Term
Operant conditions involves learning where actions are elicited because they produce rewards. WHat kinds of feedback are described by each of the following?
1) Removal of aversive stimulus elicits behavior (avoid shock by pressing button)
2) Application of aversive stimulus extinguishes unwanted behavior
3) Desired reward produces action
4) Discontinuation of reinforcement eliminates behavior |
|
Definition
1) Negative reinforcement
2) Punishment
3) Positive reinforcement
4) Extinction |
|
|
Term
| How does classical conditioning differ from operant conditioning? |
|
Definition
1) Classical (Pavlovian): Natural response (Salivation) is elicited by conditioned (learned) stimulus (Bell) that previously was presented in conjunction with an unconditioned stimulus (food)
2) Operant: Actions based on rewards (positive, negative, aversive and/or punishment). |
|
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Term
| What is the difference between transferance and counter-transferance? |
|
Definition
1) Transferance: patient projects feeling about formative or other important personas onto physicians (psychiatrist= parent)
2) Doctor projects feels about formative or other persons onto patient |
|
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Term
A number of ego defenses are used to resolve conflict and prevent undesirable feelings. For each of the following, note whether the response is "mature" or "immature" and name it.
1) Tantrums
2) Abused child identifies himself/herself as an abuser
3) A patient with libidinous thoughts enters a monastery
4) Mafia boss makes large donations to charity
5) Mother blames child because she is angry at father. |
|
Definition
1) Acting out (immature)
2) Identification (immature)- modeling behavior after someone with power (need not be admired)
3) Reaction formation (immature)
4) Altruism (mature)
5) DIsplacement (immature) |
|
|
Term
A number of ego defenses are used to resolve conflict and prevent undesirable feelings. For each of the following, note whether the response is "mature" or "immature" and name it.
1) Temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress (can result in dissociative identity disorder)
2) Men fixating on sports games
3) Nervous medical student jokes about the boards
4) Patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly
5) Choosing not to think about the USMLE until the week of the exam
6) Man who wants another woman thinks his wife is cheating |
|
Definition
1) Dissociation (immature)
2) Fixation (immature)
3) Humor (mature)
4) Splitting (immature)
5) Suppression (mature)
6) Projection (immature) |
|
|
Term
A number of ego defenses are used to resolve conflict and prevent undesirable feelings. For each of the following, note whether the response is "mature" or "immature" and name it.
1) Avoidance of awareness of some painful reality
2) Describing murder in graphic detail with no emotional response
3) Teenager' aggression toward his father is redirected to perform well in sports
4) After getting fired, claiming that the job was not important anyway
5) Not remembering a conflictual or traumatic experience; pressing bad thoughts into unconscious.
6) Turning back the maturational clock and going back to early methods of dealign with problems |
|
Definition
1) Denial (immature)
2) Isolation of affect (immature)
3) Sublimation (mature)
4) Rationalization (immature)
5) Repression (Immature)
6) Regression (immature) |
|
|
Term
| A number of ego defenses are used to resolve conflict and prevent undesirable feelings. What are the "mature" responses? |
|
Definition
Mature women wear a SASH
1) Sublimation
- putting negative things into something positive
2) Altruism
- Feelings of guilt used to do something good
3) Suppression
- choosing to think about something later (voluntary)
4) Humor
- Appreciate amusing nature of anxiety-provoking or adverse situation |
|
|
Term
| What is the difference between Suppression and Repression? |
|
Definition
1) Suppression is VOLUNTARY withholding of an idea or feeling from conscious awareness (mature)
2) Repression is INVOLUNTARY witholding (immature) |
|
|
Term
| How does Transferance differ from Projection? How are they different from displacement? |
|
Definition
1) Transferance involves projecting feeling about formative or other important persons onto physician
2) Projection involves attributing an unacceptable internal impulse to an external source (A man who wants another woman thinks his wife is cheating)
3) Displacement involves transferring unwanted feelings to neutral person (Mom is mad at Kid when she is really mad at dad) |
|
|
Term
| How is dissociation different from isolation of affect? |
|
Definition
Both are immature
1) Dissociation involves temporary, drastic changes in personality, memory, consciousness or motor function to avoid emotional stress
2) Isolation of affect involves separating feelings from ideas and events |
|
|
Term
| Which ego defense, when in extreme forms, can leads to multiple personality disorder? |
|
Definition
| Dissociation leading to dissociative identity disorder (switching so rapidly leads to production of multiple identities) |
|
|
Term
Which of the following is NOT an effect of long-term deprivation of affection for infants?
1) Low muscle tone
2) Poor language
3) Poor socialization
4) Over-trust
5) Anaclitic depression |
|
Definition
4- Lack of trust would be characteristic
The 4 W's: Weak, Wordless, Wanting (socially), Wary
Irreversible changes after 6 months and severe deprivation can result in infant death. |
|
|
Term
| What is the most important sign of physical abuse? Who is usually the abuser and how common is it? |
|
Definition
1) Healed fractures on x-ray, cigarette burns, subdural hematomas, multiple bruises, retinal hemorrhage or detached.
2) Female and primary care giver
3) 3000 deaths/year in US |
|
|
Term
| How does the typical abuser for physical abuse differ from sexual abuse? |
|
Definition
1) Sexual (Genital/anal trauma, STDs, UTIs)= MALE
- Peak incidence 9-12
2) Physical (healed fractures)= FEMALE |
|
|
Term
True or False:
Child neglect must be reported to social services. |
|
Definition
True!
Neglect and/or abuse is reported |
|
|
Term
Which early-onset childhood disorder is described blow and how do you treat?
Limited attention span and poor impulse control in child <7, with hyperactivity, motor impairment and emotional lability. |
|
Definition
ADHD- associated with decreased frontal lobe volume and persists into adulthood in 50% of cases.
