Psych

Front 1

Anhedonia

Back 1

Absence of interest in or pleasure from performance of acts that would ordinarily be enjoyable “A-” – without “hedon” – pleasure (for example, a hedonist is someone who is motivated by a desire for sensual pleasures)

Front 2

Anxiolytic

Back 2

Medicine designed to treat anxiety Example: Benzodiazepine From “-lysis” meaning to dissolve and “Anxius” meaning uneasy troubled mind

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Dissociation

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An unconscious separation of a group of mental processes from the rest of the conscious awareness

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Executive

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functioning Higher levels of cognitive/mental functioning Includes: -Planning -Abstraction-a generalized idea or theory developed from concrete examples of events-Inductive reasoning-It is commonly construed as a form of reasoning that makes generalizations based on individual instances -Organizing

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Mood

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Pervasive feeling, tone or internal emotional state which, when impaired, can markedly influence virtually all aspects of a person’s behavior or perception of external events.

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Mood

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This is what a person feels – the person may have a sad mood. Affect is how the person appears to you – i.e a person may feel down inside but appear happy to those around.

Front 7

Narcissism

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A state in which the individual interprets and regards everything in relation to himself and not to other persons or things Extreme self love with decreased or inability to love or have concern for others

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Paranoid

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A belief system that includes extreme suspiciousness and mistrust of others and may involve persecutory delusions – the belief that others are out to get you – poison, harm, follow, etc The person’s personality is otherwise intact

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Stressor

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Any event or situation that induces psychological, emotional or behavioral distress

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Dysomnia

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Disturbance in amount, quality or timing of sleep

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Insomnia

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Inability to fall asleep or stay asleep in absence of external impediments during the period when sleep should occur

Front 12

Psychomotor changes Psychomotor agitation

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Abnormal increase in physical and emotional behavior – seen in anxiety and schizophrenia

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Psychomotor retardation

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Abnormal slowing in physical and emotional activity – seen in depression

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Psychosis Syndrome

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consisting of one or more of the following symptoms: delusions, hallucinations, disorganized speech/thought/behavior, and disorder of executive functioning; Mental and behavioral disorder causing gross distortion or disorganization of a person’s mental capacity, affective response and capacity to recognize reality, communicate and relate to others to the degree of interfering with the person’s capacity to cope with ordinary demands of everyday life

Front 15

Impulse

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Sudden pushing or driving force Sudden, often unreasonable, determination to perform some act, the performance of which often provides a sense of relief or a release of tension

Front 16

Compulsion

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Uncontrollable impulses to perform an act, often repeatedly, as an unconscious mechanism to avoid unacceptable ideas or desires, which by themselves arouse anxiety Anxiety becomes fully manifest if performance of act is prevented – may be associated with obsessive thought

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Obsession

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Uncontrollable impulses to perform an act, often repeatedly, as an unconscious mechanism to avoid unacceptable ideas or desires, which by themselves arouse anxiety Anxiety becomes fully manifest if performance of act is prevented – may be associated with obsessive thought

Front 18

PTSD Essentials of Diagnosis

Back 18

Symptoms, such as flashbacks, intrusive images, nightmares, re-experiencing the event. Avoidance symptoms, numbing, social withdrawal, avoidance of stimuli associated with event. Increased vigilance, startle response, difficulty sleeping. Symptoms impair functioning.

Front 19

General Considerations

PTSD

Back 19

is more common when associated with physical injury. Problems like divorce, parenting problems, legal problems and substance use are common.

Front 20

Physical Findings

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Physiologic hyperarousal Increasing startle response Intrusive thoughts Illusions Sleep problems nightmares. Dreams about event Difficulties in concentration Hyperalertness Avoidance of situations resembling the event

Front 21

Symptoms frequently arise after a_______

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long latency period

Front 22

Differential Diagnosis

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Anxiety Disorders Affective Disorders Personality Disorders Somatic Disorders

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Treatment of PTSD

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Psychotherapy should be initiated as soon as possible after the event. Debriefing in a single session in now found to be ineffective. PTSD’s respond to interventions that help patients integrate the event in an adaptive way with some sense of mastery in having survived the trauma.

