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69 Cards in this Set

  • Front
  • Back
memory types

substracting serial 7's from 100

clock drawing

"what is the body of water that lies off coast of NY?

a/o x3
memory
-immediate=repeat #'s fwd and bwd
-recent=dinner last night or my name
-recent past=news in past several months
-remote memory=childhood and verified

7's=concentration & attention (also WORLD fwd and bwd)

clock=visuospatial ability and interlocking shapes/angles

NY= fund of knowledge

a/o x3= orientation
lab tests related to meds
-lithium
-clozapine
-TCAs
-carbamazepine
-valproate
L: recommend labs before tx and yearly thereafter (except TSH=every 6 months); check Li every 3 months

C: agranulocytosis risk--> onset of tx, weekly for 6mos, every2wks during chronic tx, and 4x's for 4weeks after discontinuation

T: ekg before

C: pre CBC, platlets, rets, iron, tx for agranulocytosis, every wk for 1st 2 months, then once every 3mos; then yearly.... LFTs+car. levels: 2x 1st 2mos;.... CMP+ekg before tx and yearly

V: v+lft every 6-12mos; must do pregnancy test
Mental Retardation
psychomotor testing
-structured clinical diagnostic assessment
-psych testing of intelligence&personality
-seizure disorder
-intracranial masses
MR: IQ test

Struc: beck rating scale for depression, hamilton anxiety rating scale, brief psychiatric rating scale, SCID-IV
Intell: subject and objective=minnesota multiphasic personality inventory, projective tests (rorschach test, thematic apperception test, sentence completion test), intelligence tests, neuropsychologic tests (wisconsin card sorting test, wechsler memory scale[korsakoff syndrome], bender visual-motor gestalt test [organic dysfunction])
Seizure: EEG
Masses: CT, MRI
5-axis diagnosis
I: clinical dx
2: personality/mental retardation (chr abnL)
3: physical/chronic disorder
4: psychosocial issues
5: GAF (global assessment of functioning)
psychotherapy
-4types
1.INDIVIDUAL: supportative (close alliance for adjustment disorder, acute emotional crises) and insight-oriented (transference/countertransference for anxiety, depression, somatoform/dissociative disorders, personality disorders, neuroses, trauma)
2.BEHAVIOR: group of loosely related; systemic, (inc. stimuli and teach to relax), substitution (gum for smoking); hypnosis
3. COGNITIVE: tx major depression, self-defeating attidtudes replace by realistic thoughts
4.SOCIAL: marital therapy
drugs and ae
-tricyclics, heterocyclics
-SSRIs, SNRIs
-MAOIs
-Mood
-1G antipyschotics
-2G antipyschotics
tricyclics=fatal cardiacarrhythmias, anticholinergic; orthostatic hypoTN
SSRI, SNRI=GI disturbances, sex dysfx; no combo with MAOI & d/c for 5wks before starting MAOI
MAOIs= htn crisis w/red wine+aged cheese; orthostatic hypoTN, somnolence, wt gain
Mood: Li=tremor, polyuria/DI, acne, hypothyroidism, cardiac dysrhythmias, wt gain, edema, leukocytosis, kidneys; Valproate=teratogenic
1G: EPS, tardive dyskinesias, sedation, NMS, anticholinergic, cardio (ortho hypoTN, QT interval), endocrine (prolactin inc), wt gain,
2G: less NMS+EPS+tardive dyskinesia

pt d/c from med after gradual reduction+increased frequent visits
Global Assessment of Functioning
91-100: nL
81-90: minimal
71-80: difficulty after argument or fall behind in schoolwork
61-70: depressed mood, mild insomnia, occasional truancy, theft
51-60: moderate amount of symptoms (circumstantiality, occasional panic attacks, problems w/work/friends)
41-50: sucididal ideation, obessional rituals, frequent shoplifting, no friends, lose job
31-40: speech illogical, depressed
21-30: incoherent, gross inappropriately, suicidal preoccupation, stays in bed all day, no job, home or friends
11-20: suicide attempts without clear expectation of death; frequently violent; manic excitement, smears feces, largely incoherent/mute
1-10: recurrent violence
factitious
malingering
somatization
conversion+meds for more answers
delusional disorder
borderline personality
f: want to be cared for by health-care system (primary gain), conscious; meet psychological need (self-mutilation)
m: $, avoid being arrested, going to work, etc (2ndary gain), conscious; FAKED (simple hallucination description)
s+c: unconscious, unintentional
S: recurrent physical complaints not explained by physical factors after conversion of psychotic issues; significant impairment/medical attention
C: may produce additional seizure-like mvmts w/o corresponding epileptic discharges appearing on EEG
-M: amobarbital, lorazepam
d: unshakable belief that he/she has some physical defect or medical condition
B: mutilate themselves to get attention or relieve stress
Admit involuntarily/voluntarily, medical floor, oupatient therapy, or outpatient therapy & halfway house

