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87 Cards in this Set

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What are psychosensory features and what are they associated with?
Sensory Distortions

Assoc w/ limbic system disease, esp temporal lobe epilepsy
Dysmegalopsia

Dysmorphopsia
Dysmegalopsia - seeing objects change in size

Dysmorphopsia - seeing objects change in shape
Derealization

Depersonalization
Derealization - world suddenly seems unreal, as if person in dream

Depersonalization - becoming detached oneself, as if outside own body (ANXIETY disorders)
Deja vu
vs
Jamas vu
deja vu - feeling like event has been exp before
jamas vu - familiar things seem suddenly unfamiliar
Define Delusions
Fixed, false beliefs
not shared with others
based on arbitrary thinking
not logical
based on other psychopathology
Define Ideas of Reference
delusional interpretations of actions of others in which delusion always is referred to self
Psychosis
presence of hallucinations, delusions, & unusual behavior that affect daily function
Reality perception vs. Reality Testing
Reality Perception - ability to accurately percieve real world

Reality testing - ability to determine if one's perceptions are accurate

(ex if someone hallucinates but knows they are hallucinationg they have poor reality perception but good reality testing)
When are agitation, hyperactivity, and hypoactivity commonly seen?
Agitation: delirium, mood disorders, anxiety, intoxication

Hyperactivity: mania, stimulant drugs

Hypoactivity: depression, frontal lobe syndromes, schizophrenia, CNS depressant abuse
Define flight of ideas
vs.
circumstantiality
& where seen
Flight of ideas = rapid, hyperverbal speech, jumping topic to topic (MANIA)

Circumstantiality = unnecessary detail or parenthetical remarks (MANIA,HYPOMANIA, chronic TEMPOROLIMBIC disease, Chronic STIMULANT DRUG USERS, ELDERLY)
Define formal thought disorder
fluent, aphasic speech with adequate repetition

Schizophrenia, Hallucinogenic drug induced psychosis
Emotional Blunting
loss emotional expression and volition (drive) for any action

Schizophrenia, frontal lobe lesions
What are the Five axis of the DSM?
Axis I (state illness with recovery until following acute episode)

Axis II (long lasting unchanging maladaptive behavior not due to underlying pathology)

Axis III psych disorder due to underlying med condition

Axis IV scale of severity of psychosocial stressors over past year

Axis V scale ass. patients overall level functioning
How do the axis work in the hierarchy?
Axis I disorders take precendence over Axis II, etc.
What is the DSM diagnostic procedure (3 steps)?
1. Determine behavioral syndrome.

2. Decide if syndrome primary or secondary to neuro/med condition

3. identify comorbid conditions
What is the typical age of onset for schizophrenia?
75% first psychotic episode 15-25
First episode after 40 = probably NOT schizophrenia
(rarely as early as 7/8)

Strong Genetic Predisposition
How is diagnosis made?

What is lifetime prevalence, and gender differences?
Periods of psychosis/disturbed behavior for at least 6 mos or greater.

Lifetime prev = 1.5%
equal for males & females, men present earlier
What are some "first rank" (subcat of positive) symptoms?
Auditory Hallucinations

Experiences of Control (outside force controlling thoughts)

Experiences of Alienation (external force putting thoughts in head)

Delusional perceptions (important meaning to real but trivial events)

Thought broadcasting (others can hear thoughts)
What are some speech/language disturbances (generally negative symptoms)
Paucity of Speech

Poverty of Speech content (vague, stock phrases)

Neologisms (words coined that are meaningless to others)

Disturbances of Affect (reduced emotion)

Disturbed social relations

Loss of volition (no plans for future)
What are the four A's described by Beuler about schizophrenia?
Ambivalence (uncertainty)
Autism (self-preocupation, lack of communication)
Affect (blunted)
Associations (loose)

"5th A" = auditory hallucinations
Name the five schizophrenia subtypes.
Disorganized
Catatonic
Paranoid
Undifferentiated
Residual
Define the following schizophrenia subtypes:

