Psychiatry - Pathology 1

whatever's version from 2016-05-31 18:36


Question Answer
Classical conditioningLearning that occurs with regard to a conditioned reaction (CR) in which an old stimulus (UCS...meat) to a natural reaction (UCR ...salivation) occurs by being associated with a new stimulus (CS... bell) that is presented in conjunction with the old stimulus ( Used with behaviors that are involuntary
Operant conditioningLearning a new behavior to an old stimulus that occurs when an old stimulus is associated with a positive or negative reinforcement (either being added or subtracted): This is used in situations with voluntary reactions

operant conditioning subtypes

Question Answer
Positive reinforcementDesired reward produces action (mouse presses button to get food).
Negative reinforcementTarget behavior (response) is followed by removal of aversive stimulus (mouse presses button to turn off continuous loud noise) .
PunishmentRepeated application of aversive stimulus extinguishes unwanted behavior.
ExtinctionDiscontinuation of reinforcement (positive or negative) eventually eliminates behavior.

Transference and Countertransference

Question Answer
TransferencePatient projects feelings about formative or other important persons onto physician (e.g., psychiatrist is seen as parent) .
CountertransferenceDoctor projects feelings about formative or other important persons onto patient (e.g., patient reminds physician of younger siblings)


Question Answer
Ego defensesUnconscious mental processes used to resolve conflict and prevent undesirable feelings (e.g.,anxiety, depression) .

Immature Ego defenses

Question Answer
Acting OutUnacceptable feelings and thoughts are expressed through actions.(tantrums)
DissociationTemporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress. Extreme forms can result in dissociative identity disorder (multiple personality disorder).
DenialAvoidance of awareness of some painful reality. A common reaction in newly diagnosed AIDS and cancer patients .
DisplacementProcess whereby avoided ideas and feelings are transferred to some neutral person or object (vs. projection) . Mother yells at her child, because her husband yelled at her.
FixationPartially remaining at a more childish level of development (vs. regression) . Men fixating on sports games.
IdentificationModeling behavior after another person who is more powerful (though not necessarily admired ) . Abused child identifies himself/herself with an abuser.
Isolation (of affect)Separation of feelings from ideas and events. Describing murder in graphic detail with no emotional response.
ProjectionAn unacceptable internal impulse is attributed to an external source (vs. displacement) . A man who wants another woman to think his wife is cheating on him .
RationalizationProclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame. After getting fired, claiming that the job was not important anyway.
Reaction formationProcess whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite (vs. sublimation). A patient with libidinous thoughts enters a monastery.
RegressionTurning back the maturational clock and going back to earlier modes of dealing with the world (vs. fixation). Seen in children under stress such as illness, punishment, or birth of a new sibling (e.g., bed wetting in a previously toilet-trained child when hospitalized).
RepressionInvoluntary withholding of an idea or feeling from conscious awareness (vs. suppression). Not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconscious.
SplittingBelief that people are either all good or all bad at different times due to intolerance of ambiguity. Seen in borderline personality disorder. A patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly.

Mature Ego Defenses Mature adults wear a SASH: Sublimation, Altruism, Suppression, Humor.

Question Answer
AltruismGuilty feelings alleviated by unsolicited generosity toward others. Mafia boss makes large donation to charity.
HumorAppreciating the amusing nature of an anxiety-provoking or adverse situation. Nervous medical student jokes about the boards.
SublimationProcess whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system (vs. reaction formation). Teenager's aggression toward his father is re-directed to perform well in sports.
SuppressionVoluntary withholding of an idea or feeling from conscious awareness (vs. repression). Choosing not to think about the USMLE until the week of the exam.


Question Answer
Infant deprivation effectsWEak, Wordless, Wanting (socially), Wary
Deprivation for > 6 months can be irreversible
↓ muscle tone;Poor language skills;Poor socialization skills;Lack of basic trust;depression (infant withdrawn/unresponsive);Weight loss;Physical illness
Severe deprivation can lead to infant death
Signs of child abuse (physical)Head fractures
subdural hematomas
multiple bruises
rib fracture
retinal hemorrhage or detachment
*abuser male ~3000 deaths/yr & %80<3yrs
Signs of child abuse (sexual)Genital, anal, or oral trauma, female circumcision
Usually 9-12 y/o & abuser male, 50% within families (uncle,older brother, step dad >dad)
Neglectmust be reported just like abuse. Failure to provide a child with adequate food, shelter, supervision, education, and/or affection. Most common form of child maltreatment. Evidence: poor hygiene, malnutrition, withdrawal, impaired social/emotional development, failure to thrive.

Childhood and early-onset disorders

Question Answer
Attention-Deficit Hyperactivity Disorder (ADHD)Onset before age 12. Limited attention span and poor impulse control. Characterized by hyperactivity, impulsivity, and inattention in multiple settings (school, home, places of worship,etc.). Normal intelligence, but commonly coexists with difficulties in school . Continues into adulthood in as many as 50% of individuals. Associated with ↓ frontal lobe volumes and anterior cingulate gyrus. Decreased dopamine. Treatment: methylphenidate, amphetamines, atomoxetine, dextroamphetamine, behavioral interventions (reinforcement, reward).
Conduct disorderrepetitive and pervasive behavior violating the basic rights of others (physical aggression, destruction of property, theft) After 18 years of age, many of these patients will meet criteria fordiagnosis of antisocial personality disorder.
Oppositional defiant disorderHostile, defiant behavior toward authority figures in the absence of serious violations of social norms
Tourette's syndromeOnset before age 18, Indirect pathway of basal ganglion defect (increased dopamine)
Sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for > 1 yr
Coprolalie - involuntary obscene speech - only in 10-20% of pts
assoc w OCD, ADHD
* antipsychotics (Halopridole, Pimozide, clonidine) and Behavioral therapy to treat
Separation anxiety disorder7-9 y/o - Overwhelming fear of separation from home or loss of attachment figure.
may lead to factitious physical complaints to avoid going to or staying at school
Tx: SSRIs and relaxation techniques/behavioral interventions

Pervasive Developmental Disorders

Question Answer
Autistic disorderSevere language impairment and poor social interactions
Greater focus on objects rather than people, restricted interests, Pronoun reversal, preference for inanimate objects, linked to chromosome 11 and 15, Associated w prenatal/perinatal injuries e.g. rubella 1st trimester,mother w asthma, allergies, psoriasis
Repetitive behavior and usually below-normal intelligence
Rarely accompanied by unusual abilities (savants). More common in boys.
Treatment: behavioral and supportive therapy to improve communication and social skills.
Medication when appropriate (i.e., disruptive/harmful behavior).
Asperger's disorderMilder form of autism - all-absorbing interests, repetitive behavior, problems with social relationships
Normal intelligence and lack verbal or cognitive deficits. no language impairment
Rett's disorderX-linked - girls (males die in utero or shortly after birth)
Regression characterized by loss of development, loss of verbal abilities, mental retardation, ataxia, hand-wringing
Usually 1-4 y/o
Childhood disintegrative disorder3-4 y/o - Marked regression in multiple areas after at least 2 years of normal development
Loss of expressive or receptive language skills, social skills, or adaptive behavior, bowel or bladder control, play, or motor skills
*more common in boys