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78 Cards in this Set

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How many suicides are committed each year?
~33,000 people/year(not including drowning, drinking, accidents)
Men ________ suicide 3x as often as women and women _________ 4xs the amount of men.
commit; attempt
Preferred method of suicide for men _________.
Preferred method of suicide for women _________.
Name risk factors for suicide.
men over 45; women over 55; single, never married, caucasian, past psychiatric illness; previous suicidal behavior; higher with increased social status.
Name factors for suicide treatment and prevention.
establish a contract and safety plan; get frequent feedback; secure lethal means; educate family
List some challenges to treating children and adolescents.
Parents and relatives disagreeing; keeping them calm about the various warnings/scares, especially with the media; getting parents to communicate with the school; getting everyone together for the appointment; very opinionated
What is the greatest challenge in child/adolescent care in psychiatry?
getting the parents/caretakers to work with you and their child and family as a team.
List some common conditions seen in the psychiatry office:
Depression, anxiety, ADHD, Oppositional defiant disorder.
What is Oppositional Defiant Disorder (ODD)?
a pattern of negativistic, hostile and defiant behavior lasting at least 6 months of which 4 or more of the following are present: a. loses temper b. argues with adults c. actively defies or refuses to comply with d. adults requests or rules e. delberately annoys people f. blames others for their mistakes or behavior g. irritable and easily annoyed by others h. angry and resentful i. spiteful and vindictive.
What are the four types of mental retardation?
mild, moderate, severe, and profound.
Name three learning disorders.
reading disorder, mathematics disorder, written expression disorder.
List some pervasive developmental disorder.
Autistic Disorder, Retts Disorder, Asperger's Disorder.
what is retts disorder?
everything is normal until ~5months and head stops growing and lose skills.
What is Asperger's disorder?
similar to autism but no delay in language, cognitive skills, curiosity about the environment, are compulsive, able to take care of themselves - severe social impairment; typically have knowledge/expertise about one subject.
What is conduct disorder?
"little criminals", aggression to people and animals, destruction of property, violating rules.
Define a tic
a sudden rapid, recurrent, non-rhythmic, stereotypic motor or vocalization; occur many times per day.
What is tourette's disorder?
at least one motor and one vocal tic onset before 18 years of age.
What is chronic or vocal tic disorder?
either motor or vocal but not both; onset before 18 years of age.
What is encopresis?
repeated passage of feces into inappropriate places whether intentional or unintentional.
What is enuresis?
What is selective mutism?
can talk, but won't
Name the child/adolescent disorder that is caused by being neglected and ending up not having good relationships with adults.
Reactive Attachment Disorder of Early Infancy.
In treating ADHD, what is the MOA and what neurotransmitters are involved?
catecholamine reuptake inhibition; causes increase in NorE and Dopamine.
What are the treatment options for ADHD?
Education, Psychosocial/behavioral interventions, and Pharmacotherapeutic interventions.
what is the diagnostic criteria for ADHD?
developmentally inappropriate levels of inattention, hyperactivity, and impulsivity that begin in childhood and cause impairment in school performance, intellectual functioning, social skills, driving, and occupational functioning. Onset<7yrs; disturbance lasting >6months; cross-situational (home, school, and work).
what are the 3 main components of ADHD?
impulsivity, hyperactivity, and inattention.
What is dopamine's role in ADHD?
enhances signal, improves attention (focus, vigilance, on-task behavior and cognition), and decreases hyperactivity.
What is norepinephrine's role in ADHD's treatment?
dampens noise, enhances executive operations, and controls impulsivity.
Untreated ADHD are more suceptible to what?
substance abuse
With ADHD, functional MRIs shows decreased blood flow to what area in the brain?
decreased blood flow to anterior cingulate and increased flow in frontal striatum.
Medications for ADHD include stimulants and nonstimulants; list the common types of stimulants and nonstimulants.
d.l-methlyphenidate (Ritalin), d-methylphenidate (Focalin), Mixed Amphetamine salts (adderall), d-Amphetamine (Dexedrine); Nonstimulants: atomoxetine (Strattera).
What is delirium?
transient mental syndrome of acute onset; impaired cognitive functions, reduced consciousness, attentional abnormalities, increased or decreased psychomotor agitation or retardation; disrupted sleep/wake cycle
In delirium, what are the primary deficits?
Attention and Concentration.
Many times, delirium is a result of what?
medical problem and/or hospitalization
Name some good bedside tests for delirium.
count back from 10 to 1 and say the months in reverse order. (this will assess focus and concentration).
