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87 Cards in this Set

  • Front
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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).

Pavlov's classical experiments with dogs—ringing the bell provoked salivation.
Learning in which a particular action is elicited because it produces a reward.
Positive reinforcement—desired reward produces action (mouse presses button to get food).
Negative reinforcement—removal of aversive stimulus elicits behavior (mouse presses
button to avoid shock).
Punishment—application of aversive stimulus extinguishes unwanted behavior.
Extinction—discontinuation of reinforcement eliminates behavior.
Patient projects feelings about formative or other important persons onto physician
(e.g., psychiatrist = parent).
Doctor projects feelings about formative or other important persons onto patient.
Acting out
--Immmature Ego defenses
--Unacceptable feelings and thoughts are expressed through actions.

Ex) Tantrums.
Temporary, drastic change in personality, memory, consciousness, or motor behavior
to avoid emotional stress.

Extreme Forms can result in dissociative identity disorder (multiple personality disorder)
Avoidance of awareness of some painful reality.

Note: A common reaction in newly diagnosed AIDS and cancer patients
Process whereby avoided ideas and feelings are transferred to some neutral personal or object (vs. projection).

Ex) Mother places blame on child because she is angry at her husband.
Partially remaining at a more childish level of development (vs. regression).
Ex) Men fixating on sports games
Modeling behavior after another person who is more powerful (though not necessarily admired).

Ex) Abused child identifies himself/herself as an abuser.
Isolation of Affect
Separation of feelings from ideas and events

Ex) Describing murder in graphic detail with no emotional response.
An unacceptable internal impulse is attributed to an external source.

Ex) A man who wants another woman thinks his wife is cheating on him.
Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame.

Ex) After getting fired, claiming that the job was not important anyways.
Reaction Formation
Process whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite.

Ex) a patient with libidinous thoughts enters a monastery.
Turning back the maturational clock and going back to earlier modes of dealing with the world.

Ex) Seen in children under stress (eg. bedwetting) and in patients on dialysis (eg. crying).
Involuntary withholding of an idea or feeling from conscious awareness. compare to suppression.

Ex) Not remembering a conflictual or traumatic experience, pressing bad thoughts into the unconscious.
Belief that people are either all good or all bad at different times due to intolerance of ambiguity. Seen in borderline personality disorder.

Ex) A patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly.
Mature defense

--Guilty feelings alleviated by unsolicited generosity toward others.
Ex) Mafia boss makes large donation to charity.
Mature Defense
--Process whereby 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.
Ex) Actress uses experience of abuse to enhance her acting.
--Mature Defense
--Voluntary withholding of an idea or feeling from conscious awareness (vs. repression)

Ex) Choosing not to think about the USMLE until the week of the exam.
Conduct disorder
---1 OF 5 childhood and early-onset disorders
---repetitive and pervasive behavior violating social norms (physical aggression, destruction of property, theft). After 18 years of age, diagnosed as antisocial
personality disorder.
Oppositional defiant disorder
------1 OF 5 childhood and early-onset disorders
---enduring pattern of hostile, defiant behavior toward
authority figures in the absence of serious violations of social norms.
Tourette's syndrome
------1 OF 5 childhood and early-onset disorders
----characterized by sudden, rapid, recurrent, nonrhythmic,
stereotyped motor movements or vocalizations (tics) that persist for > 1 year. Lifetime
prevalence of 0.1-1.0% in the general population. Coprolalia (obscene speech) found
in only 20% of patients. Associated with OCD. Onset at < 18 years of age. Treatment:
antipsychotics (e.g., haloperidol).
Separation anxiety disorder
---1 OF 5 childhood and early-onset disorders
---overwhelming fear of separation from home or loss of
attachment figure. May lead to factitious physical complaints to avoid going to school.
Common onset at 7-9 years of age.
Autistic disorder
---1 of 4 Pervasive developmental disorders (characterized by difficulties with language and failure to acquire, or early loss of, social skills).
--severe language impairment and poor social interactions. Greater
focus on objects than on people. Characterized by repetitive behavior and usually
below-normal intelligence. Rarely, may have unusual abilities (savants). More
common in boys. Treatment: behavioral and supportive therapy to improve
communication and social skills.
Asperger's disorder
------1 of 4 Pervasive developmental disorders (characterized by difficulties with language and failure to acquire, or early loss of, social skills).
---a milder form of autism. Characterized by all-absorbing interests, repetitive behavior, and problems with social relationships. Children are of normal intelligence and lack verbal or cognitive deficits. No language impairment.
Rett's disorder
-----1 of 4 Pervasive developmental disorders (characterized by difficulties with language and failure to acquire, or early loss of, social skills).
---X-linked disorder seen almost exclusively in girls (affected males die in utero or shortly after birth). Symptoms usually become apparent starting at ages 1-4,
followed by regression characterized by loss of development, mental retardation, loss
of verbal abilities, ataxia, and stereotyped hand-wringing.
Childhood disintegrative disorder
-----1 of 4 Pervasive developmental disorders (characterized by difficulties with language and failure to acquire, or early loss of, social skills).
---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. Common onset between 3 and 4 years of age. More
common in boys.
Amnesia types
Retrograde amnesia—inability to remember things that occurred before a CNS insult.
Anterograde amnesia—inability to remember things that occurred after a CNS insult (no new memory).
Korsakoffs amnesia—classic anterograde amnesia caused by thiamine deficiency. Leads to bilateral destruction of mammillary bodies. May also lead to some retrograde amnesia. Seen in alcoholics, and associated with confabulations.
Dissociative amnesia—inability to recall important personal information, usually subsequent to severe trauma or stress.
--Waxing and waning level of consciousness with acute onset; rapid in attention span and level of arousal. Characterized by acute with changes in mental status, disorganized
thinking, hallucinations (often visual),
illusions, misperceptions, disturbance
in sleep-wake cycle, cognitive dysfunction.
Usually secondary to other illness (e.g., CNS
disease, infection, trauma, substance abuse/withdrawal).
Most common psychiatric illness on medical
and surgical floors. Abnormal EEG.

