First aid psychiatry

Created by justcrutchy 

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How is the Stanford-Binet IQ calculated? What is the mean and SD?

mental age/chronological age *100; 100; SD of 15

What IQ threshold is used to define mental retardation? Severe MR? Profound MR?

<70; <40; <20

What is the difference between habituation and sensitization?

Habituation - repeated stimulation leads to decreased response; sensitization - leads to increased response

What is the difference between classical and operant conditioning?

Classical - present conditioned stimulus (bell) and unconditioned stimulus (food) simultaneously; operant - do something to get reward or avoid punishment

What is the difference between negative reinforcement and punishment?

negative reinforcement - removal of averse stimulus elicits behavior; punishment - application of aversive stimulus extinguishes unwanted behavior

What is the difference between transference and countertransference?

transference - patient onto doctor; countertransference - doctor onto patient

What are the Id, Ego, & Superego responsible for?

Id - Instinct (primal urges, food, sex, aggression); Superego - moral values, conscience; Ego - mediator

Temporary, drastic changes in personality, memory, consciousness, or motor behavior to avoid emotional stress: (dissociation/denial/displacement/regression/repression).Give example.

dissociation; (e.g. multiple personality disorder)

Process whereby avoided ideas and feelings are transferred to some neutral person or object: (acting out/displacement/projection/splitting).

displacement (e.g. mother places blame on child b/c she is angry at her husband)

Partially remaining at a more childish level of development: (acting out/dissociation/denial/fixation/identification/regression). Give example.

fixation. (e.g. men fixating on sports games)

Modeling behavior after another person who is more powerful (though not necessarily admired). (displacement/identification/projection). Example.

identification. (e.g. abused child identifies himself as an abuser)

Describing murder in graphic detail with no emotional response. (Dissociation/denial/displacement/fixation/isolation of affect/repression).

isolation of affect: separation of feelings from ideas and events

An unacceptable internal impulse is attributed to an external source: A man who wants another woman thinks his wife is cheating on him. (dissociation/denial/displacement/projection).

projection

A patient with libidinous thoughts enters a monastery (process whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite. (dissociation/displacement/reaction formation/repression).

reaction formation

Belief that people are either all good or all bad at different times due to intolerance of ambiguity. (Displacement/rationalization/reaction formation/splitting).

splitting

Process whereby one replaces an unacceptable with with a course of action that is similar to the wish but does not conflict with one's value system. (dissociation/displacement/isolation of affect/rationalization/reaction formation/repression/sublimation).

sublimation

Voluntary witholding of an idea or feeling from conscious awareness. (repression/suppression).

suppression (repression - involuntary)

Depression in an infant attributable to continued separation from caregiver. Name?

Anaclitic depression (hospitalism)

Physical abuse of a child is most likely caused by whom?

female and primary caregiver

Sexual abuse of a child is most likely caused by whom? What is the most likely age range of the child?

male known to victim; 9-12

The most common form of child maltreatment is child (physical abuse/sexual abuse/neglect).

neglect

What is the onset of ADHD?

before age 7

Which drugs are used to treat ADHD?

methylphenidate (ritalin); amphetamines (dexedrine); atomoxetine (nonstimulant SNRI)

Repetitive and pervasive behavior violating social norms (physical aggression, destruction of property, theft). (Conduct disorder/oppositional defiant disorder/childhood disintegrative disorder).

Conduct disorder (antisocial personality disorder after 18 years of age)

T/F. Coprolalia (obscene speech) is by definition found in all people with Tourette's syndrome.

F. only 20%

Tourette's syndrome is associated with what other disorder?

OCD

How is Tourette's treated?

antipsychotics (e.g. haloperidol)

What is the difference between Asperger's and Autism?

Asperger's - milder form of autism; no language impairment

Girl with loss of development, mental retardation, loss of verbal abilities, ataxia, & sterotyped hand-wringing. What's the disorder?

Rett's disorder: X-linked in girls (males die in utero or shortly after birth)

Marked regression in multiple areas of functioning after at least 2 years of apparently normal development. Disorder?

childhood disintegrative disorder

Neurotransmitter changes with anxiety?

increased NE, decreased serotonin, decreased GABA (think: NE and serotonin are associated with anxiety and depression)

Neurotransmitter changes with depression?

decreased NE, decreased serotonin, decreased dopamine (think: NE and serotonin are associated with anxiety and depression; Decreased Dopamine Depression)

Neurotransmitter changes with Alzheimer's dementia?

decreased acetylcholine (think A & A, but decreased)

Neurotransmitter changes with Huntington's disease?

