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56 Cards in this Set
- Front
- Back
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Classic Conditioning
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Learning in which a natural response is elicited by a conditioned or learned stimulus presented in conjunction with an unconditioned stimulus
ex. Pavlov's dog |
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Operant conditioning
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Learning in which a particular action is elicited due to effect
1) Positive reinforcement - desired reward produces action 2) Negative reinforcement - removal of averse stimulus elicits behavior 3) Punishment - application of aversive stimulus extinguishes unwanted behavior 4) Extinction - discontinuation of reinforcement eliminates behavior |
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Transference vs Countertransference
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Transference - Patient projects feelings about formative or other important persons onto physician (ex. psychiatrist becomes parent)
Countertransference - doctor projects feelings about formative or other important persons onto patient |
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Ego Defenses: Acting out
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Unacceptable feelings and thoughts expressed through actions (ex tantrums)
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Ego Defenses: Dissociation
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Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
Ex. in extreme multiple personality |
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Ego Defenses: Denial
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Avoidance of awareness of some painful reality
Ex. Newly diagnosed terminal disease |
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Ego Defenses: Displacement
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Process whereby avoided ideas and feelings are transferred to neutral person or object (vs projection)
ex. yell at dog, punch wall, get mad at another person Displacement = reactionary Projection = not-reactionary |
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Ego Defenses: Projection
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An unacceptable internal impulse is attributed to an external source
ex. a man who wants another woman to think his wife is cheating on him Displacement = reactionary Projection = not-reactionary |
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Ego Defenses: Fixation
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Partially remaining at a more childish level of development (vs regression)
ex. men fixating on sports games Fixation = non-reactionary Regression = reactionary |
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Ego Defenses: Regression
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Turning back the maturatioanl clock and going back to earlier modes of dealing with world
ex. young children in stress, illness, punishment, new sibling. Wetting bed after older Fixation = non-reactionary Regression = reactionary |
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Ego Defenses: Identification
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Modeling behavior after another person who is more powerful (not necessarily admired)
ex. Abused child identifies himself as abuser |
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Ego Defenses: Isolation of affect
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Separation of feelings from ideas and events
Ex. Detailing a murder in extreme detail with no emotional response |
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Ego Defenses: Rationalization
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Proclaiming logical reasons for actions actually performed for other reasons, usually avoids self-blame
ex. fail a test, say not impt information |
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Ego Defenses: Reaction formation
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Process whereby a warded off idea or feeling is replaced by an (unconsciously derived) emphasis on opposite
Ex. former smoker desires smoking ban |
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Ego Defenses: Repression
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Involuntary withholding of an idea or feeling from conscious awareness.
Ex. Not remembering a conflictual or traumatic experience; pressing bad thoughts into unconscious (UNINTENTIONAL) |
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Ego Defenses: Splitting
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Belief that people are either all good or all bad at different times due to intolerance of ambiguity. Often borderline personality
ex. Say med student is best person in world but all other medical team is cold and heartless |
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Ego Defenses: Altruism
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Guilty feelings alleviated by unsolicited generosity to others
Ex. arms dealer giving to charity |
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Ego Defenses: Humor
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Appreciating amusing nature of an anxiety provoking response or adverse situation
Ex. Joke about test |
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Ego Defenses: Sublimation
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Process where replace an unacceptable wish with course of action similar to but is not unacceptable
Ex. Like cutting so become a surgeon |
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Ego Defenses: Suppression
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Voluntary withholding (vs repression) of an idea of feeling from conscious awareness
Ex. choosing not to think of something |
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Mature Ego defenses
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SASH
Sublimation Altruism Suppression Humor |
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Infant Deprivation Effects
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Weak, Wordless, Wanting, Wary
> 6 months may be irreversible |
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ADHD, treatment
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Onset before 7, Limited attention, poor impulse control. Normal intelligence but school difficulty.
