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143 Cards in this Set
- Front
- Back
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acting out?
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behaviors to distract person to relieve tension thru activity and not verbalization
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abreaction?
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repressed material, esp painful experience of conflict, is brought back to consciousness. The person relives experience
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ventilation?
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expression of suppressed feelings, ideas or events to other group members. It relieves a sense of sin or guilt
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catharsis
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get relief when expressing thoughts, ideas, and suppressed material
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psychotherapy for borderline?
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DBT
want individual and group therapy. Group therapy has diluted transference. Group is good for stability and moderation to the extreme ways borderlines see others. |
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why individual and group therapy?
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individual therapy allows for the reflection of feelings in group and responses of others to them from group.
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automatic thoughts?
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way of perceiving situations. Cog therapy tries to find them and eliminate
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behavior therapy?
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focused on behaviors and not on possible underlying factors causing behaviors. Not uncovering unconscious things. Just changes maladaptive behavior to adaptive
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focus of interpersonal psychotherapy?
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communication analysis, then change the communication patterns by role playing or trying out diff forms of communication. It fcuses on pt's role and communication style in imp relationships, and how the role may be causing or complicating the illness, like depression.
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psychodynamic?
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interpret transference, point out resistance, character change. Can use hypnosis
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Sx of wernickes encephalopathy
First step? |
Thiamine def (B1).
Bilateral CN6 palsy; horizontal nystagmus; ataxia; global confusion w/apathy -First step is IV thiamine: excess thiamine doesn't do anything |
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signs and sxs of EtOH w/d
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unstable vitals
tremulousness agitation |
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signs of folic acid def
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diarrhea
cheilosis glossitis |
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bipolar depression drugs
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Buproprion, lamictal, TCAs
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acute stress disorder vs PTSD
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PTSD persists for over 4 weeks post traumatic event.
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-oculogyric crisis
-torticolos and retrocollis -trismus |
-spasm of muscles of extraocular motion
-spasms causing abnormal positioning of head -jaw spasm |
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Bulimia labs?
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Thyroid function is intace
-hypokalemia -hypochloremic alkalosis -high serum amylase -hypomagnesemia |
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opiate intox signs? X4
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pupillary constriction
drowsiness impaired attention and memory slurred speech |
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opiate w/d sxs? x4
TX? |
ab pain
muscle aches lacrimation or rhinorrhea fever clonidine, buprenoprhine and methadone |
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What are the 2 intelligence tests?
-Age range? |
Wechsler Adult Intelligence Scale:
-16-75 -assess overall intellectual functioning -2 parts: verbal and visual-spatial Stanford-Binet Test -tests intellectual ability in pts 2-18 |
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Objective personality assessment test?
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MMPI-2
-standardized answer format; objective -tests personality for diff pathologies and behavioral patterns |
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Projective assessment tests? x2
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For personality
-No structured response TAT: create stories based on pics of people in situations. -evaluates motivations behind behavior Rorschach: IDs thought disorders and defense mechanisms |
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idea of reference defn?
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things in the world are talking about them: TV is speaking to the person
-type of delusion |
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Types of delusions?
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i)idea of reference ii)thought broadcasting iii)delusion of grandeur iv)delusion of guilt v)paranoid delusion
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clinically, how do you know someone is psychotic?
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i)perceptual disturbance (hallucinate) ii)disorganized thinking iii)delusions
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olfactory hallucination cause?
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aura ass'd w/epilepsy
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loss of ego boundaries defn?
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Unaware of where one's mind and body end and someone elses begins
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medical causes of psychosis (CNS dz)
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-CVD
-MS -neoplasm -Temp lobe epilepsy -parkinson's and huntington's -encephalitis -prion dz |
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medical causes of psychosis (nutrition)
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B12, folate, B1
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Medical causes of psychosis: other
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CT disease: SLE, temporal arteritis
-porphyria |
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3 phases of schizophrenia?