Front 24

Early cognitive behavioral therapy has been shown to speed recovery. Referral sources for marriage counseling are important. Treatment initiated later should include programs for alcohol and drug abuse treatment

Back 24

TRUE

Front 25

Medication for PTSD

Back 25

Beta-Blockers (propranolol 80-160mg) for treatment of anxious arousal. SSRIs in full dosage are helpful in ameliorating depression, panic attacks, sleep disruption, and startle response

Front 26

Prognosis

Back 26

The sooner therapy is initiated after the trauma, the better the prognosis. Treatment reduces duration of symptoms from an average of 64 months to 32 months Half of patients experience chronic symptoms.

Front 27

Prognosis is best in patients with good premorbid psychiatric functioning

Back 27

TRUE

Front 28

Essentials of diagnosis for

Anorexia Nervosa

Back 28

Disturbance of body image and intense fear of becoming fat. Weight loss leading to body weight 15% below expected In females, absence of three consecutive menstrual cycles

Front 29

Essential of diagnosis for

Bulimia Nervosa

Back 29

Uncontrolled episodes of binge eating at least twice weekly for 3 months Recurrent inappropriate compensation to prevent weight gain such as self-induced vomiting, laxatives, diuretics, fasting, or excessive exercise Overconcern with weight or body shape

Front 30

Anorexia Nervosa Begins between

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adolescence and young adulthood.

Front 31

90% of patients are

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female Patients

Front 32

Patients characteristically come from a family whose members are highly goal and achievement oriented.

Back 32

TRUE

Front 33

Anorexia Nervosa Parents are often overly directive and concerned with slimness and physical fitness.
Patients are commonly perfectionistic in behavior and exhibit obsessional personality characteristics.

Back 33

TRUE

Front 34

Bulimia Nervosa Episodic

Back 34

uncontrolled ingestion of large quantities of food followed by recurrent inappropriate compensatory behavior to prevent weight gain. Predominantly a disorder of young, white, middle and upper class women Difficult to detect

Front 35

Physical Findings of Anorexia

Back 35

Severe emaciation, Cold intolerance or constipation, Amenorrhea, Bradycardia, Hypotension. Exam demonstrates loss of body fat, dry and scaly skin, increased lanugo body hair. Parotid enlargement and edema may also occur

Front 36

Physical Findings of Bulimia

Back 36

Consuming large quantities of high calorie food in secrecy. May have several episodes a day. Binge eating following by compensatory behavior with feelings of guilt or depression Body weight is generally within 20% of desirable weight

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Menstruation is normally preserved but may also have cryptic forms of anorexia. Family and psychological issues are generally similar to those with anorexia Premorbid obesity is much higher in Bulimics.

Back 37

TRUE

Front 38

Poor dentition, pharyngitis, esophagitis and electrolyte abnormalities are common.

Back 38

TRUE

Front 39

Differential Diagnosis

Back 39

Mainly exclusion of medical disorders that would account for the weight loss Endocrine and metabolic disorders Hyperthyroidism Chronic infections

Front 40

Treatment for Anorexia Nervosa

Back 40

Goal is to restore normal body weight. Resolution of Psychological factors Hospitalization may be necessary Treatment programs.

Front 41

2-6% of patients die or commit suicide

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TRUE

Front 42

Treatment for Anorexia Nervosa

Back 42

Structured behavioral therapy,

intensive psychotherapy,

and family therapy.