decreased GABA, decreased acetylcholine

Neurotransmitter changes with schizophrenia?

increased dopamine (think schizOphrenia, dOpamine)

Neurotransmitter changes with Parkinson's disease?

decreased dopamine, increased serotonin, increased acetylcholine (think parkinsOn, dOpamine)

Korsakoff's amnesia is (anterograde/retrograde) amnesia caused by _____ deficiency. It leads to bilateral destruction of what?

anterograde; thiamine deficiency; destruction of mammillary bodies

What is delirium?

waxing and waning level of consciousness with acute onset

Which of the following presents with an abnormal EEG: (delirium/dementia).

delirium

What's the difference between a hallucination and an illusion?

hAllucination - Absence of external stimuli

What is the difference between hypnagogic and hypnopompic hallucinations?

HypnaGOgic - going to sleep; Hypnopompic - waking up

Visual hallucinations are most commonly seen in (delirium/schizophrenia/psychomotor epiliepsy/brain tumor/alcohol withdrawal/cocain abuse).

delirium

Auditory hallucinations are most commonly seen in (delirium/schizophrenia/psychomotor epiliepsy/brain tumor/alcohol withdrawal/cocain abuse).

schizophrenia

Olfactory hallucinations are most commonly seen in (delirium/schizophrenia/psychomotor epiliepsy/brain tumor/alcohol withdrawal/cocain abuse).

psychomotor epiliepsy & brain tumors

Tactile hallucinations are most commonly seen in (delirium/schizophrenia/psychomotor epiliepsy/brain tumor/alcohol withdrawal/cocaine abuse).

alcohol withdrawal, cocaine abusers

What's the difference between a brief psychotic and schizophreniform disorder?

Brief - < 1 month; schizophreniform - 1-6 months

A diagnosis of schizophrenia requires 2 or more of what symptoms?

delusion; hallucination; disorganized speech; disorganized behavior; (flat affect, social withdrawal, lack of motivation, lack of speech or thought)

Dissociative identity disorders are more common in (men/women) and are associated with a history of what?

women; sexual abuse (formerly called multiple personality disorder)

What is depersonalization disorder?

persistent feelings of deatchment or estrangement from one's own body, a social situation, or the environment

What is the difference between bipolar I and II?

I - manic; II - hypomanic

How do you treat bipolar disorder?

mood stabilizers: lithium, valproic acid, carbamazepine

What are symptoms of major depression?

SIG E CAPS: Sleep, Interest, Guilt, Energy Concentration, Appetite, Psychomotor retardation, Suicidal, Depressed mood)

What is the difference between atypical depression and major depression?

Atypical - ability to experience improved mood in response to positive events vs. persistent sadness in major depression

How are panic disordres treated?

cognitive behavioral therapy, SSRIs, TCAs, benzodiazepines

What drug is used to treat social phobias?

SSRI

How is OCD treated?

SSRI or clomipramine

How do you treat generalized anxiety disorder?

benzodiazepines, buspirone, SSRIs

What is the difference between a factitious disorder, malingering, and a somatoform disorder?

factitious disorder - goal is to get medical attention; malingering - goal is to get secondary gain (e.g. insurance compensation); somatoform - unconscious

Munchausen's syndrome is an example of (a factitious disorder/malingering).

factitious disorder (make up to get attention)

What is a conversion disorder?

sudden loss of sensory or motor function often following acute stressor; patient is aware but indifferent toward symptoms; more common in adolescents and young adults

What are cluster A personality disorders characterized by? B? C?

A - Wierd; B - Wild, C - Wacky

Cluster A personality disorders are characterized by what? What are 3 types?

"Wierd": accusatory, aloof, awkward; Paranoid; Schizoid (socially isolated, SchizoiD - Distant); Schizotypal (SchizoTypal - magical Thinking)

Projection is a major defense mechanism of (paranoid/schizoid/schizotypal) personality disorders.

paranoid (note: projection - unacceptable internal impulse is attributed to an external source)

What is schizoid in the context of cluster A personality disorders?

voluntary social withdrawal, CONTENT with social isolation (e.g. obsession with video games)

What is schizotypal in the context of cluster A personality disorders?

eccentric appearance, odd beliefs or magical thinking

Cluster B personality disorders are characterized by what? What are 3 examples?

"Wild": Bad to the Bone; Antisocial (criminality); Borderline (unstable mood); Histrionic (excessive emotionality); Narcissistic)

What is antisocial in the context of clusber B personality disorders?

disregard for and violation of rights of others, criminality

Splitting is a major defense mechanism of (antisocial/borderline/histrionic/narcissistic) personality disorders.

borderline (splitting - belief that people are all good or all bad)

Cluster C personality disorders are characterized by what? What are 3 examples?

