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143 Cards in this Set
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IQ test that calculates mental age/chrono age x 100…
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Stanford-Binet
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Wechsler Adult Intelligence Scale… use…
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14 subtests (7 verbal, 7 performance). Can quantify intellectual decline
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What IQ test should use to quantify intellectual decline…
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WAIS
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IQ threshold for mental retardation… severe mental retardation…
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<70, sever is <40 and profound is <20
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Operant conditioning…
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Learning in which a particular action is elicited because it produces a reward
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Difference between negative reinforcement and punishment…
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Neg reinforcement is when person does something to remove an adverse stimulus (mouse pushing button to not get shocked) while punishment is application of adverse stimulus in hopes of extinguishing unwanted behavior
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Extinction…
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Discontinuation of reinforcement eliminates behavior
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Multiple personalities or drastic change in personality, membory, consciousness is an example of… what trying to avoid…
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Dissociation, immature mechanism avoiding emotional stress
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Difference between displacement and projection…
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Displacement is simply avoiding ideas or feelings is transferred to another person or object (anger) whereas projection is an internal impulse that is attributed to another person
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If a person who has witnessed a murder describes it without emotional response, this is an example of…
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Isolation of affect- separation of feelings from ideas or events
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Reaction formation…
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Warded-off ideas or feelings are replaced by the opposite. Immature defense mechanism
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If a person who has sold drugs and made lots of money doing it decides to make a large donation to charity, what is this an example of…
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Altruism- guilty feelings replaced by unsolicited generosity. Mature
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Difference between repression and suppression…
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Repression is involuntary and immature while suppression is voluntary withholding of idea or feeling from conscious awareness, mature
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Long term deprivation of affection to infant results in…
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Decr muscle tone, poor language, poor socialization, lack of trust, anaclitic depression, wt loss, physical illness. Weak, Wordless, Wanting, Wary. Changes can be irreversible after 6 months
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Associations and age threshold of ADHD… tx…
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Onset before age 7. normal intelligence but poor performance in school. Decr frontal lobe volumes. Tx: methylphenidate, amphetamines, atomoxetine (SNRI)
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Difference between conduct and oppositional defiant disorder…
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Opp defiant has pattern of hostile, defiant behavior w/o serious violation of social norms (like theft, physical aggression seen in conduct dx)
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Tx of autism…
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Behavioral and supportive therapy to improve communication and social skills
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Findings in Aspergers dx…
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All-absorbing interests, repetitive behavior, problems w/ social relationships. Normal intelligence, no language or cognitive deficits
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Rett’s disorder characterisitics and inheritance…
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X-linked dx seen in girls (males die). Normal to age 4 then regression characterized by loss of development, mental retard, loss of verbal abilities, ataxia, hand-wringing
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If small boy is normal for at least 2 yrs then suddenly loses verbal, social skills and bladder control, play skills, etc, what is disorder…
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Childhood disintegrative disorder. Rett’s is only in girls.
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Differences in Ach levels between Alzheimers, Parkinsons, and Huntingtons…
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Alzheimers and Huntingtons both have decr levels of Ach while Parkinsons has incr levels
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Main NT defect in Schizophrenia…
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Incr dopamine (also see decr dendritic branching)
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NT problems in anxiety…
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Incr NE but decr GABA and Ser
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Order of loss of factors of orientation and causes…
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1st loss: time>place>person. Causes: alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional defiency
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Drugs that one should check for when person is in delirium (waxing and waning consciousness and awareness)… test one should run…
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Check for drugs w/ anticholinergic effects and get EEG(usually abnormal)
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Difference between dementia and delirium…
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Dementia is gradual while delirium is acute and dementia does not have change in level of consciousness. Delirium often has visual hallucinations
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Difference between hallucinations vs. illusions…
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Hallucinations is perception of external stimuli when not there while illusions are misinterpreting actual external stimuli
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Tactile hallucinations common in…
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Alcohol withdrawal and cocaine abuse
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Hypnagogic hallucination… hypnopompic hallucination…
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hypnaGOgic when Going to sleep and hypnopompic upon waking up
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Diagnosis of schizophrenia based upon…
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2+ of following for > 6months: Delusions, Hallucinations, Disorganized speech, Disorganized or catatonic behavior, Negative symptoms: flat affect, social withdrawal, lack of motivation, lack of speech/thought.
