Behavioral Science - From Behavioral Science Brs

Front 1

What are Piaget's cognitive developmental stages?

Back 1

Sensorimotor: <2yo
Pre-operational: 2-6yo
Concrete operational: 7-11yo
Post-operational: >12yo

Front 2

Describe the sensorimotor phase of Piaget's cognitive developmental stages.

Back 2

1-4mo: Primary circular reactions [action & response both involve baby's own body i.e. sucking thumb]

4-12mo: Secondary circular reactions [action gets response from other person or object leading to repetition, i.e. cooing]

12-18mo: Tertiary circular reactions [action gets pleasing result leading to similar actions, i.e. stepping on sqeaky toy and attempt to get same response from another object]

Front 3

Describe the pre-operational phase of Piaget's cognitive developmental stages.

Back 3

Understands that objects are represented by words or images
Ability to pretend, Egocentric thought
Centering [can't understand more than one dimension at a time], Lacks conservation

Front 4

Describe the concrete operational phase of Piaget's cognitive developmental stages.

Back 4

Logical thinking about objects & events
Mental manipulation of objects and processes
Ability to consider more than one dimension at a time [decentrate]
Therefore: Understands CONSERVATION

Front 5

Describe the post-operational phase of Piaget's cognitive developmental stages.

Back 5

Abstract thinking, Hypothesizing, Higher order thinking [synthesizing, analyzing, evaluating]

Front 6

What are the 5 leading causes of death in the U.S. in 1-4yo?

Back 6

(1) Unintentional injuries [automobile, drowning, pedestrian]
(2) Birth defects
(3) Cancers
(4) Homicide
(5) Heart disease

Front 7

What are the 5 leading causes of death in the U.S. in 5-9yo?

Back 7

(1) Unintentional injuries [automobile, drowning, pedestrian]
(2) Cancers
(3) Birth defects
(4) Homicide
(5) Heart disease

Front 8

What are the 3 leading causes of death in the U.S. in 12-18yo?

Back 8

(1) Unintentional injuries
(2) Homicide [3-4X males, 7-8X Blacks]
(3) Suicide [higher for males]

Front 9

What are the 5 leading causes of death in the U.S. in 25-44yo?

Back 9

(1) Unintentional injuries
(2) Cancer
(3) Heart disease
(4) Suicide
(5) HIV/AIDS

Front 10

What are the 5 leading causes of death in the U.S. in 45-64yo?

Back 10

(1) Cancer
(2) Heart disease
(3) Unintentional injuries
(4) Stroke
(5) Chronic lower respiratory disease

Front 11

What are the 5 leading causes of death in the U.S. in >= 65yo?

Back 11

(1) Heart disease
(2) Cancer
(3) Stroke
(4) Chronic lower respiratory disease
(5) Influenza & pneumonia

Front 12

What are the 7 leading causes of death in children <5yo worldwide

Back 12

(1) Neonatal causes
(2) Acute respiratory infections
(3) Diarrheal
(4) Others, Including non-communicable diseases
(5) Malaria
(6) Measles
(7) Injuries & HIV/AIDS tied

Front 13

Describe what the normal language of a 2-3 month old infant should be.

Back 13

Cooing

Front 14

Describe what the normal language of a 3-4 month old infant should be.

Back 14

Babbling without intonation or discernible pattern

Front 15

Describe what the normal language of a 10 month old infant should be.

Back 15

Babbling household language [through imitating what they hear], jargon that has intonation

Front 16

Describe what the normal language of a 1 year old toddler should be.

Back 16

One-word stage

Front 17

Describe what the normal language of a 2 year old toddler should be.

Back 17

Two-word telegraphic stage

Front 18

Describe what the normal language of a child > 2 year old should be.

Back 18

Language develops rapidly into complete sentences

Front 19

Describe how an infant/toddler less than 18 months old will play?

Back 19

Solitary play [sensorimotor]

Front 20

Describe how a toddler between 18 & 24 months old will play?

Back 20

Parallel play [symbolic]. Child will play along side but not with others.

Front 21

When do children start participating in cooperative [associative/imaginative] play?

Back 21

Anywhere between 2 & 4 years old

Front 22

What are Erik Erikson's psychosocial development stages?
List the EGO strengths & conflicts, & their corresponding ages?

Back 22

In Erik Erickson's psychosocial development stages:
(1) Each stage has own psychosocial test [crisis that needs resolution] resulting in the development of an EGO STRENGTH
(2) Each builds on previous.
(3) With maturation new meaning given to lower stages.

Stages:
Infancy (Birth-1yo): Hope [Trust vs Mistrust]
Toddlerhood (1 to 3yo): Will [Autonomy vs Shame & Doubt]
Preschool (3-5yo): Purpose [Initiative vs Guilt]
Elementary School (6-Puberty): Competence [Competence vs Inferiority]
Adolescence (Teen-20's): Fidelity [Identity vs Role Confusion]
Young adulthood (20s-40s): Love [Intimacy vs Isolation]
Middle adulthood (40s-60s): Care [Generativity vs Stagnation]
Late adulthood (60s+): Wisdom [Integrity vs Despair]

Front 23

Describe the age & conflict associated with developing Erik Erikson's ego strength of HOPE.

Back 23

Infancy (Birth to 1yo)

Hope [Trust vs Mistrust]: If needs are dependably met, infants develop a sense of basic trust

Front 24

Describe the age & conflict associated with developing Erik Erikson's ego strength of WILL.

Back 24

Toddlerhood (1 to 3yo)

Will [Autonomy vs Shame & Doubt]: Toddlers learn to exercise will and do things for themselves, or they doubt their abilities

Front 25

Describe the age & conflict associated with developing Erik Erikson's ego strength of PURPOSE.

Back 25

Preschool (3-5yo)

Purpose [Initiative vs Guilt]: Learn to initiate tasks and carry out plans, or they feel guilty about efforts to be independent

Front 26

Describe the age & conflict associated with developing Erik Erikson's ego strength of COMPETENCE.

Back 26

Elementary School (6-Puberty)

Competence [Competence vs Inferiority]: Learn the pleasure of applying themselves to tasks, or they feel inferior

Front 27

Describe the age & conflict associated with developing Erik Erikson's ego strength of FIDELITY.

Back 27

Adolescence (Teen-20's)

Fidelity [Identity vs Role Confusion]: Teenagers work at refining a sense of self by testing roles and then integrating them to form a single identity, or they become confused about who they are

Front 28

Describe the age & conflict associated with developing Erik Erikson's ego strength of LOVE.

Back 28

Young adult (20s-40s)

Love [Intimacy vs Isolation]: Struggle to form close relationships and to gain the capacity for intimate love, or they feel socially isolated

Front 29

Describe the age & conflict associated with developing Erik Erikson's ego strength of CARE.

Back 29

Middle adult (40s-60s)

Care [Generativity vs Stagnation]: Discover a sense of contributing to the world, such as through family and work, or they may feel a lack of purpose

Front 30

Describe the age & conflict associated with developing Erik Erikson's ego strength of WISDOM.

Back 30

Late adult (60s+)

Wisdom [Integrity vs Despair]: When reflecting on his or her life, the older adult may feel a sense of satisfaction or failure

Front 31

What is the leading cause of injury to 14-44yo women in the U.S.?

Back 31

Domestic violence

Front 32

Between what age are children most vulnerable to abuse?

Back 32

7-12yo

Front 33

What is conservation and when does it develop?

Back 33

Understanding that the amount of a substance remains even when its form has changed [e.g. pour water from short glass into tall glass and understand there was the same amount of water in both].

Doesn't develop until a child is 6 years old and corresponds to Piaget's concrete operational stage [7-12yo].

Front 34

What is object permanence and when does it develop?

Back 34

Understanding that an object still exists even if you aren't interacting with it.

Doesn’t develop until an infant is 7-9 months.

Front 35

What is the palmar grasp [grasping] reflex and at what age does it disappear?
If it fails to disappear what does that indicate?

Back 35

The child's fingers grasp objects placed in the palm.

A reflex in competent newborns that disappears by 2mo.

Persistent fisting indicates neuromotor deficits

Front 36

What is the Babinski reflex and at what age does it disappear?
If it fails to disappear what does that indicate?

Back 36

The child's large toe dorsiflexes & the other toes fan in response to a scrape along the sole of their feet.

A reflex in competent newborns that disappears by 1 year.

Persistence of this reflex indicates a neuromotor deficit

Front 37

What is the rooting reflex and at what age does it disappear?
If it fails to disappear what does that indicate?

Back 37

The child's head turns in the direction of a stroke on the cheek when seeking a nipple to suck.

A reflex in competent newborns that disappears by 3mo.

Front 38

What is the Moro reflex and at what age does it disappear?
What does it's absence of birth indicate?

Back 38

Also known as the "startle" reflex. It is a response to unexpected loud noise or when the infant feels like it is falling that is characterized by (1) Startle (2) Spreading out arms [symmetric] (3) Unspreading arms [symmetric] (4) Crying.

A reflex in competent newborns that disappears by 3-4mo.

Deficiency or asymmetry in any except crying indicates profound disorder of motor system.

Front 39

At what age does a child smile in response to a human face? (The "social smile")

If reflex is not developed by this time what might than indicate?

Back 39

The "social smile" in response to the human face develop between 2-3 months.

Absent smile indicates visual loss attachment problems, maternal depression, or child abuse/neglect

Front 40

When should a child be able to turn over on his own?

Back 40

5 months

Front 41

When should a child be able to sit unassisted?

Back 41

6 months

Front 42

When should a child be able to transfer toys from hand to hand?

Back 42

10 months

Front 43

When should a child be able to pick up toys and food using "pincer" (thumb and forefinger) grasp?

Back 43

10 months

Front 44

When should a child be able to walk unassisted?

Back 44

Between 12-15 months

Front 45

When does a child begin to show stranger anxiety?

Back 45

6 months

Front 46

What is the cause of reactive attachment disorder of infancy or early childhood?
What are the 2 types?

Back 46

Grossly pathological care

The two types are:
(1) Inhibited type: Children are withdrawn and unresponsive
(2) Disinhibited type: Children approach and attach indiscriminately to strangers as though the strangers were familiar to them

Front 47

By what age do the 9 dimensions of temperament described by Chess and Thomas stabilize?

What are the?

Back 47

3 years old

Activity
Regularity
Initial reaction
Adaptability
Intensity
Mood
Distractibility
Persistence & attention span
Sensitivity

Front 48

By what age do children have a sense of gender identity?

Back 48

3 years old

Front 49

What is encopresis and what is the earliest age it can be diagnosed in children?

Back 49

It is soiling

Cannot be diagnosed until 4 years old

Front 50

What is enuresis and what is the earliest age it can be diagnosed in children?

Back 50

It is bed-wetting

Cannot be diagnosed until 6 years old

Front 51

At what age do children start to read?

Back 51

6 years old

Front 52

What is rapprochement?

Back 52

It is when a child moves away from and then returns to the mother for reassurance.

It is common during the 1st half of toddler hood [1-2yo]

Front 53

At what age are children commonly over-concerned about physical injury?

Back 53

4-5 years old

Front 54

At what age do children tend to have romantic feelings about the opposite sex parent?

Back 54

4-5 years old

Front 55

By what age should a child be able to use 900 words and understand 3500 words?

Back 55

3 years old

Front 56

By what age should a child be able to use 250 words?

Back 56

2 years old [generally speaks in 2-word sentences and uses pro-nouns e.g. "me do"]

Front 57

By what age should a child be able to name body parts and objects?

Back 57

2 years old

Front 58

By what age should a child be able to speak in complete sentences?

Back 58

3 years old

Front 59

At what age do children start do develop the ability to think logically?

Back 59

6 years old

Front 60

By what age should a child be able to feed themselves with a fork and spoon?

Back 60

2 years old

Front 61

What are Elizabeth Kubler-Ross's stages of dying?

Back 61

Denial: Resistance to reality of impending death, Search for other miracle cure, May withdraw from physician's care
Anger: (1) Why me (2) Hostility Resentment, & Envy at a variety of targets including the physician. Comments should not be taken personally
Bargaining: (1) Let's make a deal (2) Plea for extended life in exchange for something [e.g. change in behavior]
Depression: (1) Manifestations of illness become too serious or imposing to ignore or deny (2) Realization of unavoidable death (3) Immense sadness (4) Sense of great loss
Acceptance: (1) Resolute about impending death (2) End of struggle (3) Sincere preparations can begin

Front 62

In normal grief how long does it take for SEVERE symptoms to resolve?

Back 62

Within 2 months

Front 63

In normal grief how long does it take for MODERATE symptoms to resolve?

Back 63

Within 1 year

Front 64

What is the average life expectancy in the U.S.?
What are the longest-lived and shortest-lived ethnicities currently in the United States?

Back 64

76 years

Longest: Asians especially Chinese
Shortest: African American

Front 65

Before how many weeks gestation is a birth classified as premature?

Back 65

Less than 37 completed weeks gestation

Front 66

Before how many weeks gestation is a birth classified as VERY premature?

Back 66

Less than 32 completed weeks gestation

Front 67

Before how many weeks gestation is fetal death classified as an abortion?

Back 67

Less than 20 completed weeks gestation

Front 68

What are the "baby blues"?
When do they start?
How long do they last?

Back 68

Characteristics [incidence of 33-50%]:
(1) Exaggerated emotionality and tearfulness
(2) Interacting well with friends and family
(3) Good grooming

Starts within a few days after delivery

Lasts for up to 2 weeks

Front 69

At what age is a child most likely to start developing separation anxiety when removed from their primary caregiver?

Back 69

Towards the end of the first year of life

Front 70

At what age is an infant able to lift head when lying prone?

Back 70

2-3 months

Front 71

After what age should a child be able to spend a few hours away from the mother and in the care of others with little problem?

Back 71

3 years old

Front 72

At what age do a child's sense of morality begin to be developed?

Back 72

6 years old

Front 73

Between what ages do children prefer to interact with children of the same sex?

Back 73

7-11 (school age). Before the age of 6 children don't show any sexual preference.

Front 74

What is seriation?
At what age is it developed?

Back 74

The ability to arrange objects in order with respect to their sizes or other qualities

Children are able do do this by the age of 6

Front 75

What are the Tanner Stages of Sexual development in girls?

Back 75

1: Genitalia and associated structures are the same as in childhood, Nipples (papillae) are slightly elevated
2: Scant, straight pubic hair, Slight elevation of breast tissue
3: Pubic hair increases over the pubis and becomes curly
4: Areola rises above the rest of the breast in girls
5: Genitalia are like adult, Pubic hair now is also on thighs, Areola is no longer elevated

Front 76

What are the Tanner Stages of Sexual development in boys?

Back 76

1: Genitalia and associated structures are the same as in childhood
2: Scant, straight pubic hair, Testes enlarge, Scrotum develops texture
3: Pubic hair increases over the pubis and becomes curly, Penis increases in length & testes enlarge
4: Penis increases in width, Glans develops, Scrotal skin darkens
5: Genitalia are like adult, Pubic hair now is also on thighs

Front 77

In order to best reduce risk taking behavior in teenagers should you focus on long or short term risks?