Disorganized
Disorganized =

Poor prognosis, severe impairment

emotional blunting
silly moods
disorganized speech
disorganized thoughts
ideas of persecution
Catatonic
Rigidity
Odd postures
Resistance to being moved
Refusal obey verbal instruct.
sometimes Mute
Eruptions of excitement can occur
Paranoid
Delusions persecution/grandeur
Jealousy
Ideas of Reference
Anxious,aggressive,
quarrelsome
Less Disorganized, BETTER PROGNOSIS
Undifferentiated
mixture of psychosis (delusions and hallucinations)
Residual
In remission after episode, patient still has
subtle cognitive impairment
eccentric behavior
negative symptoms
What is the common hypothesis of etiology?
Dopamine excess theory (since antipsychotics are anti dopamine and work to tx)
Define the following conditions:

Brief Reactive Psychosis

Schizophreniform Disorder

Schizoaffective Disorder
Brief Reactive Psychosis - less than 1 month hallucinations and delusions w/o emotion expression loss
Usual mood symptoms and psychosocial stressor present.

Schizophreniform = psychotic symptoms gtr 2 wks, less than 6 mos (possibly w/o loss function)

Schizoaffective disorder = schizophrenia plus mood disorder
What are some adverse affects of antipsychotics employed to tx. schizophrenia?
Dystonia - tonic, unopposed muscle grp contraction (occur within first 72 hours tx)

Akathisia (inner restlessness)

Parkinsonian syndrome (rigidity, bradykinesia)

Tardive Dyskinesia - choreiform/athetoid mvmnts late in tx or may persist after discontinued. (usually oral/lingual)
What defines a Major Depressive Episode?
5 of following for >2 weeks including 1) depressed mood or 2)anhedonia (SIG E CAPS)

Sleep disturbances (insomnia w/ early morning wakening or excess sleep)
Interest - Loss of Interest
Guilt

Energy - Loss of energy

Concentration - Loss of Conc
Appetite changes
Psychomotor retardation (slow speech/mvmnt)
Suicidal Ideations
Define recurrent major depressive disorder
2 or more episodes with symptom free interval 2 months
What is the lifetime prevalence of depression?
Men - 5-12%
Women - 10-25%
Define Dysthymia
Milder form lasing at least 2 years
What is melancholia?
Severe form of depression (profound sad,dysphoric mood w/ vegetative signs suggestin hypothalamic dysfunction)

examples:
anorexia w/ 5% wt loss in 3 wks

early morning awakening

diurnal mood swing (worse morning)

loss libido

More likely DELUSIONAL, COMMIT SUICIDE, evidene brain dysfunction
What are the criteria for bipolar disorder - specifically for a manic episode?
Distinct period abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 WEEK.

3 or more of following:
DIG FAST
Distractability
Insomnia
Grandiosity (inflated self)

Flight of Ideas (rapid jumping topic to topic)
Activity,Agitation (increase in goal directed Activity and psychomotor Agitation)
Speech - Pressured
Thoughtlessness (seeks pleasure without regard of consequences)
Define a hypomanic episode
Like manic episode except mood disturbance not severe enough to cause marked impairment in social/occupational functioning or to necessitate hospitalization. No psychoses.
Name some criteria sets used to DEFINE bipolar disorder
At least one manic or hypomanic episode defines.

Bipolar I - Manic episode (depressive episode not necessary)

Bipolar II - hypomanic episode plus depressive episode
What is cyclothymic disorder
Milder form lasting at least 2 years.
Define pseudodementia and how to diff. from Alzheimers?
Major depression masked as dementia (intellectual impairment, memory loss, poor concentration)

More depressive features, melancholia, hallucinations, delusions than Alz.

Greater likelihood of family mood disorder history.

P.d. patients maximize complaints while Alz patients minimize theirs.
List some treatment (pharmacological) options for mood disorders.
Tricyclics (non-selective mon-amine reputake inhib)
SIDE EFFECTS -
cardiac conduction abnorm.
anticholinergic (dry mouth, blurred vision, decr GI motility - not tolerated by elderly)
Orthostatic Hypotension

SSRI's - depression and anxiety

MAO inhibitors (Phenelzine) Second line depression & anxiety tx

Lithium Carbonate - tx manic episode and prevent recurrence manic & depressive episodes

Anticonvulsants (carbamazepine, valproic acid) tx. bipolar affective disorder, those not resp. to lithium
Explain ECT

One contraindication?
tx. melancholic depression
5-7 tx needed for typical depressive episode.
General anesthetic before & depolarizing muscle relaxant during.
Ventilated, EKG/EEG monitored

Contraindication: Increased intracranial Pressure

90% patients show immed improvement!
Define Delirium
ALTERED state of Consciousness (decreased attention span and altered arousal)

Disorganized thinking
Hallucinations
Illusions
Misperceptions
Disturbances in sleep-wake cycle
Cognitive Dysfunction

Waxing and waning consciousness, develops RAPIDLY
What are some causes of delirium?