Tricyclic antidepressants,

SSRIs Severe malnutrition must be hemodynamically stabilized

Front 43

Treatment for Bulimia Nervosa

Back 43

Supportive care and psychotherapy Individual, group, and family behavioral therapy SSRIs

Front 44

When to refer/admit

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Unexplained weight loss Diagnosed issue should be managed by psychiatrist Signs of hypovolemia, electrolyte disorders, sever protein malnutrition Failure in outpatient therapy should be admitted

Front 45

Substance Abuse

Essential of Diagnosis

Back 45

Compulsive drug use leading to: 1-Psychological dependence or craving and the behavior involved in procurement 2-Physiologic dependence, with withdrawal symptoms on discontinuence

Front 46

Psychological dependence equal to____

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craving and the behavior involved in procurement

Front 47

Physiologic dependence equals to

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withdrawal symptoms on discontinuance

Front 48

Dependency

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is a function of the amount of drug used and the duration of usage

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Tolerance

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the need to increase the dose to obtain the desired effects

Front 50

Frequency of use is usually daily and duration is inevitably greater than______

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2-3 weeks

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Polydrug abuse is very common Transgenerational continuity of drug abuse is also common.

Back 51

TRUE

Front 52

Drug abuse can produce ______and made manifest_____

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damaged neurotransmitter receptor sit.

mood swings, panic, psychosis, and overt seizure activity.

Front 53

Clinician faces three major problems when it comes to substance abuse. what are they?

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1-prescribing substances such as opioids, sedatives, stimulants, might produce dependency

2-treatment of individuals who have already abused drugs, most commonly alcohol
3- the detection of illicit drug use in patients presenting with psychiatric symptoms. Usefulness or urinalysis for detection varies.

Front 54

Urinalysis detects Alcohol /opiod____after use

and Barbiturates____chronic marijuana users in _______

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- in a day or so
Barbiturates-several days,

1-2 months in chronic marijuana users.

Front 55

Physiologic dependence as manifested by evidence of withdrawal when intake is interrupted Tolerance to the effects of alcohol

Back 55

TRUE

Front 56

Evidence of alcohol-associated illnesses, such as alcoholic liver disease, cerebellar degeneration.
Continued drinking despite strong medical and social contraindications and life disruptions Impairment in social and occupational functioning

Back 56

Physiological dependence manifestation

Front 57

Depression, Alcohol Blackouts, Stigmas-Odor on breath, flushed face, tremor Unexplained work absences Frequent accidences of vague origin are all signs and symptoms of_____

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Alcohol dependent

Front 58

Alcoholism is a syndrome of two phases:

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1-problem drinking – done often to alleviate anxiety or solve other emotional problems 2-alcohol addiction-similar to that which occurs following the repeated use of other sedative- hypnotics

Front 59

Majority of suicides and intrafamily homicides involve alcohol Alcohol is a major factor in rapes and other assaults

Back 59

TRUE

Front 60

CAGE questionnaire is a useful screening instrument

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TRUE,

CUT, ANNOYED, GUILT, EYE OPENER

Front 61

Acute alcohol intoxication .

Back 61

Drowsiness, errors of commision, psychomoter dysfuction, disinhibition, dysarthria, ataxia, and nystagmus

Front 62

For a 70kg person, 12 oz bottle of beer, 4-6 oz of wine, or 1 oz of whiskey will raise BAC to

Back 62

25 mg/dL.

Front 63

Below 50 mg/dL rarely cause significant motor dysfunction.

Back 63

TRUE

Front 64

Vomiting indicates levels of .

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150 mg/dL plus

Front 65

Acute alcohol intoxication Lethal levels of BAC range between

Back 65

350 to 900 mg/dL.

Front 66

Severe case overdosage is marked by-

Back 66

respiratory depression, stupor, seizures, shock syndrome, coma, and death. Frequently overdoses are due to use with other sedatives.

Front 67

Alcohol Withdrawal Mild

Back 67

- tremor, elevated vital signs, anxiety These begin 8 hours after the last drink and usually pass by day 3.

Front 68

Seizures can occur within

Back 68

24-38 hours

Front 69

Alcohol Withdrawal Severe include

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Delerium Tremens- acute organic psychosis characterized by mental confusion, tremor, sensory hyperactivity, visual hallucinations (snakes, bugs), autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances.