Back 77

Short term risks (e.g. "smoking will stain your teeth" rather than "smoking may give you cancer in 30 years")

Front 78

During what period of adolescence is risk-taking behavior the highest?

Back 78

Middle adolescence (14-17yo) by 17yo adolescents tend to have a more realistic appraisal of their own abilities

Front 79

Between the ages of 15 months to 2.5 years old is a child more likely to fear separation from their parents or physical harm?

Back 79

Separation

Front 80

Between what ages do children have the greatest fear of bodily harm?

Back 80

2.5yo to 6yo

Front 81

At about what age do children begin to understand that children can also die and begin to fear their own death?

Back 81

9 years old

Front 82

At what age do children begin to understand the permanence of death?

Back 82

6 years old

Front 83

In what age do people possess the most power and authority?

Back 83

Middle adulthood [40-65 years old]

Front 84

What is climacterium?

Back 84

The change in physiologic function that occurs during midlife

Front 85

What is the most common psychiatric disorder in the elderly?

Back 85

Depression

Front 86

What is pseudodementia?

Back 86

Depression may mimic and thus be misdiagnosed as Alzheimer disease. This misdiagnosed disorder is referred to as pseudodementia. There is:
(1) Moderate memory loss
(2) Other cognitive problems
(3) NO decrease in IQ
(4) Disruption of normal life

Front 87

What is the "anniversary reaction"?

Back 87

In grief when symptoms return on holidays or special occasions

Front 88

What intellectual tasks do men tend to be better than women at?
Women better than men?

Back 88

Men better than women: Spatial tasks [may have better developed right hemisphere]
Women better than men: Language [may not be related to language skills but women tend to have a larger corpus callosum and anterior commissure and appear to have better inter hemispheric communication]

Front 89

What is Kluver-Bucy syndrome?

Back 89

Due to a lesion in the amygdala [temporal lobe] and results in decreased aggression, increased sexual behavior, and hyperorality.

Front 90

A lesion to the ventromedial nucleus of the hypothalamus may lead to what?

Back 90

The ventromedial nucleus reduces hunger and thus a lesion may lead to excessive hunger and obesity.

Front 91

A lesion to the lateral nucleus of the hypothalamus may lead to what?

Back 91

The lateral nucleus icnreases hunger and thus a lesion may lead to reduced hunger and weight loss.

Front 92

What region of the brain is most affected by Huntington's syndrome?

Back 92

The caudate nucleus is affected the most but the putamen is also

Caudate + Putamen = Striatum

Front 93

What region of the brain is most affected by Tourette syndrome syndrome?

Back 93

Caudate nucleus

Front 94

Describe which neurotransmitters are increased or decreased in depression.

Back 94

Norepinephrine is decreased
Serotonin is decreased
Dopamine is decreased

Front 95

Describe which neurotransmitters are increased or decreased in mania.

Back 95

Dopamine is increased

Front 96

Describe which neurotransmitters are increased or decreased in schizophrenia.

Back 96

Dopamine is increased
Serotonin is increased
Glutamate ACTIVITY is DECREASED [cause unknown but might be due to hyposecretion OR hypo activity of NMDA receptors]

Front 97

Describe which neurotransmitters are increased or decreased in anxiety.

Back 97

GABA is decreased
Serotonin is decreased
Norepinephrine is increased

Front 98

Describe which neurotransmitters are increased or decreased in Alzheimer's disease.

Back 98

Acetylcholine is decreased
Glutamate is increased

Front 99

What is 5-HIAA?
What might a decrease in it's levels indicate?

Back 99

A serotonin metabolite

Severe depression, Attempted suicide, Aggressiveness and violence, Impulsiveness, Fire setting, Tourette syndrome, Alcohol abuse, Bulimia

Front 100

What is the primary metabolite of serotonin?

Back 100

5-HIAA (5-hydroxyindoleacetic acid)

Front 101

What metabolite will you test for first in the urine or blood of an individual you suspect has pheochromocytoma?

Back 101

Pheochromocytoma: Adrenal medulla tumor

Search for the norepinephrine metabolite vanillylmandelic acid (VMA)

Front 102

What norepinephrine metabolite will be decreased in severe depression and attempted suicide?

Back 102

MHPG (3-methyoxy-4-hydroxyphenylglycol)

Front 103

A decrease of what NT metabolite would be expected in an individual with Parkinson's disease?

Back 103

HVA (homovanillic acid) which is a metabolite of dopamine

Front 104

An increase of what NT metabolite would be expected in an individual with Schizophrenia and other conditions involving psychosis?

Back 104

HVA (homovanillic acid) which is a metabolite of dopamine

Front 105

How does dopamine act on the tuberoinfundibular tract?

Back 105

It inhibits the secretion of prolactin from acidophils (prolactin and GH) from the anterior pituitary.

Front 106

Which NT is released onto the striatum from the nigrostriatal tract?

Back 106

Dopamine

Front 107

Hyperactivity or hypoactivity of which tract may be associated with the positive and negative symptoms of schizophrenia respectively?
Which NT is most important?

Back 107

Mesolimbic-mesocoritcal tract

Dopamine

Front 108

Where are most noradrenergic neurons of the CNS located?

Back 108

Locus ceruleus

Front 109

What enzyme converts dopamine into norepinephrine?

Back 109

Dopamine beta-hydroxylase

Front 110

Where are most serotonergic cell bodies in the brain located?

Back 110

Dorsal raphe nuclei

Front 111

What amino acid is the precursor for serotonin?

Back 111

Tryptophan

Front 112

What amino acid is the precursor for dopamine, norepinephrine, and epinephrine?

Back 112

Tyrosine

Front 113

What is fluoxetine (Prozac)?

Back 113

A selective serotonin reuptake inhibitor

Front 114

What do heterocyclic antidepressants work?

Back 114

The inhibit the re-uptake of BOTH norepinephrine and dopamine

Front 115

How is it thought that certain antipsychotics and tricyclic antidepressants produce side effects such as sedation and increased appetite causing weight gain?

Back 115

Histamine receptor blockade

Front 116

What are some common conditions that degeneration of cholinergic neurons of the CNS are associated with?

Back 116

Alzheimer's disease
Down syndrome
Movement and sleep disorders

Front 117

Where are most cholinergic cell bodies in the brain located?

Back 117

Basal Nucleus of Meynert

Front 118

Name some common drugs that block the action of acetylcholinesterase and are used to try and delay the progression of Alzheimer's disease.

Back 118

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)

Front 119

What is the major inhibitory NT of the CNS?

Back 119

GABA

Front 120

How do benzodiazepines work?

Back 120

e.g. diazepam (Valium)

Increase the affinity of GABA for its binding site

Front 121

How do barbiturates work?

Back 121

e.g. secobarbital (Seconal)

Increase the duration that GABA channels are open for.

Front 122

What is the major excitatory NT of the CNS?

Back 122

Glutamate

Front 123

What are some possible side effects of lithium therapy?

Back 123

Hypothyroidism (sometimes hyperthyroidism)
Nephrogenic diabetes insipidus

Front 124

Give some disease conditions in which the dexamethasone suppression test will give a positive result.

Back 124

It is test in which positive findings are not specific.

Major depressive disorder (1/2 of patients)
Schizophrenia
Dementia
Cushing's
Pregnancy, Anorexia nervosa or severe weight loss, Endocrine disorders
Abuse
Withdrawal from alcohol and antianxiety agents

Front 125

What is an evoked EEG used for?

Back 125

Evaluate vision and hearing loss in infants
Brain responses in comatose and suspected brain-dead patients

Front 126

How does an EEG differ between delirium and dementia?

Back 126

Delirium: Abnormal EEG
Dementia: Often normal EEG

Front 127

Describe the Folstein Mini-Mental State Examination.

Back 127

It is a test of cognitive function

Scoring: <25 suggests cognitive problems, <20 suggest significant impairment

Orientation [10pts]: Person, Place, Time
Language [8pts]: Name the object that I am holding
Attention & Calculation [5pts] : Serial 7 subtraction from 100
Registration [3pts]: Repeat the names of three objects
Recall [3pts]: After 5 minutes, recall the names of these three objects
Construction [1pt]: Copy this design

Front 128

Describe the Glasgow Coma Scale.

Back 128

General Notes: Score of > 12 mild, 9-12 moderate, < 9 severe neurological impairment

Eye-opening response (E): 1: None 2: Opens to pain 3: Opens to command 4: Opens spontaneously

Verbal response (V): 1: None 2: Incomprehensible sounds 3: Speaks with inappropriate words 4: Confused verbal response 5: Oriented & can converse

Motor response (M): 1: None 2: Extension to pain 3: Flexion to pain 4: Withdrawal from pain 5: Localizes a source of pain 6: Obeys commands

Front 129

What is the Amytal interview?

Back 129

It is when a sedative such as amobarbital sodium is given prior to the clinical interview and may be useful in determining whether organic pathology is responsible for symptomatology in patients who exhibit certain psychiatric disorders or malingering.

Front 130

What is IV sodium lactate administration used for?

Back 130

It can provoke a panic attack in susceptible patients and can thus help identify individuals with panic disorder. Inhalation of carbon dioxide can produce the same effect.

Front 131

What is acting out?

Back 131

Defense mechanism

Avoiding personally unacceptable emotions by behaving in an attention-getting, often socially inappropriate manner

Front 132

What is altruism?

Back 132

Defense mechanism

Assisting others to avoid negative personal feelings (a relatively "mature" defense mechanism)

Front 133

What is denial?

Back 133

Defense mechanism

Not accepting aspects of reality that the person finds unbearable

Front 134

What is displacement?

Back 134

Defense mechanism

Moving emotions from a personally intolerable situation to one that is personally tolerable [e.g. a surgeon attending with unacknowledged anger toward his mother is abrasive to the female residents on his service]

Front 135

What is dissociation?

Back 135

Defense mechanism

Mentally separating part of one's consciousness from real life events or mentally distancing oneself from others [e.g. a teenager has no memory of a car accident in which he was driving and his girlfriend was killed]

Front 136

What is humor?

Back 136

Defense mechanism

Expressing personally uncomfortable feelings without causing emotional discomfort [a relatively "mature" defense mechanism]

Front 137

What is identification (introjection)?

Back 137

Defense mechanism

Unconsciously patterning one's behavior after that of someone more powerful [can be either positive or negative]

Front 138

What is intellectualization?

Back 138

Defense mechanism

Using the mind's higher functions to avoid experiencing emotion [e.g. a sailor whose boat is about to sink calmly explains the technical aspects of the hull damage in great detail to the other crew members]

Front 139

What is isolation of affect?

Back 139

Defense mechanism

Failing to experience the feelings associated with a stressful life event, although logically understanding the significance of the event [e.g. without showing any emotion, a woman tells her family the results of tests which indicate that her lung cancer has metastasized]

Front 140

What is projection?

Back 140

Defense mechanism

Attributing one's own personally unacceptable feelings to others. Associated with paranoid symptoms and prejudice. [e.g. a man with unconscious homosexual impulses begins to believe that his boss is homosexual]

Front 141

What is rationalization?

Back 141

Defense mechanism

Distorting one's perception of an event so that its negative out-come seems reasonable. [e.g. a man who loses an arm in an accident says the loss of his arm was good because it kept him from getting in trouble with the law]

Front 142

What is reaction formation?

Back 142

Defense mechanism

Adopting opposite attitudes to avoid personally unacceptable emotions [i.e. unconscious hypocrisy]

Front 143

What is regression?

Back 143

Defense mechanism

Reverting to behavior patterns like those seen in someone of a younger age.

Front 144

What is splitting?

Back 144

Defense mechanism

(1) Categorizing people or situations into categories of either "fabulous" or "dreadful" because of intolerance of ambiguity
(2) Seen in patients with borderline personality disorder

Example: A patient tells the doctor that while all of the doctors in the group practice are wonderful, all of the nurses and office help are unfriendly and curt

Front 145

What is sublimation?

Back 145

Defense mechanism

Expressing a personally unacceptable feeling (e.g. rage) in a socially useful way (a relatively "mature" defense mechanism)

Example: A man who got into fights as a teenager becomes a professional "prize fighter"

Front 146

What is suppression?

Back 146

A defense mechanism

Deliberately pushing personally unacceptable emotions out of conscious awareness (the only defense mechanism that includes some aspect of consciousness) (a relatively "mature" defense mechanism)

Example: A medical student taking a review course for the USMLE, mentally changes the subject when her mind wanders to the exam during a lecture

Front 147

What is undoing?

Back 147

A defense mechanism

Believing that one can magically revers past events caused by "incorrect" behavior by now adopting "correct" behavior

Front 148

According to Freud what is primary process thinking?
Who is it seen in?

Back 148

A type of thinking associated with primitive drives, wish fulfillment, and pleasure seeking and has NO logic or concept of time.

Children and psychotic adults

Front 149

What are the components Freud's structural theory of the mind?

Back 149

ID
Ego
Superego

Front 150

What are the components of Freud's topographic theory of the mind?

Back 150

Unconscious mind: Contains repressed thoughts & feelings that are not available to the conscious mind and uses primary thinking
Preconscious mind: Contains memories that, while not immediately available can be accessed easily
Conscious mind: Contains thoughts that a person is currently aware of. Operates closely with pre-conscious mind but can't access the unconscious. Uses secondary process thinking.

Front 151

According to Freud what is secondary process thinking?

Back 151

Thinking that is logical, mature, time-oriented and is capable of delaying gratification.

Front 152

What is a defense mechanism?

Back 152

An UNCONSCIOUS mental technique used by the ego to keep conflicts out of the conscious mind.

Front 153

What is repression?

Back 153

It is pushing unacceptable emotions into the unconscious and is the basic defense mechanism on which all others are based.

Front 154

What is the Id?
What topographic level does it operate at?
At what age does it develop?

Back 154

Part of Freud's structural theory of the mind that contains instinctive sexual and aggressive drives, operates by primary process thinking, and not influenced my external reality

Topographic level: Unconscious

Present at birth

Front 155

What is the Ego?
What topographic level does it operate at?
At what age does it develop?

Back 155

Part of Freud's structural theory of the mind that controls the expression of the id to adapt to the requirements of the external world primarily by the use of defense mechanisms.

Topographic level: Unconscious, Preconscious, and Conscious

Begins to develop immediately after birth

Front 156

What is the Superego?
What topographic level does it operate at?
At what age does it develop?

Back 156

Part of Freud's structural theory of the mind that is associated with moral values and conscience. It controls the expression of the id.

Topographic level: Unconscious, Preconscious, and Conscious

Begins to develop by about 6 years of age

Front 157

What are the mature defense mechanisms?

Back 157

Altruism
Humor
Sublimation
Suppression [the only defense mechanism that includes some aspect of consciousness]

Front 158

What is transferance?

Back 158

An unconscious mental attitude a patient has towards a doctor based on important past personal relationships and can be positive [e.g. engender confidence, over-idealization, sexualization] or negative [e.g. resentment, anger, etc.]

Front 159

What is countertransferance?

Back 159

The same as transferance but are unconscious mental attitudes a doctor has towards a patient.