10 asa during an arguement with mother
oupt therapy & halfway house: safe/supportive environment,

suicidal: not serious since only 10 asa; 500mg/kg bodyweight
violence predictors

physically violent in ER

still violent

thrasing in the middle of the night and screaming
alochol intoxication
overt stressor
males 15-24
low socioeconomic status
few social supports

violent: full leather restraints

still: haloperidol 5mg IM (esp can not take PO), lorazepam 2mg IM and not left alone

night: diazepam(valium) in small doses
countertransference
Negative
Multiple
Unobjectionable-positive

unconscious defense mechanisms
c: transference response to pt; depends on therapist's past experience, relationships, unresolved conflicts; useful insight to pt's dynamics
-Negative Transference: nonproductive relationship b/w pt+physician
-multiple: projections of feelings, thoughts, wishes that belong to patients' past experience onto other group members and group leaders
unobjectionable-positive: pt's perception of therapist is helpful to therapeutic process & not analyzed (explore related feelings)

u: reaction formation, projection, identification with agressor
thinking
-abstract
-concrete

unconscious thought
A: generalize, formulate concepts (metaphors)
C: inability to understand abstracts d/t organic disorder (schizophrenia)

u: intellectualization, rationalization, isolation of affect
panic disorder
-hx
-secondary cause

pain disorder
panic: palpitations, sweating, SOB, trembling >1mos
-2: age
-tx: educate the harmless nature; Paroxetine/alprazolam

pain: precipitating event that intensifies
PTSD
-% of soldiers from iraq
%: 15-20%
echopraxia
folie a deux
dereistic thinking
echolalia
fugue
echopraxia: mimic posture, body mvmt
folie: shared psychotic/delusional belief
dereistic: thought activity not concordant with logic or experience
echolalia: repetition of words or phrases
fugue: new identiy with no memory of old one (travel new environment
Eriksonian Stages Psychosocial development
emphasis of cultural factors in dvlpmt

birth-1: basic Trust v. mistrust
1-3: Shame+self-doubt
3-5: Initiative v. guilt
6-12: Industry v. inferiority (neighbors, school)
12-19: Identity v. role confusion (concern w/image, who they want as visitors)
21-40: Intimacy v. isolation
40-65: Generativity v. stagnation (my life count?)
65-death: Integrity v. despair (wisdom)
Mahler ego psychology
-3phases, 4 subphases
Autistic phase: 1-2mos, mostly sleep, little interest interpersonal relationships
Symbiosis: 2-6mos, fusion or lack of differentiation b/w mother and child
Separation-indivduation: 6-36mos, concept of him/herself as different & separated from mom, +4 subphases
-Differentiation: 6-10mos, initial awareness that mom is separate person
-Practicing: 10-16mos, child's enthusiastic exploration of environment as result of his/her newly mobility
-Rapprochement: 16-24mos, need to know where mom is for refueling/vulnerabilty
-Object Constancy: 3y/o, integration of good+bad aspects of internalized images of mom&child's self
Melanie Klein's theory of infantile psychological development
-depressive
-poststroke depression
infant realizes bad mom who frustrates child's wishes and good mom who nurtures. child worried that bad mom may destroy good

depression also presents with psychotic disorders
-poststroke depression: up to 2 years
child development table
see notebook
Kohut
Freud
Erikson
Klein
Piaget
Menninger
Rank
Alder
klerman
Kohut: child needs positive, empathic, consistent response from his/her caretakers
Freud: psychosex development; normality=idealized fiction; id=primitive, nonlogical, timeless; psychoanalytic theory: narcissist, immature, neurotic, mature. (also primitive, immature)
Erikson: psychosocial development throughout life
Klein: early stages of infant-mother interaction; normality=strength of character, capacity deal w/conflict emotions, ability to lvoe, experience pleasure w/o conflict
Piaget: cognitive development, 1sensorimotor(18-24mos), 2preoperational(2-7yrs) role play surgeries/abstract things, 3concrete operational(6-11yrs), formal operational (11yrs-adulthood)
Men: normality=acculturate & be content in one's world
Rank: normality=take responsibility for one's own actions+live w/o fear, guilt, anxiety
Alder: normality=socially connect, productive for mental health and adapation
Klerman: current relationships of interpersonal therapy: complicated mourning, interpersonal role, role transition
Projection
Reaction Formation
Dissociation
Isolation of Affect
Repression
Suppression
Displacement
Fixation
Regression
P: unacceptable internal impulse (therapist interest in him when he is actually interest)
RF: do the opposite
Diss: almost 3rd person, multiple personalities, avoid emotions
I: no feelings describing event
R: Involuntary; not remembering or giggling
S: voluntary w/holding
Disp: transfer feelings to another person/object (yell at kids)
F: partially remaining at childish level (men+sports)
Reg: bedwetting, crying
object permanence
object constancy
Transitional object