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Schizophreniform disorder…
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Schizophrenia symptoms for 1-6 months
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Schizoaffective disorder…
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2+ weeks of stable mood w/ psychotic symptoms plus a MDD, manic, or mixed episode.
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If person comes to a new area post wartime or traum and is confused about who they are, can recall past, and is distressed, what is this disorder…
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Dissociative fugue
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Diagnosis of manic episode based upon…
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3+ of following for at least 1 week: Distractable Irresponsible Grandiose thoughts of self Flight of ideas Activity incr or Agitation Sleepy Talkative
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Hypomania difference from manic episode…
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Like mania but not severe enough to cause disfunxn or necessitate hospitalization. No psychotic features
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Bipolar definitions (I and II)… drugs to avoid…
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At least 1 manic episode (type I) or hypomania (type II) and MDD always eventually comes. Mood and functioning return to normal between episodes. Antidepressants can lead to incr mania.
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Tx of bipolar dx…
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CLAV: Carbamazapine, Lithium, Atypical antipsychotics, Valproic acid. Avoid antidepressants
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Cyclothymic disorder…
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Mild form of bipolar lasting at least 2 years
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MDD diagnosis based on…
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5+ of following for 2 weeks or more: Sleep disturb loss of Interest Guilt feelings loss of Energy loss of Concentration appetite or wt changes Psychomotor agitation Suicidal ideations Depressed mood
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Dysthymia…
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Mild form of depression (doesn’t have 5+ symptoms) present for 2+ years
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Changes in sleep patterns during depression…
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Decr slow wave, decr REM latency, incr REM in early sleep cycle, incr total REM, wake at night more, early morning wakenings
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Adverse effect of electroconvulsive therapy for depression…
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Disorientation and anterograde/retrograde amnesia
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Risk factors for suicide…
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SAD PERSONS: Sex (M), Age (teen or oldy), Depression, Previous attempt, Ethanol/drugs, Rational thinking lost, Sickness (3+ Rxs), Organized plan, No spouse, Social support lacking
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Diagnosis of panic disorder based on…
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Recurrent periods of intense fear peaking in 10 minutes w/ 4+ of: Palpitations, Paresthesias, Ab distress, Nausea, Intense fear, Light headedness, Chest pain, Chills, Choking, disconnectedness, Sweating, Shaking, SOB
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Tx of panic dx…
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Cog behavioral therapy, TCAs, Benzos, SSRIs
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Social phobia… tx…
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Exaggerated fear of embarrasement in public. Tx w/ SSRIs
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Tx of OCD…
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SSRIs, clomipramine, olanzapine
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PTSD timeline… tx…
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Happens at least 1 month after event and lasts for >1 month, if shorter then that it is called acute stress disorder. Tx: psychotherapy and SSRIs.
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GAD diagnosis based upon… tx…
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6 months or more of: Fatigue, Insomnia, Difficulty concentrating. Not related to specific person, event, situation. Tx: buspirone, benzo, SSRI
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Adjustment disorder…
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Emotional symptoms of anxiety or depression causing impairment associated w/ significant stressor. Lasts <6 months or >6 months w/ chronic stressor
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Diagnosis of somatization disorder based upon…
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Complaints of: 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic
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Major defense mechanism of paranoid personality disorder and what cluster is it…
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Projection and is cluster A (weird or accusatory)
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Cluster A personality disorders..
