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88 Cards in this Set

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anorexia - diagnostic criteria
*weight less than 85% expected
*fear of weight gain
*body dysmorphy
*miss 3 consecutive menustral cycles
*subtypes: restricting or binging and purging
bulimia - diagnostic criteria
*recurrent binge eating
*lack of control
*recurrent compensatory (vomiting laxatives excercise)
*2 binges weekly for 3 mo
*overconcern with weight or shape
anorexia-pathophysiology
*genetic ties
*earlier age of onset than BN
*hypothalamic disturbance
*increased CRF
*decreased NE activity
*amenorhhea before weight loss in 20%
anorexia - physical signs
*emaciation
*hypothermia
*edema
*bradycardia
*hypotension
*lanugo
anorexia labs
*GH
*cortisol
*gonadotropin
*thyroxin, TSH, T3
*electrolytes in purging
*LFT
*lipids
*GH elevated
*cortisol elevated
*gonadotropins decreased
*Thyroixine and TSH normal, T3 reduced
*hypokalemic alkalosis, decreased CA
*increased LFT, fatty deposition
*increased cholesterol and carotenemia
*parotid hypertrophy and elevated amylase
*abnormal dexamethasone suppresssion and glucose tolerance
*hypocholeremia
*leukpenia
eating disorder treatments
*indications for hospital
*special med treatments
* in AN restore weight in BN restore electrolyte abnormalities
*starvation weight loss psychosis electorlyte abnormalities hypotension or hypothermia
*cyproheptadine chlorpromazine, lorazepam, antidepressants decrease binging and purging
Epidemiology: most common disorders
*NIMH catchment area study US - substance use disorder
Freud and Erikson
the anal stage
autonomy vs shame and doubt
ages 1-3
shame from elimination or self consciousness, holding and letting go
Freud and Erikson
Phallic-oedipal
initiative vs guilt
age 3-5
guilt over aggressive goals
mimicry of adults
sibling rivalry, competition and aggression
Oedipal conflict resolved with the creation of the superego (internalized parental values and standards but not a contoller of drives)
Freud and Erikson
latency
industry vs inferiority
age 6-11
creation building and accomplishment
socially decisive stage
Freud and Erikson
genital
identity vs role diffusion
age 11-adolescense
ego formation, preoccupation with appearance.
formation of group identity
morality and ethics watershed
Erikson
generativity vs stagnation
age 40-65
not child dependent
altrusim and creativity
Erikson
integrity vs despair
over age 65
life has been productive and worthwile
despair is fear of death
integrity is your place in the life cycle
Freud and Erikson
oral
trust vs mistrust
birth to 1 year
Erikson intimacy and isolation
age 21 to 40
tasks are to love and work
friendships and intimacy
structural model of the mind
*components
ego id and superego
the superego
*consicious or unconsious?
*modulates drives?
largely unconscious
*nope, that belongs to the ego
executive organ of the psyche?
*consioucous preconsious or unconsious
*contains?
*ego
*spans consiousness
*contains logical and abstract thinking (conscious and preconsious)and defenses
*controls the reality and pleasure principle (not the id)
sublimation
negative energies are put or diverted into personally and socially acceptable activities.
denial vs repression
denial - disavowing
repression - not available
Interpretation of Dreams
expression of unconsious fantatsies or wishes
*latent dream content derives from the id
ego ideal
not the same as the superego
an amalgam of internalized representations
prescribes what you should do by making reference to the superego, connected with shame not guilt.
topographic theory
unconsious preconsious and conscious
*presented in 1900 in Interpretation of Dreams
*Ego and Id (1923) was the debut of the structual model
*Anna Freud - first systematic study of defenses, agents athat act to keep conflcits out of consiousness, the birth of Ego psychology in 1936.
