Step 1 - Psych 1

denniskwinn's version from 2015-04-25 16:14


Question Answer
Physical abuse1. Abuser usually female primary caregiver
3. 3000 deaths/year in the US
4. predisposes to MDD in future
Sexual abuse1. Genital/Anal trauma, STDs, UTIs
2. Usually male abuser, known to victim
3. Peak incidence 9-12 years of age
Child neglect1. Failure of food, shelter, supervision, education, affection 2. Most common form child maltreatment 3. Evidence = poor hygeine, malnutrition, withdrawal, impaired social/emotional development, failure to thrive
Anaclitic depression1. Depression of infant attributable to continued separation from caregiver. Infant becomes withdrawn and unresponsive.
2. Reversible, but prolonged separation can result in failure to thrive or other developmental disturbances
Regression in children1. Children regress to younger patterns of behavior under conditions of stress
2. Physical illness, punishment, birth of a new sibling, or fatigue
Attention-deficit hyperactivity disorder (ADHD)1.Limited attention span and poor impulse control.
2.Onset before age 7.
3.Characterized by hyperactivity, motor impairment and emotional lability. Normal intelligence, but commonly coexists w/difficulties in school. May continue in adulthood with as many af 50%.
4. Associated with decreased frontal lobe volumes


Question Answer
Conduct disorder-Repetitive and pervasive behavior violating social norms (physical aggression, destruction of property, theft)
- after 18 yrs diagnosed as antisocial personality disorder(Crossing social nor lines)
Oppositional defiant d/oEnduring patterns of hostile, defiants behavior toward authority figures in the absence of serious violations of social norms
Tourette’s syndrome1.Rapid, recurrent, non-rhythmic stereotyped motor movements and vocalizations that persist for >1 year.
- No tic free moment for longer than 3 consecutive months
2. Obscene speech (Coprolalia) found in 20% of patients
3. Onset before age 18; avg. age 7y/o
4. Multiple motor tics and 1+ vocal tics
Tourettes TxAntipsychotics (haloperidol)
Alpha 2agonist(Clonidine=s/e sedation, guanfacine)
ADHD treatment1.Methylphenidate (Ritalin)
2.Amphetamines (dexedrine)
Stimulants S/E=TICS!!!!!
3.Atomoxetine (non-stimulant SNRI)
Separation anxiety disorder-Overwhelming fear of separation from home or loss of attachment figure.
-May lead to factitious physical complaints to avoid going to school
- commonly 7-9 years of age

Pervasive Development Disorder

Question Answer
Autistic d/o-Severe language impairment and poor social interactions.
-Greater focus on objects than on people.
-Repetitive behavior and usually below normal intelligence.
Autism txBehavioral and supportive therapy to improve communication and social skills
Asperger’s d/o-A milder form of autism
-Characterized by all-absorbing interesting, repetitive behavior
- NL intelligence and lack verbal or cognitive deficits.
No Language impairment.
Rett’s d/o-X-linked d/o seen mostly in girls (lethal in boys)
-Sx become apparent starting at ages 1-4, followed by regression characterized by:
-loss of develop.
-loss of verbal abilities, ataxia and stereotyped hand wringing.
-100% MZ twins
Childhood disintegrative d/o-Marked regression in multiple areas of func. after at least 2 years of apparently NL development.
-Significant loss of expressive and receptive language skills, social skills or adaptive behavior, bowel or bladder control, play or motor skills.
-Common onset b/w 3 and 4 years of age.
- More common in boys.
DD Autistism from SchizoAsk if they were dx when younger


Question Answer
NT changes in anxietyNE, ↓GABA, ↓5-HT [neurotransmitter changes in?]
NT changes in DepressionNE, ↓5-HT, ↓ dopamine [neurotransmitter changes in?]
NTchanges in Alzheimer’s dementia↓Ach [neurotransmitter changes in?]
NT changes in Huntington’s disease↓GABA, ↓ACh [neurotransmitter changes in?]
NT changes in Schizophrenia↑ dopamine [neurotransmitter changes in?]
NT changes in Parkinson’s Disease dopamine, serotonin, ACh [neurotransmitter changes in?]


