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B & B Exam, Part 2

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eem8u's version from 2016-10-22 19:27

Personality disorders

Question Answer
Cluster A, primary sxodd or eccentric (paranoid, schizoid and schizotypal)
Cluster B, primary sxdramatic, emotional or erratic (antisocial, borderline, histrionic, narcissistic)
Cluster C, primary sxanxious or fearful disorders
****schizotypal PD and schizophrenia - 3 shared biologic fxabnormal working memory, eye tracking abnormalities, poor executive fx,
****schizotypal PD and schizophrenia - compare brain structurereduced volume of superior temporal gyrus in both, frontal lobe volume PRESERVED in SPD
Borderline PD - clinical feat.extreme emotional instability (esp anger), hypersensitivity to interpersonal interactions, perceived rejection , self-injury, impulsivity/impulsive aggression
***Borderline PD - epi.F > M / prevalence of 2-5%
Antisocial PD - clinical feat.*pervasive disregard for/violation of rights of others w/ LACK of REMORSE (**must be at least 18, >18 = conduct disorder)
Borderline PD - txDialectical Behavioral Therapy (to manage self-destructive behaviors and improve coping), **psychoeducation, some medication (serotonergic, antipsychotic, mood stabilizers)
Borderline PD - neurobiology findings***amygdala hyperactivity to emotional stimuli (prefrontal amygdala imbalance), poor self monitoring of emotion (?inability to recruit anterior insula), social cognition dysfunction
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Temperament and Personality

Question Answer
temperament definednatural predisposition (Biologically-based behavioral & emotional tendencies present early in life)
personality definedcharacters way one feels/thinks/behaves/relates (= temperament + sociocultural/environment/epigenetics/neurogenesis/development) — may change over time
Costa & McCrae’s Five Factor Model “OCEAN”vast array of human personality summarized into 5 broad domains/dimensions - that collectively predict most of social and health outcomes (open/concientious/extraversion/agreeableness/neurotisism)
extraversion & assc. qualitiestendency to experience positive emotions (assertive, sociable, talkative)
neuroticism & assc. qualitiestendency to experience NEGATIVE emotions (anxiety/self-conciousness, irritability)
conscientiousness & assc. qualitieslinked to academic/occupation success & behavior that PROMOTES HEALTH (industrious, orderly, self-discipline)
agreeableness & assc. qualitieslinked to empathy, social information processing (cooperation, compassion, politeness)
openness & assc. qualitiestendency to process abstract/perceptual information (imagination, intellectual engagement, aesthetic interest)
Genetics account for ___ % of variabilityabout 50% (see studies on heritability for extroversion/neuroticism)
Key of gene x environment interaction in personalityNONlinear, complex interplay between innate traits/context
Personality Traits & Risk for psychiatric disordershigh neuroticism (anxiety, MDD), low agreeable/conscientiousness (juvenile delinquency), low extraversion
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Models of the Mind
Question Answer
Freud’s topographicconscious, preconscious (memory), unconscious (most of our mind)
Freud’s structural modelid / ego / superego - id is the set of uncoordinated instinctual trends; the super-ego plays the critical and moralizing role; and the ego is the organized, realistic part that mediates between the desires of the id and the super-ego.[1] The super-ego can stop one from doing certain things that one's id may want to do
Mature defenses promote flexible adaptation to reality; Cognitively complex
Immature defenses promotedistorted reality
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Childhood development, USMLE milestones

Question Answer
Moro disappears(by 3 mo)
rooting disappears(by 4 mo)
palmar disappears(by 6 mo)
Babinski disappears(by 12 mo)
lifts head up prone(by 1 mo)
rolls and sits(by 6 mo)
crawls(by 8 mo)
stands(by 10 mo)
walks(by 12–18 mo)
orients to nameby 9 mo
Object permanence, time and definitionobjects continue to exist even when they cannot be observed (by 9 mo)
Oratory—says “mama” and “dada (by 10 mo)
Social smile(by 2 mo)
Stranger anxiety(by 6 mo)
Separation anxiety(by 9 mo)
Rapprochementmoves away from and returns to mother (by 24 mo)
object constancydevelopmental skill which most children do not develop until two or three years of age = when Mommy leaves the room, she's still on the same planet, and will reappear again
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Childhood Development, Developmental Stages