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1)Prodrome: decline in functioning that precedes 1st psychotic episode: w/drawn and irritable; interest in cult
2)Psychotic 3)Residual: b/w episodes of psychosis w/negative sxs. |
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Disorganized type schizophrenia characteristics
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-poor functioning type; early onset
1)disorganized speech 2)Disorganized behavior 3)Flat or inappropriate affect |
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Catatonic type
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2 of following
-motor immobility -excessive purposeless motor activity -extreme negativism or mutism -pecular posture or movement -echolalia or echopraxia (mimic phrase or behavior) |
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genetics/epidemiology of schizophrenia
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-50% concordance among monozygotic twins
-40% if both parents have it -10% if 1st degree relative has it |
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DA pathways responsible for Positive and negative symptoms
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-PFC: negative
-mesolimbic: positive |
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treatment for EPS
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antiparkinson drugs: amantadine, benztropine, benzos
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short term treatment for TD
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benzos, B blockers, cholinomimetics
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side effect of mellaril
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retinal pigmentation
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side effect of chlorpromazine (thorazine)
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deposits in lens and cornea
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prognosis of schizo vs other types
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mood d/o>brief psychotic d/o>schizoaffective d/o>schizophreniform>schizophrenia
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subtypes of delusional d/o
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erotomanic;
grandiose; somatic (physical delusion); persecutory type jealous type mixed type |
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TX of folie a deux
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-remove patient from person causing it
-psychotherapy -drugs if sxs not improved after 1-2 weeks after removing pt |
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Medical causes of depressive d/o
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CVD
hypoglycemia viral illness carcinoid syndrome lymphoma and pancreatic carcinoma collagen vascular disease |
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medical causes of manic episode
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-hyperthyroidism
-neurological: temporal lobe seizure; MS -HIV infection |
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medication/substance cause of depression
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-antihtn
-steroids -levodopa -hypnotics -antipsychotics and anticonvulsants -diuretics -sulfonamides |
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medication/substance cause of mania
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-steroid
-sympathomimetics -bronchodilators -levodopa |
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autonomic Sxs of anxiety
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-palpitations
-perspiration -dizziness -mydriasis -GI -urinary urgency and frequency -paresthesias |
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neurotransmitters in anxiety
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-increased NE
-decreased GABA -decreased 5HT |
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epidemiology of anxiety
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-F>M
-higher socioeconomic groups |
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Types of anxiety d/o
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-panic d/o
-agoraphobia -specific and social phobia -OCD -PTSD -Acute stress d/o -GAD -secondary to substance or medical condition |
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2ndary causes of anxiety
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-Vit B12 def
-organophosphates -pg 38 |
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Panic disorder:
-exacerbants |
-caffeine/nicotine; hyperventilation
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Associated conditions w/panic d/o
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Major depression
substance dependence social and sp phobias OCD |
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DDX for panic
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Medical: heart; temp lobe epilepsy, MS, pheo, carcinoid syndrome, COPD
Mental: depression, phobia, OCD, PTSD |
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Treatment of Panic
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-Benzos->SSRI (start SSRI low and work up)
-maintenance: paxil |
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OCD assns
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-MDD
-eating d/o -anxiety d/o -OCPD -2-3% -higher if 1st degree has tourettes -abnl reg'l of 5-HT -need higher than normal doses of SSRI; TCA -BT: exopsure and response prevention -ECT or cingulotomy as last resort |
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most common mental d/o
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1)phobia 2)substance induced d/o 3)MDD 4)OCD
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TX of PTSD
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-TCAs: imipramine and doxepin; SSRIs; anticonvulsants (flashbacks and nightmares)
-avoid benzo b/c of high drug abuse |
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comorbidity w/GAD
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-MDD; social/sp phobia; panic d/o
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tx of GAD
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1)Buspar 2)benzo 3)SSRI 4)venlafaxine
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Cluster A personality disorders:
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-schizoid
-schizotypal -paranoid -patients are eccentric, peculiar, or w/drawn\ -ass'd w/psychosis |
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Cluster B
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-Antisocial
-histrionic -narcisstic -borderline -mood disorders |
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Cluster C
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-avoidant
-dependent -obsessive compulsive anxious or fearful anxiety d/o |
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men personality d/o
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ASPD; schizoid; schizotypal; paranoid; OCPD
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women personality d/o
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histrionic, BPD; dependent;
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apraxia
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inability to perform previously learned motor skill
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anomia
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inability to name objects outside of an aphasia
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alexia
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inability to read
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prosopagnosia
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inability to recognize faces
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what parts of brain are affectd in schizo
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-hippocampus
-parahippocampus gyrus -amygdala |
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trichotillomania
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pulling hair out compulsively
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schizophrenia tracts involved
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mesolimbic: positive symptoms
amygdala: emotional sxs |
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What is prodromal schizo composed of?