Question Answer
Order of loss of orientationtime then place then person
Orientation definitionAbility to know who he or she is, what date and time it is and what his or her present circumstances are
Common causes of loss of orientationAlcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional deficiencies [common causes of?]
Retrograde amnesiainability to remember things that occurred before a CNS insult
Anterograde amnesiainability to remember things that occurred after a CNS insult (no new memory)
Korsakoff’s amnesia-Classic anterograde amnesia caused by thiamine deficiency.
-Leads to B/L destruction of mamillary bodies
-may also lead to some retrograde amnesia.
-Seen in alcoholics and associated with confabulations.
Dissociative amnesiainability to recall important personal information, usually subsequent to severe trauma or stress.(Bourne)


Question Answer
Delirium1.Waxing and waning level of consciousness with acute onset.
2.Rapid ↓ in attention span and level of arousal.
3.Acute changes in mental status, disorganized thinking, hallucinations, illusions, misperception, disturbance in sleep-wake cycle, cognitive dysfunction.
4.Most common psychiatric illness on medical and surgical floors.
5. Abnormal EEG.
Dementia1.Gradual ↓ in cognition
2. No change in level of consciousness (patient is alert)
3. Characterized by memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement.
4. ↑ incidence with age
5. Normal EEG
Dementia causes (9)1. AD
2. Vascular thrombosis/hemorrhage
3. HIV
4. Pick’s(frontal-temp lobe) disease
5. Substance abuse
6. CJD
7.Lewy body
8. NL pressure hydrocephalus
9. Huntingtons

5=name vs 4=cause
Hallucinationperception in the absence of external stimuli (seeing a light that is not actually present)
Illusionsmisinterpretations of actual external stimuli (seeing a light and thinking that it is the sun)
DelusionsFalse beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary (thinking the CIA is spying on you)
Loose associationsDisorders in the form of thought (the way ideas are tied together)


Question Answer
Visual hallucinations common in-Delirium
-Lewy body dementia [type of hallucination that's common]
Auditory hallucinations common inSchizophrenia [type of hallucination that's common]
Olfactory hallucinations common inAura in psychomotor epilepsy (temporal lobe epilepsy) and in brain tumors [type of hallucination that's common]
Tactile hallucinations common inAlcohol withdrawal, also seen in cocaine abuse [type of hallucination that's common]
Hypnagogic hallucinationoccurs while going to sleep [type of hallucination that's common]
Hypnopompic hallucinationsoccurs while waking from sleep [type of hallucination that's common]

Psychotic disorders

Question Answer
Schizo spectrumBPD, Schizophreniform D, Schizophrenia
Other Psychotic DivisionsDelusional D, Shared Psychotic d/o
5 subtypes of schizophrenia1.Paranoid (delusions)
2. Disorganized (with regard to speech)
3. Catatonic (automatisms)
4. Undifferentiated
5. Residual
Schizophrenia1. Periods of psychosis and disturbed behavior with a decline in functioning > 6mo.
2. ↑ dope. activity, ↓ dendritic branching
3. Comorbid w/ subs. abuse
4. More likely to have a parent w/ psychotic or schizotypal d/o
5. Ealry onset=poor prognosis
Schizophrenia dx
A.Requires 2 + more (for 1 month period)of:
1. Delusions
2. Hallucinations - often auditory
3. Disorganized speech (loose associations)
4. Disorganized or catatonic behavior
5. “Negative sx” - PLANT
B. Social/occupational dysfunc.
C. 6 months
D. exclusionary criteria
Brief psychotic disorder-1day < sx < 1 month usually stress related
-full return to "NL"
- >1 Positive sx

[sx duration needed to dx what?]
Neg sx of schizophrenia- aPathy
- aLogia
- -Affective flattenin
-aTtention deficit


Question Answer
What differentiations delusion from everything else ...ex obsessions?incite(Frontal lobe pathology)
Schizophreniform d/o(duration to dx)1-6 months [sx duration needed to dx what?]
Schizoaffective d/o, and how to differentiate from MDD w/ psychotic features1At least 2 weeks of stable mood with psychotic symptoms(similar to schizophrenia criterion A) plus a major depressive, manic or mixed episode
2. Two subtypes: bipolar or depressive
Delusional disorder1.-Fixed, persistent, nonbizarre belief system for atleast 1 month.
-Functioning otherwise not impaired.
-Often self limited.
-Grandiose ideas
-Erotomatic(de Clerambault's)
-Somatic(infestation, dysmorphophobia, or halitosis)
-Mixed, Unspecified
Shared psychotic disorder-Development of delusions in a person in a close relationship with someone with delusional disorder.
-Often resolves upon separation
-Delusional but behavior is NOT bizarre
-impairment worse in primary case than SPD pt
Dissociative identity d/o-Presence of 2+ distinct identities or personality stated.
-MC in women, a/w history of sexual abuse
Depersonalization d/opersistent feelings of detachment or estrangement from oneself
Dissociative fugue-Abrupt change in geographic location with inability to recall past, confusion about personal identity or assumption of a new identity.
-Assoc w/traumatic circumstances.
- Leads to significant distress or impairments.
-Not the result of substance abuse or general medical condition.