What is the classic EEG?
Substance abuse
Medical Illness
Metabolic, fluid, electrolyte
(hypoglycemia, hypoxia, uremia, encephalitis, porphyria)
High voltage slow wave EEG
(delirium tremens low-voltage fast activity)
Define Dementia
Normal state of arousal!
Difficulty with memory

Cortical involvement-
aphasia, apraxia, amnesia

Loss abstract reasoning
Language loss/difficulty naming objects

PERSONALITY CHANGE

Impaired judgment(innapropr sexual advances/etc)

Increased risk suicide

GRADUAL onset
careful about elderly pseudodementia
What are the two most common causes of dementia?
Alzheimers - mid 70s onset
early: difficulty new learning, word finding, visual-spatial/motor coordination
Brain atrophy, ventricular enlargement, plaques/tangles

Multi-infarct Dementia - with focal neurological signs (extremity wknss,dysarthria)
What are some other causes of Dementia?
Parkinson's - 20-40% develop subcortical dementia (more characterized by motor signs)

Huntingtons - mid 30s-40s
early stage: depression, impulsiveness, personality changes, suicide risk
Late: subcortical dementia, choreiform mvmnts
Some more causes dementia?
Wilsons' - defect ceruloplasmin, reduced copper excretion. Build up in basal ganglia =
wing beating mvmnt
tremor
mental retardation in kids
dementia in adults

Normal Pressure hydrocephalus - blocked foramen of Monro
Normal spinal P, buildup ventricular P
Hugely dilated ventricles
Dementia
Ataxia
Urinary Incontinence
Causes: alcoholism, subarachnoid hem, vitamin def, Syphilis
(tx with shunt)

Pick's disease - schizophrenia like psychosis & frontal lobe problems can precede dementia

Amnesic Disorders
Somatization disorder
Complaints in multiple organ systems
Begins before age 30, women more than men, familial, assoc w/ antisocial pers/alcoholism in men

4 pain symptoms
2 GI symptoms
1 Sexual symptom
1 pseudoneurologic (muscle wkness, sensory loss)
Conversion disorder
neurologic-like complaints
paralysis, blindness, tunnel vision, pain, seizures, etc

PATIENT ACTUALLY EXPERIENCES

conversion allows "primary gain" (keep conflict from awareness)
and "secondary gain" - avoid anxiety provoking activities, gain sympathy
Psychogenic Pain
Chronic Pain disorder
Psychologic stress or conflict results in pain
30-40, women>men
Hypochondriasis
40s-50s, equal male/female
substitute physical symptom for emotional one
Misinterpret normal physical findings, preocupation with disease dispite medical reassurance
Body Dysmorphic Disorder
patient convinced part of anatomy malformed
Dissociative Amnesia
Women 15-30
Lost memory for personal events
Threats of physical harm/death/stress may precipitate
Dissociate Fugue
Person suddenly travels away from customary place of daily activities
Brief, limited to unexpected travel
Dissociative Identity Disorder (formerly multiple personality disorder)
Rare, usually malingering or misdiagnosed borderline personality disorder
Two or more personalities alternate in control of a person, original personality not aware of others except for "lost time"
Depersonalization Disorder
Person feels like observing themself from afar, mechanical feeling, may be accompanied by derealization (alteration in perception of external reality)
Psych theories for dissociative disoders?
Massive repression of unacceptable sexual impulses, response is splitting of person

Protecting person from stressful event
Specific Phobia:

Gamophobia
Algophobia
Acrophobia
Agoraphobia
Fear excessive or unreasonable to specific entity

Gamophobia= fear of marriage
Algophobia=fear of pain
Acrophobia= fear of heights
Agoraphobia=fear of being in public places where escape difficult
Post Traumatic Stress Disorder
Re-experiencing trauma through recurrent recollections,dreams

Reduced responsiveness to external world

Psychic Numbing - feeling detached from others

Loss of interest in activities

Symptoms if increased arousal (hyperalert, disturbed sleep, difficulty concentrating, memory probs)

Survivor's guilt
Avoidance of returning to scene or things that remind them of it
Differentiate levels of PTSD and contrast it to Acute Stress Disorder
Acute stress disorder = 2-4 weeks