1) Methylphenidate (Ritalin)
2) Amphetamines (Dexedrine)
3) Atomexetine (non-selective NRI) |
|
|
Term
Which early-onset childhood disorder is described blow and what is it called if the child is >18?
Repetitive and pervasive behavior violating social normals. |
|
Definition
| Conduct Disorder turning into Antisocial Personality disorder |
|
|
Term
| How does Conduct disorder differ from oppositional defiant disorder? |
|
Definition
1) Conduct involves repetitivea nd pervasicve behavior violating social norms (physical aggression, destruction of property)
2) Oppositional Defiant disorder involves enduring patterns of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms. |
|
|
Term
Which early-onset childhood disorder is described blow and how do you treat?
Sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations (tics) that persist for > 1 year and begin before age 18. |
|
Definition
Tourette's syndrome: Caprolalia (obscene speech) only in 20%p
- Antipsychotics (haloperidol)
- Associated with OCD |
|
|
Term
| What other psychiatric condition is associated with Tourette's |
|
Definition
OCD
Treat TS with Haloperidol. |
|
|
Term
Pervasive developmental disorders are characterized by difficulties with language and failure to acquire, or early loss of social skills.
What disorder is described by each of the following?
1) Severe language impairment and poor social interactions with greater focus on objects than on people. Characterized by repetitive behavior and usually below-normal intelligence (rarely as "savants")
2) Milder form of 1 with all-absorbing interests, repetitive behavior and problems with social relationships. Intelligence is normal and verbal/cognitive features are intact.
3) X-linked disorder seen almost exclusively in girls (males die) with regression (age 1-4) characterized by loss of development, loss of verbal abilities, mental retardation, ataxia and stereotypes hand-wringing.
4) At age 3-4, child regresses in multiple areas of functioning after at least 2 years of apparently normal development, with loss of expression or receptive language skills, social skills or adaptive behavior, bowel or bladder control, play or motor skill (most common in boys) |
|
Definition
1) Autistic disorder- Behavior and supportive therapy to improve communication and social skills
2) Asperger's disorder
3) Rett's disorder
4) Childhood disintegrative disorder |
|
|
Term
| How can you distinguish Childhood disintegrative disorder from Rett's syndrome when both present and regression after apparently normal early life? |
|
Definition
1) Rett is in women (males die) and may start any time after 1 year, usually with severe symptoms like ataxia and mental retardation
2) CDD occurs in boys after age 2 and generally is a bit less severe (vary variable) |
|
|
Term
| What is the suggested treatment for Autism? |
|
Definition
| Behavioral and supportive therapy to improve communication and social skills. |
|
|
Term
What are the important neurotransmitter changes in the following diseases?
1) Anxiety
2) Depression
3) AD
4) Huntington's
5) Schizophrenia
6) Parkinson's |
|
Definition
1) High NE, low GABA, low serotonin (5-HT)
2) Low NE, low 5-HT, low Dopamine (all is low)
3) Low ACh,
4) Low GABA, low ACh, high dopamine
5) High dopamine
6) Low dopamine, high 5-HT and high ACh |
|
|
Term
Which disorder is associated with the following NT changes?
1) High NE, low GABA, low serotonin (5-HT)
2) Low NE, low 5-HT, low Dopamine (all is low)
3) Low ACh,
4) Low GABA, low ACh, high dopamine
5) High dopamine
6) Low dopamine, high 5-HT and high ACh |
|
Definition
1) Anxiety
2) Depression
3) AD
4) Huntington's
5) Schizophrenia
6) Parkinson's |
|
|
Term
| Which disorders are characterized by high dopamine levels? Which disorders have high ACh? |
|
Definition
1) Schizophrenia and Huntington's (with low ACh and GABA)
2) Parkinson's (low dopamine and high 5-HT) |
|
|
Term
| In what order do you lose the signs of orientation and what are the most common causes? |
|
Definition
Time > Place> Person
1) Alcohol and drugs
2) Fluid/electrolyte imbalance
3) Head trauma
4) Hypoglycemia
5) Nutritional deficiency |
|
|
Term
What type of amnesia is described below?
Inability to remember things that occurred before a CNS insult |
|
Definition
| Retrograde amnesia (vs. Anterograde) |
|
|
Term
| What classic anterograde amnesia is caused by thiamine deficiency and the associated destruction of mamillary bodies? What patient populations is it seen in? |
|
Definition
1) Korsakoff's amnesia (dry Beri Beri)
- may also have some retrograde amnesia
- associated with confabulations
2) Alcoholics |
|
|
Term
| What is dissociative amnesia? |
|
Definition
| Inability to recall important persona information, usually subsequent to severe trauma or stress (loss of memory for war) |
|
|
Term
| What is the difference between delirium and dementia? |
|
Definition
1) Delirium- rapid changes in sensory function with "waxing and waning" consciousness and abnormal EGG.
- Usually reversible and check of anti-ACh drugs
- mental status changes, disorganized though, hallucinations (visual), illusions, misperceptions, ect.
2) Dementia- Gradual decrease in intellectual ability without affecting level of consciousness and NORMAL EGG
- Irreversible memory loss in elderly patients due to AD cerebral vascular infarcts, HIV, PIck's, substance abuse, ect. |
|
|
Term
| What is the most common psychiatric condition found on medical and surgical floors? |
|
Definition
Delirium
Acute, reversible changes in sensory function with "waxing and waning" levels of consciousness and abnormal EGG. |
|
|
Term
What are each of the following signs of psychosis?