Fantasy play age
O.P: preoperational stage 2-6y/o
O.C: children's ability to maintain stable, realistic internalized constructs of caretakers and themselves; ego psychology, self psychology
T.O.: toy/blanket represents comforting substitute for primary caregiver; tolerate separation from mom

Fantasy: 2-4y/o, negative/positive
identification
introjection
distortion
intellectualization
rationalization
Undoing
abreaction
Identify: incorporation of another's person's qualities into one's ego system (aggressor)
introj: internalization of qualities of an object (saying ridiculous and everybody else does it)
distort: gross reshaping of external reality to suit inner needs (hallucinations, delusions) (therapist no interest when yawns)
intel: walking through steps excessively to avoid emotions
ration: rational explanations in attempt to justify attitudes, beliefs, or behavior
Undo: compulsive negate or avoid the consequences of a fantasized action, obsessional impulse. Repeated fear irrational
Abreaction: traumatic experience available to conscious mind, becomes less powerful, gradually integrated into patient's current view of him/herself in a meaningful way
3 phases of separation
Protest: anger expressed when parent returns (4 days and still clings nurse aide)
Despair: indifferent response to return
Detachment: irreparable separation
Freud's psychosexual development
stages of pleasure
Oral: 18mos, feeding, sucking, biting; dependent characteristic
Anal: 18-36mos, independent, active compared to previous stage; likes erotic stimulation of anal mucosa through excretion/retention of feces; toilet training determines if anal personality, stubborn, obstinancy, frugality
Phalic: 3y/o, concentration of penis/clitoris areas; starts looking at oneself for an erotic object;
Oedipal: 3-5y/o; ends when no rivalry with parent for opposite sex parent
Latency: 5-11/13y/o; no sex interest; focus on learnign new skills, social interactions
genital: puberty-adulthood; reintensification of sex drives and mastering it; separation from parents; establish sexuality
Freud's other theories
-topographic
-parapraxes
-infantile sexuality
-structural
-primary process
T: conscious, preconscious, unconscious
P: unwitting slips of tongue reveal unconscious at work
I.S: change of erotic activity from birth to puberty: oral, anal, etc
S: id, ego, superego
PP: dereistic, illogical, magical normally in dreams; abnL if psychosis
significant age milestones
6-12y/o: attending school
12-15: puberty
17-20: personality development
Freud's Dream
-Dream Work
-Latent Content
-Primary Processes
-Secondary Revision
DW: latent content of dream transformed into more acceptable manifest content
LC: mind combines different concepts/feelings into 1 single image (condensation), uses neutral/innocent images to represent highly charged ideas/impusles (symbolic representation), and diverts feeling or energy associated w/1 object to another more acceptable to dreamer's superego (displacement)
PP: condensation, displacement, smbolic representation
SR: guided by ego, intervenes at end of dream work to make manifest content more rational and acceptable to dreamer
cataplexy
catalepsy
negativism
automatism
stereotypy
waxy flexibility (cere flexibilitas)
cataplexy: loss of muscle tone triggered by strong emotions during full wakefulness; abnl REM sleep phenomena and tx by antidepressants
catalepsy: immobile position constnantly maintained
n: resistance to any/all attempts to have patient move/allow himself or herself to be moved even when no obvious motive for such resistance
auto: automatic performance of act/acts being unconscious symbolic meaning
ste: repetitive/fixed pattern of behavior/speech
waxy: person can literally be molded into any position examiner chooses and maintained
tourette's genetic predisposition
T: multigenetic; difficult to characterize spread

R/o wilsons, huntingtons, and seizures w/eeg

tx haloperidol or pimozide
REM
narcolepsy tx
dec

PET scan of depression
REM: random, fast sawtooth EEG; active eye movements; lack of muscle tone; inc HR, bp, penile/clitoral nocturnal erections
-Narcolepsy: REM not segregated appropriately; cataplexy, hypnagogic hallucinations, sleep paralysis (tx methylphenidate, pemoline, amphetamines; cataplexy w/modafinil=inc monoamines+histamine)

dec. w/ major depression; also early morning awakening, other neuroendocrine perturbations