--Check for drugs with anti-cholinergic effects. Often reversible.
Gradual in cognition with no change in level of
consciousness. Characterized by memory deficits,
aphasia, apraxia, agnosia, loss of abstract thought,
behavioral/personality changes, impaired
judgment. Patient is alert. No psychotic symptoms.
"r incidence with age. More often gradual onset.
Normal EEG.
Caused by Alzheimer's disease, vascular thrombosis/
hemorrhage (may have acute/subacute onset), HIV,
Pick's disease, substance abuse, CJD.

NOTES: DeMEMtia is characterized by
MEMory loss. Usually irreversible. In elderly patients, depression
may present like dementia (pseudodementia).
Hallucination vs.
illusion vs.
delusion vs.
loose association
Hallucinations—perceptions in the absence of external stimuli (e.g., seeing a light that is not actually present).
Illusions—misinterpretations of actual external stimuli (e.g., seeing a light and thinking that it is the sun).
Delusions—false beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary (e.g., thinking the CIA is spying on you).
Loose associations—disorders in the form of thought (the way ideas are tied together).
Delusional disorder
--Fixed, persistent, nonbizarre belief system lasting > 1 month. Functioning otherwise not impaired. Often self-limited.
--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.
Dissociative identity disorder
--1 of 3 dissociative disorders
--formerly known as multiple personality disorder.
Presence of 2 or more distinct identities or personality states. More common in women. Associated with history of sexual abuse.
Depersonalization disorder
--1 of 3 dissociative disorders
--persistent feelings of detachment or estrangement from
one's own body, a social situation, or the environment.
Dissociative fugue
---abrupt change in geographic location with inability to recall 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. Not the result of substance abuse or general medical condition.
Manic episode
--Distinct period of abnormally and persistently
elevated, expansive, or irritable mood lasting at
least 1 week. Often disturbing to patient.
--Diagnosis requires 3 or more of the following
are present during mood disturbance:
1. Distractibility Maniacs DIG FAST.
2. Irresponsibility—seeks pleasure without
regard to consequences (hedonistic)
3. Grandiosity—inflated self-esteem
4. Flight of ideas—racing thoughts
5. Increased in goal-directed Activity/psychomotor Agitation
6. need for Sleep
7. Talkativeness or pressured speech
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.
Bipolar disorder
Defined by the presence of at least 1 manic (bipolar I) or hypomanic (bipolar II) episode.
Depressive symptoms always occur eventually. Patient's mood and functioning usually
return to normal between episodes. Use of antidepressants can lead to T mania.
High suicide risk. Treatment: mood stabilizers (e.g., lithium, valproic acid,
carbamazepine), atypical antipsychotics.
Cyclothymic disorder—dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years.
Atypical depression
Differs from classical forms of depression. Characterized by hypersomnia, overeating, and
mood reactivity (the ability to experience improved mood in response to positive events
vs. persistent sadness). Associated with weight gain and sensitivity to rejection. Most
common subtype of depression. Treatment: MAO inhibitors, SSRIs.
Maternal (postpartum) blues
50-85% incidence rate. Characterized by depressed affect,
tearfulness, and fatigue. Usually resolves within 10 days. Treatment: supportive.
Follow-up to assess for possible postpartum depression.
Postpartum depression
10-15% incidence rate. Characterized by depressed affect, anxiety, and poor concentration. Lasts 2 weeks to 2 months. Treatment:
antidepressants, psychotherapy.
Postpartum psychosis
--0.1-0.2% incidence rate. Characterized by delusions, confusion, unusual behavior, and possible homicidal/suicidal ideations or attempts. Usually lasts
days to 4-6 weeks. Treatment: antipsychotics, antidepressants, possible inpatient
therapy (ECT)
--Treatment option for major depressive disorder refractory to other treatment. Produces
a painless seizure in an anesthetized patient. Major adverse effects are disorientation and temporary anterograde/retrograde amnesia usually fully resolving in 6 months.
Panic disorder
Defined by the presence of recurrent 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. Strong genetic component.
Treatment: cognitive behavioral therapy
(CBT), SSRIs, TCAs, benzodiazepines
Specific phobia
--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.
--Social phobia (social anxiety disorder)— exaggerated fear of embarrassment in social