1) Perceptions in the absence of external stimuli
2) Perceiving external stimuli as something they are not
3) False beliefs about oneself or others despite persisting facts
4) Disorders in the form of thought (the ways ideas are tied together) |
|
Definition
1) Hallucination (visual, auditory, olfactory, gustatory, tactile, hypnagogic, hypnopompic)
2) Illusion
3) Delusion
4) Loose association |
|
|
Term
When do the following hallucination types generally occur?
1) Visual
2) Auditory
3) Olfactory
4) Gustatory
5) Tactile
6) Hypnagogic
7) Hypnopompic |
|
Definition
1) Medical illness (drug) > Psych
2) Psych (schizo) > medical
3) Aura of psychomotor epilepsy and in brain tumors
4) Aura of psychomotor epilepsy and in brain tumors
5) Alcohol withdrawal (formication- insects crawling on skin)
6) Going to sleep
7) While waking from sleep |
|
|
Term
| When might a patient feel like "worms are crawling on his toes"? |
|
Definition
| Tactile hallucinations are common in alcohol withdrawal and are called "Formication" |
|
|
Term
| How can you diagnose Schizophrenia? |
|
Definition
Need 2 or more
1) Delusion
2) Hallucination (auditory common)
3) Disorganized speech (loose association)
4) Disorganized or catatonic behavior
5) Negative symptoms (flat affect, social withdrawal, lack of speech/thought) |
|
|
Term
Schizophrenia is a chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning.
How is it distinguished from a Schizophreniform disorder?
What neurotransmitter changes are seen? |
|
Definition
1) Schizophrenia > 6 months while Schizophreniform is 1-6 months (brief psychotic disorder is < 1 month and stress related)
2) High dopamine, low dendritic branching
- associated with marijuana |
|
|
Term
| What are the 5 subtypes of Schizophrenia and how are they identified? |
|
Definition
Genes + Environment here, with early presentation in men (early 20s) than in women (late 20s-mid thirties)
1) Paranoid (delusions)
2) Disorganized (speech)
3) Catatonic (automatism)
4) Undifferentiated (elements of all types)
5) Residual |
|
|
Term
True or False:
Males are more likely to get schizophrenia than females. |
|
Definition
False, no gender or racial bias
Men get it EARLIER (early 20s vs late 20s-30s) |
|
|
Term
| How is Schizoaffective disorder different from Schizophreniform disorder? |
|
Definition
1) Schizoaffective lasts involves at least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic or mixed (both) episode (Can be bipolar or depressive sub-types)
2) Schizophreniform is really Schizophrenia for 1-6 months (Positive and negative symptoms) |
|
|
Term
| What is a delusional disorder? How does it relate to a shared psychotic disorder, or "folie a deux"? |
|
Definition
Fixed, persistent, non-bizarre belief system lasting > 1 month, with otherwise normal functioning.
It is "shared" when a person in a close relationship develops delusions as well (resolves after separation). |
|
|
Term
Which dissociative disorders are described below?
1) 2 or more distinct identities, most commonly in women with h/x of sexual abuse.
2) Persistent feelings off detachment or estrangement from one's own body, a social situation or environment.
3) Abrupt changes in geographic location with inability to recall past, confused about personal identity or assumption of new identity (NOT from substance abuse or GM condition) |
|
Definition
1) Dissociative identity disorder
2) Depersonalization disorder
3) Dissociative fugue- Associated with traumatic circumstances like wartime and trauma |
|
|
Term
| What are the major mood disorders and what are their distinguishing features? |
|
Definition
1) Major depressive disorder (5 or 9 SIG E CAPS)
2) Bipolar (at least 1 manic-type 1 or 1 hypomanic-type 2 episode)
- Suicide risk
3) Dysthymic disorder
- Milder depression lasting at least 2 years
4) Cyclothymic disorder
- Dysthmia and hypomania; milder form of bipolar lasting at least 2 years. |
|
|
Term
| How is a manic episode diagnosed? |
|
Definition
3 or more of "maniacs DIG FAST"
** If it does not impair social and /or occupational functioning and there are no psychotic features, it is a "Hypomanic episode**
1) Distractibility
2) Irresponsibility
3) Grandiosity
4) Flight of ideas
5) goal-directed Activity/psychomotor Agitation
6) decreased need for Sleep
7) Talkativeness or pressured speech |
|
|
Term
| True or False: Diagnosis of Bipolar disorder can be made with a single hypomanic episode. |
|
Definition
True- Bipolar II (vs. 1, where it is manic)
- Depressed symptoms always occur eventually
- Mood usually returns to normal between episodes |
|
|
Term
| What is the treatment of choice for Bipolar disorder and what drugs should be avoided? |
|
Definition
1 episode of mania (type 1) or hypomania (type 2) with high suicide risk.
1) Mood stabilizers
- Lithium, Valproic acid, Carbamazepine (all are teratogenic)
- Atypical antipsychotics
2) AVOID anti-depressents, which can lead to increased mania |
|
|
Term
| How is major depressive disorder diagnosed and treated? |
|
Definition
Self-limited disorder, with major depressive episodes lasting 6-12 months.