Menthylphenidate, amphetamins, atomoxetine |
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Conduct disorder
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Repetitive and pervasive behavior violating social norms (aggression, property destruction, theft). Over 18 it is antisocial personality
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Oppositional defiant disorder
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Hostile defiant behavior towards authority in absence of social norm violations
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Tourrette's, treatment
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Onset before 18, sudden, rapid, recurrent sterotyped movements or tics persisting over a year. Associated with OCD. Desire for tic precedes unlike myotonic seizure jerk
Treat with antispychotics (Haloperidol) |
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Asberger's
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Milder autism. Autism has severe language and social impairment, and below average intelligence. Asperger's has normal intelligence and lack verbal or cognitive or language impairments
Focus on interests, repetitive behavior and problems in social relationships |
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Rett's disorder
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Females only (male lethal) that causes regression of development starting at age 4
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Neurotransmitter changes with disease
a) Anxiety b) Depression c) Alzheimers d) Huntingtons e) Schizophrenia f) Parkinsons |
Neurotransmitter changes with disease
a) Anxiety - up NE, down GABA, serotonin b) Depression - down NE, down serotonin, down dopamine c) Alzheimers - down ACh d) Huntingtons - Down GABA, down ACh, up dopamine e) Schizophrenia - up dopamine f) Parkinsons - down dopamine, up serotonin, up ACh |
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Delirium vs Dementiad
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Delirium - ACUTE lowered consciousness, changes in mental status, thinking, hallucinations, illusions, sleep. Often due to other things (CNS disease, infection, trauma, substance abuse/withdrawal). ANTICHOLINERGICS reverse often. ABNORMAL EEG
Dementia - GRADUAL decline in cognition without affecting consciousness. Memory, aphasia, apraxia, agnosia, abstract thought, personality changes, CAN get delirium. NORMAL EEG Alzheimers, cerebral infarcts, Pick's disease, substance abuse, CJD. |
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Psychosis signs
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Hallucinations
Illusions Delusions Loose associations |
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Hallucination types
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Visual - medical illness (intoxication) usually
Auditory - psych illness Olfactory - aura of epilepsy and brain tumors Gustatory - rare Tactile - bugs on skin seen in withdrawal (alcohol) or cocaine use Hypnagogic - going to sleep HypnaPOMPic - waking up |
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Schizophrenia and Subtypes
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Psychosis, disturbed behavior and thought, functional decline. HIGH dopamine, LOW dendritic branching. Marijuana RF
MUST 1) last > 6 months 2) Have 2 or more of a) Delusions b) Hallucinations c) Disorganized speech d) Disorganized or catatonic behavior e) "Negative symptoms" - flat affect, social withdrawal, lack of motivation, lack of speech or thought Brief Psychosis <1 month, Schizophreniform 1-6 months IF just delusion and normal then Delusional disorder |
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Schizoaffective Disorder
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At least 2 weeks STABLE mood with psychotic symptoms plus:
a) major depressive episode b) manic episode c) mixed episode Often misdiagnosed as bipolar (not because have stable mood with persistent psychotic symptoms) |
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Dissociative disorders
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a) Dissociative identity disorder - 2 or more personality states
b) Depersonalization disorder - persistent detachment or estrangement from own body, social situation or environment c) Dissociative fugue - abrupt change in geographic locatoin, cannot recall past, confusoin about identity or assume new identity. Associated with war, trauma, natural disasters), stress and impairment |
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Mood disorders
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Major Depressive Disorder
Bipolar disorder Dysthymic disorder Cyclothymic disorder MAY have psychotic features |
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Manic episode
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Distinct period of abnormally and persistently elevated, expansive mood lasting 1 week at least. Needs 3 of
Distractibility Irresponsibility - hedonistic Grandiosity Flight of Ideas Activity/psychomotor agitation - goal directed Sleep - LESS Talkativeness DIG FAST Hypomanic if no marked impairment and no psychosis |
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Bipolar disorder
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At least 1 manic (Bipolar I) or hypomanic (Bipolar II) episode, followed later by depressive symptoms
Normal mood and functioning between. Treat with mood stabilizers (lithium, valproic acid, carbamazepine) and atypical antipsychotics |
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MDD vs Dysthymia
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Major depressive is usually episodes 6-12 months with 5 of 9 for 2 weeks
SIG E CAPS Sleep disturbance Interest decreased (anhedonia) Guilt or worthlessness Energy loss Concentration loss Appetite/weight changes Psychomotor retardation or agitation Suicidal ideation Depressed mood Dysthymia - milder (<5) and lasting 2 YEARS or more |
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Cyclothymic disorder
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dysthymia and hypomania
dysthymia necessitates lasting 2 years at least |
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Atypical depression
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Hypersomnia, overeating, mood reactivity (improves with positive events)
Associated with weight gain and sensitive to rejection MAOIs or SSRIs to treat |
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Postpartum mood disturbances
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Maternal "blues" - MOST women, depressed affect, tearfulness, fatigue, resolves in <2 weeks. Follow up