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-increasing neg sxs in absence of positive sxs.
-difficult to tell apart from depressive sxs -include autistic features |
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neuroanatomy of anxious state
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locus ceruleus is the alarm center of the brain and hyperactive in anxiety states.
-has the most NE neurons in brain. |
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CT: hypointensities
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lacunar stroke
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defn of externalization
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generalized form of projection. See the patterns of behavior in others but really its true about oneself
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sublimation
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channel fears or conflicts into goals that become gratifying
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Where is 5HT synthd in CNS?
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dorsal and medial raphe nucleus of brainstem.
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Diff b/w tertiary and secondary amines
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-tertiary: inhibit reuptake of 5-HT more than NE
-secondary: inhibit reuptake of NE more |
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glossolalia
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ability to suddenly speak languages
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verbigeration
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repetitive and meaningless talking
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loosening of ass'n
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lack of logical connections b/w ideas but sentence structure is intact
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flight of ideas
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every sentence or 2 is new idea but connections b/w the 2 are seen.
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chlorpromazine S/E
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obstructive jaundice
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thioridizine s/e
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pigmented retinopathy
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kindling
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one depressive decompensation can lead to another
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double depression
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MDE superimposed on dysthymic d/o
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when does EtOH w/d happen?
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-tremulousness, w/d seizures, w/d delirium: 5 days after drinking
-w.d seizures: 48 hours after EtOH consumption ceases |
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developmental milestones
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-copy circle at age 2
-age and gender; ride trike: age 3 -copy a square and id left hand at age 5 |
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positive prognostic factor in autism
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-can converse meaningfully with others
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common findings in anorexia nervosa
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-hypercholesterolemia
-normocytic normochromic anemia -leukopenia -hypochloremic-hypokalemic metabolic alkalosis |
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signs of anorexia
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state of starvation=bodily functions suppressed
-rest energy expenditure decreased -sinus bradycardia -low estrogen and testosterone -ventricular-brain ratios increased |
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true or false: more affective sxs in schizo of kid is prognostic factor
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true
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common feature b/w ADHD and mania in kids
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ADHD kids have low self esteem
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age of when kids understand death
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7 years old: need to be aware of continuity of time, able to fantasize, solid sense of his or her own individuality
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most common adverse effect of clonidine
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sedation (not hypotension!)
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Tourette's family hx and depressed
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TCAs
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Identification (defense mech)
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adopt other people's characteristics
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displacement
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emotions shifted from one idea or object to another that resembles original but evokes less distress
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dissociation
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person's character or sense of identity is temporarily but drastically changed to avoid emotional distress
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defn stereotypic movement d/o
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self inflicted bodily injury severe enough that you need medical attn (bleeding rectum and anemia)
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catatonic schizophrenic presentation
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-motor behaviors
-nonverbal communication like facial expressions -echolalia and echopraxia |
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disorganized schizo presentation
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severe thought disorder that can be refractory to neuroleptics
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fetishism
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sexual arousal connected to nonliving objects
-need social impairment |
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haldol and chlorpromazine teratogenicity?