Front 160

What is a expansive mood?

Back 160

Feelings of self-importance and generosity

Front 161

What is a euthymic mood?

Back 161

Normal mood, with no significant depression or elevation of mood

Front 162

What is a dysphoric mood?

Back 162

Subjectively unpleasant feeling

Front 163

What is an anhedonic mood?

Back 163

Inability to feel pleasure

Front 164

What is a labile mood?

Back 164

Mood swings, alterations between euphoric and dysphoric moodes

Front 165

What is a restricted affect?

Back 165

Decreased display of emotional responses

Front 166

What is a blunted affect?

Back 166

Strongly decreased display of emotional responses [same as restricted affect but more severe]

Front 167

What is flat affect?

Back 167

Complete lack of emotional response

Front 168

What is labile affect?

Back 168

Sudden alterations in emotional responses NOT related to environmental events

Front 169

How is the psychophysiologic states of fear, anxiety, and free-floating anxiety defined?

Back 169

Fear: Fright caused by real danger

Anxiety: Fright caused by imagined danger [danger is not known, not recognized, or inadequate to account for the symptoms]

Free floating anxiety: Fright not associated with any specific cause

Front 170

Define clouded consciousness.

Back 170

Inability to respond normally to external events

Front 171

Define somnolence

Back 171

Abnormal sleepiness

Front 172

Define stupor

Back 172

Responds only to shouting, shaking, or uncomfortable prodding

Front 173

Define coma

Back 173

Total unresponsiveness

Front 174

What is habituation?

Back 174

A simple form of learning in which repeated stimulation results in a DECREASED response.

Example: A child who receives weekly allergy injections cries less and less with each injection

Front 175

What is sensitization?

Back 175

A simple form of learning in which repeated stimulation results in an INCREASED response.

Example: Child who is afraid of spiders fells more anxiety each time he encounters a spider.

Front 176

What is an unconditioned stimulus?

Back 176

Something that automatically, without having to be learned produces a response.

Example: The odor of food

Front 177

What is an unconditioned response?

Back 177

A natural reflexive behavior that does not have to be learned

Example: Salivation in response to the odor of food

Front 178

What is a conditioned stimulus?

Back 178

Something that produces a response following learning

Example: The sound of the lunch bell

Front 179

What is a conditioned response?

Back 179

A behavior that is learned by an association made between conditioned stimulus and an unconditioned stimulus.

Example: Salivation in response to the lunch bell

Front 180

What is the definition of acquisition in behavior learning?

Back 180

When a conditioned response is learned

Front 181

What is the definition of extinction in behavior learning?

Back 181

When the conditioned response decreases if the conditioned stimulus (e.g. the sound of the bell) is never again paired with the unconditioned stimulus (e.g. the odor of food).

In operant conditioning it is the gradual disappearance of a learned behavior when reinforcement (reward) is withheld.

Front 182

What is the definition of "stimulus generalization" in behavior learning?

Back 182

When a new stimulus (e.g. a church bell) that resembles a conditioned stimulus (e.g. the lunch bell) causes a conditioned response (e.g. salivation)

Front 183

What is aversive conditioning?

Back 183

When an unwanted behavior (e.g. chewing your nails) is paired with a painful or aversive stimulus (e.g. a slap on the wrist). An association is created between the unwanted behavior and the aversive stimulus and the aversive behavior ceases.

Front 184

What is learned helplessness?

Back 184

When an animal learns that there is an association between an aversive stimulus and the inability to escape from that stimulus. Subsequently the animal makes no attempt to escape when faced with that stimulus and instead becomes hopeless and apathetic. It may be a model system for depression in humans.

Front 185

What is imprinting in behavior learning?

Back 185

The tendency of organisms to make an association with and the follow the first thing they see after birth or hatching (in birds)

Front 186

What is the definition of positive reinforcement?

Back 186

When the INTRODUCTION of a POSITIVE stimulus (reward) is introduced following an action that increases the rate of the behavior.

Front 187

What is the definition of negative reinforcement?

Back 187

When the REMOVAL of a NEGATIVE stimulus occurs following an action that increases the rate of the behavior.

Front 188

What is the definition of punishment in learning behavior?

Back 188

The introduction of an aversive stimulus aimed at reducing the rate of an unwanted behavior.

Front 189

What is the definition of "shaping" in learning behavior?

Back 189

It is rewarding closer and closer approximations of the wanted behavior until the correct behavior is achieved.

Front 190

What is the definition of "modeling" in learning behavior?

Back 190

It is a type of observational learning.

Example: Individual behaves in a manner similar to that of someone she admires.

Front 191

Describe a "continuous" schedule of reinforcement and it's effect on behavior?

Back 191

Reinforcement is presented after every action

Example: Getting gumballs from a machine.

Effect on behavior: Quickly learned and has little resistance to extinction [e.g. don't use machine again if no gumball comes aout]

Front 192

Describe a "fixed ratio" schedule of reinforcement and it's effect on behavior?

Back 192

Reinforcement is presented after a designated number of actions

Effect on Behavior: It results in a faster response rate [e.g. the person make widgets more quickly]

Front 193

Describe a "fixed interval" schedule of reinforcement and it's effect on behavior?

Back 193

Reinforcement is presented after a fixed time interval

Example: Having a quiz every Friday

Effect on behavior: The response rate increases towards the end of each interval [study more and more the closer a quiz comes]

Front 194

Describe a "variable ratio" schedule of reinforcement and it's effect on behavior?

Back 194

Reinforcement is presented after a random and unpredictable number of responses

Example: Gambling

Effect on Behavior: Harder to learn but extremely resistant to extinction [hard to leave the black jack table even if you haven't won any of the last 30 hands]

Front 195

Describe a "variable interval" schedule of reinforcement and it's effect on behavior?

Back 195

Reinforcement after a random and unpredictable amount of time

Example: Fishing

Effect on Behavior: Highly resistant to extinction [if you catch a fish early then you'll stay and tray and catch more even if you don't catch one for the next 8 hours]

Front 196

What is "mental age" as defined by Alfred Binet?

Back 196

It reflects a person's level of intellectual functioning regardless of what their chronological (actual) age is.

Front 197

What is definition of the IQ?
How is it calculated?

Back 197

Intelligence Quotient

IQ = (Mental Age/Chronological age) * 100

Front 198

How does IQ change throughout life?

Back 198

It is determined to a large extent by genetics (though poor nutrition and illness in childhood can negatively affect it) & as such is essentially the same in old age as in childhood.

Front 199

What is a normal or average IQ?
What is the mean IQ?
How much is one standard deviation from the mean?

Back 199

Normal/Average: 90-109
Mean: 100
Standard Deviation: 15

Front 200

What IQ score indicates borderline intellectual functioning?

Back 200

71-84

Front 201

Below what IQ is an individual considered mentally retarded?

Back 201

Less than 2 standard deviations below the mean which is 70 or less

Front 202

Over what IQ is an individual said to have superior intelligence?

Back 202

> 130 [more than 2 standard deviations above the mean]

Front 203

In what age group is IQ generally tested?

Back 203

<16yo

Front 204

What IQ test is used most often to test intelligence in children 6-16.5 years old?

Back 204

Wechsler Intelligence Scale for Children-Revised (WISC-R)

Front 205

What IQ test is used most often to test intelligence in children 4-6.5 years old?

Back 205

Wechsler Preschool and Primary Scale of Intelligence (WPPSI)

Front 206

What test is used to evaluate skills for daily living (e.g. dressing, using telephone, etc.) in mentally retarded and other challenged people (e.g. deaf or blind)

Back 206

Vineland Social Maturity Scale

Front 207

List the levels of mental retardation based on IQ and describe each.

Back 207

Mild: 70-55 IQ [2-3 SD below mean] Educable: (1) Basic academic skills (2) Usually employable

Moderate: 55-40 IQ [3-4 SD below mean] Trainable: (1) Self-help skills (2) Can work under close supervision (3) Limited social skills

Severe: 40-25 IQ [4-5 SD below mean] (1) Limited language (2) Self-care w/ intensive training (3) Constant supervision

Profound: <25 IQ [6+ SD below mean]. (1) May not learn to talk (2) Total care

Front 208

What is the difference between an objective and projective personality test?

Back 208

Objective Personality Test: Based on questions that are easily scored and statistically analyzed

Projective Personality Test: Requires the subject to interpret the questions. Responses are assumed to be based on the subject's motivational state and defense mechanisms.

Front 209

What is the Minnesota Multiphasic Personality Test (MMPI-2) used for?

Back 209

Use: The MOST COMMONLY used OBJECTIVE personality test & is useful for primary care physicians because no training is required for administration.

Characteristics: 567 T/F questions with both clinical [depression, paranoia, etc.] and validity scales [identifying individuals trying to look ill or look well]

Front 210

What is the Rorschach Test used for?

Back 210

Uses: The MOST COMMONLY used PROJECTIVE personality test used to identify thought disorders and defense mechanisms.

Characteristics: Patients are asked to interpret 10 bilateral symmetrical ink blot designs

Front 211

What is Thematic Apperception Test (TAT) used for?

Back 211

Use: Projective tests in which stories are used to evaluate unconscious emotions and conflicts

Characteristics: Patients are asked to create verbal scenarios based on 30 drawings depicting ambiguous situations

Front 212

What is the Sentence Completion Test (SCT) used for?

Back 212

Use: Projective test used to identify worries and problems using verbal associations

Characteristics: Patients complete sentences started by the examiner (e.g. my mother ...)

Front 213

What are the variables evaluated in the Mental Status Examination?

Back 213

General Appearance: Appearance, Behavior, Attitude toward the interviewer, Level of consciousness
Cognition: Mini-mental status exam, Spatial, Abstraction (e.g. how are an orange and apple similar?), Speech
Mood and Affect: Mood and demonstrated affect, Match of emotions with current events
Though: Form or process of thought, Thought content (e.g. delusion)
Perception: Illusion, Hallucination
Judgment & Insight: Hypothetical questions (Find postmarked envelope on street. What do you do?
Reliability: The patients ability to reliably recount his health and history
Control of Aggressive and Sexual Impulses

Front 214

Define substance abuse.
Define substance dependence.

Back 214

Substance Abuse: A pattern of abnormal substance use that leads to impairment of occupational, physical, or social functioning.

Substance Dependence = Substance abuse + Withdrawal symptoms, Tolerance, or a Pattern of repetitive use

Front 215

Define withdrawal.

Back 215

Development of physical or psychological symptoms after the reduction or cessation of intake of a substance

Front 216

Define tolerance.

Back 216

The need for increased amounts of the substance to achieve the same positive psychological effect

Front 217

Define cross-tolerance.

Back 217

The development of tolerance to one substance to achieve the same positive psychological effect

Front 218

In what demographic age group is the use of illegal substances most common?

Back 218

Young adults 18-25yo
Twice as common in males

Front 219

How much caffeine is in a cup of coffee?
Cup of tea?
Cup of soda?

Back 219

Coffee: 125mg/cup
Tea: 65mg/cup
Soda: 40g/cup

Front 220

What are two psychiatric conditions in which amphetamines are medically indicated for?

Back 220

ADHD & Narcolepsy

Sometimes used to treat depression in the elderly and terminally ill, and depression and obesity in patients how do not respond to other treatments

Front 221

What is the street name for methamphetamine?

Back 221

"speed" or "ice"

Front 222

What is the street name for methylene dioxymethamphetamine?

Back 222

"ecstasy"

Front 223

What is the difference "crack", "freebase", and "cocaine".

Back 223

"crack" and "freebase" are cheap smokable forms of cocaine ; in expensive pure form cocaine is snorted

Front 224

What symptoms are seen in newborns of mothers who used cocaine during pregnancy?

Back 224

Hyperactivity & growth retardation

Front 225

What is formication?

Back 225

It is a hallucination in which the person believes there are bugs crawling on the skin

Front 226

What is the primary manner in which cocaine causes it's psychological effects?

Back 226

Inhibit the reuptake of dopamine

Front 227

What is the primary manner in which amphetamines cause their psychological effects?

Back 227

Stimulate dopamine release

Front 228

How long does the elevation of mood typically last with cocaine use?

Back 228

Typically 1 hour

Front 229

What are the psychological effects of amphetamine & cocaine use?

Back 229

Significant elevation of mood (lasting only 1 hour with cocaine)
Increased alertness and attention span
Aggressiveness, impaired judgement
Psychotic symptoms
Agitation and insomnia

Front 230

What are the physiological effects of amphetamine & cocaine use?

Back 230

Loss of appetite and weight
Pupil dilation
Increased energy
Tachycardia and other CVS effects
Seizures (particularly w/ cocaine)
Hypersexuality

Front 231

What are the psychological effects of amphetamine and cocaine withdrawal?

Back 231

Significant depression of mood
Strong pyschological craving (peaking a few days after the last dose)
Irritability

Front 232

What are the physiological effects of amphetamine and cocaine withdrawal?

Back 232

Hunger (particularly with amphetamines)
Pupil constriction
Fatigue

Front 233

What is the primary way in which sedatives have their psychological effects?

Back 233

Primarily by increasing the activity of GABA.

Front 234

What are the CAGE questions and what are they used for?

Back 234

To help identify people who have a problem with alcohol.

Do you ever?
C ... try to Cut down on your drinking?
A ... get Angry when someone comments on your drinking?
G ... feel Guilty about your drinking
E ... take a drink as an Eye-opener in the morning

Front 235

At what BAL does coma occur in non-alcoholic individuals?

Back 235

0.40-0.50%

Front 236

What is the legal intoxication limit range in the U.S.?

Back 236

0.08-0.15%

Front 237

What is delirium tremens?
When do they occur?
Who does it occur in?
Is it life threatening?

Back 237

Alcohol withdrawal delirium

May occur during the 1st week of withdrawal from alcohol (most common on the 3rd day of hospitalization)

It usually occurs in patients who have been drinking heavily for at least 5 years

It is life threatening with a mortality rate of about 20%

Front 238

What drugs are most often taken to commit suicide?

Back 238

Barbiturates

Front 239

Why do barbiturates have a low safety margin?

Back 239

Because they cause respiratory depression

Front 240

What 4 major categories can most abused substances be classified into?

Back 240

Stimulants
Sedatives (depressants)
Opioids
Hallucinogens and Related Agents

Front 241

What is LSD?
How is it taken?

Back 241

A hallucinogen called lysergic acid diethylamide and is ingested

Front 242

What is PCP and it's street name?
How is it taken?
How does it work?
What amount may lead to convulsions, coma, and death?

Back 242

A hallucinogen called phencyclidine or "angel dust" and is smoked

Binds with NMDA receptors of glutamate-gated ion channels

20mg

Front 243

What is "Special K"?

Back 243

Ketamine

Front 244

What hallucinogen is extracted from mushrooms?

Back 244

Psilocybin

Front 245

What hallucinogen is extracted from cacti?

Back 245

Mescaline

Front 246

What are the physical effects of hallucinogen use?

