Cardiovascular collapse Flushing Diarrhea Seizures Treatment: Cyproheptadine (5-HT2 receptor antagonist) |
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SNRIs
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MOA: Inhibit 5-HT and NE reuptake
Use: Depression Venlafaxine also used in general anxiety and panic disorders Duloxetine is also indicated for diabetic peripheral neuropathy, and has a greater effect on NE Toxicity: ↑ BP; also stimulant effects, sedation, nausea |
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Tricyclic Antidepressants
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Amitriptyline, Nortriptyline, Imipramine (bed-wetting), Desipramine, Clomipramine (OCD), Doxepin, Amoxapine (-iptyline or -ipramine)
MOA: Block reuptake of NE and 5-HT Tx: MDD, fibromyalgia, bedwetting, OCD Toxicity: Convulsions, Coma, Cardiotoxicity; sedation, postural hypoTN, atropine-like S/Es, respiratory depression, hyperpyrexia; Elderly: confusion, hallucinations Desipramine is less sedating and has lower seizure threshold 3° TCAs (Amitriptyline) > anticholinergic effects than 2° TCAs (Nortriptyline) |
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TCA Toxicity
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Toxicity: Sedation, α1-blocking effects including postural hypotension, and atropine-like (anticholinergic) side effects (tachycardia, urinary retention, dry mouth)
Tri-C's: Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic side effects (use Nortriptyline) Treatment: NaHCO3 for cardiovascular toxicity Desipramine less sedating, lower seizure threshold 3° TCAs (Amitriptyline) > anticholinergic effect than 2° (Nortriptyline) |
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Monoamine oxidase (MAO) inhibitors
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MAO Takes Pride In Shanghai: Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor)
MOA: Nonselective MAO inhibition ↑ amine NTs (NE, 5-HT, DA) Use: Atypical depression, anxiety, hypochondriasis Toxicity: HyperTN crisis (esp. ingesting tyramine in wine, cheese); CNS stimulation; Contraindications: SSRIs, TCAs, St. John's Wort, Meperidine, and Dextromethorphan (to prevent serotonin syndrome) |
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Atypical Antidepressants
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Bupriopion
Mirtazapine Maprotiline Trazodone |
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Bupropion
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Atypical Antidepressant. Also used for smoking cessation.
↑ NE and DA via unknown MOA Toxicity: Stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients No sexual side effects |
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Mirtazapine
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Atypical Antidepressant
α2-antagonist (↑ release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist Toxicity: Sedation (may be desirable in depressed patients with insomnia), ↑ appetite, Weight gain (may be desirable in elderly or anorexic patients), Dry mouth |
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Maprotiline
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Atypical Antidepressant
MOA: Blocks NE reuptake Toxicity: Sedation, orthostatic hypotension |
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Trazodone
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Atypical Antidepressant
MOA: Primarily inhibits 5-HT reuptake Use: Primarily insomnia (high dose req. for antidepressant effect) Toxicity: Sedation, nausea, priapism, postural hypotension Called TrazoBONE due to male-specific side effects |
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Treatment of Alcoholism
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Disulfiram (condition patient to abstain from alcohol), support care
Alcoholics Anonymous/support groups helpful sustaining abstinence |
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Antipsychotic Toxicities
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Highly lipid soluble, stored as fat so very hard to remove from body
Extrapyramidal side effects, Endocrine side effects Side effects from blocking muscarinic, α1, and histamine receptors, Neuroleptic Malignant Symdrome, Tardive Dyskinesia |