Acute PTSD = less then 6 mos

Chronic PTSD = greater than 6 mos
Panic Disorder
Sudden, spontaneous episodes increased anxiety.
Attacks last 20-30 minutes

PANIC
P=Palpitations
A=Abdominal Distress
N=Nausea
I=Increased Perspiration
C=Chest Pain, Chills, Choking

often misdiagnosed as CV event
Can be triggered by sodium lactate infusion.
Generalized Anxiety Disorder
Lower constant anxiety not triggered by anything in particular
GI symptoms
Fatigue
Difficulty Concentrating
Motor tension
Autonomic Hyperactivity
Hypervigilance
Define following therapies:
Flooding
Desensitization
Systematic Desensitization
Flooding = patient has to imagine most anxiety provoking situation and hold image for extended time

Desensitization=person placed in feared situation

Systematic Desensitization=mental imagery of feared situation systematically increased (sometimes actual situation used)
Adjustment Disorder
emotional symptoms (anxiety, depression) causing impairment following identifiable psych stressor and leasting less than 6 most (exp is NOT relived like in PTSD)
What are the criteria for personality disorders?
Inflexible, maladaptive, long-standing behaviors beginning in childhood or adolescence that lead to interpersonal distress and affect several areas of life

CANNOT be diagnosed until person is 18
What are the Cluster A personality Disorders?

What are they genetically associated with?
Odd or Eccentric

Paranoid- distrust, suspiciousness (vigilance to environment, concern with hidden meanings, sensitive to criticism) Cold, lack humor, unwilling seek help

Schizoid - loners, cold, voluntary social withdrawal, limited emotions

Schizotypal - emotionally cold/awkward, display magical thinking (ideas reference, perceptual illusions, depersonalization, suspicion)respond to low dose neuroleptics

Genetic assoc w/ schizophrenia
Cluster B personality disorders?

Genetic assoc?
Dramatic-emotional-erratic

Histrionic - excessive emotionality, somatization, attention seeking, sexually provocative (shallow, exagg affect, dramatic, constant attn)

Narcissistic- Grandiosity, sense entitlement, demand top physician/hcare, alternates with unworthiness, lack of empathy, rct poorly to criticism

Antisocial - disregard and violate rights of others, deceitful/impuslive/reckless/irresponsible/remorseless. Delinquency,lying,substance abuse, criminal behavior IF LESS THAN 18=CONDUCT DISORDER
Rare after 55 (mellow or don't make it)

Borderline - unstable mood/behavior, impulsive, sense emptiness (problems with identity, anger, impulse control) Emotional labile, destructive behavior, micropsychotic episodes, difficulty being alone, also meet mood disorder criteria often

Genetic assoc w/ mood disorders
What is childhood conduct disorder?
Childhood antisocial personality like disorder.

Triad: fire setting, cruelty to animals, enuresis.
Cluster C Personality Disorders?
Anxious-Fearful

Avoidant - sensitive to rejection, socially inhibited, timid, feel inadequate

Obsessive-Compulsive - preoccupation with order, perfection, control (rigid, conformist, perfectionis)
Tight range of affective expression, compulsive=workaholic
(Distinguise from OCD)

Dependent - submissive, clinging, need to be taken care of, low self-esteem
OCD?
Obsessions= recurrent, persistent, intrusive thoughts

Compulsion= repetitive, stereotyped behavior performed in ritualistic fashion
Define the following disorders of impulse control:

Intermittent Explosive Disorder

Kleptomania

Pathologic Gambling

Pyromania

Trichotillomania
Intermittent explosive disorder - enraged from time to time over trivial matters

duh
duh

Trichotillomania-compulsive pulling of hair
What are symptoms of alcohol intoxication?

Withdrawal?
Intoxication -
Disinhibition
Emotional Lability
Slurred Speech
Ataxia
Coma
Blackouts
Nystagmus

Withdrawal
Tremor
Tachycardia
HTN
Malaise, Nausea
(2-5 days post)
Delirium Tremens:
(first autonomic hyperactivity-tachycardia,anxiety,tremors)
(second psychotic symptoms - visual/tactile hallucinations, delusions, confusion)
Possible seizures
Symptoms of Barbiturate Intoxication? Tx?