Back 246

Impairment of complex motor actvity
Cardiovascular symptoms
Sweating
Tremor
Nystagmus [vertical, horizontal, or rotational is an important diagnostic clue for PCP use]

Front 247

What are the physiological and psychological withdrawal symptoms of hallucinogens?

Back 247

There are few if any of either

Front 248

Levels of what can be tested in bodily fluids (e.g. blood & urine) in nicotine use and for how long can it be detected?

Back 248

Cotinine (a metabolite)
1-2 days

Front 249

Levels of what can be tested in bodily fluids (e.g. blood & urine) in amphetamines use and for how long can it be detected?

Back 249

Amphetamines themselves
1-2 days

Front 250

Levels of what can be tested in bodily fluids (e.g. blood & urine) in cocaine use and for how long can it be detected?

Back 250

Benzoylecgonine (a metabolite)
1-3 days in occasional use and 7-12 days in heavy users

Front 251

Levels of what can be tested in bodily fluids (e.g. blood & urine) in alcohol use and for how long can it be detected?

Back 251

Alcohol itself
7-12 hours

Front 252

What is gamma-glutamyltransferase (GGT) a metabolite of and how long after use of the substance that it is metabolized from can it be detected in bodily fluids?

Back 252

A metabolite of sedatives
7-12 hours

Front 253

How long after use can specific barbiturates or benzodiazepine or their metabolites be found in bodily fluids?

Back 253

1-3 days

Front 254

How long after use can cannabinoid metabolites be detected in bodily fluids?

Back 254

3-28 days

Front 255

How long after use can PCP be detected in the bodily fluids of heavy users?
What are it's metabolites and how long after use can they be detected?

Back 255

PCP: 7-14 days

Glutamic-oxaloacetic transaminas (SGOT) level and creatinine phosphokinase (CPK) can be detected more than 7 days after use

Front 256

What immediate steps are taken in the detoxification from minor stimulants such as caffeine and nicotine?

Back 256

Eliminate or taper from diet
Analgesics to control headache due to withdrawal

Front 257

What immediate steps are taken in the detoxification from amphetamines and cocaine?

Back 257

Benzodiazepines to decrease agitation
Antipsychotics to treat psychotic symptoms
Medical and psychological support

Front 258

What immediate steps are taken in the detoxification from alcohol, benzodiazepines, barbiturates?

Back 258

Hospitalization
Flumazenil (Mazicon) to reverse effects of benzodiazepines
Substitution of long-acting barbiturate or benzodiazepine in decreasing doses
IV diazepam of phenobarbital if seizures occur
Thiamine restoration in alcohol withdrawal

Front 259

What immediate steps are taken in the detoxification from opioids?

Back 259

Hospitalization and naloxone of overdose
Clonidine to stabilize the autonomic nervous system during withdrawal
Substitution of long-acting opioid (methadone) in decreasing doses to reduce withdrawal symptoms

Front 260

What immediate steps are taken in the detoxification from hallucinogens?

Back 260

Calming or "talking down" the patient
Benzodiazepines to decrease agitation
Antipsychotics to treat psychotic symptoms

Front 261

What brain wakes indicate an awake state? When & where are they seen?

Back 261

Alpha: Over occipital and parietal lobes are seen when a person relaxes with closed eyes

Beta: Over the frontal lobes with active mental concentration

Front 262

What is a normal sleep latency?

Back 262

Period of time from going to bed to falling asleep is normally less than 20 minutes

Front 263

Does the longest REM period of sleep occur in the first half or second half of the sleep cycle?

Back 263

2nd half

Front 264

What stages of sleep decrease the most with age?

Back 264

REM (50% in infancy to 5% in elderly)and Stage 3 & 4 non-REM (Delta sleep)

Front 265

How do levels of ACh in the reticular formation affect sleep time?

Back 265

Increased ACh levels increase both total and REM sleep. ACh is essential in the induction of REM sleep.

Front 266

How do levels of dopamine affect sleep?

Back 266

Increased levels of dopamine decrease total sleep time [treatment with antipsychotics which block dopamine receptors, may improve sleep in patients with psychotic symptoms.

Front 267

How do levels of norepinephrine affect sleep?

Back 267

Increased levels of NorE decrease both total & REM sleep

Front 268

How do levels of serotonin affect sleep?

Back 268

Increased levels of serotonin increase both total sleep time and delta sleep [non-REM 3 & 4]. Treatment with antidepressants, which increase serotonin availability can improve sleep in depressed patients.

Front 269

What is the difference between a dyssomnia and a parasomnia?

Back 269

Dyssomnia: Characterized by problems in the timing, quality, or amount of sleep

Parasomnia: Characterized by abnormalities in physiology or in behavior associated with sleep

Front 270

What is bruxism?
How is it treated?

Back 270

A parasomnia in which there is tooth grinding during sleep during stage 2 of non-REM sleep and can lead to tooth damage and jaw pain
Treated with dental appliance worn at night or corrective orthodontia

Front 271

How does the DSM-IV define insomnia?

Back 271

It is a dyssomnia
(1) Difficulty falling asleep or staying asleep that occurs 3 times a week for at least 1 month.
(2) Leads to sleepiness during the day or causes problems fulfilling social or occupational obligations

It is a very common disorder in at least 30% of the population

Front 272

What is the most common sleep characteristic in depressed patients?

Back 272

Terminal insomnia (waking too early)

Front 273

What is sleep terror disorder?
During what part of sleep do they occur?
What might an onset in adolescence indicate?

Back 273

Repetitive experiences of fright in which a person (usually a child) screams in fear during sleep during which the person cannot be awakened and has no memory of having a dream

Occurs during delta sleep [non-REM 3 & 4]

Temporal lobe epilepsy

Front 274

What is nightmare disorder?
During what part of sleep do they occur?

Back 274

Repetitive, frightening dreams that cause nighttime awakenings in which the person usually can recall the nightmare

Occurs during REM sleep

Front 275

What is sleepwalking disorder?
During what part of sleep does it occur?
What is the usual age of onset?

Back 275

Repetitive walking around during sleep with no memory of the episode on awakening

Occurs during delta [non-REM 3 & 4] sleep

Usually 4-8 years of age [childhood]

Front 276

What is circadian rhythm sleep disorder?
What are the 3 different types?

Back 276

Inability to sleep at appropriate times

Three types:
Delayed sleep phase type: Involves falling asleep and waking later than wanted
Jet Lag: Typically lasts 2-7 days after a change in time zones
Shift Work Type: For example residency

Front 277

What is nocturnal myoclonus?
In what age group is this most common?

Back 277

Repetitive, abrupt muscular contractions in the legs from toes to hips that cause nighttime awakenings

More common in the elderly

Front 278

What is restless leg syndrome?
In what population is this most common?

Back 278

Uncomfortable sensation in the legs necessitating frequent motion. Includes repetitive limb jerking during sleep. It causes difficulty falling asleep and nighttime awakenings.

More common in aging, pregnancy, and kidney disease

Front 279

What is sleep drunkenness?
What other conditions must it be differentiated from?
What are predisposing conditions?

Back 279

Difficulty awakening fully after adequate sleep

Rare and must be differentiated from substance abuse or other sleep disorders

Associated with genetic factors

Front 280

What is REM sleep behavior disorder?

Back 280

REM sleep without skeletal muscle paralysis. Patients can injure themselves or their sleeping partners

Front 281

What is Kleine-Levin syndrome?
What age group is onset most common?
What is the course of the disease?

Back 281

Kleine-Levin Syndrome (“KLS”) is a rare primary hypersomnia characterized by recurrent and unusually long episodes of hypersomnia, associated with behavioral/cognitive disturbances, megaphagia and more rarely sexual disinhibition. These serious episodes alternate with periods without any symptom, normal sleep and behavior typically lasting months to years

Primarily strikes adolescents

Is self-limiting; cessation of episodes typically occurs in early adult life

Front 282

What is the definition of a primary hypersomnia?

Back 282

Recurrent periods of excessive sleepiness occurring almost daily for at least 1 month and is not relieved by daytime naps
It is often accompanied by hyperphagia

Front 283

What are the characteristics of sleep stages in depression?

Back 283

Increased REM early in the sleep cycle and decreased REM later in the sleep cycle that may lead to waking too early [MOST COMMON]

Short REM latency (appearance of REM within 45 minutes of falling asleep)

Long first REM period and INCREASED TOTAL REM

Reduced delta [non-REM 1 & 2] sleep

Front 284

What is obesity hypoventilation syndrome?
What is another name?

Back 284

A condition that occurs in obese people, in which poor breathing leads to lower oxygen levels and higher carbon dioxide levels in the blood. It results in sleep apnea and chronic hypoxia

Pickwickian syndrome

Front 285

What is central sleep apnea?

Back 285

It is when little or no respiratory effort occurs resulting in less air reaching the lungs

Front 286

What is obstructive sleep apnea?
What age group and sex is it most common in?

Back 286

Respiratory effort occurs, but an airway obstruction prevents air from reaching the lungs.

40-60yo and males

PATIENTS OFTEN SNORE

Front 287

What is the peak age of onset of schizophrenia in men?
Women?

Back 287

Men: 15-25 years
Women: 25-35

Front 288

What differences exist in how schizophrenics with positive and negative symptoms respond to anti-psychotics?

Back 288

Positive: Respond well to most traditional AND atypical antipsychotic agents

Negative: Respond better to atypical than to traditional antipsychotics

Front 289

What are the 3 phases of schizophrenia?

Back 289

Prodromal: Signs and symptoms occur prior to the first psychotic episode, and include avoidance of social activities ; physical complains ; and new interest in religion, the occult or philosophy

Psychotic phase: The patient loses touch with reality. Disorders of perception, thought content, thought process, and form of though occur during an acute psychotic episode
Residual: Time period between psychotic episodes in which the patient IS in touch with reality but does not behave normally and is typically associated with NEGATIVE symptoms

Front 290

What are factors improve prognosis and reduce suicide risk in schizophrenics?

Back 290

Older age of onset, Has social relationships, Female, Employment, Few negative symptoms, Few relapses

Front 291

Define illusion?
Hallucination?

Back 291

They are both disorders of perception.

Illusion: Misperception of real external stimuli [e.g. interpreting the appearance of a coat in a dark closet as a man]
Hallucination: False sensory perception [e.g. hearing voices]

Front 292

Give examples of disorders of perception?
Thought Content?
Thought Process?
Form of Thought?

What disease are all of these often present in?

Back 292

Perception: Illusion, Hallucination
Thought Content: Delusion, Idea of Reference
Thought Process: Impaired abstraction ability, Magical thinking
Form of Thought: Loose associations, Neologisms, Tangentiality

Schizophrenia

Front 293

Define delusions
Ideas of reference?

Back 293

They are both disorders of thought content

Delusion: False belief not shared by others [e.g. feeling of being followed by FBI]

Idea of reference: False belief of being referred to by others [e.g. feeling of being discussed by someone on TV]

Front 294

Define impaired abstraction ability?
Magical thinking?

Back 294

They are both disorders of thought process.

Impaired abstraction ability: Problems discerning the essential qualities of objects or relationships [e.g. when asked what brought her to the emergency room the patient says "an ambulance"]

Magical thinking: Belief that thoughts affect the course of events [e.g. knock on wood]

Front 295

Define loose associations?
Neologisms?
Tangentiality?

Back 295

They are all disorders of form of thought.

Loose associations: Shift of ideas from one subject to another in an unrelated way

Neologisms: Inventing new words

Tengentiality: Getting further away form the point as speaking continues

Front 296

Birth in what season of the year is associated with an increased incidence of schizophrenia?

Back 296

Cold weather months [maybe viral influence?]

Front 297

What are the anatomical differences in a schizophrenic brain?

Back 297

(1) Abnormalities in frontal lobes [decreased glucose use demonstrated by PET scans]
(2) Lateral and third ventricle enlargement
(3) Decreased volume of limbic structures [e.g. amygdala, hippocampus]

Front 298

Use of which drug mimics the psychotic symptoms of schizophrenia and why?

Back 298

PCP [phencyclidine] b/c it is an NMDA receptor antagonist and one theory of schizophrenia states that symptoms might be attributable to a HYPO-functioning glutamate system. Certain NMDA agonists may help alleviate symptoms.

Front 299

What is the approximate occurrence of schizophrenia in the
General population?
Person who has one parent or sibling with schizophrenia?
Person who has two parents with schizophrenia?
Person who has a monozygotic twin with schizophrenia?

Back 299

General: 1%
Parent of sibling: 10%
Two parents: 40%
Monozygotic twin: 50%

Front 300

What are the 5 DSM-IV subtypes of schizophrenia?

Back 300

Disorganized
Catatonic
Paranoid
Undifferentiated
Residual

Front 301

Describe the characteristics of the disorganized subtype of schizophrenia.

Back 301

Poor grooming and disheveled appearance
Inappropriate emotional response [e.g. silliness]
Facial grimacing, Mirror gazing
Onset BEFORE 25 years of age

Front 302

Describe the characteristics of the catatonic subtype of schizophrenia.

Back 302

Stupor or agitation, lack of coherent speech
Bizarre posturing [wavy flexibility]
Rare since the introduction of anti-psychotic agents

Front 303

Describe the characteristics of the paranoid subtype of schizophrenia.

Back 303

Delusions of persecution
Better functioning and older age at onset than other subtypes

Front 304

Describe the characteristics of the undifferentiated subtype of schizophrenia.

Back 304

Characteristics of more than one subtype [Disorganized, Catatonic, Paranoid]

Front 305

Describe the characteristics of the residual subtype of schizophrenia.

Back 305

At least one previous psychotic episode
Subsequent residual symptoms but no current frank psychotic symptoms [residual phase?]

Front 306

What time frame of symptoms are required to diagnose schizophrenia?
What is the prognosis?

Back 306

Psychotic and residual symptoms lasting > 6 months

Lifelong social and occupational impairment

Front 307

What time frame of symptoms are required to diagnose brief psychotic disorder?
What is the prognosis?

Back 307

Psychotic symptoms lasting > 1 day but < 1 month that often occur with precipitating psychosocial factors

50-80% recover completely

Front 308

What time frame of symptoms are required to diagnose schizophreniform disorder?
What is the prognosis?

Back 308

Psychotic symptoms lasting > 1 month but < 6 months

33% recover completely

Front 309

What is schizoaffective disorder?
What is the prognosis?

Back 309

Symptoms of mood disorders AS WELL AS psychotic symptoms

Lifelong social and occupational impairment [somewhat higher over-all functioning than in schizophrenia]

Front 310

What is delusional disorder?
What is the prognosis?
What are the different types?

Back 310

Fixed, persistent, NON-bizzare, delusional system that persist for AT LEAST 1 month

50% recover completely ; many have relatively normal social and occupational functioning

Erotomanic type, Grandiose type, Jealous type, Persecutory type, Somatic type, Mixed type, Unspecified type

Front 311

What is shared psychotic disorder [folie a deux]?
What is the prognosis?

Back 311

Development of delusions in a person in a close relationship with someone with delusional disorder [the inducer]

10-40% recover completely when separated from the inducer

Front 312

Define the Five Axes of the DSM-IV.