PET: reduce metabolic activity & blood flow in both frontal lobes
Damage to specific brain
-Frontal
-occipital
-Mesial
-Orbitofrontal
-hippocampus
-Temporal
-R prefrontal cortex
-L orbitofrontal cortex
-dorsolateral
-pituitary
F: not dementia d/t memory, language, calculation ability, praxis, IQ
Occipital: HA, papilledema, homonymous hemainopsia; visual hallucinations/auras of flashing lights & movements
M: movements, emotional responses, speecH
Orbitofrontal: abnL social behaviors, great opinon of oneself, jocularity, sex disinhibition, lack of concern (SETH)
T: partial complex seizures (e.g. SMELLS opposed to ARSENIC that does garlicky)
H: memory
RPC: laugh, euphoria, joke, puns
LPC: depression, uncontrolled cry
DL: inattentive, undermotivated, unfocused, linger trivial thoughts (ADHD kid)
P: basophilic adenoma; depression d/t craniopharyngioma
Prader Willi
Fragile X
Down syndrome
Hurler syndrome
Rett Syndrome
Williams syndrome
Childhood Disintegrative Disorder
PW: hypothalamic dysfx,
X: most common form of INHERITED MR; large testes d/t large GnRH
D: most common GENETIC MR
H: 1y/o and death by 10y/oo
R: progressive deterioration b/w 5-18mos after nL initial period of development
W: rare GENETIC MR; delete pair of chr23
CDD: nL dvlpmt for 1st 2 yrs; then, loss of skills before age 10
acute dystonic reaction
anticholinergic
ACUTE DYSTONIC RXN
MOA: adverse effect of neuroleptic meds 2ndary to block DA receptors in nigrostratal system
S/S: spasmodic contractions of muscles; stiffness, twisting; painful, frightening (EPS)
d/t: high postency neuroleptics
tx. benzotropine PO or diphendyramine PO

ANTICHOLINERGIC
s/s: forgetful, flushed, dry skin, tachy, disoriented
Cushing syndrome

others
C: hypoCa, hyperCortisol; depression
can cause substance-induced mood disorder w/chronic steroid tx. Occurs suddenly

others: pheochromocytoma, hyperthyroidism, hypercortisolemic, hyperparathyroidism; hypoxemia, hypercalcemia, hypoglycemia; neuro disorders=vascular, trauma, degenerative
serotonin
DA
ACh
Epi
Neuropeptide Y
S: low=suicidal behavior; high=OCD
DA: psychosis; hallucinations d/t L-dopa, amantidine, MAOi, anticholinergics
ACh: cognitive fx, memory; dementias
Y: appetite
Epi: anxiety disorders
Broca
WErnicke
Conduction
Global
B: nonfluent spontaneous speech; L hemi.
W: poor auditiory comprehension; L hemi.
C: poor repetition and naming (fluent speech, good auditory) L arcuate fasciculus
G: poor everythng (l perisylvian region)
Dyslexia
Reactive attachment disorder
Selective Mutism
School Phobia
Oppositional Defiant Disorder
Asperger
Conduct disorder
Rabbit Syndrome
Dys: reading disorder d/t visual or hearing acuity issues; spelling and verbal language defects and not grow out of during adulthood; nL story and communication skills
RAD: severely dysfx early relationship b/w principal caregiver & child d/t disregard and less relationship with original caregiver
SM: speaks only at certain times; interactive in other ways
SP: refuse school; no language problems
ODD: persistent refusal to follow rules and defiance; not speak to people; at least 6mos; over 18 leads to antisocial personality disorder; not routinely; no empathy
Asp: no delay in spoken/receptive language
Con: persistent disregard for rules, rights at least 1 yr; aggression toward people & animals, property, truancy; later become antisocial personality
Rabbit: uncommon EPS neuroleptic-induced syndrome; excess chewing; not tongue or other body parts
#1 behavior for psychiatrist to see a child in the ER?

and highest risky time period?