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Class C drug: seen in animals
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Txs of PMDD
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SSRi, OCPs, spironolactone, benzos
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causes nystagmus
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-etoh w/d
-pcp |
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high tyramine content
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etoh
sauerkraut salami |
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infarcts of braine:
-L frontal hemispheres (LMCA) -right MCA -diffuse bilateral frontal injury |
-Left: depression
-Right: euphoria, inappropriate indiff, mania -Obsessive compulsive behaviors |
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impotence and ages for psych etiology
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-90% of impotence in 30-50=psychological
-after 50, becomes more medical |
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metabolite measured in CSF of suicide, impulsive, and aggressive peeps
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5HT
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causes of amnestic disorders
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-hypoglycemia
-EtOH and benzos -MS -seizure -trauma or tumor or CVA |
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treatment of dissociative amnesia
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-help pts retrieve lost memories to prevent future recurrences
-use ativan or sodium amobarbital to help them talk more freely |
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abreaction
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-the strong emotion peeps get when talking about a traumatic event
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somatoform disorder r/o causes:
Who are they most common in? |
-CNS dz
-endocrine d/o -CT d/o -most common in women except hypochondriacs |
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comorbidity w/somatoform
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-anxiety
-depression |
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-treatment in somatization d/o
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-not many meds; relaxation tx hypnosis; group and individual
-won't see a psychiatrist |
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what d/o ass'd w/labelle indifference
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Conversion
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hypochondriasis DSM
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-fear for 6 months
-persist despite medical evaluation -misinterpreted body sxs. |
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commonly feigned sxs in factitious
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-psychiatric: hallucinations, depression
-medical: fever, ab pain; seisures, hematuria |
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factitious epidemiology
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-males
-higher intelligene, poor sense of identity, poor sexual adjustment -child abused or neglected |
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somatization d/o age?
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<30 years old
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treatment of IED
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SSRIs; anticonvulsants; Li; propanolol
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anorexic electrolyte abnormality
-other physical findings |
-hypochloremic hyperkalemic alkalosis
-hypercholesterolemia -melanosis coli |
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bulimia electrolyte abnormality
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-hypochloremic hypokalemic alkalosis
-esophagitis |
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what neurotransmitter abnormalities exist for sleep d/o?
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-elevated DA or NE decreases total sleep time
-elevated Ach increases total sleep time and increased REM -Increased 5HT increases total sleep time and increased delta wave sleep (stage 3 and 4). Have lowest f |
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Primary sleep sleep disorder subdivisions (x2)
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1)dyssomnia: amt, quality, or timing fucked
2)parasomnia: behavior or physiology of sleep fucked up |
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pharm therapy for primary insomnia
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-pharm is 2nd line
-zalepon, trazodone, benedryl, ambien |
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ass'n of OSA and CSA
-what do they cause |
OSA=snoring
CSA=heart failure -EDS(excessive daytime sleepiness) due to abnormal sleep ventilation |
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treatment of OSA and CSA
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-nCPAP (nasal cont pos airway press)
-CSA=bPAP (mechanical ventilation) with a backup rate |
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DA and 5HT effects on libido?
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DA enhances
5HT inhibits |
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Treatment for insomnia using antidepressants
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-TCA
-trazodone |
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Use of nortriptylin
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-least orthostatic hypotension
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use of desipramine
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-least anticholinergic, least sedating
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use of clomipramine
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-most 5HT specific, useful in OCD treatment
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Major complications of TCA
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3C's
Cardiotoxic coma convulsions (neurotoxic) -lethal in overdose |
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Fcns of MAOA and B
-1st step in 5HT syndrome |
A: reuptake of 5HT
B: reuptake of NE -Both act on DA and tyramine -Discontinue medication |
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fluvoxamine use
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OCD
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paroxetine imp facts
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-most 5HT specific
-most activating |
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sertraline
fluoxetine |
-highest risk for GI disturbance
-don't need to taper, longest 1/2 life |
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immediate treatment of mania
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haldol
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strongest indicator for suicidal attempt x
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prior suicidal attempt
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Picks symptoms
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altered personality
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