1) Diagnosis: Episodes characterized by 5 of 9
- Sleep disturbance
- loss of Interest (anhedonia
- Guilt or feelings of worthlessness
- loss of Energy
- loss of Concentration
- Appetite/weight changes
- Psychomotor retardation or agitation
- Suicidal ideation
2) Treat
- SSRIs are first line
- SNRIs and TCAs |
|
|
Term
| How can seasonal affective disorder be treated? |
|
Definition
| Full spectrum light exposure! |
|
|
Term
| How does atypical depression differ from major depression? |
|
Definition
Most common subtype of depression, associated with weight gain and sensitivity to rejection (Give MAOis or SSRIs)
1) Hypersomnia
2) Overeating
3) Mood reactivity
- the ability to experience improved mood in response to positive events vs. persistent sadness. |
|
|
Term
| What post-partum mood disturbances are known to occur? |
|
Definition
1) Maternal "blues" (50-85%): Depressed affect, tearfulness and fatigue (resolves within 10 days)
- Supportive treatment
2) Postpartum depression (10-15%): Depressed affect, anxiety and poor concentration lasting > 2 weeks
- Antidepressents and psychotherapy
3) Postpartum psychosis (0.1-0.2%): Delusions, confusion, unusual behavior and possible homicidal/suicidal ideations or attempts (lasts days to 4-6 weeks)
- Antipsychotics, anti-depressents and possible inpatient hospitalization. |
|
|
Term
| What is Electroconvulsive therapy and when should it be used? |
|
Definition
Produces painless seizure in an anesthetized patient (adverse effects include disorientation and temporary anterograde/retrograde amnesia resolving in 6 months)
Used in MDD refractory to other treatment and for pregnant women with MDD. |
|
|
Term
| What are the major risk factors for suicide completion? |
|
Definition
SAD PERSONS
1) Sex (male)
2) Age (teenager or elderly)
3) Depression
4) Previous attempt
5) Ethanol or drug
6) loss of Rational thinking
7) Sickness
8) Organized plan
9) No spouse
10) lacking Social support |
|
|
Term
Which of the following is not a risk factor for suicide completion?
1) Male gender
2) Age
3) Organized plan
4) Loss of rational thinking
5) Previous attempt |
|
Definition
|
|
Term
| What defines an anxiety disorder and what are the major forms? |
|
Definition
Inappropriate experience of fear/worry that interferes with daily functioning.
1) Panic disorder (recurrent episodes of fear/panic peaking at 10 minutes)
2) Specific phobia (Cued by presence or anticipation of specific object)
3) OCD (recurring intrusive thoughts, feeling or sensations (obsessions) that cause severe distress relieved in part by performance of repetitive actions (compulsions)
4) PTSD (Disturbance > 1 month with onset of symptoms beginning anytime after event)
5) Generalized anxiety disorder (uncontrolled anxiety > 6 months) |
|
|
Term
How do you treat the following anxiety disorders?
1) Recurrent periods of intense fear with palpitations, parasthesia, abdominal distress and chest pain.
2) Unreasonable level of fear when told a spider is in the other room, recognizing that this fear is "over the top"
3) Exaggerated fear of embarrassment in social situations like public speaking
4) Recurring feeling of anxiety relieved by tapping a table twice with the index finger.
5) Nightmares and flashbacks to being raped lasting > 1 month
6) 8 months of anxiety that is unrelated to person, place or event, but that has been disturbing sleep and causing fatigue |
|
Definition
1) Panic disorder: CBT, SSRI, TCA, benzodiazepine
2) Specific phobia- desensitization therapy
3) Social phobia- SSRIs
4) OCD- SSRI, Comipramine
5) PTSD- Psychotherapy and SSRI
6) GAD (> 6 months)- Benzo, Buspirone, SSRI |
|
|
Term
| How does a Generalized anxiety disorder differ from an Adjustment disorder? |
|
Definition
1) GAD: at least 6 months of anxiety that is unrelated to specific person, situation or event (psychotherapy and SSRI)
2) Adjustment: Emotional symptoms causing impairment following an identifiable psychosocial stressor (divorce, illness) and lasting < 6 months ( 6 months is presence of chronic stressor) |
|
|
Term
| How does an acute stress disorder differ from PTSD? |
|
Definition
| ASD lasts 2 days to 1 month, while PTSD is > 1 month. |
|
|
Term
|
Definition
Consciously faking or claiming to have a disorder in order to attain a specific secondary gain (avoiding work, drugs, ect).
Poor compliance with treatment or follow-up of diagnostic tests with complaints that cease after gain. |
|
|
Term
You have a patient who is complaining of manic episodes. However, he is difficult to get a hold of and he has not been taking his medications. However, whenever he comes into your office, he seems happy to be missing work.
What is going on most likely? |
|
Definition
|
|
Term
| How does Munchausen's syndrome differ from Malingering? |
|
Definition
Muchausen's are willing to get invasive procedures, while Malingering patients try to avoid them. However, both are concious
1) Munchausen's is chronic factitious disorder with predominantly physical signs and symptoms, where the aim is to play the "sick role" and to receive primary gains (medical treatment)
** can be given "by proxy," where child learns to assume sick role with motivation from caregiver**
2) Malingering is constructed disorder for secondary gain (miss work or get drugs) |
|
|
Term
| True or False: Muchausen's syndrome involves factitious physical symptoms that are unconsciously generated by patient to receive primary gains through medical care. |
|
Definition
False: It is still conscious- they will, however, get invasive procedures.
Unconscious motivation is Somatoform |
|
|
Term
There are numerous disorders with physical symptoms and no identifiable cause that are unconsciously produced by patient.
What are these disorders and what are the common types? |
|
Definition
Somatoform (more common in women)
1) Somatization: various complaints in multiple systems over period of years
2) Conversion: Sudden loss of sensory/motor function following acute stressor (patient is aware, but indifferent)
3) Hypochondriasis: fear of having serious illness despite medical evaluation and reassurance.
4) Body dysmorphic: Preoccupation with minor or imagined defect in appearance
5) Pain disorder: Prolonged pain with no physical findings (intensity regulated by psychological changes) |
|
|
Term
An 13 year old girl's parents both just died in a car crash. She is in the hospital because a neighbor called after seeing her lying on the floor of the house.