Question Answer
Piaget Stages, describecognitive development - sensory motor (0-2), pre-operational (3-6), concrete operations (7-12), formal operation
Sensorimotor Stage (Piaget Stages)ages 0-2; no language or logic
Pre- operational Stage (Piaget Stages) ages 3-6; preschool, has language without logic / magical thinking, animism, no concept of real vs imaginary
Concrete operations (Piaget Stages) age 7-12; onset of logical thought
Formal operations (Piaget Stages)13+; logic + abstract thought/imaginign possibilities
Erikson developmental stages8 stages of “conflict” - trust vs mistrust (infant) / autonomy vs shame and doubt (toddler) / initiative vs guilt (preschool) / industry vs inferiority (school age) / indent vs role confusion (adolescence) / identity vs isolation (young adulthood) / generatively vs stagnation (middle age) / integrity vs despair (old age)
Freud developmental stages(psychosexual categories) oral (0-1, babies suck on things), anal (1-3, toilet trained/focuss on controlling bowel and things in general), genital (3-5, interest in babies, playing with genitals)
Kohlberg Developmental stagesmoral development/ PRECONVENTIONALITY (until 10 yo, defined by geocentricism, stage 1 = punishment/obedience, stage 2 = relativists = does it satisfy my need) / CONVENTION (adolescent, measured against society, desire to support stereotypically good behavior, **most peoples stay here) / POSTCONVENTION (utilitarianism, guided by universal moral principles)
Mahler - theory of early childhood developmentfocus on relationship and EVOLUTION OF SEPARATION between baby and caregiver in early development (normal autism, symbiosis @ 2 mo, differentiation @ 4 mo, practicing @ 1 yr, rapprochement @ 1-2y, object constancy @ 2-5 y)
Bowlby & Ainsworth - development theory ****Attachment theory (secure vs insecure)
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Childhood Development, Milestones

Review the major motor, cognitive, language, and social/emotional milestones expected at each of the following ages
Question Answer
NewbornMOTOR - basic reflexes disappear, limited purposeful / LANG - basic cry, coo @ 2-4 mo, babble @ 5-6 / COG - “sensorimotor” stage, pre-intelligence
6 monthsMOTOR -rool &sit , LANG- babble, COG- working memory, stranger anxiety
1 yrMOTOR - walking, LANG - mama/dada/one other word / COG - object permanence (@ 9 mo) / EMO -trust vs mistrust (will i get my needs met?), separation anxiety (10mo - 2 years)
2 yrsMOTOR - run/climb/copy a line / LANG - 2 word phrases/250 words / COG - pre operational (lang w/o logic) / EMO - “NO” development of shame and doubt
3 yrsMOTOR- tricycle, copy a circle, toilet / LANG- grammar, colors, name / EMO - gender ID development, parallel play, object constancy
latency (School age 5-10, less active psychosexual development)MOTOR - as adult, COG - @7, decreased egocentrism, most of brain developed, logic begins / SOC- sexual preference established, industry vs inferiority, healthy narcissism
adolescence**huge development of PFC, limbic and mesocortical regions / COG - capacity for abstraction / SOC - identity vs role confusion, changes in parental relationships, importance of peers
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Ego defenses, Mature v Immature (FA 509)! and Ernst Slide Show!!

ADHD And Autism

ADHD
Question Answer
Dx of ADHDinattention set, hyperactivity-impulsivity set, some symptoms before age 12, at least 2 settings for at least 6 months
Epidemiology of ADHD3M>1F (boys hyperactive, girls inattentive), 8% prevalence in kids
Heritability of ADHDup to 0.8 (highly heritable!!)
***Neurobiology of ADHDtrouble filtering out noise ) NE (enhances signals) vs DA (filters out irrelevant signals)
***structural brain changessmaller volume of PFC / corpus callosum / cerebellum
***functional brain changes (2)less efficient information processing, reduced striatal activation (striatum imp for attn/motor planning, loaded with DA receptor’)
Tx of ADHDamphetamines (block reuptake and stimulate release of DA)
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Autism
Question Answer
***Dx criteria of Autismimpaired social interaction/communication in 3 domains 1) social-emotional reciprocity 2) nonverbal behavior 3) developing/maintaining reln PLUS restricted/repetitive patterns of behavior *must be in early childhood
co-morbiditiesADHD (up to 70%), 1/3 seizures, intellectual disability, anxiety, aggression
*** Genetic heritabilityup to 90% **most heritable of all disorders // either rSNPs or single genes (such as Fragile X) —> MZ is about 70-80% and DZ is up to 35%
environmental risk factorsadvanced parental age, intrauterine infection, toxins, medications
*** Risk alerts for autismimpairments in joint attention, eye contact, response to name being called, expressive and receptive language, emotional tone/affection, interest in other children, and pretend play
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