Question Answer
Schneider's first rank sx (main two)-Delusional perception
-Somatic passivity(puppet)
Psych determinants of Schizophrenia-Projection
-Unconscious process=his/her's unacceptable feelings to another
-Ego process= for the organism
-Frontal lobe impairment
Social determinants of Schizophrenia-Schizo mommy
-Downward drift=schizo causes poverty
-Stress-Diathesis model=genetic vs stress
Culturally-bound syndromerecognizable disease only within a specific society or culture
Cultural-sanctionedNormal in culture
Substance-Induced psychosis (intox.) that must be r/o before schizoAll substances except caffeine and nicotine
Substance-induced psychosis(w/d) that must be r/o before schizoAlcohol and sedatives, hypnotics

Unspecified delusional disorder

Question Answer
Name 4Capgra's, Fregloi's, Cotard, Otoscopic illusions
Capgra's syndromeclose relatives/friends replaced by imposter; a/w other functional psychosis
Fregoli's syndromevariant of Capgra's; familiar ppl can change themselves to other ppl
Cotard syndromeloss of status, heart, blood, and intestines


Question Answer
Manic episode1. Distinct period of abnormality and persistently elevated, expansive or irritable mood lasting at least 1 week.
-Often disturbing to patient.
Manic diagnosis (7)3+ of following:
2. Irresponsibility - seeks pleasure without regard to consequences (hedonistic)
3. Grandiosity - inflated self esteem
4. Flight of ideas
5. ↑ in goal directed Activity/psychomotor agitation
6. ↓ need for Sleep
7. Talkativeness or pressured speech
Hypomanic episode-Like manic except mood disturbance is not severe enough to cause marked impairments in social/ occupational functioning or to necessitate hospitalization.
-No psychotic features
Bipolar d/oPresence of at least 1 manic or hypomanic episode and depressive episodes.
2. Mood and functioning usually NL between episodes.
3. Use of antidepressants can ↑ mania
4. High suicide risk.
Bipolar tx-Mood stabilizers (lithium, valproic acid[also a anti-convulsant] -carbamazepine)
-Atypical antipsychotics
Cyclothymic disorderMilder form of bipolar disorder lasting at least 2 years


Question Answer
Depressive sx5/ 8 SIG E CAPS = Sleep disturbance, (loss of) Interest, Guilt (or feelings of worthlesness), (loss of) Energy, (loss of) Concentration, Appetite/weight changes, Psychomotor retardation/agitation, Suicidal ideations, and depressed mood
Major depressive d/o-Recurrent
- 5/9 of the sx
- requires 2+ major depressive episodes with a sx free interval of 2 months
(greater than a year)
DysthymiaMilder form of depression lasting at least 2 years
Seasonal affective d/o [a/w? improves w/?]A/w winter season; improves in response to full-spectrum light exposure
Sleep patterns of depressed patients1. ↓ slow wave sleep
2. ↓ REM latency= ↑ REM early in sleep cycle
4. ↑ total REM sleep
5. Repeated nighttime awakenings
6. Early-morning awakening (important screening question)
Atypical depression1. hypersomnia 2.overeating 3.mood reactivity (ability to experience improved mood in response to positive events vs. Persistent sadness) 4. A/wweight gain and sensitivity to rejection. Most common subtype of depression.
Atypical depression txMAOI, SSRIs
ECT-Tx option for MDD refractory to other tx.
- Produces painless seizure in anesthetized patient.
-Major adverse effects are disorientation and anterograde/retrograde amnesia
RF for suicide completion1.SAD PERSONS
- Sex (male)
-Age (teenager or elderly)
-Previous attempt
-Ethanol (or drug) use
-Rational thinking(lost)
-Sickness (medical illness, 3 + more prescription medications),
-Organized plan,
-No spouse (divorced, widowed, or single especially if childless), Social support lacking...
2.Women try more often, men succeed more often


Question Answer
Substance dependence+3/7 in a year
1. Withdrawal
2. Tolerance
3. Substance taken in larger amounts or over longer time than Intended
4. Persistent unsuccessful attempts to Cut down
5. Significant Time spent obtaining, using or recovering from subtance
6.Activities reduced because of substance use.
7. Continued use in spite of knowing the problems that it causes.(WTICTAC)
Substance abuse1.Work affected
2.Interpersonal conseq.
4.Dangerous activities