mature defenses
altruism anticipation ascetism humor sublimation suppression
head balanced
16 weeks
visual accomodation
16 weeks
sits steadily/leans
28 weeks
sits alone
40 weeks
creeps
pulls self to stand
points
40 weeks
walks with one hand
stand brifely
52 weeks
responds to sounds
4 weeks
follows moving object
16 weeks
social smile
16 weeks
separation anxiety
40 weeks
peek a boo
40 weeks
feeds self
40 weeks
dresses self
52 weeks
draws cross
4 years
copies square
5 years
copies triangle
6 years
walks up stairs with one hand held
18 months
names self
2 years
put on shoes
3 years
object constancy
2 to 5 years (mahler)
babbles and sounds
birth to 6 mo
pat a cake and peek a boo
7-11 months
vocabulary at 12-18 months
150 understood
uses 20
speech intelligble, language to tell stories and ideas
54 months on
two words
12 months
phrases
18 months
one word
40 weeks
grasping and manipulation
16 weeks
creeping and poking
40 weeks
anal sphincter control
3 years
first smile, social smile
1-2 weeks, social smile 4-8 weeks
visual fixation
2-4 weeks
5 stages
DABDA: denial anger bargainging depression acceptance
normal auditory perception
2 years
Pick's Disease
*dementia
*incidence peaks in late 50's
most cases younger than 65
*rare with familial tendency
*frontal and anterior prominence (spares parietal lobes)
*Pick Bodies (silver staining)
*early personality changes
*frontal lobe syndrome, Kluver Bucy hyperorality
speech preserved
psychosis
Argyll Robertson pupils
facial tremor
strokes
tabes dorsalis
neurosyphilis
visual disturbances
white matter lestions on MRI
dementia
PML
cognitive fluctuation without memory impairment
dementia
Parkinsonism
VH
Dementia with Lewy Bodies
avoid EPS
Apo e4
amyloid precursor
chromosome 19
chromosome 21
early memory loss
progressing to disorientation
then aphasia
depression
agitation gait disturbance
AD
CJD EEG
non specific sharp waves and spikes
diarrhea
glossitis
dementia
glossitis
anemia
skin lesions
alcohol use
Pellegra (niacin deficiency)
dementia
necrosis of corpus callosum
dysarhtria
gait problems
Marchiafava bignami
amnestic syndromeof recent memory impairment
bitemporal hemianopia
visual agnosisa
alexia without agraphia
bilateral PCA occlusion
dementia
related to degeneration of dorsomedial thalamic nuclei
polyneuropathy
nystagmus
ataxia
confabulation and apathy
Korsakoff dementia/amnestic syndrome (thiamine B1 deficiency)
opthalmoplegia
ataxia
confusional state
Wernicke encpehalopathy
gait apraxia
urinary incontinence
dementia
NPH
Parkinson tremor
4-6 hz
pill rolling
greater at rest and stress
starts unilateral and goes to generalized
kiddie epidemiology: child abuse
neglect most common
15/1000 kids
2-3%
BZD without active metabolites
LOT
lorazepam, oxazepam, temazepam.
treatment of hypertensive crisis
phentolamine IV
MAO and SRI
serotonin syndrome (fever diaphoresis confusion myoclonus htn tremor and diarrhea)
MAO stopping and starting
wait 2 weeks before normal diet, or using TCA
TCAs with plasma levels
nortryptiline desiprmaine and imimpramine
TCA and SRI
keep dose of TCA low
TCA and MAOI
start them together
after a medication free period.
Tertiary amines
amytriptiline
imiparamine
doxepin
more prominent antilcholinergic side effects
cardiac complications of TCA
long conduction
avoid in 1st degree of RBBB;anyone highter than first degree block should not get TCA
Lithium levels
.9-1.4 for acute mania MEQ/L
maintenance .6-.8
mostly antimanic
works as well as antidepressant for unipolar pts.
Lithium kinetics
no metabolites
presnent in all fluids
levels 12 hrs after the last dose
Lithium side effects
thirst or polyuria, tremor, diarrhea, weight gain, edema, hypothyroid,
Lithium toxicity and adverse events
dehydration
thiazides
anything that increases sodium reuptake in the proximal tubule
may cause hypercalcemia and PTH elevation
T wave changes like in hypokalemai
acne
leukocytosis
nephrogenic DI
nephrotic syndrome
rare Parkinsonia sx
LI contraindications
renal dz
d/c for MI for 10-14 days
MG
PD
d/c in 1st trimester
no breast feed
adolescent suicide
3rd leading cause of death behind MVA and homocide
gun most common
girls attempt but boys complete more.
major risk factor is trying before
ppt is argument in fmaily
more common as older
hanging second
ingestions in females
not always with mood d.o.