#1 indicator?

tx if catatonic
suicide

1st week of hospitalization (also end of June with rotation of old residents, staff demoralization)

#1=hopelessness

tx. catatonic is ECT w/METHOHEXITAL (barbituate; fastest and shortest t1/2) b/c not eat/drink
alzheimer
pick
cocaine intoxication
korsakoff
Multi-infarct Dementia
CJD
Pseudodementia
Narcissitic Personaliy
Temporal Lobe Epilepsy
Wernicke-Korsakoff
Normal Pressure Hydrocephalus
Chronic Traumatic Encephalopathy
A: #1 dementing; memory loss, aphasia, anomia, apraxia, agnosia; motor affected near end; personality LATER stages; trisomy21; neurofibrillary tangles, neuritic plaques, loss of ACh neurons at nucleus basalis of Meynert; tx donepezil, rivastigmine, galantamine, tacrine (cholinesterase inhibitors)
P: EARLY personality change (disinhibition, apathy, socially inappropriate behavior, mood changes, psychotic symptoms; Frontotemporal atrophy, gliosis of frontal lobes; pick bodies (intracellular inclusions), pick cells (swollen neurons)
C: agitation, hypervigilant, anxiety; lack of medical complaints; inhibit reuptake of NE and DA; excess vasoconstriction, high SNS activity
K: anterograde+retrograde memory deficits
MID: htn CVD, thromboclusive dz; memory, muscle weakness, spasticity, dysarthria, extensor plantar reflex
CJD: myoclonic jerks; EEG w/periodic bursts; very rapid decline;
Pseudo: major depression; previous hx
Narc: even with MI, exaggerated denial of problem
TLE: bizarre behavior w/o grand mal shaking movements; hyposex, emotional intensity
WK: confusion, ataxia, nystagmus d/t thiamine deficiency
W: thiamine deficient, damage to mammilary bodies+doromedial nucleus of thalamus; mental confusion, ataxia, CN6 paralysis
K: anterograde, retrograde memory deficits; preserved remote memory
NPH: urinary incontinence, gait, dementia; frontal-subcortical dysf(x); ventricle dilation w/o sulcal widening (no atrophy); nL CSF pressure
CTE: retired boxer/multiple head traumas; cognitive decline, memory deficits to parkinsonian symptoms
Partial Complex Seizures
Absence Seizure
Tonic-clonic seizure
PC: ALOC, staring, (olfactory) hallucinations, automatisms, perceptual alterations, complex verbalizations, autonomic symptoms (pilorection, gastric sensation, nausea), flashbacks, dejavu, derealization
A: shorter, no motor activity, no postictal phenomena
TC: prl incr dramatically w/in 20mins
Hyperventilation
Panic Disorder
Generalized Anxiety Disorder
Anxiety Disorder not otherwised specified
Anxiety Disorder 2ndary to medical condition
Argorophobia
H: perioral tingling, carpopedal spasms, derrelaization; tx paperbag
P: tachycardia, tachypnea, tremor, dizzy, hot/cold sensations, CP (at least 4 symptoms) recurring, spontaneous, unexpected anxiety attacks w/rapid onset, short duration, max intensity w/in 10 mins;
GAD: >6mos; restlessness, fatigue, concentration, irritable, muscle tension, sleep disturbance; more chronic & less intense than phobic disorder; tx bzd, bsupirone, b-blocks
Not Specified: insufficient criteria to meet any one of diagnoses
2ndary: hyperthyroidism, angina, hypoglycemia, etc
Argoro: prisoners in own homes & where escape may be difficult
New onset hallucinatioins (3days)
delirium tremens: NEVER had symptoms before (unlikely to be schizophrenia); ELEVATED enzymes;
fever, diaphoresis, tremulousness, htn
confusion, combativeness post sx
NMS
NMS: FALTER (fever, autonomic instability, leukocytosis, tremor, elevated CPK, rigid muscles;
tx dantrolene (muscle relaxant) then bromocriptine (and amantidine=DA receptor agonist)
schizophrenia
-dx studies
-good prognosis
-ER: agitated, screaming tx
-home care meds
-family influence
Dx studies: PET inc D2 receptors; EEG dec alpha activity; eyes unable to follow moving visual target; CT lateral & 3rd ventricle enlargement;
Prog: late onset, obvious stressors/factors, acute onset, good morbid fx, presence of mood disorder symptoms, married, fhx mood disorders, good support systems, less (-) symptoms
ER: haloperidol, lorazepam IM
home: no DA receptor antagonist response switch to low does 2g antipsychotic (OLANZAPINE)
Family: faulty mothering leads to increased relapsed rate
Schiozo- timing/types

RF

Major Depression w/antipsychotic features
Delusional disorder
D3HN: delusions, disorganized speech/behavior, halluciantions, negative symptoms

Schizoaffective disorder >2weeks of stable mood w/psychotic symptoms then major depression and/or mania
Brief Pyschotic disorder<1 month due to stress; spontaneous onset and quick resolution
Schizophreniform 1-6months; optional social/occupational dysfx, self-limited
Schizophrenia >6months: paranoid, disorganized, catatonic, residual
Schizoid (video games) <Schizotypal (magical thinking) <Schizophrenic (hallucinations)
tx. haloperidol
RF for good outcome: onset 20-25, possibly female gender, middle-high socioeconomic status, stable occupational record. missing social factors; fhx affective disorder