Back 312

Axis I: Clinical disorders (most of psychiatry)
Axis II: Personality disorders, Mental retardation (essentially life-long problems) consisting of 3 clusters A, B, & C
Axis III: General Medical Conditions (all other biological illness)
Axis IV: Psychosocial, Environmental Problems (stressors)
Axis V: Global Assessment of Functioning

Front 313

What are the 3 Clusters of DSM IV Axis II?
What are the characteristics of each cluster and the associated diseases?

Back 313

Axis II --> Personality disorders, Mental retardation (essentially life-long problems) consisting of 3 clusters A, B, & C:
A:
(1) Avoids social relationships, is "peculiar" not not psychotic
(2) Paranoid, Schizoid, Schizotypal
B:
(1) Dramatic, emotional, inconsistent, Mood disorders, Substance abuse, and somatoform disorders
(2) Antisocial, Borderline, Histrionic, Narcissistic
C:
(1) Fearful, Anxious, Anxiety disorders
(2) Avoidant, Dependant, Obsessive-Compulsive

Front 314

Define a major depressive episode according to DSM IV.

Back 314

Requires at least 2 weeks of depressed mood or loss of interest accompanied by AT least 4 ADDITIONAL symptoms of depression

Front 315

What is seasonal affective disorder?
What treatment might improve symptoms?

Back 315

Subtype of major depressive disorder associated with the winter season and short days

Many patients improve in response to full-spectrum light exposure

Front 316

What are the top 5 risk factor for suicide from highest to lowest?

Back 316

1) Serious prior suicide attempt
2) Older than 45yo
3) Alcohol dependence
4) History of rage and violent behavior
5) Male

Front 317

Which gender is more likely to commit suicide?

Back 317

Female: 3 times more likely to attempt
Male: 3 times more likely to succeed

Front 318

What does the DSM IV require to diagnose bipolar I disorder?
Bipolar II disorder?

Back 318

Bipolar I: Mania and depression [requires only 1 episode of mania for diagnosis b/c there is no pure mania]

Bipolar II: Hypomania and depression [hypomania plus one episdoe of major depression]

Front 319

How do periods between episodes compare between people with mood disorders [e.g. bipolar] and schizophrenia or schizoaffective disorder?

Back 319

Schizophrenics and people w/ schizoaffective disorder are CHRONICALLY impaired with residual symptoms between episodes while functioning in those with mood disorders usually returns to normal between episodes

Front 320

What is dysthymic disorder?
What is cyclothymic disorder?
Compare them to major depressive disorder and bipolar disorder.

Back 320

Dysthymic: Dysthmia continuing over a 2-year period with NO discrete episode of illness

Cyclothymic: Periods of hypomania and dysthmia occurring over a 2-year period with NO descrete episodes of illness

Dysthmic and cyclothymic disorders are LESS SEVERE, NON-EPISODIC, CHRONIC, and NEVER associated with psychosis

Front 321

When is the use of electroconvulsive therapy indicated?

Back 321

The primary indication is MAJOR DEPRESSIVE DISORDER
(1) Symptoms don't respond to antidepressant medications
(2) Antidepressant medications are too dangerous or have intolerable side effects [ECT may be particularly useful in elderly]
(3) RAPID RESOLUTION of symptoms is necessary (e.g. acutely suicidal)
(4) There are psychotic features

Front 322

Why aren't benzodiazepines used for long term treatment of anxiety disorders?

Back 322

Benzodiazepienes carry a high risk of dependence and addiction and are therefor usually used only to treat acute anxiety symptoms [e.g. panic attack]

Front 323

How does DSM IV define panic disorder [it may occur with or without agoraphobia]?

Back 323

Episodic [about twice weekly] periods of intense anxiety [panic attacks]
Cardiac and respiratory symptoms and the conviction that one is about to die
Sudden onset of symptoms, increasing in intensity over a period of approx 10min and lasting about 30 min [attacks rarely follow a fixed pattern]
Attacks can be induced by administration of sodium lactate or CO2
More common in young women in their 20s

Front 324

What is agoraphobia?

Back 324

Fear being in places where it may be difficult or embarrassing to get out quickly or where you may have a panic attack and can't get help. Because of your fears, you avoid places where you think you may have a panic attack or panic-like symptoms.

Front 325

What event in childhood or childhood disorder is panic disorder with agoraphobia in an adult is associated with?

Back 325

Separation anxiety disorder

Front 326

How does DSM IV define phobias?
What is the difference between specific and social phobias?

Back 326

Specific: Irrational fear of certain things
Social: Exaggerated fear of embarrassment in social situations

Because of the fear, the patient avoids the object or situation with avoidance leading to social and occupational problems

Front 327

How does DSM IV define obsessive-compulsive disorder?

Back 327

Recurring, intrusive feelings, thoughts, and images [obsessions] that cause anxiety
Anxiety is relieved in part by performing repetitive actions [compulsions]
A common obsession is avoidance of hand contamination and compulsive need to wash hands after touching things
Repeated checking (e.g. gas jets on stove) are common
Patients usually have INSIGHT (understand thoughts and behaviors are irrational and want to eliminate them)

Front 328

What is the most common age of onset of obsessive-compulsive disorder?
What factors are involved in it's development?

Back 328

Usually young adulthood [may start in childhood]

Genetic factors are involved
Increased incidence in 1st degree relatives of Tourette disorder patients

Front 329

How does DSM IV define generalized anxiety disorder?

Back 329

Persistent anxiety symptoms including hyperarousal and worrying lasting 6 months or more
Gastrointestinal symptoms are common
Symptoms are not related to a specific person or situation [the anxiety is "free floating"]

Front 330

What is the most common age of onset of generalized anxiety disorder?

Back 330

Commonly during early 20's

Front 331

What is the cause of post traumatic stress disorder (PTSD) and acute stress disorder (ASD)?

Back 331

Symptoms in both occur after a catastrophic life-threatening or potentially fatal event affecting the patient or a close friend or relative of the patient

Front 332

What are the four classifications of symptoms in post traumatic stress disorder (PTSD) and acute stress disorder (ASD)?

Back 332

(1) Re-experiencing: Intrusive memories of the even such as flashbacks or nightmares
(2) Hyperarousal: Anxiety, increased startle response, impaired sleep, hypervigilance
(3) Emotional numbing: e.g. difficulty connecting with others
(4) Avoidance: e.g. survivor's guilt, dissociation, and social withdrawal

Front 333

How do post traumatic stress disorder (PTSD) and acute stress disorder differ in their onset and duration?

Back 333

PTSD: Symptoms last for more than 1 month (sometimes years) and may have a delayed onset
ASD: Symptoms last only between 2 days and 4 weeks

Front 334

What are the DSM IV diagnostic criteria for adjustment disorders?

Back 334

(1) The development of emotional or behavioral symptoms in response to an identifiable stressor(s) that occur within 3 months of the onset of stressor(s)
(2) These symptoms or behaviors are clinically significant through impairment of function
(3) The stress-related disturbance does not meed the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder
(4) These symptoms do NOT represent bereavement
(5) Once the stressor or its consequences have terminated the symptoms do not persist for more than an additional 6 months

Front 335

What are the subtypes of adjustment disorders?

Back 335

(1) With depressed mood
(2) With anxiety
(3) With mixed anxiety & depressed mood
(4) With disturbance of conduct
(5) With mixed disturbance of emotions and conduct
(6) Unspecified

Front 336

What are somatoform disorders characterized by?
Which sex are they more common in?

Back 336

Characterized by physical symptoms without sufficient organic cause.

Most are more common in women although hypochondriasis occurs equally in both sexes

Front 337

What are factitious disorders and malingering characterized by and how do they differ from somatoform disorders?

Back 337

Individuals with somatoform disorders truly believe they are ill while those with factitious disorders or malingering feign or induce symptoms for psychological (factitious disorder) or tangible (malingering) gain.

Front 338

How does DSM-IV classify somatization disorder?
What is the usual onset?

Back 338

History over years of wide ranging physical complaints including at least two GI symptoms (e.g. nausea), four pain symptoms, one sexual symptom (e.g. menstrual problems), and one psuedoneurological symptom (e.g. paralysis)

Before 30yo

Front 339

How does DSM-IV classify hypochondriasis?
What is the usual onset?

Back 339

Exaggerated concern with health and illness lasting at least 6 months
Concern persists despite medical evaluation and reassurance
Goes to many different doctors seeking help (doctor shopping)

More common in middle and old age

Front 340

How does DSM-IV classify conversion disorder?
What is the usual onset?

Back 340

Sudden, dramatic loss of sensory or motor function (e.g. blindness, paralysis) often associated with a stressful life event
Patients appear relatively unworried "la bell indifference"

More common in unsophisticated adolescents and young adults

Front 341

How does DSM-IV classify body dysmorphic disorder?
What is the usual onset?

Back 341

Excessive focus on a minor or imagined physical defect
Symptoms not accounted for by anorexia nervosa

Usually in late teens

Front 342

How does DSM-IV classify pain disorder?
What is the usual onset?

Back 342

Intense acute or chronic pain not explained completely by physical disease

Usually 30's and 40's

Front 343

What are the most commonly feigned symptoms in factitious disorder and malingering?

Back 343

Abdominal pain
Fever (by heating thermometer)
Hematuria (adding blood from a needle stick)
Induction of tachycardia (drugs)
Skin lesions (injuring easily reached areas)
Seizures

Front 344

How does DSM-IV classify factitious disorder [formerly Munchausen syndrome]?

Back 344

Conscious simulation of physical or psychiatric illness to gain attention from medical personnel
Undergoes unnecessary medical and surgical procedures
Has a "grid abdomen" --> Multiple crossed scars from repeated surgeries

Front 345

How does DSM-IV classify factitious disorder by proxy?

Back 345

Conscious simulation of illness in another person, typically in a child by a parent, to obtain attention from medical personnel
Is a form of child abuse because the child undergoes unnecessary medical and surgical procedures
Must be reported to child welfare authorities

Front 346

How does DSM-IV classify malingering?

Back 346

Conscious simulation or exaggeration of physical or psychiatric illness for financial or other obvious gain
Avoids treatment by medical personnel
Health complaints stop as soon as the desired gain is obtained

Front 347

What is the hallmark of delirium?
Dementia?
Amnestic disorder?

Back 347

Delirium: Impaired consciousness
Dementia: Loss of memory and intellectual abilities
Amenstic disorder: Loss of memory with few other cognitive disorders

Front 348

People with amnestic disorder commonly have a history of what?

Back 348

Alcohol abuse (thiamine deficiency leading to destruction of mamillary bodies)

May also be due to temporal lobe trauma due to vascular disease or infection such as Herpes

Front 349

How do the physical findings of delirium, dementia, and amnestic disorder differ?

Back 349

Delirium:
(1) Acute medical illness
(2) Autonomic dysfunction
(3) Abnormal EEG (fast wave activity or generalized slowing)
Dementia and Amnestic Disorder:
(1) No medical illness
(2) Little autonomic dysfunction
(3) Normal EEG

Front 350

How do the psychological findings of delirium, dementia, and amnestic disorder differ?

Back 350

Delirium:
(1) Impaired consciousness
(2) Illusions or hallucination (often visual and disorganized)
(3) Anxiety with psychomotor agitation
(4) "Sundowning" (symptoms much worse at night)
(5) Acute onset & is reversible
Dementia & Amenstic disorder
(1) Normal consciousness (sensorium)
(2) No psychotic symptoms in early stages
(3) Depressed mood
(4) Little diurnal variability
(5) Confabulation
(6) Progressive disease

Front 351

What is confabulation?

Back 351

Untruths told to hide memory loss in amnestic disorder

Front 352

What are the genetic associations with Alzheimer's disease?

Back 352

Amyloid Precurosor Protein: Chromosome 21 [Alzheimer's is inevitable in patients with down syndrome if they live into their 40's]
Presenilin 1 [chr 14] & II [chr 1]: Involved in the processing in A-beta
Apoliprotein E3 [Chr 19]

Front 353

What are the characteristics of personality disorders?
What is required for DSM-IV-TR diagnosis of personality disorder?

Back 353

Characteristics:
(1) Chronic, lifelong, rigid, unsuitable patterns of relating to others that cause social and occupational problems
(2) Persons with PD's are generally not aware that they are the cause of their own problems, do NOT have frank psychotic symptoms, and do not seek psychiatric help

PD must be present by early adulthood. Antisocial PD cannot be diagnosed until age 18 ; prior to this age, the diagnosis is conduct disorder

Front 354

What are the characteristics of dissociative disorders?
What is the treatment?

Back 354

Characteristics:
(1) Abrupt but temporary amnesia or loss of identity, or by feelings of detachment owing to psychological factors
(2) Commonly related to disturbing emotional experiences in the patient's recent or remote past

Treatment: Hypnosis, Amobarbital sodium interview, Long-term psychoanalytical oriented psychotherapy to recover "lost" memories of disturbing emotional experiences

Front 355

What are the DSM-IV diagnostic criteria for paranoid personality disorder?
[BRS does not have all details]

Back 355

Cluster A: A pervasive distrust and suspiciousness of other such that their motives are interpreted as malevolent, and is indicated by at least 4 out of the following 7:
(1) Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
(2) Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
(3) Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
(4) Reads hidden, demeaning, or threatening meanings into benign remarks or events
(5) Persistently bears grudges
(6) Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
(7) Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

Front 356

What are the DSM-IV diagnostic criteria for schizoid personality disorder?
[BRS does not have all details]

Back 356

Cluster A: Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings and is indicated by at least 4 of the following 7:
(1) Neither desires nor enjoys close relationships, including being part of a family
(2) Almost always chooses solitary activities
(3) Little, if any interest in having sexual experiences with another person
(4) Takes pleasure in few, if any activities
(5) Lacks close friends or confidants other than 1st degree relative
(6) Appears indifferent to the praise or criticism of others
(7) Shows emotional coldness , detachment, of flattened affectivity

Front 357

What are the DSM-IV diagnostic criteria for schiztypal personality disorder?
[BRS does not have all details]

Back 357

Cluster A: A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior that is indicated by at least 5 of the following 9:
(1) Ideas of reference
(2) Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms
(3) Unusual perceptual experiences, including bodily illusions
(4) Odd thinking and speech
(5) Suspiciousness or paranoid ideation
(6) Inappropriate constricted affect
(7) Behavior or appearance that is odd, eccentric, or peculiar
(8) Lack of close friends or confidants other than first-degree relatives
(9) Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

Front 358

What are the DSM-IV diagnostic criteria for antisocial personality disorder?
[BRS does not have all details]

Back 358

Cluster B: There is a pervasive pattern of disregard for and violation of the rights of others occurring SINCE AGE 15 but the current age of the patient most be AT least 18 (otherwise conduct disorder) and is indicated by at least 3 of the following 7:
(1) Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
(2) Deceitfulness, as indicted by repeated lying, use of aliases, or conning others for personal profit or pleasure
(3) Impulsivity of failure to plan ahead
(4) Irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) Reckless disregard for safety of self or others
(6) Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
(7) Lack of remorse, as indicated by being indifferent to or rationalizing having, hurt, mistreated, or stolen from another

