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Step 1 - Psych 2

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ibench85lbs's version from 2016-07-21 01:59

Section

 

Question Answer
Tx of a teen suffering from PASSRI(Sertra-line)
Specific phobiasExcess fear that interferes with NLfunction
- cued by presence or anticipation or object of fear
- treat with desensitization(vs Social phobia tx: SSRI)
Social phobia-social anxiety disorder
- exaggerated fear of embarrassment in social situations
- treat with SSRIs
OCD-Recurring, intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions (compulsions).
-Ego dystonic: behavior inconsistent with one’s own beliefs and attitudes
- a/w Tourette’s d/o in first degree relatives
OCD tx-1st line:SSRIs
-TCA: clomi-pramine
PTSD-Persistent reexperiencing of a previous traumatic event
- nightmares, flashbacks, intense fear, helplessness or horror.
- Leads to avoidance of stimuli a/w trauma and persistently ↑ arousal or emotional numbing.
-Disturbance lasts > 1 month with onset beginning anytime after event→significant distress and or impaired functioning
PTSD tx(3 main pts)-Psychotherapy: CBT
-Anitdepressants: SSRIs, TCA, MAOI
-Anticonvulsants: for flashbacks and nightmares
Acute stress d/o[duration?]lasts b/w 2 days and 1 month [which d/o]
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Question Answer
GADPattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event. Sleep disturbance, fatigue, difficulty concentrating, muslce tention, irritability and restless fatigue
GAD tx(name 4 grps)-Benzos(clonazepam, diazepam)
-Buspirone
-SSRIs
-Venla-faxine
["...BUS will be ON time, so I take BUSpirONe"]
Adjustment disorder-Begin w/i 3months of a stressor[Like MDD]
-Emotional sx (anxiety, depression) causing impairment following an identifiable (Non-lifethreating)psychosocial stressor and lasting <6 months (> 6 months in presence of chronic stressor)
-33% of kids dx w/ Type 2 DM will get this
MalingeringPatient consciously fakes or claims to have a d/o in order to obtain a specific secondary gain (avoid work, obtain drugs) - avoids treatment by medical personnel
- complaints cease after gain (vs. Facticious disorder)
Factitious d/o1. Created physical/psych symptoms to assume “sick role” to get medical attention=primary gain
Munchausen’s syndrome1.Chronic factitious d/o with predominantly physical signs and sx.
2.Characterized by a hx of multiple hospital admissions and willingness to receive invasive procedures
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Question Answer
Munchausen’s by proxywhen illness in a child is caused by the caregiver - motivation is to assume a sick role by proxy - form of child abuse( Eminem's mom)
Somato-form d/o-Characterized by physical sx with no identifiable physical cause
- both illness production and motivation are unconscious drives
- sx are not intentionally produced or feigned.
-MC in women.
Somati-zation d/ovariety of complaints in multiple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over period of years
Conversion-Atleats one neuro sx: motor or sensory sx (paralysis, blindness, mutism) often following an acute stressor

- patient is aware of but indifferent(Calm and Chill) toward sx
Hypochondriasis-Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance
-persist for atleast 6 months
Body dysmorphic d/opreoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning; patients often repeatedly seek cosmetic surgery
Pain d/oprolonged pain with no physical findings
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Personality d/o

Question Answer
Personality traitAn enduring, repetitive pattern of perceiving, relating to and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts
Personality disorder-Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning person is usually not aware of problem.
- Stable by early adulthood; not usually diagnosed in children.
-either ego dystonic or systonic
Cluster A personality disorders-Odd or eccentric; inability to develop meaningful social relationships. -No psychosis
- genetic a/wschizophrenia
Paranoid personality1. Cluster A type
2. Pervasive distrust and suspiciousness; projectionis a major defense mechanism
Schizoid personality1. Cluster A type
2. Eccentric and reclusive.Voluntary social withdrawal, limited emotional expression, content with social isolation (vs. Avoidant)
3. Usually No fixed delusion(seen in paranoid schizophrenia), but may exist transiently in some
Schizotypal personality1. Cluster A types
2. Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness.
3.Cult or strange religious practices
(type cult ish)
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Question Answer
Cluster B personality d/oDramatic, emotional or erratic; genetic a/w mood d/o and substance abuse
Antisocial personality1. Cluster B types
2. Disregard for and violation of right of others, criminality; males>females; conduct d/o if <18years
3. Hx of abuse(both)
4. Tx: Behavioral therapy
Borderline d/o1. Cluster B types
2. Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, sense of emptiness, female>males
3.splitting is a major defense mech.
tx=DBT & Psych dynamic/analytic therapy
Histrionic personality1. Cluster B types
2. Excessive emotionality and excitability, attention seeking, sexually inappropriate/proactive, overly concerned with appearance
(Accept me)
Narcissistic personality1. Cluster B type
2. Grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demands the “best” and reacts to criticism with rage
(Not on my level)
Cluster C personalities-Anxious or fearful; genetic a/w anxiety d/o
- Worried (Cowardly, Compulsive, Clingy)
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Question Answer
Avoidant personality1. Type C personalities
2. Hypersensitive to rejections, socially inhibited, timid, feeling of inadequacy
3. Desires relationship with others (vs. Schizoid)
4. Evident since before adulthood(vs Social phobia), also Social phobia is fear of embarrassment in a particular setting
5. Cling to relationships like dependent BUT do NOT seek relationships as aggressively.
Obsessive-Compulsive personality1. Type C
2. Preoccupation with order, perfectionism and control. Ego syntonic: behavior consistent with one’s own beliefs and attitudes (vs. OCD)
Dependent personality1. Type C
2. Submissive and clinging, excessive need to be taken care of, low self-confidence
3. Long lasting relationships(unlike Histrionic and Borderline which also have a sense of clinginess)
Schizotypalschizoid + odd thinking(type odd)
Schizophrenicschizoid + greater odd thinking than schizotypal
Schizoaffective disorderschizophrenic psychotic symptoms + bipolar or depressive mood disorder
Schizophrenia time course1.<1mo (brief psychotic disorders, usually stress related)
2. 1-6 months (schizophreniform d/o)
3. >6 mo (schizophrenia)
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Question Answer
Anorexia nervosa1. Excessive dieting +/- purging; intense fear of gaining weight, body image distortion and ↑ exercise, leading to body weight <85% below ideal body weight. A/w↓ bone density. Severe weight loss, metatarsal stress fractures, amenorrhea, anemia, and electrolyte disturbances. Seen primarily in adolescent girls.
-Commonly coexists with depression.
2. Tx=FOOD!!!,
-Behavioral &family therapy,
-Low-dose 2nd gen antipsychotics=weight gain
Bulimia nervosa1. Binge eating +/- purging; Body weight often maintained w/i normal range. Assoc with parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting (Russell’s sign)
-A/w mood, anxiety, sex, substance abuse, and Cluster B and Cluster C
2.TX: SSRI=first line, most effective therapy =CBT
Gender identity disorderStrong, persistent cross-gender identification. 2. Persistent discomfort with one’s sex causing significant distress and/or impaired functioning
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substances