Front 70

Suspect alcohol withdrawal in every unexplained delirium Mortality rates can be improved with early diagnosis

Back 70

TRUE

Front 71

Alcohol Abuse Treatment

Psychological-

Back 71

The problem of denial must be faced, most easily done with family members present. Identify enabling from others which allows alcoholic to avoid facing consequences of behavior

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Alcohol Abuse Treatment

Social-

Back 72

Alcoholics Anonymous, religious counseling. Alcoholics are often dependant people so do not underestimate the importance of religion. Fear of losing a job can be a powerful motivation to stop drinking.

Front 73

Alcohol Abuse Treatment Medical

Back 73

- Do a complete physical exam Special attention to lab tests like the LFT Disulfiram has been used for many years as an aversion drug to discourage use. Naltrexone has been helpful in lowering relapse rates.
Benzodiazepines is important to counteract the excitability resulting from sudden cessation of intake. Diazepam 20 mg orally initially, decreasing by 5 mg daily

Front 74

Treatment of Alcohol withdrawal

Severe

Back 74

withdrawal may indicate intravenous therapy Alenolol, as an adjunct to benzos can reduce symptoms of alcohol withdrawal. Meticulous examination for other medical problems is necessary.

Front 75

Cannabis AKA marijuana

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- hemp plant that is normally smoked to produce a high. Usually inhaled by smoking
Effects can occur within 10-20 minutes

Front 76

“joints” of good quality can have about_____

Back 76

5-15 mg of tetrahydrocannabinol (THC).

Front 77

Cannabis With moderate dosage it produces two phases.

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1- mild euphoria followed by sleepiness

2- acute state- altered perception of time, less inhibited emotions, psychomotor problems, impaired immediate memory, conjunctival injection.

Front 78

Cannabis treatment

Back 78

No specific treatment is necessary unless someone has a “bad trip”. Can also affect motor performance Long term use results in similar abnormalities for those who smoke cigarettes. Also low sperm counts in males and possible abnormal menstration in females.

Front 79

Cocaine/Amphetamine

Back 79

Stimulant use is quite common either alone or in combination with abuse of other drugs. Amphetamines include- speed, ice which is smoked, methylphenidate, and phenmetrazine under prescription control but street availability is high.

Front 80

Cocaine Usage produces____

Back 80

hyperactivity, a sense of enhanced physical and mental capacity Sweating, tachycardia, elevated blood pressure, mydriasis, hyperactivity. Tolerance can develop quickly.

Front 81

Cocaine hydrochloride is the salt and most commonly used form. “Crack” is a purer and stronger derivative of cocaine.

Back 81

TRUE

Front 82

Snorting cocaine will act in 2-3 minutes and last about an hour. This can eventually lead to tissue necrosis and septal perforation. Intravenous use is effective in about 30 seconds and produces a high that lasts about 15 minutes

Back 82

TRUE

Front 83

Cocaine/Amphetamine treatment

Back 83

1.5 mg of bromocriptine orally TID alleviates some of the craving associated with acute cocaine withdrawal.

Front 84

Cocaine/Amphetamine Approaches to treatment should be based off of the Alcoholics Anonymous model. Hospitalization may be required if self-harm or violence toward others is perceived.

Back 84

TRUE

Front 85

Essentials of Diagnosis of Mood Disorder

Back 85

Mood varies from mild sadness to intense feelings of guilt, worthlessness, and hopelessness. Difficulty in thinking, including inability to concentrate and lack of decisiveness Loss of interest , with diminished involvment in work and recreation.

Front 86

Somatic complaints such as headache, excessive sleep, loss of energy, change in appetite, decreased sexual drive. Anxiety In some severe depressions: psychomotor agitation or retardation, Delusions, withdrawal from activities are also diagnosis of mood disorder

Back 86

TRUE

Front 87

Adjustment Disorder with Depressed Mood: This may occur in reaction to some identifiable stressor or adverse life situation.