MD: >2wks; SIGECAPS+delusions
DD: nonbizzare delusions w/o deterioration of psychosocial fx; no bizarre/odd behavior; may be tactile, olfactory hallucinations; erotomanic, grandiose, jealous, persecutory, somatic delusions; fluctuating course
delusion
persecutory delusion
hallucinations
illusions
concrete thinking
idea of reference
loose association
clouding of consciousness
circumstantiality
neologism
perseveration
flight of ideas
clang association
blocking
tangentiality
derealization
magical thinking
delusion: fixed, false belief, grandiose theme attributes special powers/talents; terminally ill pts
persecute: harm individual, unshakable beliefs
h: no real basis
illusion: misinterpretations of ext stimuli
concrete: cognitive style utilizes info related to actual objects, events, devoid of abstractions
idea: object/event/person in one's enviroment (TV/radio) particular personal significance (glass house break windows)
l: distubrance in continuity and not logically related
cloud: overall reduced awareness of surrounding environment
circum: no goal-direction; many irrelevant details and comments eventually to point
n: fabricated word/combo of existing words
p: cognitive disorder exist after new stimulus (no ifs, ifs, ifs, ifs; instead of no ifs and or buts)
flight: rapid thoughts w/shifting though connected
clang: rhyming pattern, whether or not verbalized or logical
b: speech disrupted
t: answers ? w/something related to question and not answer directly (how are you? sofa feels soft today)
perservation: repeat 3 words w/every question; inability to change topic
dereal: unreal or distant environment
magic: thinking like a kid (snows b/c i buy sidewalk salt or wish for something exciting)
Multi-infarct dementia
Delirium
HIV associated dementia
Stress of dz
Alzheimer
Postcardiotomy delirium
M: progressive dementia, step-wise, focal neuro signs, depression, mood lability, delusions
Del: wax/wane, abnL consciousness over time and orientation problems (person, place, time) d/t fever, hypoxia, drug intoxication, withdrawal symptoms, allergic reactions, head trauma, epilepsy, neoplasms, vascular, injuries by physical agents; hallucinations, altered attention/perception/arousal level
HIV: cd4<200, cognitive impairments, fever, persistent cough, 10lb wt loss; parenchymal abnLs
Stress: nL fx before dz
Alzheimer: presinilin 1>presinilin 2>APP; fhx, advanced age, no head trauma
P: complication of cardiac Sx; drug effects: opiods, anticholinergic meds; subclinical brain injury; complement activation; poor nutritional status; embolism; ENVIRONMENT change; NO additional drugs need
Delusions
-persecutory
-jealous
-erotomanic
-somatic
-grandiose
-mixed
-unspecified
P: harassed/harmed by others
J: verbally/physically abusive to others
E: "celebrity"-like status is in love with them
S: have some physical disorder and fixed and misinterpreted (unlike hypochondriac)
G: pt believes they are God's messenger
M: mixed description
U: reserved for presentations not characterized (Capgras syndrome: people replaced by imposters)
Cocaine
Amphetamines
C: agitation, hypervigilant, anxiety; lack of medical complaints; inhibit reuptake of NE and DA; excess vasoconstriction, high SNS activity
A: paranoid delusions, visual hallucinations like paranoid schizophrenia
Autoscopic Psychosis
Capgras Syndrome
Lycanthropy
Cotard Syndrome
Folie a deux
AP: visual hallucination of transparent phantom of one's own body
Cap: delusion of doubles; imposters substituted
L: person=werewolf/other animal
Cot: false perception of having lost everything
FaD: 2 people with same issues
Eye Movement Desensitization & Reprocessing
Supportive Psycotherapy
Insight-oriented psychotherapy
Face-saving behavioral strategies
Cognitive Therapy
Dynamic Therapy
Psychoanalysis
Experimental-humanistic
Behavior
Desensitization
hypnosis
biofeedback
Electroconvulsive Therapy (ECT)
EDMR: focus on therapist finger & maintain mental image of stressful event
Support: undergoing ACUTE life crises, feeling overwhelmed; reduce pt symptoms; (+)transference
Insight: strongly MOTIVATED pt who tolerate great deal of frustration and good capacity for insight; great impulse control w/o acting out
Face: SPLITTING and not flee therapy
Cogn: unravel (-)thoughts by testing them, identifying (e.g automatism, social phobia)
Dynamic: therapist uses clarification, confrontation, interpretation