"Worried"; cowardly, compulsive, clingy; Avoidant (socially inhibited, but desire); Obsessive compulsive (behavior consistent with own beliefs and attitudes (vs. OCD)); Dependent

What does avoidant mean in the context of cluster C personality disorders?

hypersensitive to rejection, socially inhibited, DESIRES relationships with others.

What is the difference between schizoid and avoidant?

both withdrawan; schizoid - content with isolation; avoidant - wants relationships with others

Put in order of severity: schizoaffective, schizoid, schizophrenic, schizotypal.

schizoid, schizotypal, schizophrenic, schizoaffective (also has bipolar or depressive mood disorder)

What is the difference between schizotypal and schizoid? Schizoaffective vs. schizophrenic?

Schizotypal - schizoid + odd thinking; Schizoaffective - add bipolar or depressive to schizophrenic

What length of time must something last to be classified as schizophrenia?

6 months (1-6 months -> schizophreniform; <1 month -> brief psychotic)

Anorexia nervosa commonly coexists with what other psychiatric condition?

depression

What is the difference between transvestite and transsexual?

Transvestite - paraphilia; transsexual - desire to be opposite sex

What lab measurements indicate alcohol use?

serum gamma-glutamyltransferase; lab AST value is twice ALT value

What drug is used for alcohol dependence?

naltrexone

What is a symptom of alcohol withdrawal? How do you treat it?

delirium tremens; benzodiazepines

Pinpoint pupils. Depressant. Which one?

opioid

Constipation. Depressant. Which one?

opioid

How is opioid intoxication treated?

naloxone, naltrexone

What drug is used to treat benzodiazepine intoxication?

flumazenil (competitive GABA antagonist)

How is cocaine intoxication treated?

benzodiazepines

Nicotine is a (stimulant/depressant).

stimulant

Nicotine withdrawal. Other than giving small amounts of nicotine, what else can you give?

bupropion & varenicline

Vertical and horizontal nystagmus in a hallucinogen. Which one?

PCP

Which of the following drugs leads to flashbacks: (PCP/LSD/Marijuana/amphetamines).

LSD

What are two options for treating heroin withdrawal?

methadone (long-acting oral opiate); suboxone (naloxone + buprenorphine)

Whernicke-Korsakoff syndrome is caused by what? What are its symptoms?

thiamine deficiency; confusion, opthalmoplegia (paralysis of extraocular muscle), ataxia

What is mallory-weiss syndrome, and what can be its cause?

longitudinal lacerations at the gastresophageal junction caused by excessive vomiting; alcoholism

What is delirium tremens, and what can be its cause?

Life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink; alcohol

How is delirium tremens treated?

benzodiazepines

Treatment for anorexia/bulimia.

SSRIs

Treatment for anxiety.

benzodiazepines, buspirone, SSRIs

Treatment for ADHD

methylphenidate (ritalin), amphetamines (dexedrine)

Treatment for atypical depression

MAOi, SSRIs

Treatment for bipolar disorder.

lithium, valproic acid, carbamazepine, typical antipsychotics

Treatment for depression with insomnia.

mirtazapine

Treatment for OCD.

SSRIs, clomipramine

Treatment for panic disorder.

SSRIs, TCAs, benzodiazepines

Treatment for PTSD.

SSRIs

Treatment for schizophrenia.

antipsychotics

Treatment for Tourette's syndrome.

antipsychotics (haloperidol)

How do amphetamines work?

increase catacholamines at the synaptic cleft, especially NE and dopamine

What are names of antipsychotics (neuroleptics)?

haloperidol + "-azine"s (e.g. trifluoperazine, fluphenazine, thioridazine, chlorpromazine)

How do antipsychotics work?

block dopamine D2 receptors (increase cAMP)

Antipsychotics are mainly used to treat what?

schizophrenia (primarily positive symptoms), Tourette's

Antipsychotics (neuroleptics) are (quickly/slowly) removed from the body. Why?

slowly b/c stored in fat

Dopamine receptor antagonism->hyperprolactinemia->galactorrhea. Side effect of what class of drugs?

antipsychotics

What is neuroleptic malignant syndrome? What class of drugs causes it? How do you treat it?

rigidity, myoglobinuria, autonomic instability, hyperpyrexia; antipsychotics (haloperidol, "azine"s); treat using dantrolene, bromocriptine)

Tardive dyskinesia is a side effect of which class of drugs?

antipsychotics

Which of the following cause anticholinergic, antihistamine, and alpha blockade effects: (chlorpromazine/fluphenazine/haloperidol/thioridazine/trifluoperazine).

chlorpromazine, thioridazine (they are low potency antipsychotics)

Which of the following causes corneal deposits? Retinal deposits? (chlorpromazine/fluphenazine/haloperidol/thioridazine/trifluoperazine).

