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48 Cards in this Set
- Front
- Back
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Effects of long infant deprivation:
Reactive attachment disorder |
Weak, wordless, wanting, and wary.
Decreased muscle tone, poor language skills, poor socialization, lack of trust, anaclitic depression, weight loss, physical illness, and even death. |
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Anaclitic depression
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Depression in an infant owing to continued separation from caregiver. Infant becomes withdrawn and unresponsive.
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Rett disorder
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X linked DOMINANT; only seen in females (males die in utero).
Xq28, MECP2 gene, usually a denovo mutation. Loss of milestones and mental retardation beginning at age 4. There can be characteristic hand wringing stereotypy. |
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Conduct disorder, antisocial personality disorder, and opposition defiant disorder.
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ODD is noncompliance in absence of criminality.
Conduct disorder is continued behavior VIOLATING SOCIAL NORMS (criminality). Antisocial personality disorder is basically conduct disorder at >18 years of age. |
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Tourette's, and its treatment
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Disorder associated with mutation on Chromosome 18, causes involuntary motor/vocal tics.
Treatment includes haloperidol. |
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Who is the abuser?
Child abuse (3000 deaths per year) Sexual abuse (peak incidence 9-12 yo) |
Child abuse: usually female and the primary caregiver.
Sexual abuse: known to victim, usually male. |
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Anosognosia
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unawareness of illness
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Autotopagnosia
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unable to locate one's body parts
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Depersonalization
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body seems unreal or dissociated
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Does patient with delirium have a normal or abnormal EEG?
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Abnormal EEG.
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Dementia
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Impairment in MORE THAN ONE cognitive area with impaired ability to FUNCTION. No change in level of consciousness.
EEG is normal, characteristically. |
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Alzheimers: male>female or female>male ?
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Females > Males
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Idea of reference
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false belief of being referred to by others (e.g. "The news anchor is always talking about me...")
Not narcissism |
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Hallucination associations:
Visual/auditory Olfactory Formication |
V/A - schizophrenia
Olfactory - aura of psychomotor epilepsy Formication - DTs and cocaine abuse |
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How long do you have to have periods of psychosis and disturbed behavior with decline in functioning for:
Brief psychotic disorder Schizophreniform disorder Schizophrenia |
<1 month brief
1-6 month schizophreniform >6 month schizophrenia |
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Inheritance of schizophrenia (?)
Risk if 1st degree, risk if both parents? |
Risk is 10% if first degree relative has it.
Risk is 40% if both parents have it. |
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Hypomanic episodes: can they have psychotic features?
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No, can't have psychotic features in hypomania.
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Manic episode
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At least 1 week of 3 or more of: DIG FAAST
distractibility, irresponsibility, grandiosity, flight of ideas, agitation, increased activity, decreased need for sleep, talkativeness or pressured speech. |
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Bipolar
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1 manic or hypomanic episode defines bipolar disorder
1% lifetime risk, male = female 20% risk if 1st degree relative has disorder 60% risk if both parents have it |
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Cyclothymia
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dysthymia and hypomania lasting at least 2 years
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Depression
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Females(10-25%)>>Males(5-12%)
At least 5 of SIGEMCAPS for 2 weeks Sleep disturbance Interest Guilt Energy Mood Concentration Appetite Psychomotor retardation or agitation Suicide |
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Atypical features of depression
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Hypersomnia, hyperphagia, leaden paralysis
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Dexamethasone suppression test and depression
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50% of patients with depression have no response to dexamethasone suppression tests (!)
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Risk factors for completing suicide
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Male, Age, Depression, Previous attempt, Ethanol/drugs, loss of Rational thinking, Sickness, Organized plan, No spouse, Social support lacking
Also: history of rage/violence Men are 4x more likely to succeed, women 3x more likely to try. |
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Sleep patterns in depression
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Decreased slow wave sleep, decreased REM latency, increased REM early in sleep cycle, increased REM sleep, repeated night time awakenings
Early morning awakening is one of the most important things |
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Postpartum reactions
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Blues: 33-50% of mothers; sad, tearful, normal grooming, lasting up to two weeks post delivery.
MDD: 5-10% of mothers; poor grooming, typical depressed signs, begins usually 4 weeks postpartum Psychosis: .1-.2%; hallucinations, delusions, no depression; begins usually 2-3 weeks postpartum. |
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Fear versus anxiety
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fear - normal reaction to known source of danger
anxiety - unknown or inadequate source of danger |
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Organic causes of anxiety
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excessive caffeine
substance abuse B12 deficiency hyperthyroidism hypoglycemia anemia arrhythmia pulmonary disease pheochromocytoma |
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Algophobia
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fear of pain
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Acrophobia
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fear of heights
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PTSD
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lasting greater than 1 month and causing impairment
intense fear, helplessness, horror, avoidance of stimuli associated with trauma, guilt, dissociativeness Often follows acute stress disorder |
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Adjustment disorder
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Emotional symptoms causing impairment following an identifiable psychosocial stressor and lasting <6 months.
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Generalized anxiety disorder
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uncontrollable anxiety for at least 6 months
that is not related to anything specific there can be associated sleep disturbance, fatigue, difficulty concentrating |
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Malingering
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faking to attain a gain, aside from attention
avoids treatments |
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Factitiious disorder
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consciously creates symptoms in order to assume sick role and get attention. Classic grid abdomen.
Munchausen's syndrome Munchausen's by proxy: child abuse |
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Somatoform disorders
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patients truly believe they're ill
"physical symptoms without organic cause" -conversion disorder -somatiform pain disorder -hypochondriasis -somatization -body dysmorphic disorder -pseudocyesis - false pregnancy |
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Cluster A personality disorders
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"Peculiar"
Paranoid Schizoid - social withdrawal but content with it, limited emotion Schizotypal - awkward, odd, magical thinking, eccentric |
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Depersonalization disorder
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Persistent and recurrent feelings of detachment from one's body, social situation, or environment.
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Cluster B personality disorders
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"Dramatic, erratic"
- Antisocial (increased ETOH, ADHD, criminality) - Borderline - splitting, impulive, unstable (increased risk of MDD, substances) - Histrionic - excessive emotionality, attention seeking, sexually provocative (increased risk of somatization) - Narcissistic - grandiosity, entitlement, react to criticism with rage |
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Cluster C personality disorders
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"Anxious, fearful"
Avoidant - sensitive to rejection, socially inhibited, timid, inadequacy Obsessive compulsive - preoccupation with order, perfectionism, control Dependent - submissive, clinging, excessive need to be taken care of |
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Mood in anorexia and bulimia
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Anorectics tend to have normal mood
Bulimics tend to have depression, especially post binge. Bulimics can get varices, by the way. |
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GGT
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sensitive indicator of alcohol use, increases within hours of use
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cotinine
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a nicotine metabolite that is excreted in urine, lasts for 1-2 days after last cigarette
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benzoylecgonine
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a cocaine metabolite that lasts for 1-12 days, depending on use
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SGOT and CPK increases, lasting for >7days
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indicates PCP use
also, belligerence, fever, agitation, nystagmus, homicidality, psychosis, ataxia, tachycardia |
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Mechanism of fatty liver
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Ethanol --> acetaldehyde --> acetyl-CoA --> increased fatty acid synthesis --> fatty liver
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Alcoholic cirrhosis: macro or micronodular?
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micronodular
macronodular results from major insults with gross necrosis |
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Mallory Weiss tears
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lacerations at the GEJ caused by excessive vomiting, associated with pain, unlike varices
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