Psychoanalysis: same as dynamic but visit office more frequently
Experiemental: develop supportive & gratifying RELATIONSHIP w/pt provide empathic response
Behavior: control own behavioral responses to anxiety (car accident)
Desens: low exposure to stimuli/phobia to higher stimui (operant conditioning, flooding, reframing)
hyponosis: c/i to paranoid delusions
bio: meausre body fx and emit tones
ECT: complaints=HA, N, muscle soreness, memory impairment (retro-, anterograde); c/i=space-occupying lesion in brain, recent MIs, aneurysms, bleed disorders
Universalization
Group Cohesion
Validation
Shared belief system
U: pt not alone/unique
GC: working together toward a common goal
V: confirmation through comparisons with other group members' experiences & conceptualization
SBS: framework of beliefs and ideas about issues common to everyone in group
Interpretation
confrontation
clarification
flooding
habit reversal training
desensitization
extinction
I: explantory cornerstone statements link symptom, behavior, feeling to unconscious meaning to help pt
conf: point out to pt that pt is avoiding
clarif: putting together info from pt and reflecting back to pt
habit: eliminate dysfx habits by doing other habits
extinction: progressive disappearance of a behavior/symptom when expected consequence does not happen (getting sick of contamination)
postpartum blues
postpartum depression
Blues: freqent, tearfulness, irritability, anxiety, mood; onset=2-4d; peak=5-7d; resolved at 14d spontaneously; 10-15%
Depression:blues+suicidal ideation; not anhedonia
Bereavement
AbnL Bereavement
Major Depression after loss of family member
Adjustment Disorder
Seasonal Affective disorder
Bipolar Mania+Depression tx
Cyclothymic Disorder
Premenstrual Dsysphoric Disorder
Dysthmic Disorder
B: nL <2mos; depress, low concentration, lose wt, not sleeping well
abnL B: guilt about things other than actions taken or not taken by the survivor at the time of loved one's death (2)thoughts of death other than the survivor feeling he/she would be better off dead without the loved one (3) morbid preoccupation with worthlessness (4) marked psychomotor retardation (5) marked & prolonged fx impairment (6) hallucinations other than of the survivor
MD: SIGECAPS on top of bereavement; preschoolers=irritable, aggressive, w/drawn, clingy; school-age=anhedonia of friends & school; adolescence=like adults; high likelihood of bipolar as adults
AD: not with death of family member; receiving +HIV test
SAD: hypersomnia, hyperphagia; tx. light therapy & 5ht agents
BM+D: continue lithium and start antidepressant
C: recurrent periods of mild depression alternat w/hypomania; >2yrs (>1yr kids); during 2yrs symptom-free intervals should not be longer than 2mos.
PDD: 1wk before menses w/HA, anxiety, depression, irritability, emotional lability; also, edema, wt gain, breast pain; tx SSRIs
DD: >2yrs (>1yr if kid); still doing well in school; no suicide ideation/psychotic symptoms; NOT that severe compared to MD
hypothyroidism w/tx and nL levels but still depress?
start antidepressant medications.
mood disorders caused by endocrine disorders persist even after underlying med conditions treated
Melancholic Depression
Double Depression
Atypical Depression
Seasonal Affective Disorder
M: anhedonia, lack of reactivity, guilt, wt loss, early morning awakening, marked psychomotor retardation (TCAs)
DD: dysthmic depression+ >1 major depression during lives
AD: pleasurable events improve mood (mood reactivity); self-pity, excess sensitivity to rejection, feel better in the MORNING (reverse diurnal mood); reversed vegetative symptoms
SAD: inc sleep+appetite+wt; irritable,
Obessions
Compulsions
O: persistent thought/mental images subjectively experienced as intrusive & alien that provoke anxiety
C: repetitive acts, behaviors, thoughts designed to counteract anxiety elicited by obsessions
preoccupied with rules, regulations, orderliness, neatness, details, achievement of perfection
Dissociative Identity disorder
Dissociative Amnesia
Dissociative Fugue
Depersonalization Disorder
DID: multiple personality disorder; significant gaps in autobiographical memory; fluctuation in skills, well-learned abilities, habits; dramatic changes in mannerisms, tone of voice, affect
DA: temporary inability to recall important personal info; more extensive than forgetfulness; not by medical/psychiatric condition