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Paranoid, schizoid, schizotypal
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Signs and symptoms of borderline PD…
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Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, sense of emptiness. Splitting
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Avoidant PD based upon…
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Hypersensitive to rejxn socially inhibited, feeling inadequate, wants social relationships
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Dependent PD based upon…
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Submissive and clinging, excessive need to be taken care of, low self confidence
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Substance dependence based upon…
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3+ signs in one year: tolerance, withdrawal, taken in larger amts or over longer time then desired, persistent desire or unsuccessful attempts to cut down, significant energy spent obtaining/recovering, reduced social/occupational/recreational activities, continued despite knowledge of problems associated
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Susbstance abuse based upon…
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Never having met criteria for substance dependence. Has following: recurrent use despite failure to meet obligations, Recurrent use in physically hazardous situations, Recurrent substance-related LEGAL problems, Continued use despite PRESISTENT PROBLEMS CAUSED by use
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Alcohol withdrawal symptoms… tx…
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Tremor, tachycardia, HTN, delirium tremens, agitation, hallucinations (tactile). Tx DT w/ benzos
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Opioid withdrawal symptoms…
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Anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection, fever, rhinorrhea, N/D, flulike, yawning. Tx: naloxone + buprenophine, methadone
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Tx of barbiturate OD…
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Assist respiration and incr BP
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Withdrawal symptoms of barbiturates…
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Anxiety, seizures, delirium, CV collapse
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Symptoms of amphetamine OD…
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Psychomotor agitation, impaired judgement, pupil dilation, HTN, tachycardia, eduphoria, prolonged wakefulness/attn, cardiac arrhythmias, delusions, hallucinations, fever
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Symptoms of amphetamine withdrawals…
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Crash- depression, lethargy, HA, stomach cramps, hunger, hypersomnolence
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Tx of cocaine OD…
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Symptoms very similar to amphetamines. Give benzos for overdose
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Symptoms of nicotine intoxication…
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Restlessness, insomnia, anxiety, arrhythmias
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Symptoms and tx of nicotine withdrawals…
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Irritable, HA, anxiety, wt gain, crave. Tx: buproprion/varenicline
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Symptoms of LSD intoxication…
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Anxiety or depression, FLASHBACKS, delusions, visual hallucinations, papillary dilation
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Heroin users at incr risk for…
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Hepatitis, abscesses, OD, hemorroids, AIDS, right sided endocarditis
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Why does naloxone have a decr abuse potential… what is MOA of buprenorphine…
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Naloxone is only active if injected. Buprenorphine is a PARTIAL agonist of opioid receptors
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Delirium tremens and when does it peak… tx…
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1st symptom: tachycardia/tremors/anxiety/seizures > psychotic symptoms (hallucinations) > confusion. Peaks 2-5 days after last drink. Tx w/ benzos
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Tx of depression w/ insomnia and MOA of drug…
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Mirtazapine which is alpha2 agonist causing incr release of NE and Ser and is antagonist of Ser2,3. other side effects include wt gain
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Tx of PTSD…
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SSRIs
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MOA of typical antipsychotics…
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Block D2 receptors causing incr in cAMP
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Evolution of side effects for typical antipsychotics…
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4h-acute dystonia, 4d-akinesia (parkinsonism), 4wk-akasthesia (restlessness), 4mo- tardive dyskinesia
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Besides dystonia, akinesia, akasthesia, TD, what are other side effects of atypical antipsychotics…
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Antimusc: dry mouth, constipation, dizziness. Anti-alpha: postural hypotensn, anti-histamine: sedation, antiandrogen: prolactinemia, galactorrhea. Also, Chlorpromazine causes Corneal deposits and Thioridazine causes reTinal deposits
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High potency typical antipsychotics… what kind of SEs most common with these…
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Haloperidol, trifluperazine, fluphenazine. Mainly get neuro side effects
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Low potency antipsychotics… what kind of SEs most common with these…
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Thioridazine (retinal deposits), Chlorpromazine (corneal deposits). Usually non-neuro side effects
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MOA of atypical antipsychotics…
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Block 5-HT2, alpha, H1, and DA receptors
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Uses of olanzapine…
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Schizophrenia, OCD, anxiety, depression, mania, Tourrettes
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Atypical antipsychotics causing wt gain…
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Olanzapine and clozapine
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SEs of Lithium…
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Tremor, sedation, heart block, hypothyroid, polyruria and nephrogenic DI, teratogen (Tricuspid problems)
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MOA of buspirone… use and why is it so good…
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Stimulates 5HT1 receptors. Used for GAD. No sedation, addiction, nor tolerance. Does NOT interact w/ alcohol. Good for alcoholics or people with abuse potential
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Tx of fibromyalgia…
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TCAs
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SEs of TCAs… which ones have less of these effects…
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Sedation, alpha-block, anticholinergic-tachycardia, urinary retn, which are more common in amitriptyline. Nortriptyline has less anticholinergic and despiramine has less sedation.