According to the DSM-IV, what is the criteria for delirium?
1. Disturbance of consciousness (reduced ability of awareness,environment,attention) 2. cognitive change not resulting from dementia; 3. quickly evolving (hours-days); 4. caused by the direct physiological consequence of a general medical condition.
List the factors of Acute Confusional States that are impaired.
alertness, attention, language, memory, constructions(visuospatial deficits), cognition, neuropsychiatric disorders(delusions/hallucinations), motor system abnormalities, diffuse slowing on an EEG.
What are the 3 predisposing factors in delirium?
1. AGE, 2. Brain damage (esp.basal ganglia and frontal lobe), 3. chronic brain dz like Alzheimer's.
Is delirium diagnosed clinically or by lab/radiology?
Why do geriatric patients get delirium?
its often a presenting feature of an acute physical illness or an exacerbation of a chronic one, or from a medication.
Why is it important to recognize/treat delirium in elderly patients?
1. they are at risk for falls, 2. high rate of mortality and morbidity with delirium in elderly, 3. risk for aspiration,DVT, 3. scares family into putting person in hospital (try to find sitter)
What are the top reasons people get delirium?
1. drugs(esp. anti-cholinergics) 2. electrolyte imbalance, and 3. infections (esp. cystitis)
The etiologies of delirium come from multiple areas, including:
systemic conditions(cardiac failure, hepatic encephalopathy, electrolyte disturbance); endocrinopathies; nutritional deficiencies; intoxication(drugs,alcohol); withdrawal from drugs and alcohol; infections; intracranial disorder; focal cerebral lesions(stroke); miscellaneous(postoperative); idiopathic psychiatric disorders(mania, schizophrenia, depression)
The pathogenesis and pathophysiology of delirium is not well understood. What is the best understanding?
PSYCHOPATHOLOGICAL: widespread reduction of cerebral oxidative metabolism and imbalance of neurotransmission. PATHOPHYSIOLOGICAL: involves one or more of: 1. reduced cerebral oxidative metabolism, 2. impaired chemical energy storage; 3. deficient synthesis, blockade, or imbalance of neurotransmitters, esp. ACh in the brain.; 4. problem with normal ionic passage in excitable membranes; 5. impaired nutrition for the neuron; 6. vascular changes in the head of the caudate nucleus.
Common treatments to help delirium patients get good sleep are:
Ativan (lorazepam-BZD) and antipsychotics: Haldol, Seroquel
What is the difference between the onset of delirium and dementia?
delirium is acute and often at night; dementia is slowly progressive
What is the difference between the ATTENTION of delirium and dementia?
delirium = fluctuates, easily destractible; dementia = relativity unaffected.
What is the difference between the DRUG TOXICITY of delirium and dementia?
delirium = often present; dementia = often absent.
What vitamin deficiency is often associated with delirium?
What is amnestic syndrome?
1. impaired ability to learn new info despite normal attention, 2. memory disturbance causes significant social and occupational functioning, 3. memory disturbance doesn't occur exclusively during dementia or delirium, 4. there is evidence from H&P, labs, of physiological causation.
What are some causes of amnestic syndrome?
Korsafoff's Syndrome (thiamine deficiecy), cerebral anoxia, pharm (anti-cholinergics and BZDs) etc
What is dementia?
syndrome of acquired intellectual impairment characterized by persistent deficits in at least 3 of the following: memory, language, visuospatial skills, personality or emotional state, and cognition(abstraction, math, judgement)
What is the correlation between Alzheimer's and dementia?
Alzheimer's is a disease that causes dementia. Dementia can be caused by 100s of things.
What is Alzheimer's Disease?
a neurodegenerative dz from a decrease in cholinergic system of the brain, onset is gradual and typically starts with short-term memory loss, some cases have a genetic relationship, symptoms progress to problems with cortical functioning, linear association with age, involves plaques and (tau proteins)neurofibrillary tangles. most pts are unaware of memory impairment.
When evaluating a demented patient, what labs are required?
CBC, Serum electrolytes, Ca, Glucose, BUN/Creatinine, Liver Fxn, TSH, B-12, imaging(not diagnostic)
When looking at a coronal cut of the brain, what looks atrophied/odd in an Alzheimer's patient?
hippocampus is atrophied and temporal tips of lateral horns are enlarged.
What are the unproven risk factors for developing Alzheimer's?
#1 AGE, gender, head trauma, CV risks, depression (chronic dep shrinks hippocampus), ApoE-4
What % of pts over 65 are severley demented?