Withdrawal?
Intoxication - low safety margin, respiratory depression
Similar to alcohol intox.
TX=gastric lavage followed by charcoal load

Withdrawal-
Anxiety
Seizures
Delirium (increased REM sleep, nightmares, seizures)
Life threatening CV collapse
Opiod (Heroin,morphine, meperedine, methadone) intoxication? Tx?

Withdrawal?
Intoxication-
CNS depression (sleepy, slurred speech, non-combative)
Nausea
Vomiting
Constipation
Pupillary CONSTRICTION
seizures (OD life threatening)
TX - naloxone

Withdrawal -
Anxiety
Insomnia
Anorexia
Sweating
Dilated pupils
Piloerection (cold turkey)
Influenza like:
Fever
Rhinorrhea
Nauseau
Stomach Cramps
Diarrhea
Yawning
Cocaine
Intoxication -
Euphoria
Psychomotor Agitation
Impaired Judgment
Tachycardia
Pupillary Dilation
HTN
Hallucinations (tactile, formication)
Paranoid Ideations
Angina
Sudden Cardiac Death
Sweating, chills, nauseau/vomiting
TX - urine acidification to enhance excretion
phentolamine/nifedipine for arrythmias
neuroleptic (haloperidol)

Withdrawal - Post use Crash
Severe Depression
Suicidality
Hypersomnolence
Fatigue
Malaise
Severe Psycho craving, hyperphagia
Tx- antidepressants can reduce craving
Amphetamine
Intoxication - similar to cocaine
Agitation
Impaired Judgment
Pupillary Dilation
HTN
tachycardia
euphoria
Prolonged wakefulness/attn
Arrythmias
Delusions
Hallucinations
Fevers

Withdrawal: within 3 days cessation
Post use crash:
Depression
lethargy
headache
stomach cramps
hunger
hypersomnolence (Incr REM sleep, disturbed sleep)

usually gone in few days = rarely persists, depression
What is Stimulant Delusional Disorder?
psychosis caused by chronic use of stimulants

Persecutory delusions
ideas of reference
aggression, hostility
agitation
jerky mvmnts
PCP (phencyclidine)
Intoxication - Belligerence
impulsiveness
fever
psychomotor agitation
vertical&horizontal nystagmus
tachycardia
ataxia
homicidality
psychosis
delirium
Higher doses: catatonia, seizures
Tx: acidify urine
benzos for sedation
neuroleptics for psychosis

Withdrawal: Recurrence intoxication due to reabs. in GI tract, sudden onset severe, homicidal violence
LSD (or DMT,psilocybin,mescaline)
Intoxication-
anxiety or depression
delusions
visual hallucinations
flashbacks
pupil dilation
tx: single dose benzo or neuroleptic for more severe cases
Marijuana

acute intox and chronic use?
Intoxification:
euphoria
anxiety
paranoid delusions
perception slowed time
impaired judgment
social withdrawal
Incr appetite
dry mouth
hallucinations

Chronis use: memory problems
What medicines can lead to anticholinergic toxicity

flushed, hot skin
dry mouth
pupillary dilation
delirium
(dry as a bone, red as a beet, etc)
Atropine
Scopalamine
Most allergy/cold preps
over the counter sleep meds
antidepressants
neuroleptics
antiparkinsonian agents

TX - 1-2 days physostigmine
What is malingering?
patient consciously fakes a disorder to attain specific secondary gain (financial, avoid military, etc)
Factitious disorder?
creates symptoms to get into sick role.

Munchhausen's: chronic history multiple admissions/invasive procedures

Munchhausens by proxy: moter induces symptoms in kid (or parent on a kid, or somebody in someone else)
Chromosomal disorders that cause Mental Retardation
Down's
Fragile X
Klinefelter's
Genetic Recessive Conditions that cause MR
PKU
Tay-Sachs
Niemann Pick
Maple Syrup Urine
Lesch Nyhan
Hunter's
Infectious Conditions causing Mental Retardation
Rubella (+deafness, blindness, heart defects)

Congenital Syphilis (+8th nerve deafness)

Toxoplasma Gondii (+encephalitis, hepatosplenomegaly, intracranial calcifications, chorioretinitis)

CMV (+deafness, chorioretinites, microcephaly)
Misc causes Mental Retardation
Rh factor
Cretinism
Malnutrition during pregnancy
Lead/Mercury poisoning
Anoxia at birth (MR plus cerebral palsy)