Postpartum depression - Rare, depressed affect, anxiety, poor concentration. 2 weeks to 2 months. antidepressants, psychotherapy Postpartum psychosis - very rare, delusions, confusion, homicidal/suicidal ideation. 4-6 weeks. May need hospitalization |
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ECT uses
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Refractory major depressive disorder
Pregnant women with major depressive disorder Can cause mild temporary amnesia |
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Suicide Risk Factors
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SAD PERSONS
Sex (male; though women try more) Age (teenage or elderly) Depression Previous attempt Ethanol or drugs Rational thinking loss Sickness Organized plan No spouse Social support lacking |
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Anxiety disorders
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Panic disorder
Phobias - specific, recognized OCD - recurrent thought to do, realizing that it is there (insight) PTSD - LASTS > 1month (or just acute stress). Flashbacks, high arousal Generalized anxiety disorder - 6 months (adjustment if less) GENERAL anxiety unrelated to any specific |
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Malingering Disorder
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CONSCIOUSLY fakes or claims to have a disorder to get secondary gain (money, drugs, avoid work). Often poorly compliant with treatment or follow up
Complaints CEASE after gain |
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Factitious disorder
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CONSCIOUS creation of physical or psychological symptoms to assume "sick role" and get medical attention (PRIMARY gain)
Munchausen's syndrome - CHRONIC with physical signs and symptoms, willingness to get invasive procedures Munchausen's syndrome by proxy - illness in a child is caused by caregiver, form of child abuse |
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Somatiform disorders and categories
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Physical symptoms with no identifiable physical cause: Illness production and motivation by unconscious drives. NOT intentional or produced
a) Somatization - variety of complaints in many systems (4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over years b) Conversion - sudden loss of sensory or motor function (paralysis, blindness, mutism) following ACUTE STRESSOR; Pt aware of but indifferent to symptoms c) Hypochondriaisis - fear of having serious illness d) Body dysmorphic disorder - preoccupation with minor defects in appearance, emotional distress, seek cosmetic surgery e) Pain disorder - prolonged pain with no physical findings, pain is predominant focus of clinical presentation and psychological factors have role in severity, exacerbation or maintenance of pain |
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Cluster A personality disorders
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WEIRD (Accusatory, Aloof, Awkward), no psychosis but associated with schizophrenia
a) Paranoid - pervasive distrust and suspicious; projection defense mechanism b) Schizoid - voluntary social withdrawal, limited emotion, content with social isolation (distant) c) Schizotypal - eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness |
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Cluster B personality disorders
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WILD, (Bad to the Bone) associated with mood disorders and substance abuse
a) Antisocial - disregard for and violation of rights of others, criminality, conduct disorder if <18 b) Borderline - unstable mood, relationships. Impulsive, self-mutilation, boredom, SPLITTING c) Histrionic - excessive emotion, attention seeking, sexually provacative, concerned with appearance d) Narcissistic - grandiosity, sense of entitlement, lack empathy and requires admiration. DEMANDS BEST, RAGE with criticism |
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Cluster C personality disorders
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WORRIED (Cowardly, Compulsive, Clingy)
a) Avoidant - hypersensitive to rejection, timid, feeling inadequate. DESIRES relationships but avoids (vs schizoid where content with isolation) b) Obsessive-compulsive - preoccupation with order, perfection, control. Ego syntonic (consistent with beliefs, no compulsion to prevent bad stuff from happening like OCD) c) Dependent - submissive and clinging, excessive need to be taken care of, low self-confidence |
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"Schizo" conditions
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Schizoid - social withdrawal, limited emotion, OK with it
Schizotypal - above + eccentric thinking Schizophrenic - above + greater odd thinking, hallucinations, may have delusions, disorganized speech, catatonic behavior, negative symptoms. Typal has less than 2/5 Schizoaffective - psychosis of schizophrenia and bipolar or deppresive mood disorder. MUST have period with psychosis and normal mood |
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Transexualism vs transvestism
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Transvestism - like to wear clothes
Transsexualism - desire to live like other sex |
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Substance dependence vs abuse
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Dependence - Maladaptive pattern of use with 3 of following in a year:
Tolerance Withdrawal Substance in greater amounts Persistent desire to cut down Significant energy used to get or recover from Reduced activities Continued use despite knowledge of drawbacks Abuse Fail to meet obligations Use in hazardous situations Legal problems Use in spite of problems with use |
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Stages of change in substance abuse
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Precontemplation - haven't acknowledged problem
Contemplation - acknowledged but not ready Preparation/Determination - getting ready Action/Willpower - chaning Maintenance Relapse |
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Developmental Milestones: Social, Fine motor, Gross motor and Language at 1,2,3,4
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1 - Imitation, pointing; pincer grasp; walking; Mama, Dada
2 - imitation of household tasks; page turn; jump, stand on one foot; 2 word phrase 3 - Parallel play (not together); reproduce simple shapes; tricycle, stair; simple sentence 4 - cooperative play, toilet; dress self with help; run without difficulty; complex sentences with pronoun and plurals |
