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158 terms

First aid psychiatry

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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
What is schizoaffective disorder?
schizophrenia + mood disorder (e.g. depression, mania)
Depression is associated with (increased/decreased) REM sleep.
increased
How do you treat narcolepsy?
methylphenidate
Sore throat and fevers. Person with both "positive" and "negative" symptoms of schizophrenia. What drug caused it?
clozapine->agranulocytosis->risk of infections
What is clomipramine?
tricyclic antidepressant (think: "pramine"-prime-3-tricyclic)
What is risperidone?
atypical antipsychotic "idone"
Anorexia. Which antidepressant would cause seizures?
bupropion
What is first line treatment for multiple personality disorder?
antipsychotic (e.g. haloperiodol or risperidone)
How do you treat acute dystonia caused by antipsychotics?
anticholinergic (e.g. benztropine) (note: beta-blockers can treat akathisia (restless leg))