Lange - Chapter 3: Adult Psychopathology

Front 1

What is the downward drift hypothesis?

Back 1

Chronic mental illness's tendency to cause its sufferers to move downward through social strata. Socioeconomic cost of schizophrenia is the result of drift, NOT its cause.

Front 2

Bleuler's classical model of schizophrenia:

Back 2

Four A's:
1. association
2. affect
3. autism
4. ambivalence

Front 3

Levels of the following in depression changes:
1. cortisol
2. catecholamines
3. sex hormones
4. immune function

Back 3

1. cortisol is increased
2. catecholamines is decreased
3. sex hormones are decreased
4. immune function is decreased

Front 4

What is the % risk mood disorders in 1st degree relatives of bipolar patients

Back 4

25%

Front 5

Abdominal pains + psychiatric Sxs (= manic or psychotic appearing) should cause concern for:

Back 5

porphyria

Front 6

Type of hallucinations seen in delirium:

Back 6

- any type
- visual

Front 7

TYpe of hallucinations seen in schizophrenia-spectrum illness, including brief psychotic disorder:

Back 7

- auditory hallucinations

Front 8

Kluver-Bucy syndrome:

Back 8

Presents with:
- docility
- lack of fear response
- anterograde amnesia
- hyperphagia
- hypersexuality

Front 9

Pick's disease:

Back 9

- form of dementia
- frontotermporal lobes are atrophied

Front 10

Arnold-Chiari syndrome:

Back 10

- hydrocephalus
- cerebellar anatomic & functional abnL-ties

Front 11

Punchdrunk syndrome:

Back 11

- acquired movement disorder
- associated with traumatic damage to the substantia nigra

Front 12

Mobius syndrome:

Back 12

- congenital absence of the facial nerves and nuclei with resulting B/L facial paralysis

Front 13

amygdala damage results in:

Back 13

Kluver-Bucy syndrome

Front 14

hippocampus associated with:

Back 14

- short-term memory

Front 15

superior temporal gyri is associated with:

Back 15

- processing complex auditory information
- eg. understanding of language

Front 16

Missing 3 consecutive periods:

Back 16

- anorexia nervosa

Front 17

Levels of biological hormones in anorexia:

Back 17

- increased BUN
- increased serum growth hormone
- no change in TSH responsiveness to TRH
- anemia

Front 18

In major depression, what % of pts do NOT have blunted cortisol levels to a dexamethasone suppression test?

Back 18

50%

Front 19

In MDD, what % of patients do NOT show an increase of TSH with administration of TRH?

Back 19

30%

Front 20

What amt of methadone is needed in most addicts to experience a sufficient decrease of their cravings?

Back 20

> 60 mg/day

Front 21

What lab findings are elevated in alcoholics?

Back 21

- GGT
- AST/ALT ratio
- uric acid levels
- serum TGs
- also can have macrocytic anemia

Front 22

What is the best treatment for borderline personality disorder?

Back 22

- psychotherapy
- antidepressants, neuroleptics, and moo stabilizers have been shown to have some efficacy in treating TARGET Sxs

Front 23

What is first-line pharmacotherapy for OCD?

Back 23

- fluvoxamine and other SSRIs (paroxetine, fluoxetine, sertraline)

Front 24

What % pts with depression respond to placebo effect?

Back 24

~30%

Front 25

What % of pts with depression respond to SSRI and TCAs?

Back 25

~65-75%

Front 26

Best studied psychotherapy for panic disorder?

Back 26

CBT

Front 27

1st line Rx for panic disorder with or without agoraphobia?

Back 27

SSRIs

Front 28

Best studied psychotherapy for MDD?

Back 28

interpersonal therapy - addresses relationships as a contributor of depression

Front 29

What is the purpose of supportive psychotherapy?

Back 29

- to strengthen a patient's defense mechanisms in order to return them to a previous level of functioning

Front 30

Specific therapy for PTSD?

Back 30

EMDR: eye movement desensitization and reprocessing

Front 31

Risk of completed suicide in MDD?

Back 31

10-15%

Front 32

Rx for narcolepsy?

Back 32

methylphenidate
[Ritalin]

Front 33

Mean age of onset of Bipolar disorder:

Back 33

30
Range: childhood - 50 yrs

Front 34

Left middle cerebral artery stroke associated with:

Back 34

depression

Front 35

Right middle cerebral artery stroke associated with:

Back 35

euphoria, inappropriate indifference, or mania

Front 36

Diffuse B/L frontal injury associated with:

Back 36

obsessive-compulsive behaviors

Front 37

What % of impotence in the age group btwn 30-50 y.o. have a psychological etiology?