situations (e.g., public speaking, using public restrooms). Treatment: SSRIs.
Obsessive Compulsive Disorder
--Recurring, intrusive thoughts, feelings, or sensations (obsessions) that cause severe compulsive distress; relieved in part by the performance of repetitive actions (compulsions). Ego disorder (OCD) dystonic: behavior inconsistent with one's own beliefs and attitudes (vs. obsessive compulsive personality disorder). Associated with Tourette's disorder. Treatment:
SSRIs, clomipramine.
Post-Traumative Stress Disorder
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 INcreased arousal. Disturbance lasts > 1 month, with onset of symptoms beginning anytime after
event, and causes significant distress and/or impaired functioning. Treatment: psychotherapy,
SSRIs. Acute stress disorder—lasts between 2 days and 1 month.
Generalized Anxiety Disorder
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. Treatment: benzodiazepines, buspirone, SSRIs.
Adjustment disorder—emotional symptoms (anxiety, depression) causing impairment
following an identifiable psychosocial stressor (e.g., divorce, illness) and lasting < 6 months (> 6 months in presence of chronic stressor).
Patient consciously fakes or claims to have a disorder in order to attain a specific 2° gain
(e.g., avoiding work, obtaining drugs). Avoids treatment by medical personnel;
complaints cease after gain (vs. factitious disorder).
Munchausen's Syndrome and Munchausen's syndrome by proxy
1 of 2 factitious disorder.
--Patient consciously creates physical and/or psychological symptoms in order to assume
"sick role" and to get medical attention (1° gain).
-chronic factitious disorder with predominantly physical signs
and symptoms. Characterized by a history of multiple hospital admissions and
willingness to receive invasive procedures.
--By PROXY: when illness in a child is caused by the caregiver.
Motivation is to assume a sick role by proxy. Form of child abuse.
Somatization disorder (type of somatoform disorder)
General Somatoform disorders:
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.
1 of 5 somatoform disorders
--variety of complaints in multiple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over a period of years
Conversion disorder (type of somatoform disorder)
General Somatoform disorders:
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.
1 of 5 somatoform disorders
Conversion—sudden loss of sensory or motor function (e.g., paralysis, blindness,
mutism), often following an acute stressor; patient is aware of but indifferent
toward symptoms ("la belle indifference"); more common in adolescents and
young adults
Hypochondriasis (type of somatoform disorder)
General Somatoform disorders:
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.
1 of 5 somatoform disorders
Hypochondriasis--preoccupation with and fear of having a serious illness despite medical evaluation and reassurance
Body dysmorphic disorder (type of somatoform disorder)
--General Somatoform disorders:
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.
--1 of 5 somatoform disorders
--preoccupation with minor or imagined defect in
appearance, leading to significant emotional distress or impaired functioning; patients often repeatedly seek cosmetic surgery
Pain disorder (type of somatoform disorder)
--General Somatoform disorders:
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.
--1 of 5 somatoform disorders
--Pain disorder—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.
Cluster A personality Disorders
Odd or eccentric; inability to develop meaningful
social relationships. No psychosis; genetic
association with schizophrenia.
1. Paranoid—pervasive distrust and suspiciousness;
projection is major defense mechanism
2. Schizoid—voluntary social withdrawal, limited
emotional expression, content with social
isolation (vs. avoidant)
3. Schizotypal— eccentric appearance, odd beliefs
or magical thinking, interpersonal awkwardness
Cluster B personality disorders
Dramatic, emotional, or erratic; genetic association
with mood disorders and substance abuse.
1. Antisocial—disregard for and violation of rights
of others, criminality; males > females; conduct
disorder if < 18 years
2. Borderline—unstable mood and interpersonal
relationships, impulsiveness, self-mutilation,
boredom, sense of emptiness; females > males;
splitting is a major defense mechanism
3. Histrionic— excessive emotionality and
excitability, attention seeking, sexually
provocative, overly concerned with appearance
4. Narcissistic —grandiosity, sense of entitlement;
lacks empathy and requires excessive admiration;
often demands the "best" and reacts to criticism
with rage
Cluster C personality disorders