The girl complains of "losing all sensation in her legs," but seems more worried about when she will get lunch
What is going on? |
|
Definition
Somatoform disorder
Conversion disorder: Loss of sensory/motor function following acute stressor with indifference ("la belle indifference") |
|
|
Term
| What differentiates a personalty trait from a personality disorder? |
|
Definition
1) Trait is enduring, repetitive pattern of perceiving, relating to and thinking about the environment and oneself.
2) Disorder is inflexible, maladaptive and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning (not usually aware).
- Usually presents in early adulthood. |
|
|
Term
| What are the personality disorders in cluster A? |
|
Definition
Cluster A is "Weird" (Accusatory, Aloof and Awkward)
- No psychosis, but genetic association with schizophrenia
1) Paranoid
- pervasive distrust and suspiciousness,
- defense is Projection
2) Schizoid
- voluntary social withdrawal, limited emotional expression
- content with social isolation
3) Schizotypal
- Eccentric appearance, odd beliefs or magical thinking
- Interpersonal awkwardness |
|
|
Term
| What are the personality disorders in cluster B? |
|
Definition
"Wild" (Bad to the Bone)
- Genetic association with mood disorders and substance abuse
1) Anti-social (Males)
- disregard for and violation of right of others (called "conduct disorder" if < 18)
2) Borderline (Females)
- Unstable mood and interpersonal relationships, impulsiveness, self-mutatino, boredom
- Defense is Splitting
3) Histrionic
- Excessive emotionality and excitability
- Sexually provocative and overly concerned with appearance
4) Narcissistic
- Grandiosity
- Demands "best" and reacts to criticism with rage. |
|
|
Term
| What are the personality disorders in cluster C? |
|
Definition
C is "Worried" (Cowardly, Compulsive, Clingy)
- Genetic association with anxiety disorders
1) Avoidant
- Hypersensitive to rejection, socially inhibited, timid
- Desires relationships (vs Schizoid)
2) Obsessive-compulsive
- Preoccupation with order, perfectionism and control
- Behavior is consistent with one's own beliefs (vs. OCD)
3) Dependent
- Submissive and clinging
- Low self confidence and needs to be taken care of |
|
|
Term
| How can you distinguish OCD from obsessive compulsive personality disorder? |
|
Definition
| In OCD, behaviors are inconsistent with person belief's desires, while in the perfectionistic OCPD, they are consistent (cluster C disorder) |
|
|
Term
| What differentiates Schizoid personality disorder from Avoidant personality disorder? |
|
Definition
| Schizoid patients (Cluster A) show no concern for social isolation, while Avoidant (Cluster C) patients desire relationships with others |
|
|
Term
Brain Game: Name that personality cluster!
1) Histrionic
2) Avoidant
3) Schizotypal
4) Dependent
5) Schizoid
6) Paranoid
7) Narcissistic
8) Antisocial
9) Borderline
10) Obsessive compulsive |
|
Definition
1) B (wild)
2) C (worried)
3) A (weird)
4) C (worried)
5) A (weird)
6) A (weird)
7) B (wild)
8) B (wild)
9) B (wild)
10) C (worried) |
|
|
Term
| What is the difference between Schizoid, Schizotypal, Schizophrenic and Schizoaffective disorders? |
|
Definition
1) Schizoid is cluster A personality disorder with voluntary social withdrawal and limited emotional expression
2) Schizotypal is Schizoid + odd (magical) thinking and eccentric behavior
3) Schizophrenic is greater odd thinking often with psychosis
4) Schizoaffective has schizophrenic psychotic symptoms and bipolar or depressive mood disorder. |
|
|
Term
| What are the major differences between Anorexia nervosa and Bulimia nervosa? |
|
Definition
1) AN= Excessive dieting +/- purging
- Fear of gaining weight with distorted body image
- Low bone density, amenorrhea, anemia and electrolyte disturbances
2) BN= Binge eating +/- purging
- Self-induced vomiting or use of laxatives/diuretics/emetics with normal body weight
- Parotitis, enamal erosion, electrolyte disturbance, alkalosis, dorsal hand calluses from induced vomiting (Russell's sign). |
|
|
Term
| What are the major genetic identity disorders? |
|
Definition
Strong, persistent cross-gender identification characterized by persistent discomfort with one's sex.
1) Transsexualism- desire to live as opposite sex
2) Transvestism- cross dressing |
|
|
Term
| How can you diagnose substance dependence? |
|
Definition
3 or more of the following signs in 1 year
1) Tolerance
2) Withdrawal
3) Substance taken in large amounts or over longer time than desired
4) Persistent desire or unsuccessful attempts to cut down.
5) Significant energy spent obtaining, using and recovering after use
6) Important social, occupational, or recreation activities reduced
7) Continued use in spite of knowing the problems that it causes |
|
|
Term
| How can you be sure of substance abuse? |
|
Definition
Maladaptive pattern leading to clinically significant impairment or distress
1) Recurrent use resulting in failure to fulfill obligations
2) Recurrent sue in physically hazardous situations
3) Recurrent related legal problems
4) Continued use in spite of persistent problems caused by use |
|
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Term
| What are the stages of change in overcoming substance addiction? |
|
Definition
1) Pre-contemplation (not acknowledging)
2) Contemplation (acknowledging there is a problem, but not ready to make change)
3) Preparation/Determination (Getting ready to change)
4) Action/Willpower (Changing behaviors)
5) Maintenance (Maintaining behavior change)
6) Relapse |
|
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Term
| What stage of change is person in who admits that they have a drug problem, but who is unwilling to make a change |
|
Definition
| Contemplation (when they start getting ready to change, it is Preparation/Determination) |
|
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Term
What kind of drug abuse is each of the following patients experiencing? What are the signs of withdrawal?
1) Mood elevation with decreased anxiety, sedation and behavioral disinhibition and respiratory depression.