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In an elderly person using TCAs who gets confusion and hallucinations, which TCA should you give him… what is tx for TcA toxicity.
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Give elderly nortipyline (less anticholinergic). Tx for CV toxicity of TCAs is NaHCO3
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SEs of SSRIs… Tx of serotonin syndrome…
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GI distress (runs), Sexual dysfunxn, Serotonin syn (hyperthermia, muscle rigid, CV collapse, flushing). Tx of Serotonin syndrome- cyproheptadine (5-HT2 receptor antagonist)
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SNRIs and their uses… SEs…
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Venlafaxine (depression and GAD), Duloxetine (depression and diabetic peripheral neuropathy). SEs: incr BP, sedation, stimulant effects
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MOAIs and their uses… SEs and contraindications…
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Phenelzine, tranylcypromine, isocarboxazid, selegine (MOA-B). used for atypical depression, anxiety, hypochondriasis. SE: hypertensive crisis w/ tyramine and beta-agonists. Contraindicated w/ SSRIs or meperidine (Ser Syn)
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MOA of buproprion and uses… SEs…
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Incr NE and DA. Used for atypical depression and smoking cessation. Can cause stimulant effects, HA, seizure in bulimic patient. NO sexual side effects
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MOA of maprotiline and use…
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Atypical antidepressants that blocks NE reuptake
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MOA of trazodone and uses… SEs…
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Inhibits Ser reuptake. Used for insomnia and atypical antidepression but high doses are needed. SEs: sedation, Nausea, priapism
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Design of case-control… what can be measured…
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Compares group of people w/ DISEASE to group without. Look for Odds ratio
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Design of cohort study… what can be measured…
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Compares group of people w/ RISK factor to group without risk factor. Look for relative risk
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Design of cross-sectional study… what can be measured…
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Collects data from group of people to measure frequency of disease and related risk factors at a particular point in time. Measures prevalence, can show risk factor association only
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What can a meta-analysis achieve…
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Greater statistical power
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What measures the ability of a test to detect a disease when it is present…
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Sensitivity
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Which test measurement is used in screening in diseases with a low prevalence…
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Sensitivity
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What is the probability that a person has a disease when they test positive… equation…
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PPV= TP/(TP+FP)
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If the prevalence of a disease is low and a specific test has a high sensitivity and specificity, what will the relative PPV be…
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Low even though sensitivity and specifity are high
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Coorelation between specificity and FP rate…
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A FP rate approaching zero means you have high specificity
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In what case does the prevalence approximate the incidence…
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In low disease duration because Prevalence=Incidence x disease duration
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When does odds ratio approximate the relative risk…
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If prevalence of disease is not too high
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Attributable risk… equation…
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Difference in risk between exposed and unexposed group or proportion of disease occurances attributable to risk factor. EER-CER
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Absolute risk reduction…
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Reduction in risk associated with treatment compared to placebo. EER-CER
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Equation for number needed to treat…
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1/ARR
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Equation for attributable risk percentage…
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ARP=(RR-1)/RR
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Effect of …. Reduces the precision of a test…
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Random error
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Effect of …. Reduces the accuracy of a test…
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Systematic error
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What is a cross-over study…
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When each subject acts as own control
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Sampling bias vs. selection bias…
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Sampling occurs when subjects NOT REPRESENTATIVE of population. Selection occurs when nonrandom ASSIGNMENT occurs because maybe the investigator chooses subject for a particular characteristic
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Late-look bias and an example…
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Gathering info at an inappropriate time. Eg. Using a survey to study a fatal disease, only those alive can answer
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Procedure bias…
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Subjects in different groups not treated the same
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Pygmalion effect…
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Researchers belief in efficacy of tx changes outcome of that treatment
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Hawthorne effect…
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Group being studied changes its behavior owing to knowledge of being studied
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Beta...