Back 37

90%

After 50 y.o., the etiology becomes increasingly medically related.

Front 38

What NT is shown to be lower in the CSF in patients with impulsivity, violence, or aggression?

Back 38

serotonin metabolite
(5-hydroxyindole acetic acid)
5-HIAA

Front 39

% of children who suffer from schizophrenia if:
- 1 parent has schizophrenia
- both parents have schizophrenia

Back 39

1 parent = children 12%
both parents = children 40%

Front 40

Of all identical twin siblings with schizophrenia, about how many of their twins also have schizophrenia?

Back 40

50%

Front 41

OCD causes increased activity in what part of the brain?

Back 41

- caudate nucleus
- frontal lobes
- cingulum
*these changes are reversed after adequate pharmacologic or behavioral therapy

Front 42

anomia:

Back 42

- inability to name objects outside of aphasia

Front 43

alexia

Back 43

- inability to read

Front 44

apraxia

Back 44

- inability to perform previously learned motor skills

Front 45

paralinguistic components of speech

Back 45

- refers to nonverbal communications such as facial expression and body movements

Front 46

prosopagnosia

Back 46

- inability to recognize faces despite perception of all the components

Front 47

neurovegetative signs

Back 47

- physiologic aspects of depression
- eg. changes in sleep, bowel habits, weight

Front 48

sexual sadism

Back 48

- derivation of sexual pleasure from CAUSING mental or physical pain

Front 49

sexual masochism

Back 49

- derivation of sexual pleasure from RECEIVING mental or physical pain

Front 50

Koro

Back 50

- South and East Asians
- worry that the penis is shrinking into the abdomen

Front 51

Zar

Back 51

- delusional possession by a spirit

Front 52

Taijin Kyofusho

Back 52

- belief that one's body is offensive to others

Front 53

Schizophrenic changes in the brain include:

Back 53

- decreased hippocampus, parahippocampal gyrus and amygdala

Front 54

ideas of reference

Back 54

- the delusion that others are focusing on you in some positive or negative way
- commonly seen in paranoid schizophrenia

Front 55

loss of ego boundaries is commonly manifested as:

Back 55

- inappropriate conversational distance

Front 56

prodromal schizophrenia:

Back 56

- increasing negative Sxs in the absence of positive Sxs

Front 57

Sxs associated with schizophrenia NOT included in Dx-tic criteria:

Back 57

- short-term memory deficits
- unstable smooth-pursuit eye movements
- decreased ability to habituate to repeated sensory stimuli (sensory gating abnL-ties)

Front 58

Factors that increase risk for completed suicide:

Back 58

- white race
- male gender
- older age
- single/divorced
- Protestant or Jewish religion

Front 59

localized amnesia

Back 59

- memory loss surrounding a discrete period of time
- typically occurs after a traumatic event

Front 60

continuous amnesia

Back 60

- memory loss of all events following a trauma, except for the immediate past

Front 61

Abnormal sleep patterns in depression include:

Back 61

- increased sleep latency (difficulty falling asleep)
- early morning awakening
- increased wakefulness
- REM sleep redistributed so most of it occurs in first half of the night
- REM latency (period of time btwn falling asleep and starting REM sleep) decreases

Front 62

Narcolepsy tetrad:

Back 62

- hypersomnia
- cataplexy (transient loss of motor tone associated with strong emotions)
- sleep paralysis
- hypnagogic hallucinations (occurs in wake to sleep transition)

Front 63

catalepsy

Back 63

- state of immobility sometimes seen in catatonic states

Front 64

Doppelganger

Back 64

- belief in the existence of an identical counterpart

Front 65

Cacodemonomania

Back 65

- delusion of being poisoned by an evil spirit

Front 66

Fregoli syndrome

Back 66

- delusion that a person is taking the form of a number of people or creatures

Front 67

haptic hallucination:

Back 67

- a tactile hallucination in which one feels as if he is being touched, for example, by a phantom

Front 68

synesthesia

Back 68

- secondary sensation following an actual perception
- eg. the sensation of a color associated with taste
- usually 2/2 neurologic dz or hallucinogen use (most notably LSD/acid)