2) Emotional lability, slurred speech, ataxia, coma, blackouts. Serum GGT with AST 2X ALT
3) CNS depression, nausea and vomiting, with constipation, pupillary constriction (pinpoint) and possibility of seizures
4) Marked respiratory depression that must be treated with assisted respiration and volume expansion.
5) Ataxia, minor respiratory depression that is reversed with flumazenil. |
|
Definition
1) Any depressent: Anxiety, tremor, seizures, insomnia
2) Alcohol- DTs in severe cases, treated with benzodiazepines
3) Opioids (morphine, heroin, methadone)
- Sweating, pupil dilation, piloerection (cold turkey), fever, rhinorrhea, nausea
4) Barbiturates
- Delirium, life threatening CV collapse
5) Benzos
- Delirium (less significant than barbiturates)
4) |
|
|
Term
How do you treat an overdose of the following?
1) Morphine
2) Barbiturate
3) Benzodiazepine
4) Cocaine
5) DTs from alcohol |
|
Definition
1) Opioids get Naloxone or Natrexone
2) Respiratory support and increase BP
3) Flumazenil (GABA antagonist- competitive)
4) Benzodiazepines
5) Benzodiazepines |
|
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Term
What kind of drug abuse is each of the following patients experiencing? What are the signs of withdrawal?
1) Impaired judgment, pupillary dilation, prolonged wakefulness and attention, delusions/hallucinations and fever
2) Impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death (treated with benzos)
3) Restlessness, diuresis and muscle twitching
4) Restlessness after smoking cessation |
|
Definition
1) Amphetamine (Stimulant)
- Stomach cramps, hunger and hyper-somnolence
2) Cocaine (Stimulant)
- Suicidally, hyper-somnolence, malaise, severe psychological craving.
3) Caffeine
4) Nicotine
- Irritability, anxiety, craving |
|
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Term
What might a patient on PCP, LSD and marijuana, respectively , look like?
What are the signs of withdrawal? |
|
Definition
1) PCP
- Belligerence, impulsiveness, fever, psychomotor agitation, nystagmus, tachycardia, homicidality, psychosis
- Withdrawal: Depression, anxiety, restlessness, anergia, sleep/though disturbance
2) LSD
- Anxiety or depression, delusions, visual hallucinations, Flashbacks, pupillary dilation
3) Marijuana
- Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth
Withdrawal: Irritability, depression, insomnia, nausea, anorexia (peak at 48 h and last 5-7 days) |
|
|
Term
| How long can Marijuana be detected in the urine after cessation? |
|
Definition
|
|
Term
| What are the risks associated with Heroin use and how is it treated? |
|
Definition
1) Hepatitis, Abscesses, Hemorrhoids, AIDS, Right-sided endocarditis
2a) Methadone (long-acting oral opiate for detox and long-term maintenance)
2b) Suboxone
- Naloxone + Buprenorphine (partial agonist)
- Since nalaxone is not active orally, withdrawal symptoms are fewer than Methadone. |
|
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Term
| What are the most common serious complications of alcohol abuse? What is Wernicke-Korsakoff syndrome? What about Mallory-Weiss-syndrome? |
|
Definition
Disulfiram conditioning and AAA for treatment
1) Cirrhosis, Hepatitis, Pancreatitis, Peripheral Neuropathy, Testicular atrophy
2) Wernicke-Korsakoff syndrome
- Thiamine deficiency with traid of confusion, opthalmoplegia and ataxia (periventricular hemorrhage of mammillary bodies may lead to Korsakoff's psychosis)
2) Mallory-Weiss syndrome- Longitudinal lacerations of GE junction caused by excessive vomiting (presents with hematemesis) |
|
|
Term
| What is Wernicke-Korsakoff syndrome and how do you treat? |
|
Definition
1) Thiamine deficiency from Alcoholism leads to Confusion, Opthalmoplegia and Ataxia (Wernicke's encephalopathy).
May progress to irreversible memory loss, confabulation and personality change (Korsakoff's psychosis) in associated with periventricular hemorrhage/necrosis of mammillary bodies
2) Give IV B1 (thiamine) |
|
|
Term
| What is Mallory-Weiss syndrome and how do you treat? |
|
Definition
1) Longitudinal ulcerations to G-E junction usually due to vomiting from alcohol use or Bulimia
- Painful (vs. esophageal varices)
2) disulfiram (conditioning for alcohol abuse), supportive care |
|
|
Term
| How can you tell between Hematemesis due to Mallory-Weiss syndrome vs. Esophageal varices? |
|
Definition
1) Mallory-Weiss will be PAINFUL tears at G-E junction in alcoholic/bulimic
2) Esophageal varices will be PAINLESS dilations in patient with portal hypertension. |
|
|
Term
| What is "Delirium tremens"? |
|
Definition
Life-threatening signs of withdrawal from severe alcohol abuse- Give benzodiazepines
Peaks 2-5 days after last drink in following order
1) Autonomic system hyperactivity (Tachycardia, tremors, anxiety, seizures)
2) Psychotic symptoms (Hallucinations, delusions)
3) Confusion |
|
|
Term
What are the treatments for the following conditions?
1) Alcohol withdrawal
2) Bulimia
3) Anxiety
4) ADHD
5) Atypical depression |
|
Definition
1) Benzodiazepines (DTs)
2) SSRI
3) Benzo, Buspirone, SSRI
4) Methylphenidate (Ritaline), Amphetamines (Dexedrine)
5) MAOi, SSRI |
|
|
Term
What are the treatments for the following conditions?
1) Bipolar
2) Depression
3) Depression with insomnia
4) OCD
5) Panic disorder |
|
Definition
1) "Mood stabilizers" like Lithium, Carbamezepine and Valproic acid, as well as Atypical Antipsychotics
2) SSRI, SNRI, TCAs
3) Mirtazapine
4) SSRI, Clomipramine
5) SSRI, TCAs, Benzodiazepines |
|
|
Term
What are the treatments for the following conditions?
