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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 |
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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 |
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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 |
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5-axis diagnosis
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I: clinical dx
2: personality/mental retardation (chr abnL) 3: physical/chronic disorder 4: psychosocial issues 5: GAF (global assessment of functioning) |
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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 |
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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 |
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Global Assessment of Functioning
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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PTSD
-% of soldiers from iraq |
%: 15-20%
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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 |
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Eriksonian Stages Psychosocial development
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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) |
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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 |
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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 |
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child development table
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see notebook
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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 |
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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 |
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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 |
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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 |
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3 phases of separation
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Protest: anger expressed when parent returns (4 days and still clings nurse aide)
Despair: indifferent response to return Detachment: irreparable separation |
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Freud's psychosexual development
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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 |
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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 |
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significant age milestones
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6-12y/o: attending school
12-15: puberty 17-20: personality development |
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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 |
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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 |
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tourette's genetic predisposition
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T: multigenetic; difficult to characterize spread
R/o wilsons, huntingtons, and seizures w/eeg tx haloperidol or pimozide |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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) |
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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 |
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#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 |
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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 |
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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 |
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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 |
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New onset hallucinatioins (3days)
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delirium tremens: NEVER had symptoms before (unlikely to be schizophrenia); ELEVATED enzymes;
fever, diaphoresis, tremulousness, htn confusion, combativeness post sx |
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NMS
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NMS: FALTER (fever, autonomic instability, leukocytosis, tremor, elevated CPK, rigid muscles;
tx dantrolene (muscle relaxant) then bromocriptine (and amantidine=DA receptor agonist) |
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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 |
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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 |
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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) |
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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 |
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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) |
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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 |
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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 |
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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 |
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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 |
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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) |
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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 |
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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 |
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hypothyroidism w/tx and nL levels but still depress?
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start antidepressant medications.
mood disorders caused by endocrine disorders persist even after underlying med conditions treated |
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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, |
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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 |
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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 |
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Impulse Control Disorders
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pathological gambling,
pyromania, intermittent explosive disorder, trichotillomania, kleptomania (not this b/c not primary issue if gambling issue) |
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Sleepwalking disorder
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SW: 4-8y/o; if try to awake, maybe violent; 1/month; keep safe environment & monitor symptoms
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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) |
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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 |
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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 |
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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 |
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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 |
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Vaginismus
Sexual aversion |
V: painful, vaginal contraction
SA: averse to genital contact |
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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 |