Back 87

Usually a loss of a person by death, divorce, financial reversal, or loss of an established role.

Front 88

Anger is frequently associated with the loss and this turns into feeling of guilt. Occurs within 3 months of the stressor and causes significant impairment in social or occupational functioning

Back 88

TRUE

Front 89

General complaint of depression

Back 89

Loss of interest and pleasure in, withdrawal from activities, feelings of guilt, inability to concentrate, some cognitive dysfunction, anxiety, chronic fatigue, feelings of worthlessness, loss of sexual drive, and thoughts of death.

Front 90

General Considerations of Mania:

Back 90

Characterized by elation with hyperactivity. Over involvement in life activities. Increased irritability Flight of ideas Easy distractibility
Little need for sleep Overenthusiastic mood usually attracts others but the irritability and mood liability that swings into depression can create interpersonal difficulties. Excessive spending Sexual acting out

Front 91

Exhibitionistic behavior These feelings can last

Back 91

several days to several months

Front 92

Bipolar disorders consist of

Back 92

episodic mood shifts into mania, major depression, hypomania, and mixed mood states.

Front 93

Treatment of Mood Disorders:

Back 93

Drug therapy is usually suggested by a family history of major depression in first degree relatives or a past personal history. SSRIs: bupropion, duloxetine, venlafaxine, nefazodone TCAs MAO inhibitors

Front 94

Hospitalization is necessary if suicide is a major consideration or if complex modalities are required. Early suicidality in antidepressant treatment is possible so patients should be followed closely.

Back 94

TRUE

Front 95

Treatment of Mood Disorders: For Mania:

Back 95

Lithium Atypical Neuroleptics High potency benzodiazepines Haloperidol for behavioral control, 5-10mg

Front 96

Prognosis of Mood Disorders:

Back 96

Major affective disorders usually respond well to a full trial of drug treatment Patient adherence to treatment can often be challanging in Mania and bipolar disorder

Front 97

Essentials of Diagnosis for Anxiety Disorders

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Subsequent symptoms of anxiety or depression commonly elicited by similar stress of lesser magnitude Alcohol and other drugs are commonly used in self-treatment

Front 98

General Considerations for Anxiety Disorders

Back 98

When adaptive capacity of an individual is overwhelmed by events. STRESS EXISTS. Remember that stress is defined subjectively Response to stress is a function of a person’s personality and physiologic environment

Front 99

Clinical findings for Anxiety Disorders

Back 99

Reaction to stress is manifested as anxiety or depression. Development of a physical symptom like running away, having a drink, starting an affair. Common subjective responses include fear, rage, guilt, and shame. Inability to concentrate Restlessness, irritability, fatigue, tension Maladaptive response to stress is called adjustment disorder

Front 100

Treatment for Anxiety Disorders Behavioral:

Back 100

Stress reduction techniques for immediate symptom reduction (re-breathing into a paper bag). Early removal from the stress source before full blown symptoms appears. Often behavioral approaches are used in conjunction with medication. Desensitization Physiologic symptoms in panic attacks respond well to relaxation training.

Front 101

Treatment for Anxiety Disorders Social:

Back 101

Squash any denial system that may obscure the issue. Ensure clarification of the problem, this allows patient to view it with in proper context and facilitates the sometimes difficult decisions the patient must make. Treatment for Anxiety Disorders

Front 102

Treatment for Anxiety disorder

Psychological:

Back 102

In depth psychotherapy is seldom necessary. Supportive therapy with emphasis on the here and now and strengthening coping mechanisms. Group therapy is treatment of choice for social anxiety.

Front 103

Treatment for Anxiety Disorders
Medical:

Back 103

Sedatives (laraazepam, 1-2 mg orally daily) for a limited time. Medications should be used for a limited time

Front 104

Generalized Anxiety Disorder This is the most common of the clinically significant anxiety disorders. Manifestations generally appear between age

Back 104

20 and 35 years.