Front 69

derealization

Back 69

- sense that one's surroundings are strange or unreal

Front 70

depersonalization

Back 70

- the feeling that one's identity is lost or the feeling of being unreal or strange

Front 71

dereism

Back 71

- simple mental activity not in accordance with reality

Front 72

anterograde amnesia

Back 72

- loss of immediate or short-term memory
- pts are unable to form NEW memories

Front 73

retrograde amnesia

Back 73

- loss of remote or previously formed memories

Front 74

astereognosis

Back 74

- inability to recognize an object by touch despite the tactile sensations being intact

Front 75

logorrhea

Back 75

- uncontrollable or excessive talking
- sometimes seen in mania

Front 76

derailment

Back 76

- refers to abrupt interruption of an idea and then resuming after a period of time (a few seconds) to a new topic
- usually WITHOUT the patient being aware of the switch

Front 77

illusion

Back 77

- misperception of an actual stimulus

Front 78

hallucination

Back 78

- perception in the absence of a stimulus

Front 79

micropsia

Back 79

- misperception of objects being smaller than they really are

Front 80

macropsia

Back 80

- misperception of objects being larger than they really are

Front 81

palinopsia

Back 81

- persistence of the visual image after the stimulus has been removed

Front 82

serotonin is produced in:

Back 82

- raphe nucleus of brain stem
(dorsal and medial)

Front 83

dopamine is produced in:

Back 83

- substantia nigra

Front 84

NE is produced in:

Back 84

- locus ceruleus

Front 85

locus ceruleus is the:

Back 85

- "alarm" center of the brain
- hyperactive in anxiety states
- center of most of the NE-containing neurons in the brain

Front 86

hippocampus

Back 86

- part of limbic system
- memory

Front 87

amygdala

Back 87

- emotional coding

Front 88

mammillary bodies

Back 88

- smells that contribute to a memory

Front 89

thalamus

Back 89

- the brain's relay center

Front 90

basal ganglia

Back 90

- coordinates motor activity

Front 91

normal pressure hydrocephalus triad includes:

CT changes include:

Back 91

1. confusion
2. gait ataxia
3. incontinence

CT changes:
- dilated ventricles

Front 92

frontal sulcal widening is found in:

Back 92

- dementias that have underlying cerebral atrophy

Front 93

hypointensities found in sub-cortical areas are often indicative of:

Back 93

- lacunar strokes

Front 94

cerebellar atrophy is seen most often in:

Back 94

- congenital disorders
- alcoholism

Front 95

MAOIs should not be used in conjunction with:

Back 95

- SSRIs
- TCAs
- buspirone [BuSpar]
- velafaxine [Effexor]

Front 96

The psychiatric disorder that carries the greatest risk for suicide in both men and women:

Back 96

#1 is mood disorder

THEN:
- alcohol dependency
- schizophrenic

Front 97

Most predictive factor of suicide risk:

Back 97

#1 is age 45 or greater

THEN:
2. alcohol dependence
3. rage or violence
4. prior suicidal behavior
5. male gender

Front 98

Common iatrogenic cause of reversible psychiatric Sxs such as depression and psychosis:

Back 98

- glucocorticoids

Front 99

Hamilton

Back 99

- Depression Scale
- measure of depressive Sxs

Front 100

Rorschach Test

Back 100

- projective test using inkblots

Measures:
- perceptual accuracy
- reality testing
- integration of affective and intellectual functioning

Front 101

dementia praecox

Back 101

- early term for schizophrenia
- coined by Kraeplin

Front 102

dyscalculia:

Back 102

- difficulty with simple arithmetic

Front 103

verbigeration

Back 103

- repetitive and meaningless talking

Front 104

dysarthria

Back 104

- difficulty with articulation

Front 105

glossolalia

Back 105

- ability to speak a new language suddenly

Front 106

flight of ideas

Back 106

- represents a change of direction every sentence or two with identifiable connections or associations tying them together
- often Sx of manic behavior and reflects underlying racing thoughts

Front 107

loosening of associations

Back 107

- lack of logical connections between ideas, but sentence structure remains intact

Front 108

tangential thought

Back 108

- never comes to the point, but remains logically connected and can be folloed

Front 109

circumstantial thought

Back 109

- finally reaches a point after much unnecessary detail and digressions
- can be seen in disorders such as OCD, but can also be seen in normal people