Chlorpromazine - Corneal; Thioridazine - reTinal

What are examples of atypical antipsychotics?

"apine" and "idone"; (e.g. olanzapine, clozapine, quetiapine, resperidone, ziprasidone) (note: "azine" refers to typical antipsychotics)

How do atypical antipsychotics work?

block dopamine, serotonin, alpha, and H1 receptors

Which of the following may cause significant weight gain: (aripiprazole/clozapine/olanzapine/quetiapine/risperidone/ziprasidone).

clozapine/olanzapine

Which of the following may cause agranulocytosis: (aripiprazole/clozapine/olanzapine/quetiapine/risperidone/ziprasidone).

clozapine (must watch clozapine clozely) (require weekly WBC monitoring) (note: agranulocytosis may predispose to infections)

What are side effects of lithium?

LMNOP: Lithium side effects - Movement (tremor), Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy problems

What would you use to treat generalized anxiety disorder? How does it work?

buspirone; stimulates serotonin receptors (gives a boost)

Name tricyclic antidepressants.

"triptyline" & "pramine" & "pin": amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine (note amoxapine is a tricyclic antidepressant, not an atypical antipsychotic) (think: amiTRIptyline, norTRIptyline->TRIcyclic) (think: 3 is a prime number)

How do tricyclic antidepressants work?

block reuptake of NE and serotonin

Which drug would you use to treat bedwetting?

imipramine (tricyclic)

Which drug would you use to treat OCD?

clomipramine (tricyclic)

What are toxicities of tricyclic antidepressants? How do you treat it?

TRI-C's: convulsions, coma, cardiotoxicity; NaHCO3 for CV toxicity

Name 4 SSRIs.

fluoxetine, paroxetine, sertraline, citalopram

What is serotonin syndrome?

SSRIs combined with any drug that increases serotonin (e.g. MAOi)->hyperthermia, muscle rigidity, cardiovascular collapse, flushing, diarrhea, seizures)

How can you treat serotonin syndrome?

fluids, benzodiazepines for control of delirium, cooling measure for hyperthermia, neuromuscular blockers such as dantrolene for hyperthermia, muscle rigidity, and prevention of rhabdomyolysis (also cyproheptadine, a serotonin receptor antagonist)

Name 2 SNRIs.

venlafaxine, duloxetine

Name 4 MAOi's.

phenelzine, tranylcypromine, isocarboxazid, selegiline (selective MAO-B inhibitor)

How do MAOi's work?

increase levels of amine neurotransmitters (NE, serotonin, dopamine)

Hypertensive crisis with tyramine ingestion and beta-agonists. Which drug class?

MAOi's (note: tyramine is found in wine and cheese)

When is bupropion used?

smoking cessation

How does mirtazapine work?

alpha-2 antagonist (increase release of NE and serotonin); also potent serotonin receptor antagonist

What is maprotiline? How does it work?

atypical antidepressant; blocks NE reuptake

How does trazodone work?

inhibits serotonin reuptake

Priapism. Which atypical antidepressant?

trazodone (called trazoBONE due to male-specific side effects)

What is aversive conditioning? What is an example?

part of classical conditioning; unwanted behaviors are punished by noxious and aversive stimuli; e.g. disulfiram

What is adjustment disorder?

depression or anxiety in the setting of a spychosocial stressor

Mood stabilization. Not lithium. What are 2 options?

carbamazepine & valproic acid

How does reserpine work?

deplete central and peripheral catecholamines and depress sympathetic nerve function->vasodilation and sedation; can cause depression (think: catecholamines)

Childlike. Schizophrenia. Which kind: (catatonic/disorganized/paranoid/residual/undifferentiated).

disorganized

What is the treatment of choice for social phobia disorders?

SSRIs (e.g. fluoxetine)

"azine" What is it? What about "apine"?

typical antipsychotic; apine - atypical antipsychotic

How does selegiline work? What is it used for?

MAOi; Parkinson's

What is tranylcypromine?

MAOi

What is citalopram?

SSRI

What is sertraline?

SSRI

How long must symptoms of schizophrenia last before being diagnosed as schizophrenia? What if it lasts less than that time?

> 6 months; 1-6 months - schizophreniform; <1 month - brief psychotic disorder

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