Anxious or fearful; genetic association with anxiety
1. Avoidant—hypersensitive to rejection, socially
inhibited, timid, feelings of inadequacy,
desires relationships with others (vs. schizoid)
2. Obsessive-compulsive—preoccupation with
order, perfectionism, and control; ego syntonic:
behavior consistent with one's own beliefs and
attitudes (vs. OCD)
3. Dependent—submissive and clinging,
excessive need to be taken care of, low
Anorexia nervosa
excessive dieting +1– purging; intense fear of gaining weight, body
image distortion, and "r 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.
Bulimia nervosa
binge eating +/– purging; followed by self-induced vomiting or use
of laxatives, diuretics, or emetics. Body weight often maintained within normal range.
Associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal
hand calluses from inducing vomiting (Russell's sign).
Gender Identity Disorder
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 (vest) of the opposite sex (cross-dressing).
Stages of change in overcoming substance addiction
1. Precontemplation—not yet acknowledging that there is a problem.
2. Contemplation—acknowledging that there is a problem, but not yet ready or willing to make a change.
3. Preparation/Determination—getting ready to change behavior.
4. Action/Willpower—changing behaviors.
5. Maintenance—maintaining the behavior change.
6. Relapse—returning to old behaviors and abandoning new changes.
(Intoxication and withdrawl)
--CNS depressant
--Intoxication: Emotional lability, slurred speech, ataxia,
coma, blackouts. Serum. y-glutamyltransferase (GGT) — sensitive indicator of alcohol use Lab AST value
is twice ALT value. Treatment: naltrexone.
--Withdrawl: Mild alcohol withdrawal: symptoms similar
to other depressants. Severe alcohol
withdrawal: DTs. Treatment for DTs:
Opioids (e.g.,
---CNS depressant
---Intoxication: CNS depression, nausea and vomiting,
constipation, pupillary constriction (pinpoint pupils), seizures (overdose is life-threatening). Treatment: naloxone,
---Withdrawl: Sweating, dilated pupils, piloerection ("cold
turkey"), fever, rhinorrhea, nausea,
stomach cramps, diarrhea ("flulike"
symptoms). Treatment: symptomatic.
---CNS depressant
Intoxication: Low safety margin, marked respiratory
depression. Treatment: symptom
management (assist respiration, increased BP).
Withdrawl: Delirium, life-threatening cardiovascular
---CNS depressant
Intoxication: Greater safety margin. Ataxia, minor
respiratory depression. Treatment:
flumazenil (competitive GABA antagonist).
Withdrawl: NONE listed
CNS stimulant
Intoxication: Impaired judgment, pupillary dilation,
prolonged wakefulness and attention,
delusions, hallucinations, fever.
Withdrawl: Stomach cramps, hunger, hypersomnolence.
---CNS stimulant
---Intoxication: Impaired judgment, pupillary dilation,
hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death. Treatment: benzodiazepines.
Withdrawl: Suicidality, hypersomnolence, malaise,
severe psychological craving.
CNS stimulant
-INtoxication: Restlessness, T diuresis, muscle twitching.
--Withdrawl: None
CNS stimulant
--Intoxication: Restlessness
Withdrawl: Irritability, anxiety, craving. Treatment:
nicotine patch, gum, or lozenges;
PCP (phencyclidine)
1 of 3 hallucinogens
--Intoxication: Belligerence, impulsiveness, fever,
psychomotor agitation, vertical and
horizontal nystagmus, tachycardia,
homicidality, psychosis, delirium.
---Withdrawl: Depression, anxiety, irritability, restlessness,
anergia, disturbances of thought and sleep.
1 of 3 hallucinogens
---Intoxication: Marked anxiety or depression, delusions,
visual hallucinations, flashbacks,
pupillary dilation.
No withdrawl
1 of 3 hallucinogens
---Intoxication: Euphoria, anxiety, paranoid delusions,
perception of slowed time, impaired
judgment, social withdrawal, "increased appetite,
dry mouth, hallucinations.
---WIthdrawl: Irritability, depression, insomnia, nausea,
anorexia. Most symptoms peak in 48 hours
and last for 5-7 days. Can be detected in
urine up to 1 month after last use.
Heroin addiction
Users at increased risk for hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided
endocarditis. Look for track marks (needle sticks in veins).
Methadone—long-acting oral opiate; used for heroin detoxification or long-term maintenance.
Suboxone—naloxone + buprenorphine (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).
Delirium Tremens (DTs)
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.
Alcohol withdrawal

Methylphenidate (Ritalin)
Amphetamines (Dexedrine)
Bipolar disorder
"Mood stabilizers":
Valproic acid
Atypical antipsychotics
Tourette's syndrome
Antipsychotics (haloperidol)
Social phobias
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