DF: individual's sudden unexplained travel away from home, coupled with amnesia of identity
DD: persistent/recurrent experience of feeling detached from and as if outside observer of one's mental processes/body
Impulse Control Disorders
pathological gambling,
pyromania,
intermittent explosive disorder,
trichotillomania,
kleptomania (not this b/c not primary issue if gambling issue)
Sleepwalking disorder
SW: 4-8y/o; if try to awake, maybe violent; 1/month; keep safe environment & monitor symptoms
Characteristic Traits
-Harm Avoidance
-Novelty Seeking
-Reward Dependence
-Persistence
HA: inhibit behavior if punishment/nonreward; uncertain, shy (seth with $)
NS: impulsive, curious, easily bored, disordered (seth with random activities)
RD: tenderhearted, socially dependent, sociale (me socially)
P: hard-working, ambitious over-achievers; view frustration & fatigue as a personal challenge (me studying)
Periodic Limb Movement Disorder
Circadian Sleep Disorder
Primary Hypersomnia
Caffeine-induced sleep disorder
PLMD: aka nocturnal myoclonus; very frequent, stereotyped limb movments; brief arousal+disrupt sleep pattern; only chronically tired during the day
Circ: insomnia, chronic sleepiness; lack of synchrony b/w individuals internal circadian sleep-wake cycles & desired times of falling asleep & waking; travel different time zones & work shifts
Primary: chronic/recurrent daytime sleepiness, excess nighttime sleep, daytime naps; found by poly= inc slowwave sleep; dx of exclusion
Caffeine: produce delay in falling asleep, inability to remain asleep, early morning awakening; (-)tox
Heroin
Opiate
Alcohol
Salicylates+Acetaminophen
Acid
Marijuana
PCP
BZD
Cocaine
Inhalant
LSD
MDMA/Ectasy
H: 48hrs w/d symptoms, dilated pupils, HTN, muscle twitches, NVD, piloerection; tx methadone
O: constrict pupils, Profound RESP depression, stuporous; grand mal seizure; tx naloxone after respiration (adjunct= haloperidol); methadone and clonidine (a2 agonist)
Alch: diazepam; 20-30mg/dL; w/d lead to seizure
S+A: forced diuresis
Acet: inc release of DA, NE into synaptic cleft
Acid: 8-12hrs of "jessica craziness"
MJ: 3d-4wks UA
PCP: 8d UA; vertical nystagmus; rage; generalized seizure; tx minimize sensory input
BZD: 3d UA
Cocaine: inc. ANXIETY level; agitation, hyperactivity, visual/tactile hallucinations,
Inhalant: hearing loss, peripheral neuritis, parasthesia, cerebellar signs, motor impairment; muscle weakness; vomit/hematemesis
LSD: sensory disturbances, visual hallucinations, sympathomimetic effects; die acting on false perceptions
Ectasy: bruxism, euphoria, inc. self-confidence, peaceful feelings empathy & closeness
Alcohol w/d delirium
Wernicke's psychosis
Alcohol Hallucinosis
Alcohol Dependence
Alcohol Tolerance
Substance Abuse
Potentiation
w/d: DTs; most severe; coarse tremor; coarse tremor of hands, insomnia, anxiety, agitation, autonomic hyperactivity
W: severe thiamine deficiency; prolonged, severe EtOH abuse; confusion, ataxia, ophthalmoplegia
Hallucin: vivid auditory hallucinations shortly after cessation/reduction; clear sensorium; autonomic instability less prominent; tx. diazepam & chloridiazepoxide (then lorazepam, oxazepam)
Dependence: compulsive drinking w/attempts to stop/cut down; evidence of severe impairment of social/occupation/family fx and still drinks anyway; physical signs of w/d and tolerance;
T: >150mg/dL and no signs of intoxication; Asians no acetaldehyde dehyrogenase
SA: maladaptive behavioral pattern recurrent use in spite of academic/social/work problems; used in dangerous situations (driving) & recurrent substance-related legal problems
Po: coadmin of bzd+antipsychotic to an agitated psychotic pt w/lower doses instead of high doses by themselves
CAM
Saw palmetto
Ginko biloba
Garlic
St John warts/ginseng
Glucosamine
Women
saw palmetto....BPH. not result in a decreased prostate volume.
Gingko biloba... dementia, SE Antiplatelet
garlic...heart disease.
St. John's wort....depression. SE serotonin syndrome
Glucosamine...arthritis symptoms.
70% not report use and 5% only use CAM exclusively
Vaginismus
Sexual aversion
V: painful, vaginal contraction
SA: averse to genital contact
Cognitive distortion
-arbitrary inference
-dichotomous thinking
-overgeneralization
-magnifcation/minimization
AI: drawing specific conclusion w/o sufficient evidence
DT: all or none
O: general conclusion on single event
M: over-/under-value event