1) PTSD
2) Schizophrenia
3) Tourette's syndrome
4) Social phobias
5) Depression with insomnia |
|
Definition
1) SSRI
2) Antipsychotics
3) Antipsychotics (haloperidol, resperidone)
4) SSRI
5) Mirtazepine |
|
|
Term
| How do CNS stimulants like Methylphenidate, Dextroamphetamine and mixed amphetamine salts work and how are they used? |
|
Definition
1) Increase catecholamine at synaptic cleft, especially NE and dopamine
2) ADHD, narcolepsy, appetite control |
|
|
Term
What are the typical anti-psychotic drugs (Neuroleptics)?
Which are high potency vs. low potency? What are the SE of each? |
|
Definition
All typical antipsychotics block dopamine D2 receptors (increasing [cAMP])
High potency: Try to Fly High
- Triflouperazine, Fluphenazine, Haloperidol
- Extrampyramidal effects
Low potency: Cheating Thieves are low
- Chlorpromazine, Thioridazine
- Anti-ACh, anti-hiatmine and alpha blockage side effects |
|
|
Term
| A patient taking Trifluoperazine is developing extrapyramidal side effects. Describe the evolution of these effects at 4h, 4d, 4w and 4m. |
|
Definition
High potency anti-psychotic (typical)
1) 4h: acute dystonia
2) 4d: akinesia (Parkinsonian)
3) 4w: Akathisia (Restless)
4) 4m: Tardive dyskinesia (irreversible stereotypic oral-facila movements) |
|
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Term
| What are the major sues of typical anti-psychotic medications and what are the important toxicities to consider? |
|
Definition
1) Schizophenia (positive symptoms), acute mania, psychosis and Tourette's syndrome
2) SE
- Highly lipid soluble and stored in body fat (slow to be removed)
- Extrapyramidal (EPS) for high potency (Trifluoperazine, fluphenazine and Haloperidol)
- Endocrine side effects (Dopamine receptor antagonism- prolactinemia)
- Anti ACh (dry mouth, constipation), alpha receptors (hypotension), and histamine (Sedation) for low potency (Chlorpromazine and Thioridazine) |
|
|
Term
| What is Neuroleptic malignant syndrome? How is it treated? |
|
Definition
1) FEVER: Syndrome associated with typical anti-psychotic use
- Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigidity of musles
2) Treat with Dantrolene, D2 agonists (bromocriptine) |
|
|
Term
| Why might a female patient with Tourette's syndrome develop gallactorhea? |
|
Definition
| Taking typical anti-psychotic which inhibits D2 receptors, preventing inhibition of Prolactin release from anterior pituitary. |
|
|
Term
Which anti-psychotics cause the following?
1) Corneal deposits
2) Retinal deposits
3) Agranulocytosis
4) QT prolongation |
|
Definition
1) Chlorpromazine (typical, low potency)
2) Thioridazine (typical, low potency)
3) Clozapine (atypical)
4) Ziprasidone |
|
|
Term
| How do Atypical anti-psychotics work differently than typicals? What are the major options? |
|
Definition
1) Atypicals have varied effects on 5-HT2, Alpha, Dopamine and H1 receptors, while typicals hit D2 receptors only.
2) Atypical for old closets to quietly risper from A to Z
- Olanzapine
- Clozapine (agranulocytosis)
- Quetiapine
- Ripseridone
- Aripiprazole
- Ziprasidone (QT prolongation) |
|
|
Term
Which of the following drugs would treat both the positive and negative symptoms of schizophrenia?
1) Trifluoperazine
2) Haloperidol
3) Chlorpromazine
4) Clozapine
5) Tioridazine |
|
Definition
| 4- Clozapine is an Atypical, which hits both (Typicals only hit positive symptoms) |
|
|
Term
| What is the major use(s) of Olanzapine? |
|
Definition
| Atypical antipsychotic used for Schizophrenia (+ and -) and OCD, anxiety disorder, depression, mania, Tourette's |
|
|
Term
Why might a psychiatrist choose to prescribe an atypical anti-psychotic instead of a typical variant?
What are the important side effects to consider with atypicals? |
|
Definition
Less extrapyramidal and anti-cholinergic side effects
1) Olanzepine= weight gain
2) Clozapine= agranulocytosis (weekly WBC monitoring)
3) Ziprasidone= QT prolongation |
|
|
Term
| What is the major use(s) of Olanzapine? |
|
Definition
| Atypical antipsychotic used for Schizophrenia (+ and -) and OCD, anxiety disorder, depression, mania, Tourette's |
|
|
Term
Why might a psychiatrist choose to prescribe an atypical anti-psychotic instead of a typical variant?
What are the important side effects to consider with atypicals? |
|
Definition
Less extrapyramidal and anti-cholinergic side effects
1) Olanzepine= weight gain
2) Clozapine= agranulocytosis (weekly WBC monitoring)
3) Ziprasidone= QT prolongation |
|
|
Term
| Why might you prescribe Lithium, how does it work and what are the important side effects? |
|
Definition
1) "Mood stabilizer" for bipolar, blocking acute and relapse manic events
- also used in SIADH
2) Possibly related to inhibition of phosphoinosital cascade
3) LMNOP
- Lithium side effects:
- Movement (tremor)
- Nephrogenic DI
- HypOthryoidism
- Pregnancy problems
- |
|
|
Term
| Why might a patient taking Lithium for bi-polar gain weight and exhibit periorbital edema? |
|
Definition
Hypothyroidism is one side effect
Also causes NDI, Tremors and Pregnancy issues |
|
|
Term
| What is Buspirone and how is it used? |
|
Definition
1) Partial agonist of 5-HT1a receptors
2) Used in GAD
- No worry of sedation, addiction or tolerance and does NOT interact with alcohol (vs. barbiturates and benzos) |
|
|
Term
Where do each of the following drugs exert their actions?