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Probability of making a type II error -Stating that there is not a difference when one actually exists or failing to reject the null when in fact Ho is false
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Power (1- b)…
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Probability of rejecting the null hypothesis when it is in fact false or the likelihood of finding a difference if one actually exists
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Power depends on …
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Total # of end points experienced by population, difference in compliance between tx groups, size of expected effect
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Relationship between standard error fo the mean an standard dev as well as SEM and n…
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SEM < standard deviation and SEM decreases as n increases
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How determine if there is significant difference or not using CIs…
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If CI for mean difference between 2 variables includes 0 then there is NO sig diff. If CI for odds ratio or RR includes 1 then there is NO sig diff and Ho is not rejected
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Diff between t-test and Chi-square…
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T-test checks difference between MEANS of two groups (Mr. T is mean) while chi-square checks difference between 2+ percentages or proportions of categorical outcomes (NOT means)
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APGAR stands for and what are points given for…
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Appearance (1 pt for trunk pink), Pulse (2pts for >100), Grimace (2pts for cough), Activity, Respiration (1pt for irregular)
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Milestones at 3 months…
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Holds head up, social smile
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What should a child be able to do from age 1-2…
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Climb stairs, stack 3 up to 6 blocks, object permanence, 200 words and word sentences by 2
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When is a kid able to copy a circle drawing...
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3yrs
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When should a kid be able to use complete sentences…
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3 yrs
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When should a child be able to hop on one foot… what else at this age…
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4yrs, also simple drawings, cooperative play, imaginary friends, grooming, buttons and zippers
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What happens in Piaget’s sensorimotor stage and when is it…
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0-2yrs. Egocentric exploration w/ 5 senses. Novel use of objects to obtain goal (stick to reach), object permancence is achieved
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Piaget’s preoperational stage and when is it…
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2-7yrs. Acquisition of motor skills, magical thinking predominates w/o logic
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Piagets concrete operational stage and when is it…
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7-12yrs. Logical thinking beginning but confined to concrete concepts. No longer egocentric
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Sleep patterns in old people…
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Decrease: REM and slow wave. Increased: latency and awakenings
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Normal bereavement characterized by and time frame…
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Shock, denial, guilt, somatic symptoms, perhaps illusions. 6ms-1yr
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Pathological grief consists of and what may experience…
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Excessively intense or prolonged, grief that is delayed or inhibited. Depressive symptoms, delusions, hallucinations
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Differential diagnosis for sexual dysfunxn…
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Drugs (antihypertensives, neuroleptics, SSRIs, ethanol), Depression, Diabetes, Psychological
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Beta sleep is characterized by what on EEG waveform…
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Highest frequency, lowest amplitude
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In what stage of sleep does teeth grinding occur and what is seen on EEG…
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Stage 2 sleep, sleep spindles and K complexes
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In what stage of sleep does one night walk… what else happens at this stage…
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Stage 3-4. deepest sleep. Night terrors, bedwetting.
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In what stage of sleep does one dream… what else happens in this stage…
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REM, loss of motor tone, erections, incr O2 use
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What NT REduces REM sleep…
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NE reduces REM
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Extraoccular movements in REM due to…
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PPRF activity
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What drug do you want to give for night terrors and bedwetting and MOA…
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Benzodiazepine, shortens stage 4. Imipriamine (TCA) also shortens stage 4
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Principal NT involved in REM sleep…
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Ach
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Stage of sleep w/ greatest % of time in young adults…
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Stage 2
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