Front 359

What are the DSM-IV diagnostic criteria for borderline personality disorder?
[BRS does not have all details]

Back 359

Cluster B: Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity and is indicated by at least 5 of the following 9:
(1) Frantic efforts to avoid real or imagined abandonment (do not include suicidal or self0mutilating behavior covered in criterion 5)
(2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) Identify disturbance: markedly and persistently unstable self-image or sense of self
(4) Impulsivity in at least TWO areas that are potentially self-damaging (e.g. spending, sex, etc.)
(5) Recurrent suicidal behavior, gestures, or threats, self-mutilating behavior
(6) Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) Chronic feelings of emptiness
(8) Inappropriate, intense anger or difficulty controlling anger
(9) Transient, stress-related paranoid ideation r severe dissociative symptoms

Front 360

What are the DSM-IV diagnostic criteria for histrionic personality disorder?
[BRS does not have all details]

Back 360

Cluster B: Pervasive pattern of excessive emotionally and attention seeking, and is indicated by 5 or more of the following 8:
(1) Is uncomfortable in situations in which he or she is not the center of attention
(2) Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
(3) Displays rapidly shifting and shallow expression of emotions
(4) Consistently uses physical appearance to draw attention to self
(5) Has a style of speech that is excessively impressionistic and lacking in detail
(6) Shows self-dramatization, theatrically, and exaggerated expression of emotion
(7) Is suggestible (easily influenced by others or circumstances)
(8) Considers relationships to be more intimate than they actually are

Front 361

What are the DSM-IV diagnostic criteria for narcissistic personality disorder?
[BRS does not have all details]

Back 361

Cluster B: Pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy and is indicated by 5 or more of the following 9:
(1) Has a grandiose sense of self-importance
(2) Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
(3) Believes that he or she is "special" and unique and can only be understood by, or should associated with, other special or high-status people (or institutions)
(4) Requires excessive admiration
(5) Has a sense of entitlement
(6) Is interpersonally exploitive
(7) Lacks empathy: Unwilling to recognize of identify with the feelings or needs of others
(8) Often envies others or believes that others are envious of him/her
(9) Shows arrogant, haughty behavior or attitudes

Front 362

What are the DSM-IV diagnostic criteria for dependent personality disorder?
[BRS does not have all details]

Back 362

Cluster C: Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation and is indicated by at least 5 of the following 8:
(1) Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
(2) Needs others to assume responsibility for most major areas of his or her life
(3) Has difficulty expressing with others because of fear of loss of support for approval [DO NOT include realistic fears of retribution]
(4) Has difficulty initiating projects or doing things on his or her own [because of lack of self-confidence rather than lack of motivation]
(5) Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
(6) Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for him/herself
(7) Urgently seeks another relationship as a source of are and support when a close relationship ends
(8) Is unrealistically preoccupied with fears of being left to take care of himself or herself

Front 363

What are the DSM-IV diagnostic criteria for avoidant personality disorder?
[BRS does not have all details]

Back 363

Cluster C: Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation and is indicated by at least 4 of the following 7:
(1) Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
(2) Is unwilling to get involved with people unless certain of being liked
(3) Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
(4) Is preoccupied with being criticized or rejected in social situations
(5) Is inhibited in new interpersonal situations because of feelings of inadequacy
(6) Views self as socially inept, personally unappealing, or inferior to others
(7) Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrasing

Front 364

What are the DSM-IV diagnostic criteria for obsessive-compulsive personality disorder?
[BRS does not have all details]

Back 364

Cluster C: Pervasive pattern f preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency and is indicated by 4 or more of the following 8:
(1) Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
(2) Shows perfectionism that interferes with task completion
(3) Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
(4) Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values
(5) Is unable to discard worn-out or worthless objects even when they have no sentimental value
(6) Is reluctant to delegate tasks or to work with others unless they submit to exactly his/her way of doing things
(7) Adopts a miserly spending style toward both self and others ; money is viewed as something to be hoarded for future catastrophes
(8) Shows rigidity and stubborness

Front 365

What does the code for adult antisocial behavior denote?

Back 365

Denotes antisocial (e.g. criminal) behavior NOT due to an Axis I or II mental disorder

Before using this diagnosis, the diagnosis of Conduct disorder, Antisocial personality disorder, and Impulse control disorders should be considered

Front 366

What are the DSM-IV diagnostic criteria for dissociative amnesia?

Back 366

Failure to remember important information about oneself
Amnesia usually resolves in minutes or days but may last years

Front 367

What are the DSM-IV diagnostic criteria for dissociative fugue?

Back 367

Amnesia combined with sudden wandering from home
Adoption of a different identity

Front 368

What are the DSM-IV diagnostic criteria for dissociative identity disorder (formerly multiple personality disorder)?

Back 368

At least 2 distinct personalities ("alters") in an individual
More common in women (particularly those sexually abused in childhood)
In a forensic (e.g. jail) setting, malingering and alcohol abuse must be considered and excluded

Front 369

What are the DSM-IV diagnostic criteria for depersonalization disorder?

Back 369

Recurrent, persistent feelings of detachment from one's own body, the social situation, or environment (derealization)
Understanding that these perceptions are only feelings (i.e. normal reality testing)

Front 370

People on commercial dieting and weight loss programs generally regain the weight in how much time?

Back 370

Within a 5-year period

Front 371

What is orlistat?

Back 371

Pancreatic lipase inhibitor used to aid weight loss?

Front 372

What is sibutramine hydrochloride?

Back 372

Monoamine reputake inhibitor, which thereby increases feelings of satiety

Front 373

What are the DSM IV criteria for anorexia?
What are some of the physical characteristics of an individual w/ anorexia?

Back 373

DSM IV:
(1) Extreme weight loss (15% or more below normal weight) w/ refusal to maintain normal weight
(2) Amenorrhea for >3 mo
(3) Distortion of body image
(4) Fear of becoming fat

PHYSICAL CHARACTERISTICS:
Metabolic acidosis
Hypokalemia
Hypercholesterolemia
Mild anemia and leukopenia
Lanugo (body hair on the trunk)
Osteoporosis
Cold intolerance
Syncope

Front 374

What is malanosis coli?

Back 374

Blackened area of the colon if there is laxative abuse

Front 375

What are the DSM IV criteria & physical characteristics of an individual w/ bulimia?

Back 375

DSM IV:
(1) Binge eating followed by compensatory behavior to prevent weight gain
(2) Behavior 2 times a week for at least 3 months
(3) If meets DSM IV for anorexia than anorexia is diagnosed

PHYSICAL CHARACTERISTICS
Relatively normal body weight
Esophageal varices caused by repeated vomiting
Tooth enamel erosion due to gastric acid in the mouth
Swelling or infection of the parotid glands
Metacarpal-phalangeal calluses (Russell's sign) from the teeth because the hand is used to induce gagging
Electrolyte disturbances
Menstrual irregularities

Front 376

What is Russel's sign

Back 376

Metacarpal-phalangeal calluses from the teeth because the hand is used to induce gagging in bulimia

Front 377

What are the stages of Rett's syndrome?

Back 377

Stage 1: Signs and symptoms are subtle & easily overlooked . Starts between 6 and 18 months of age. May show less eye contact & start to lose interest in toys. They may also have delays in sitting or crawling.

Stage II: Starts between 1 and 4yo. Gradually lose ability to speak and to use their hands purposefully. Repetitive, purposeless hand movements — wringing, washing, clapping or tapping — begin during this stage. Some hold their breath or hyperventilate and may scream or cry without provocation. Often difficult for them to initiate movement. Slowing of head growth usually is noted during this stage.

Stage 3: Plateau that usually begins between 2 and 10yo and can last for years. Although problems with mobility continue, behavior may improve. Often cry less, aren't as irritable, and may show improvement in alertness, attention span and nonverbal communication skills. Many remain in stage III for the rest of their lives.

Stage 4: Last stage. Marked by reduced mobility, muscle weakness and scoliosis. Understanding, communication and hand skills generally don't decline further during this stage. In fact, repetitive hand movements may decrease. Although sudden death in sleep can occur, most live into their 40s or 50s. They usually need care and assistance throughout life.

Front 378

What is the cause of Rett's syndrome?

Back 378

Most cases of Rett syndrome are caused by mutations in the MECP2 gene.

It is an X-linked dominant inheritance.

Primarily a disease of females with most males having the mutation dying before birth.

Front 379

At what age is autism usually diagnosed?
What is the latest it is usually diagnosed?
What diseases must be excluded for diagnosis?

Back 379

Usual diagnosis: 1yo
Latest diagnosis: 3yo
Exclude: Rett's or CDD

Front 380

What social symptoms do autistic children generally exhibit?

Back 380

* Fails to respond to his or her name
* Has poor eye contact
* Appears not to hear you at times
* Resists cuddling and holding
* Appears unaware of others' feelings
* Seems to prefer playing alone — retreats into his or her "own world"

Front 381

What language symptoms do autistic children generally exhibit?

Back 381

* Starts talking later than other children
* Loses previously acquired ability to say words or sentences
* Does not make eye contact when making requests
* Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
* Can't start a conversation or keep one going
* May repeat words or phrases verbatim, but doesn't understand how to use them

Front 382

What language behavioral do autistic children generally exhibit?

Back 382

* Performs repetitive movements, such as rocking, spinning or hand-flapping
* Develops specific routines or rituals
* Becomes disturbed at the slightest change in routines or rituals
* Moves constantly
* May be fascinated by parts of an object, such as the spinning wheels of a toy car
* May be unusually sensitive to light, sound and touch and yet oblivious to pain

Front 383

What are language pragmatics?

Back 383

Social rules around language (e.g. how loud to speak)

Front 384

What is language prosody?

Back 384

Intonation and stress points in language

Front 385

How does the onset of Asperger's syndrome compare to autism?

Back 385

The onset is generally later

Front 386

What are the signs and symptoms of Autism?

Back 386

* Engaging in one-sided, long-winded conversations, without noticing if the listener is listening or trying to change the subject
* Displaying unusual nonverbal communication, such as lack of eye contact, few facial expressions, or awkward body postures and gestures
* Showing an intense obsession with one or two specific, narrow subjects, such as baseball statistics, train schedules, weather or snakes
* Appearing not to understand, empathize with, or be sensitive to others' feelings
* Having a hard time "reading" other people or understanding humor
* Speaking in a voice that is monotonous, rigid or unusually fast, marked deficits in pragmatics and prosody of language
* Moving clumsily, with poor coordination
* Having an odd posture or a rigid gait
* Generally normal intelligence

Front 387

The autism spectrum of disorders is more common in what sex?

Back 387

4-5 more common in males

Front 388

What is the onset of childhood disintegrative disorder (aka Heller's syndrome)?

Back 388

After 2 years old but before 10yo.

Development of the child is completely normal up until this time.

Front 389

In what are the areas do children with childhood disintegrative disorder experience loss of previously learned skills?

Back 389

Significant loss in at least two of the following areas before the age to 10yo:
* Ability to say words or sentences (expressive language)
* Ability to understand verbal and nonverbal communication (receptive language)
* Social skills and self-care skills (adaptive behavior)
* Bowel and bladder control
* Play skills
* Motor skills (ability to voluntarily move the body in a purposeful way)

Front 390

What are the DSM-IV criteria for the diagnosis so ADHD?

Back 390

(1) 6 or more specific symptoms of inattention or 6 or more specific symptoms of hyperactivity-impulsivity have persisted for AT LEAST 6 months to a degree that is maladaptive and inconsistent with the developmental level
(2) Some hyperactive-impulsive or inattentive symptoms that caused impairment were present BEFORE age 7
(3) Some impairment from the symptoms is present in TWO OR MORE settings
(4) There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning
(5) The symptoms DO NOT OCCUR exclusively as during the course of some other pervasive developmental disorder

Front 391

What are the 3 categories of ADHD?

Back 391

(1) Combined Type
(2) Predominantly Inattentive Type
(3) Predominantly Hyperactive-Impulsive Type

Front 392

What are the 9 specific symptoms of inattention?

Back 392

6 of the 9 are required for ADHD diagnosis
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.

Front 393

What are the 9 specific symptoms of hyperactivity-impulsivity?

Back 393

6 of the 9 are required for ADHD diagnosis
Hyperactivity:
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.

Impulsivity:
7. Often blurts out answers before questions have been finished.
8. Often has trouble waiting one's turn.
9. Often interrupts or intrudes on others (e.g., butts into conversations or games).

Front 394

What is the prognosis of ADHD?

Back 394

Most children show remission by adulthood with usually being the 1st symptom to disappear as the child reaches adolescence the

Front 395

What is the DSM-IV criteria for the diagnosis of conduct disorder?

Back 395

A repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms are violated as manifested by 3 OR MORE of the following criteria in the past 12 months and a LEAST one present in the past 6 months.
(1) Aggression to people and animals
(2) Destruction of property
(3) Deceitfulness or theft
(4) Serious violation of rules

The disturbance in behavior MUST cause clinically signification impairment in social, academic, or occupational functioning

If the individual is 18 years or older then criteria for antisocial personality disorder must not be met

Onset can be in childhood [at least 1 criteria prior 10yo] or adolescent [absence of any criteria prior to age 10]

Front 396

What is the prognosis for conduct disorder?

Back 396

There is a risk for criminal behavior, antisocial personality disorder, substance abuse, and mood disorders in adulthood

Most children show remission by adulthood

Front 397

What are the characteristics of oppositional defiant disorder?
What is the usual age of onset?

Back 397

Behavior that, while defiant, negative, and non-compliant, does not grossly violate social norms

Gradual onset, usually before age 8

Front 398

What is the prognosis of oppositional defiant disorder?

Back 398

A significant # of cases progress to conduct disorder.

Most children show remission by adulthood

Front 399

What are the characteristics and symptom of Tourrette disorder?

Back 399

Characterized by involuntary movements and vocalizations (tics), which may include the involuntary use of profanity. Whiles these behaviors can be controlled briefly, they must ultimately be expresed.

Front 400

At what age is the normal onset of Tourrette disorder and what is the course of the disease?
What sex is it more common in?
What are the predisposing factors?

Back 400

Usually begins before 18yo, most commonly between the ages of 7 & 8 with a motor tic (e.g. facial grimacing)

3 times more common in males

Strong genetic component & genetic relationships with both ADHD and obsessive compulsive disorder

Front 401

What is thought to be the cause of Tourrette disorder?
What are the most effective treatments?

Back 401

Believed to involve dysfunctional regulation of dopamine in the caudate nucleus.

Haloperidol and atypical antipsychotic agents

Front 402

What is separation anxiety disorder characterized by?
How does it present?
What are these children at risk for in adulthood?

Back 402

Overwhelming fear of loss of a major attachment figure, particularly the mother

Child often complains of physical symptoms to avoid going to school and leaving mother

Anxiety disorders in adulthood especially agoraphobia

Front 403

What is selective mutism?
What sex is it more common in?

Back 403

Children with this rare disorder speak in some social situations but not in others. The child may whisper or communicate in hand gestures.

Selective mutism must be distinguished from normal shyness

Front 404

What does electroconvulsive therapy do?
What is done prior to administration of ECT?