1) Desipramine and Maprotiline
2) MAO inhibitors
3) Mirtazapine
4) Fluoxetine and Trazodone |
|
Definition
1) TCAs that prevent NE/5-HT reuptake
2) MAO-i that prevent presynaptic degradation of mono-amine compounds
3) Blocks pre-synaptic a-2 receptor, leading to increased sympathetic drive (opposite of Clonidine and alpha-methyl Dopa in hypertension treatment)
4) SSRI that block 5-HT reuptake |
|
|
Term
| How are TCAs used clinically and what are their side effects? |
|
Definition
TCA's end in "iptyline" or "ipramine" (Amitriptyline, Imipramine, Deipramine) except for Doxepin and Amoxapine
1) Block NE and 5-HT re-uptake in MDD, bedwetting (imipramine), OCD (Clomipramine), fibromyalgia
2) Tri-C's (Convulsions, Coma , Cardiotoxicity-arrhythima)
**Treat CV toxicity with NaHCO3 to alkalinize urine (they are acidic drugs) |
|
|
Term
| What would you not use Amitryptyline in elderly folks to treat depression? |
|
Definition
TCAs cause confusion and hallucinations in elderly due to anti-ACh effects
- Amitryptyline is a tertiary agent and has the WORST anti-cholinergic effects
- Use Secondary agent like Nortriptyline as the only TCA option for elderly. |
|
|
Term
Which TCA should be used in the following situation?
1) Bed-wetting
2) OCD
3) Elderly folks with depression
4) Prevent sedation/seizure |
|
Definition
All inhibit re-uptake of NE/5-HT
1) Imipramine
2) Clomipramine
3) Nortriptyline
4) Desipramine |
|
|
Term
| What are the major side effects and toxicity associate with TCA use? |
|
Definition
1) Anti-alpha sympathetic (hypotension)
2) Anti-Cholinergy (tachycardia, urinary retention)
3) Sedation
Toxicities include (Convulsions, Coma and Cardiotoxicity) |
|
|
Term
| What are the major available SSRIs, how do they work and when are they given? |
|
Definition
FLashbacks PARalyze SEnior CITizens
1) FLuoxetine, PARoxetine, SErtraline, CITalopram
2) Block 5-HT reuptake (takes 4-8 weeks to have effect)
3) Depression, OCD, bulimia, social phobias, PTSD |
|
|
Term
| How long will it take for Fluoxetine to start having anti-depressive effects? What toxicities are associated? |
|
Definition
1) SSRI= 4-8 weeks to wait
2) GI, sexual (anorgasmia).
"Serotonin Syndrome" with any drug that increaes 5-HT (MAO-i)- hyperthermia, myoclonus, CV collapse, flushing, diarrhea, seizures.
Give Cyproheptadine (5-HT2 receptor antagonist)!! |
|
|
Term
Patient who you are seeing for depression recently saw a second physician and presents today with flushing, hyperthermia, myoclonus, signs of CV collapse, diarrhea and seizures.
What is going on and what do you do? |
|
Definition
Serotonin Syndrome- He probably added an MAOI like Phenelzine to your SSRI treatment.
Give Cyproheptadine (5-HT2 receptor antagonist) |
|
|
Term
| What are the available SNRIs and how are they used? |
|
Definition
1) Venlafaxine and Duloxetine
- INhibit serotonin and NE reuptake
2) Used in depression
- Venlafaxine (GAD)
- Duloxetine (NE effect > 5-HT)
3) Watch out for increased BP, as well as stimulant effects, sedation and nausea |
|
|
Term
| What are the available MAOi's and how are they used? |
|
Definition
MAO Takes Pride In Shanghai
1) Tranylcypromine, Phenelzine, Isoacarboxazid, Selegilin (seleectiev MAO-B)
- Non-selective MAO inhibition increases levels of amin NT (NE, 5-HT, dopamine)
2) Atyptial depression, anxiety, hypochondriasis |
|
|
Term
| Why are drugs like Isocarboxazid dangerous without dietary restriction? |
|
Definition
| Hypertensive crisis with tyramine ingestion (wine and cheese) in patients on MAOI's |
|
|
Term
| When are MAOIs like Tranylcypromine contraindicated? |
|
Definition
1) Patients on SSRIs (Serotonin syndrome)
2) Patients on Beta agonists (hypertensive crisis)
3) Patients consuming tyramine (hypertensive crisis)
4) Patients on meperidine (serotonin syndrome) |
|
|
Term
| What are the available atypical anti-depressent drugs and how do they work? |
|
Definition
1) Buproprion- Increase NE and Dopamine via unknown mechanism (also used in smoking cessation).
- Stimulant effects , headache and seizure in bulimics, but NOT SEXUAL SIDE EFFECTS
2) Mirtazapine- Presynaptic Alpha-2 antagonist and potent 5-HT2 and 5-HT3 antagonist (pre-synaptic)
- can cause sedation, weight gain and dry mouth
3) Maprotiline- Blocks NE reuptake
- Sedation and orthostatic hypotension
4) Trazadone- Inhibits 5-HT re-uptake
- Used in insomnia, as high doses are needed for anti-depressant effects
- Sedation, nausea, priapism, postural hypotension. |
|
|
Term
| Which atypical anti-psychotic medication is given mostly for insomnia? |
|
Definition
Trazadone- doses must be too high to get anti-depressive effects
Gives men boners |
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