5%; 75% of pts with moderate to severe impairment escape diagnosis in Primary Care setting
What % of pts over 65 are mild to moderately demented?
10-15% - 95% of pts with mild impairment escape diagnosis in Primary Care setting
If you are writing up a differential diagnosis for a demented patient, what would you include?
Alzheimers, Frontotemporal Dementia, Vascular Dementia, Dementia with Lewy Bodies, Parkinsonian syndromes with dementia, Huntington's Dz, Prion Dz, Viral, Toxic, etc.
What is the clinical criteria for Diagnosis of probable Alzheimer's Dz?
1. Dementia Present, 2. onset b/w 40-90 years of age, 3. deficits of 2 or more cognitive areas, progression of deficits >6 months, 5. Consciousness undisturbed, 6. absence of other potential etiology
What is Mild Cognitive Impairment and what are the clincial criteria?
MCI is the transitional state b/w normal aging and AD. CC= 1. memory compliant(pref. by someone else) 2. normal objective memory impairment for person's age and education, 3. largely intact general cognitive fxn, 4. ADLs are preserved, 5. not demented - its normal to slow down, but not to lose S/T memory.
There are 3 stages of AD, which one is this? Language: anomia, empty speech, Memory: defective, Visuospatial skills:impaired, Calculation:impaired, personality:indifferent, EEG:normal, Structural scan:medial temporal atrophy?
stage 1
There are 3 stages of AD, which one is this? Language: fluent aphasia, Memory: severly impaired, Visuospatial skills:severly impaired, personality:indifferent, EEG:background slowing, Structural scan:temporal-parietal atrophy
stage 2
There are 3 stages of AD, which one is this? Language: palilalia(repetitive echoing of one's own words), echolalia, or mutism, EEG:diffuse slowing, Structural scan:diffuse atrophy
stage 3
There are some psychiatric disorders associated with dementia. List some common ones.
1. Depression, 2. Anxiety/Agitation, 3. Psychotic symptoms, 4. sleeping disorders, 5. bipolar disorder
How do you manage a dementia patient?
1. diagnose underlying problem and manage it, 2. manage behaviors, 3. prevent secondary compmlications, 4. support the family
What is psychotherapy?
a way of treating mental and emotional disorders by talking about your condition/issues with a mental health professional; it can be individual, group, couples, family.
Besides talk psychotherapy what are some other types of psychotherapy?
art therapy (T), music T, behavior T(focuses on changing unwanted or unhealthy behaviors), martial T, family T, cognitive T(identify and change distorted thought patterns that lead to negative outcomes or feelings), exposure T(sensitize), dialectical behavior T (teach behavioral skills to help tolerate stress, regulate emotions, and improve relationships), interpersonal T(improve interpersonal skills), play T(children express emotions with toys), psychoanalysis($$couch psychiatry-look into past), Psychodynamic psychotherapy(shorter, less involved than psychoanalysis, increases awareness of unconscious thoughts, develop new insights into motivation, and resolve conflicts to be happier), psychoeducation(teaching pt, family, friends about illness).
Define Anorexia Nervosa.
1. refusal to maintain body weight at or above a minimally normal weight for age leading to a weight of 85% of what is expected; 2. intense fear of gaining weight, even though he/she is underweight; 3. disturbed image of body's weight or shape, denial of low body weight; 4. absence of at least 3 consecutive menstrual cycles. onset age~9-18
What are the two types of anorexia nervosa?
1)Restricting Type: Anorexic but not involved in binge eating or purging; and 2)Binge-Eating/Purging Type: Anorexic and regularly engages in binging and purging
Define bulimia nervosa.
1. Recurrent episodes of binge eating consisting of the following: a)discretely eating large amounts of food in the normal time a person would eat a normal meal. b)have a sense of lack of control over eating; 2. recurrent compensatory behavior to prevent weight gain (ie. laxatives) 3. binging and compensatory behavior occur at least 2/wk for 3months; 4. weight rules how person feels and 5. the disturbance doesn't occur just during episodes of Anorexia nervosa.
Define obesity.
body exceeds by 20% the standard weight in typical height/weight tables.
What do you call persistent eating of non-nutritive substances for at least one month?
Pica - eat clay, dirt, coal
What is the condition called that is characterized by repetitive regurgitation and rechewing of food for at least one month following a period of normal functioning?
Rumination Disorder - not a GI problem; voluntary behavior
If you have a child that is less than 6yo and doesn't eat adequately,loses significant weight over 1 month and doesn't have a medical reason why, what is the condition?
Feeding Disorder of Infancy or Early Childhood.