Back 404

Induces a generalized seizure, lasting 25-60 seconds by passing an electrical current ACROSS the brain

Prior to seizure induction patient is pre-medicated with atropine, then a short-acting general anesthesia (e.g. methohexital) and a muscle relaxant (e.g. succinylcholine) to prevent injury during seizure

Front 405

What are the different ways in which electrodes can be placed in electro convulsive therapy?
What are the differences?

Back 405

Unilateral: Two electrodes in the NON-dominant hemisphere
Bilateral: One electrode placed on each temple
Bifrontal: One electrode placed above the end of each eyebrow

With unilateral and bilateral ECT, there are fewer side effects but less efficacy than with bilateral ECT

Front 406

What are the problems associated with electro convulsive therapy?

Back 406

Major adverse effects are memory problems that include:
(1) Acute confusional state after treatment that lasts about 30 minutes and then remits
(2) Anterograde amnesia (inability to make new memories): Resolves within a few weeks
(3) Retrograde amnesia: Inability to remember events occurring up to 2 months prior to ECT [these memories rarely return]

Front 407

What are the major contraindications of electro convulsive therapy?
What is the mortality rate?

Back 407

Increased ICP
Recent (2 weeks) myocardial infarction

Very low and is comparable to that associated with induction of general anesthesia

Front 408

What are psychoanalysis and related therapies based on?
What is the central strategy of these techniques?

Back 408

Freud's concepts of the unconscious mind defense mechanism and transference reactions

To uncover experiences that are repressed in the unconscious mind and integrate them into the person's conscious mind and personality

Front 409

What is free association?
How does the therapy differ in psychoanalysis and related therapies?

Back 409

Patient says whatever comes to mind

Psychoanalysis: Patient lies on couch facing away from therapist
Related therapies: Person sits in chair and faces the therapist

Front 410

Aside from free association what are 2 other techniques used to recover repressed experiences in psychoanalysis and related therapies?

Back 410

Dream analysis
Analysis of transference reactions

Front 411

What are the characteristics of a person that is appropriate for receiving psychoanalysis or related therapies?

Back 411

(1) Younger than 40 years old
(2) Intelligent and not psychotic
(3) Have good relationships with others
(4) Have a stable life situation (e.g. not in midst of divorce)
(5) Have the time and money to spend on treatment

Front 412

How does the frequency and the time course of therapy sessions in psychoanalysis compare with related therapies?

Back 412

Psychoanalysis: Treatment 4-5 times weekly for 3-4 years
Related therapies: Briefer and more direct

Front 413

What are behavioral and cognitive-behavioral therapies based on?

Back 413

Learning theory [symptoms are relieved by unlearning maladaptive behavior patterns and altering negative thinking patterns]

Unconscious conflicts are IRRELEVANT and thus are not examined

Front 414

Who is the target population for group therapy?
How do groups with therapists differ from groups without?

Back 414

People with a common problems [e.g. rape victims]
People with personality disorders or other interpersonal problems
People who have trouble interacting with therapists as authority figures in individual therapy

With therapist: Members of the group provide the opportunity to express feelings as well as feedback, support, and friendship to eachother. Therapist has LITTLE input. He/she facilitates and observes the members' interpersonal interactions
Without: These groups are LEADERLESS. Members of the group provide support and practical help for a shared problem (e.g. Narcotics, Overeaters, and Alcoholics Anonymous are built on this model.

Front 415

When developing a strategy in family therapy what are useful things to identify about the functioning of the family unit?

Back 415

Dyads: Subsystems between two family members
Triangles: Dysfunctional alliances between two family members against a 3rd member
Boundaries: Barriers between subsystems that may be too rigid or too permeable

Front 416

What is the goal of supportive therapy?

Back 416

NOT aimed at insight into problems but rather at helping people feel protected and supported during a life crisis.

It is also used over many years for chronically ill people such as the mentally retarded.

Front 417

What is the basis of interpersonal therapy?
How many sessions per week?

Back 417

Based on the idea that psychiatric problems such as anxiety and depression are based on difficulties in dealing with others and aims to develop interpersonal skills.

12-16 weekly sessions.

Front 418

What is systemic desensitization?
What is it's most common use?

Back 418

(1) In the past, through classical conditioning, the person associated an innocuous object with a fear-provoking stimulus, until the innocuous object became frightening
(2) As part of therapy increasing doses of fear-provoking stimulus are paired with a relaxing stimulus to induce a relaxation response (since fear and relaxation are reciprocally inhibited less anxiety occurs when exposed to the fear-provoking stimulus in the future)

Most common use: Treatment of phobias

Front 419

What is aversive conditioning?
What is it's most common use?

Back 419

(1) Classical conditioning is used to pair a maladaptive but pleasurable stimulus with an aversive or painful stimulus (e.g. a shock) so the two become associated.
(2) The person ultimately stops engaging in the maladaptive response because it automatically provokes an unpleasant response

Most Common Use: Treatment of paraphilias or addictions

Front 420

What are flooding & implosion?
What are their most common uses?

Back 420

(1) The person is exposed to an actual (flooding) or imagined (implosion) overwhelming does of the feared stimuls
(2) Through the process of habituation the person becomes accustomed to the stimulus and is no longer afraid

Most Common Use: Treatment of phobias

Front 421

What is a token economy?
What is it's most common use?

Back 421

(1) Through the process of operant conditioning, desirable behavior is reinforced by a reward or positive reinforcement
(2) The person increases the desirable behavior to gain the reward

Most Common Use: To increase positive behavior in a person who is severely disorganized (psychotic) autistic, or mentally retarded

Front 422

What is biofeedback?
What is it's most common use?

Back 422

(1) Through the process of operant conditioning, the person is given ongoing physiologic information (e.g. blood pressure), which acts as a reinforcement
(2) The person uses this information along with relaxation techniques to control visceral changes (e.g. heart rate, BP, smooth muscle tone)

Most Common Use: To treat hypertension, Raynaud disease, migraine and tension headaches, chronic pain, fecal incontinence, and temporomandibular joint pain

Front 423

What is cognitive therapy?
What is it's most common use?

Back 423

(1) Weekly, for 15-25 weeks, the person is helped to identify distorted, negative thoughts about himself or herself
(2) The person replaces these negative thoughts with positive, self-assuring thoughts and symptoms improve

Most Common Use: To treat mild to moderate depression somatoform disorders, eating disorders

Front 424

What is the difference between, sole, joint residential, and split custody?

Back 424

Sole: Child lives with one parent while the other has visitation rights
Joint residential: Child spends some time living with each parent
Split: Each parent has custody of at least one child

Front 425

With whom do most elderly Americans live with?

Back 425

Most spend their last years living on their own

Only about 20% live with family members and about 5% live in nursing homes

Front 426

What is culture shock?

Back 426

A strong emotional response, which may involve psychiatric symptoms, related geographic relocation and the need to adapt to unfamiliar social and cultural surroundings. Culture shock is reduced when groups of immigrants of a particular culture live in the same geographic area

Front 427

Who is at the highest risk form culture shock?
Why?

Back 427

Young men

Because lose the most status on leaving their culture of origin and unlike others in the group who can stay at home among familiar people, young men often must get out into the new culture and earn a living

Front 428

What is gender identity disorder?
What is the presumed cause?

Back 428

Also known as transsexuality. Individuals that have a pervasive psychological felling of being born into the body of the wrong sex despite a body form normal for their physiological sex.

Associated with altered prenatal brain exposure to sex hormones

Front 429

What is the difference between gender identity and gender role?

Back 429

Gender identity: Sense of self as being male or female
Gender role: Expression of one's gender identity in society

Front 430

What role does estrogen play in sex drive?
Testosterone?

Back 430

Estrogen: Only minimally involved in libido, so menopause and aging do not reduce sex drive if a woman's general health is good
Testosterone: Believed to play an important role in sex drive in BOTH men and women

Front 431

What are the 4 states in the four-stage model for sexual response developed by Masters and Johnson?

Back 431

Excitement (min-hours)
Plateau (30-180 seconds)
Orgasm (3-15 seconds)
Resolution (10-15 minutes)

Front 432

What are the characteristics of Masters and Johnson's four-stages of sexual response that are exclusive to men?

Back 432

Excitement: Penile erection
Plateau: Increased size and upward movement of testes, Secretion of a few drops of sperm-containing fluid
Orgasm: Forcible expulsion of seminal fluid
Resolution: Refractory, or resting, period (length varies by age and physical condition) when restimulation is not possible

Front 433

What are the characteristics of the four-stages of sexual response that are exclusive to women?

Back 433

Excitement: Clitoral erection, Labial swelling, Vaginal lubrication, Tenting effect (rising of uterus in the pelvic cavity)
Plateau: Contraction of the outer one-third of the vaina, forming the orgasmic platform (enlargement of the upper one third of the vagina)
Orgasm: Contractions of the uterus and vagina
Resolution: Little or no refractory period

Front 434

What are the characteristics of the four-stages of sexual response in both men and women?

Back 434

Excitement: Increased BP and respiration
Plateau: Further increase in BP and respiration, Flushing of the chest and face ("sex flush")
Orgasm: Contractions of the anal sphincter, Further increase in BP and respiration
Resolution: Muscle relaxation, Return of the sexual and cardiovascular systems to the prestimulated state over 10-15 minutes

Front 435

What findings in a male complaining of erectile dysfunction would tend to point to psychological rather than physiological causes?

Back 435

Presence of morning erections
Erections during REM sleep

Front 436

What are the characteristics of hypoactive sexual desire disorder?

Back 436

Decreased interest in sexual activity

Front 437

What are the characteristics of hypoactive sexual aversion disorder?

Back 437

Aversion to and avoidance of sexual activity

Front 438

What are the characteristics of hypoactive female sexual arousal disorder?

Back 438

Inability to maintain vaginal lubrication until the sex act is completed, despite adequate physical stimulation (reported in as many as 20% of women)

Front 439

What are the different types of and characteristics of hypoactive male erectile disorder (impotence)?

Back 439

Lifelong/primary: RARE, Has never had an erection sufficient for penetration
Acquired/Secondary: MOST COMMON males sexual disorder, Currently unable to maintain erections despite normal erections in the past
Situational: COMMON, Has difficulty maintaining erections in some sexual situations but not others

Front 440

What are the different types of and characteristics of orgasmic disorder?

Back 440

A disorder of male OR female (more common)

Lifelong/Primary: Has never had an orgasm
Acquired: Currently unable to achieve orgasm despite adequate genital stimulation and normal orgasms in the past

Front 441

What are the characteristics of premature ejaculation?

Back 441

Ejaculation before the MAN would like it to occur
Plateau phase of the sexual cycle is short or absent
Is usually accompanied by anxiety
Is the second most common male sexual disorder

Front 442

What are the characteristics of vaginismus?

Back 442

Painful spasms occur in the outer one-third of the vagina, which makes intercourse or pelvic examination difficult

Front 443

What are the characteristics of dyspareunia?

Back 443

Persistent pain occurs in association with sexual intercourse without pelvic pathology (functional dyspareunia)
Can also be caused by pelvic pathology e.g. pelvic inflammatory disease (PID) due to chlamydiosis (most common) or gonorrhea (most serious)
Occurs much more commonly in women; can occur in men
The disturbance is not caused by lack of lubrication or by vaginismus

Front 444

What are sensate-focus exercises and what are they used for?

Back 444

They are used to treat sexual desire, arousal, and orgasmic disorders

In these exercises the individual's awareness of touch, sight, smell, and sound stimuli are increased during sexual activity, and psychological pressure to achieve an erection or orgasm is decreased

Front 445

What is the squeeze technique and what is it used for?

Back 445

It is used to treat premature ejaculation

Man is taught to identify the sensation that occurs just before emission of semen and at this moment, the man asks his partner to exert pressure on the coronal ridge of the glans on both sides of the penis until the erection subsides, thereby delaying ejaculation

Front 446

What drugs are used to treat premature ejaculation?
What are some treatments for erectile dysfunction?

Back 446

Premature ejaculation: SSRI's because they delay orgasm

Erectile dysfunction: Oral or intracorporeal injection of vasodilators, Implantation of prosthetic devices

Front 447

What is the DSM-IV definition of paraphilias?
In what sex are they most common?
What are some pharmacologic treatments?

Back 447

Paraphilias involve the preferential use of unusual objects of sexual desire or engagement in unusual sexual activity. To fit DSM-IV criteria the behavior must continue over a period of at least 6 months, and cause impairment in occupational or social functioning.

Almost exclusively men

Pharmcalogic treatment: Antiandrogens and female sex hormones for paraphilias that are characterized by hypersexuality

Front 448

How do exhibitionists derive sexual pleasure?

Back 448

Revealing one's genitals to unsuspecting women so that they will be shocked

Front 449

How do individuals with fetishism derive sexual pleasure?

Back 449

Using inanimate objects

Front 450

How do individuals with transvestic fetishism derive sexual pleasure?

Back 450

Wearing women's clothing, particularly underclothing (exclusive to HETEROSEXUAL men)

Front 451

How do individuals with frotteurism derive sexual pleasure?

Back 451

Rubbing the penis against clothed woman who is not consenting and not aware (e.g. crowded subway)

Front 452

How do individuals with necrophilia derive sexual pleasure?

Back 452

Engaging in sexual activity with dead bodies

Front 453

How do individuals with pedophelia derive sexual pleasure?

Back 453

Engaging in fantasies or actual behaviors with children under age 14 years, of the opposite or same sex

THE MOST COMMON PARAPHILIA

Front 454

How do individuals with sexual sadism or masochism derive sexual pleasure?

Back 454

Giving (sadism) or receiving (masochism) physical pain or humiliation

Front 455

How do individuals with telephone scatologia derive sexual pleasure?

Back 455

Making telephone calls to unsuspecting women and engaging them in conversation of a sexual nature (obscene phone calls)

Front 456

How do individuals with voyeurism derive sexual pleasure?

Back 456

Secretly watching other people (often by using binoculars) undressing or engaging in sexual activity

Front 457

What guideline is generally used to see if an individual is healthy enough for sexual activity following an myocardial infarction?

Back 457

If exercise that raises the heart rate to 110-130 beats/minute (e.g. exertion equal to climbing two flights of stairs) can be tolerated without severe shortness of breath or chest pain

Sexual positions that produce the least exertion in the patient (e.g. the PARTNER in the superior position) are the safest after MI

Front 458

What is the major cause of erectile dysfunction in diabetics?

Back 458

1/4 to 1/3 of all diabetic men (more commonly older patients) have erectile dysfunction while orgasm and ejaculation are less likely to be affected

Main causes are vascular changes and diabetic neuropathy

Front 459

How do spinal cord injuries affect male sexual function and reproduction?
Female?

Back 459

Male: Cause erectile dysfunction, Orgasmic dysfunction, Retrograde ejaculation (into bladder), Reduced testosterone levels, Decreased fertility

Female: Problems of vaginal lubrication, pelvic vasoconstriction, and orgasm. Fertility is NOT usually adversely affected

Front 460

What are the physical alterations that occur in sexual function in males with age?
Females?