Front 105

Generalized Anxiety Disorder Symptoms include:

Back 105

anxiety, symptoms of apprehension, worry, irritability, difficulty in concentrating, insomnia, and somatic complaints. Symptoms are present for at least 6 months. Focus of anxiety can be about a number of activities.

Front 106

Generalized Anxiety Disorder Treatment

Back 106

Benzodiazapines are the anxiolytics of choice in the acute management of GAD. These are almost immediately effective. Diazepam is the most popular drug, 5-10 mg orally twice daily. Antidepressants are first line for long term treatment.

Front 107

Panic Attacks Treatment

Back 107

Sublingual dose of lorazepam or alprazolam is effective for urgent treatmeant. SSRIs are drugs of choice for sustained treatment. Benzodiazepines generally not used due to the chronicity of the disorder and the danger of dependency.

Front 108

Anxiety Disorders Prognosis

Back 108

Usually longstanding and difficult to treat All can be relieved to varying degrees with medications and behavioral techniques.

Front 109

Diagnostic Criteria and Disposition of: Schizophrenia and Psychosis
Essentials of Diagnosis

Back 109

Social withdrawal, usually slowly progressive, often with deterioration in personal care. Loss of ego boundaries, with inability to perceive oneself as a separate entity. Auditory hallucinations, often of a derogatory nature Delusions, frequently of a grandiose or persecutory nature. Symptoms of at least 6 months duration

Front 110

Flat affect and rapidly alternating mood shifts Hypersensitivity to environmental stimuli Concrete thinking with inability to abstract Impaired concentration worsened by hallucinations and delusions Depersonalization, wherein one behaves like a detached observer of one’s own actions. are also diagnosis of_____

Back 110

Schizophrenia and Psychosis

Front 111

General Considerations

Back 111

These syndromes are manifested by massive disruption of thinking, mood, and overall behavior. It is believed that there are mutifactual casues, with genetic, environmental, and neurotransmitter components.

Front 112

Schizophrenic symptoms have been classified into positive and negative categories

Back 112

Positive Symptoms: hallucination, delusions, and formal thought disorders

Negative symptoms include: diminished sociability, restricted affect, and poverty of speech.

Front 113

Schizophrenic Disorders Subdivided on the basis of certain prominent phenomena.

Examples include:

Back 113

Disorganized type Catatonic type
Schizophrenic Disorders Paranoid type Undifferentiated type Residual type

Front 114

Delusional Disorders

Back 114

Psychoses with the predominant symptoms are persistent nonbizarre delusions with minimal impairment of daily functioning. Hallucinations not present

Front 115

Delusional themes include

Back 115

paranoid delusions of persecution
Delusional Disorders Delusions of being related to or loved by a well known person Delusions that one’s partner was unfaithful

Front 116

Schizoaffective Disorders

Back 116

These cases present with affective symptoms Symptoms precede or develop concurrently with psychotic manifestations

Front 117

Schizophreniform Disorders

Back 117

These are similar to schizophrenic disorders except the symptoms last more than a week but less than 6 months.

Front 118

Brief Psychotic Disorders

Back 118

Last less than 1 week Result of psychological stress Normally has a good prognosis

Front 119

Clinical Findings

Back 119

Appearance may be bizarre Usually an unkempt appearance Motor activity can be frenzied or reduced Withdrawn social activity and disturbed interpersonal relationships. Poor self image are common Often with unassociated rambling statements Neologisms, echolalia, verbigeration Catatonia. False beliefs Paranoid thinking Auditory/visual hallucinations Cenesthetic hallucinations

Front 120

Differential Diagnosis

Back 120

Manic episode OCD Paranoid disorders

Front 121

Treatments

Back 121

Hospitalization when patient shows gross disorganization of behavior Prevent self inflicted harm or harm to others Full medical examination with CT and MRI should be considered. Antipsychotic medications are treatment of choice, included in these are: Phenothiazines, thioxanthenes, clozapine, risperidone, olanzapine Antipsychotic medications generally have severe side affects and are used with care