Back 460

Males: Slower erection, Diminished intensity of ejaculation, Longer refractory period, Need for more direct stimulation

Women: Vaginal thinning, Shortening of vaginal length, Vaginal dryness

Front 461

How does sexual interest change with age?

Back 461

Does NOT usually change significantly with increasing age

Front 462

What type of intercourse is the riskiest in the transmission of HIV?
What is the physician's role in informing the partner of a HIV positive patient?

Back 462

Anal intercourse because of the likelihood of tissue tearing leading to contact with the blood supply

Patients how are HIV-positive MUST protect their sexual partners from infection. If they fail to do so (e.g. do not use a condom) and the physician has knowledge of such a failure, the physician MUST ensure that the threatened partner is informed

Front 463

Of the following drugs ; alcohol, cocaine, amphetamines, and PCP. Which are associated with increased aggressiveness.

Back 463

Alcohol in LOW doses inhibits aggression but facilitates it in HIGH doses

Cocaine, amphetamines and PCP all increase aggression

Heroin user show LITTLE aggression

Front 464

Which neurotransmitters are associated with increased & decreased aggression?

Back 464

Serotonin and GABA inhibit aggression

Dopamine and norepinephrine fascilitate it

Front 465

Low levels of what neurotransmitter is associated with impulsive aggression?

Back 465

Serotonin

Front 466

What is the usual age of sexual abuse?

Back 466

1/3 are between 8-13yo and 25% are younger than 8yo

Front 467

What percentage of sexual abusers are known to the child?
Percent men?
Percent relatives?

Back 467

Known to child: 70-90% (50% of these are relatives while the other 50% are family acquaintances)
Men: 90%

Front 468

What are the 3 phases of physical and sexual abuse of domestic partners?

Back 468

(1) Buildup of tension in the abuser
(2) Abusive behavior (battering)
(3) Apologetic and loving behavior by the abuser to the victim

Front 469

What is the responsibility of the physician when child or elder abuse is suspected?
What responsibilities if any does the physician have to the abuser?

Back 469

Abuse MUST be reported to the appropriate agency BEFORE or in conjunction with treatment of patient. Even if there was NO intention to injury a cultural remedy such as "coining" ALSO MUST be reported

Physician does NOT have to tell the suspected abuser of the child or impaired elder that he or she suspects abuse
Physician does NOT need family consent to hospitalize the abused child or elderly person for protection or treatmetn

Front 470

What is the responsibility of the physician when domestic partner abuse is suspected?

Back 470

Direct reporting by the physician is NOT appropriate because the victim is usually a competent adult. The physician who suspects abuse should:
(1) Document the abuse
(2) Ensure the safety of the abused person
(3) Develop an emergency escape plan for the abused
(4) Provide emotional support
(5) Refer the abused person to an appropriate shelter or program
(6) Encourage the abused person to report the case to law-enforcement officials

Front 471

What is the definition of sodomy?

Back 471

Insertion of penis into the oral or anal orifice

Front 472

What are the usualy characteristics of rapists (age, race with respect to victim)?
Rape victims (age, where rape occurred, presence of vaginal injures)?

Back 472

Rapists: <25yo, Same race as victim, Known to victim, Often use alcohol
Victim: 16-24yo, Most commonly occurs in victim's home

Front 473

What should the physical setting for a medical interview be?

Back 473

As private as possible
Ideally, there should be no desk or other obstacle between the physician and patient
Participants should interact at eye level (both should be seated)

Front 474

What is the Social Readjustment Rating Scale created by Homes and Rahe?

Back 474

This scale ranks the effects of life events

Events with the highest scores require people to make the most social readjustment in their lives

Front 475

What types of thoughts or actions in patients prior to entering surgery predispose them to the greatest psychological and medical risk?

Back 475

Patients that believe that they won't survive surgery
Patients who do not admit that they are worried before surgery

Front 476

What is the time period that defines chronic pain?

Back 476

Pain lasting at least 6 months

Front 477

What is the APGAR score?

Back 477

General notes: Measures physical functioning in premature and full-term newborns and can be sued to predict the likelihood of IMMEDIATE survival. It is evaluated at 1 minute and either 5 or 10 minutes after birth. A score >7 indicates no imminent survival threat while one <4 indicates an imminent survival threat.

A ppearance [Color]: 0 (Both body and extremities pale or blue), 1 (Pink body, blue extremities) 2 (Pink body, Pink extremities)

P ulse [Heartbeat]: 0 (Absent) 1 (Slow [<100/min]) 2 (Rapid [>100/min])

G rimace [Reflexes e.g. heel prick / nasal tickle]: 0 (Absent) 1 (Grimace) 2 (Foot withdrawal, Cry, Sneeze, Cough)

A ctivity [Muscle tone]: 0 (Flaccid, Limp) 1 (Weak, Inactive) 2 (Strong, Active)

R espiration: 0 (Absent) 1 (Irregular, Slow) 2 (Good, Crying)

Front 478

What is the definition of "latent learning" in learning behavior?

Back 478

Occurs without immediate reinforcement, and what is learned is not exhibited until some time later when reinforcement is available.

Front 479

What is the definition of "discrimination training" in learning behavior?

Back 479

Involves the use of reinforcement and extinction to establish behavioral contingencies and obtain precise stimulus control.

Front 480

What is the definition of "spontaneous recovery" in learning behavior?

Back 480

The reappearance of a conditioned response after extinction.

Front 481

What is the definition of "stimulus discrimination" in learning behavior?

Back 481

Responding to one stimulus but not to a stimulus which is similar.

Front 482

What are Freud's stages of childhood development?

Back 482

(1) Oral (birth-1yo): Id satisfied through mouth
(2) Anal (1-2yo): Id satisfied through anus
(3) Phallic (3-5yo): When a boy typically resolves to overcome Oedipal feelings of incestuous love for his mother by incorporating his perceptions of his father's traits. In doing so, he obviates the need to fear his father's wrath, Castration anxiety, Electra complex, Penis envy
(4) Latency (6-11yo): Child becomes more involved w/ outside world, gaining social and technical skills and, upon adolescence, experiencing new stirrings of his or her own sexuality
(5) Genital (adolescence-adulthood): Makes up the final 2 stages of personality development along with the latency stage

Front 483

Describe how the stability of personality in each of the following periods?
(1) Infancy
(2) Adolescence
(3) Young adulthood
(4) Middle adulthood
(5) Later adulthood

Back 483

(1) Infancy: Temperament at about 3mo is a good predictor of temperament at about age 10
(2) Adolescence: Personality traits tend to remain stable during this period but outward behavior associated with these traits tend to become more socially acceptable
(3) Young adulthood: Least amount of personality stability
(4) Middle adulthood: Where stability of personality highest
(5) Later adulthood: As activity declines with age there is a tendency to become more accepting of the way things are and to challenge and risk less often than they did previously

Front 484

What is the Bender Visual Motor Gestalt Test?

Back 484

An expressive technique designed to detect brain damage by observing visual motor coordination and behavioral tests as the patient copies test designs.

Front 485

What is the Omnibus Personality Inventory?

Back 485

It was designed to assess effective functioning in college students by measuring values, interest, attitudes, and social and emotional adjustment.

Front 486

What is astereognosia?

Back 486

Inability to recognize objects by touch.

Front 487

What is asomatognosia?

Back 487

Inability to recognize bodily states.

Front 488

What is spatial agnosia?

Back 488

Deficit in stereoscopic vision and ability to relate objects in space.

Front 489

What is autotopagnosia?

Back 489

Inability to name or localize body parts.

Front 490

What is prosopagnosia?

Back 490

Inability to recognize faces.

Front 491

What are the stages of sleep and what is seen in an electroencephalogram in each phase?

Back 491

Normal Sleep Cycle: 90minutes w/ 20-25% in REM during adulthood
(1) non-REM 1: Characterized by vertex sharp waves in the beginning, the disappearance of occipital α-waves, the appearance of θ-waves, and slow rolling eye movements. Characterized by 3-7 cycles/second. It is the lightest stage of sleep characterized by peacefulness, slowed pulse and respiration, decreased BP, & episodic body movements.
(2) non-REM 2: 12-14 cycles/second, Slower θ-waves, K-complexes [high-amplitude, slow tri-phasic waves that are smaller than 4 cycles/second]
(3) non-REM 3: Increasing appearance of δ-waves [high amplitude, slow waves, smaller than 4 cycles/second]
(4) non-REM 4: characterized by 50% of waves being δ-waves
(5) REM: Rapid eye movement, Intermittent saw-toothed waves [4-7 cycles/second], Occipital α-waves, Ocular & middle ear muscles active while rest are paralyzed, Low responsiveness to external stimuli

Front 492

How do benzodiazepines affect sleep stages & in what sleep disorders are these changes useful?

Back 492

Benzodiazepines shorten non-REM 4 (delta sleep).

This is the period during which night terrors, sleepwalking, & bed wetting occur and thus are useful in the treatment of these conditions.

Front 493

What are the characteristics of expressive language disorder?

Back 493

Associated with childhood onset & typically involves limitations in the linguistic features of language.

Front 494

What is troilism?

Back 494

Engaging in sexual interaction with another person in the presence of a third person.

Front 495

What are the DSM-IV diagnostic criteria for nicotine withdrawal?

Back 495

Dysphoric mood, Insomnia, Irritation, Frustration, Anger, Difficulty concentrating, Restlessness, Increased appetite, Weight gain, & Decreased heart rate

Front 496

What is the difference between gender role & identity?

Back 496

Identity --> Inward perception of "maleness" or "femaleness"

Role --> Outward perception of "maleness" or "femaleness"

Front 497

What are the six categories of sexual dysfunction?

Back 497

(1) Sexual desire disorders
(2) Sexual arousal disorders
(3) Orgasm disorders
(4) Sexual pain disorder
(5) Sexual dysfunction "not otherwise specified"
(6) "Other" sexual disorders

Front 498

What is Peyronie's disease?

Back 498

Connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting as many as 1-4% of men. Specifically the fibrosing process occurs in the tunica albuginea, a fibrous envelope surrounding the penile corpora cavernosa causing an abnormal upward curvature of the penis.

The disease may cause pain, hardened, cord-like lesions (scar tissue known as "plaques"), or abnormal curvature of the penis when erect. In addition, narrowing and or shortening of the penis may occur. Pain felt in the early stages of the disease often resolves in twelve to eighteen months. Erectile dysfunction, in varying degrees, often accompanies these symptoms in the later stages of the disease process. The condition may also make sexual intercourse painful and/or difficult, though many men report satisfactory intercourse in spite of the disease. Although it can affect men of any race and age, it is most commonly seen in caucasian males above the age of 40.

Front 499

What is sexual (orgasmic) anhedonia?

Back 499

Sexual anhedonia is known as 'ejaculatory anhedonia'. This rare condition means that the person will ejaculate with no accompanying sense of pleasure. This condition is most frequently found in males, but women can suffer from lack of pleasure when the body goes through the orgasm process as well.

Front 500

What is the definition of anhedonia?
What conditions is this common in?

Back 500

Anhedonia is an inability to experience pleasure from normally pleasurable life events such as eating, exercise, and social or sexual interaction.

Anhedonia is recognized as one of the key symptoms of the mood disorder depression according to both the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) and the International Statistical Classification of Diseases and Related Health Problems (ICD). Other than anhedonia, the DSM considers only depressed mood to be a key symptom.[citation needed] The ICD lists both depressed mood and fatigue or loss of energy as the other key symptoms. Anhedonia is also seen in schizophrenia, schizoid personality disorder and other mental disorders.

Front 501

What is the definition of perseveration?

Back 501

Perseveration is the uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder.

Front 502

What are the 4 situations in which information about a patient can be disclosed without consent?

Back 502

(1) Child or elder abuse
(2) Gunshot or stabbing
(3) Reportable communicable disease
(4) Threatens to kill or harm themselves or others with reasonable ability to do so

Front 503

Describe the following interviewing technique:
Empathy

Back 503

It requires the patient to try and put themselves in the patient's shoes and vicariously experience their feelings, thoughts, and actions. It differs from support in that it requires the physician to project him/herself into the patient's experience.

Example: "I can imagine ..."

Front 504

Describe the following interviewing technique:
Reflection

Back 504

When the patient repeats what the patient told him/her for example by summarizing

Example: "So you are telling me that ..."

Front 505

Describe the following interviewing technique:
Confrontation

Back 505

When a physician points out discrepancies in a patient's responses.

Front 506

Describe the following interviewing technique:
Support

Back 506

When a physician expresses concern and interest in the patient. This differs from empathy in that physician does not attempt to project him or herself into the patients experience.

Front 507

Describe the following interviewing technique:
Facilitation

Back 507

When a physician encourages a patient to talk more about an experience.

Example: "Then what happened?"

Front 508

What is the female athlete triad?

Back 508

(1) Eating disorder
(2) Amenorrhea
(2) Osteoporosis

Front 509

What is a hypnagogic hallucination?

Back 509

A hallucination that occurs when falling asleep

Most often brief & simple such as hearing a bell ring or name called but can be complex.

Front 510

What is a hypnopompic hallucination?

Back 510

A hallucination that occurs on waking

Most often brief & simple such as hearing a bell ring or name called but can be complex.

Front 511

What are the common psychiatric co-morbidities of OCD?

Back 511

Tic disorders

Front 512

What are the common psychiatric co-morbidities of eating disorders?

Back 512

Body dysmorphic disorder

Front 513

What are the common psychiatric co-morbidities of panic disorder?

Back 513

Depression, Simple phobias, PTSD

Front 514

Obsessive compulsive disorder is associated with increased activity in which part of the brain?

Back 514

Caudate nucleus

Front 515

What is the tonic neck reflex and at what age does it disappear?

Back 515

Extension of the ipsilateral leg and flexion of the of the contralateral leg when the head is turned.

It is a reflex in competent infants that disappears between 7 & 8 months.

Front 516

What is deja vu?
What is it commonly associated with?

Back 516

When the experience of an event, person, or thing is seen as familiar, even though it has never previously been experienced before.

It is commonly associated with the aura preceding complex partial siezures [especially in temporal lobe epilepsy]

Front 517

What is jamais vu?

Back 517

When a patient fails to recognize familiar events that have been encountered before.

Front 518

What is the Halstead-Reitan Battery of tests?

Back 518

A group of tests that reflect the basic & higher level neuro-sensory functioning of the entire brain, & can be used in a serial fashion with little learning effect being present.

Front 519

What is the Stanford Binet Intelligence test used for?

Back 519

Used in adults and mainly reflects verbal skills.

Front 520

What is the only defense mechanism that includes some aspect of the consciousness?

Back 520

Suppression

Front 521

What is the defense mechanism on which all other defense mechanisms are based?

Back 521

Repression

Front 522

What are the "stages of change" in a patient's motivation to change his or her health risk behaviors (e.g. smoking)?

Back 522

Precontemplation (denial, minimization)
Contemplation (musing or thinking about doing something)
Preparation (actually getting ready to do something)
Action (implementing concrete actions to deal with the problem)
Maintenance (acting to ensure that the changes are maintained)