Question Answer
Alcohol intoxicationDisinhibition, emotional lability, slurred speech, ataxia, coma, blackouts,
Serum gamma-glutamyltransferase (GGT)sensitive indicator of alcohol use [not in FA: level is elevated]
Alcohol intoxic. txnaltrexone, disulfiram
Alcohol withdrawal sxTremor, tachycardia, HTN, malaise, nausea, seizures, DT, tremulousness, agitation, hallucinations (including tactile)
Tx for DTbenzo
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Question Answer
Opioids intox.CNS depression, nausea and vomiting, constipation, pupillary constriction (pinpoint pupils), seizures (OD is life-threatening)
Opioids intox.. txNaloxene, Naltrexone
Opioid withdrawal sxAnxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (cold turkey), fever, rhinorrhea, nausea, stomach cramps, diarrhea, yawning. NOT life threatening
Opioid withdrawal tx1.Symptomatic:
-clonidine(alpha-2-agonist) for autonomic sx(also good fr ADD)
-dicyclomine(antichol) for abdom pain

2.-Naloxone + buprenorphine (suboxone)
-buprenorphine(Subling) safeer than methadone
-methadone=long act.recep. agonist;GS for preggo's. but can prolong QT
-naltrexone= compe. antag.
Sedatives MOA-Barbs and Benzo both potentiate GABA by incre freq of CL- channel opening
-At high dose Barbs act as GABA agonist
Barbiturates use, intoxi.-epilepsy & anesthetics
-Low safety margin, respiratory depression
Barbiturates intox. tx-sx management (assist respiration, ↑ BP)
-Alkalinize urine w/ NaHCO3 to promote renal excretion
Barbi-turates w/danxiety, seizures, delirium, life-threatening CV collapse
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Question Answer
Benzo intox.Greater safety margin - ataxia, minor resp distress [removed in FA 2011 - amnesia, somnolence, additive effects with alcohol]
Benzo intox. txFluma-zenil (competitive GABA antagonist)
Benzo w/drebound anxiety, seizures, tremor, insomnia [w/drawal from what?; no entry in FA 2011]
Amphetamine action & intox.-Block reuptake and promote release of DE and NE
-Psychomotor agitation, impaired judgement, pupillary dilation, HTN, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever
-designer drugs ex. molly release DE, NE, ST:can lead to Serotonin syndrome if combined w/ SSRI
-chronic use= meth/yuck mouth, hypertherm,and rhabdomyolysis=RF
Amphetamine w/dPost-use “crash” including depression, lethargy, HA, stomach cramps, hunger, hypersomnolence
Cocaine intox.-Blocks DE reuptake
-Euphoria, psychomotor agitation, impaired judgement, tachycardia, pupillary dilation,Resp. depress. ,HTN, hallucinations (including tactilevs. EtoH w/d), paranoid ideations, angina, AMI
Cocaine intox. tx.benzos
Cocaine w/dPost-use “crash” - including severe depression and suicidality, hypersomnolence, malaise, severe psychological craving, [removed in FA 2011: fatigue; crash & depression are nonspecific sx's of this "class"]
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Question Answer
Caffeine action and intoxication-Adenosine antag.=incre CAMP and stim DE system
-Restlessness, insomnia, ↑ diuresis, muscle twitching, cardiac arrhythmias
-death may occur due to seizures and resp. fail.
Caffeine withdrawalHeadache, lethargy, depression, weight gain [w/drawal from what]
Nicotine action & intoxication-stim SNS &PNS: addictive via DE system
-Restlessness, insomnia, anxiety, arrhythmias
Nicotine withdrawalIrritability, headache, anxiety, weight gain, craving [w/drawal from?]
Nicotine withdrawal treatment-Varenicline(chantix)=alpha4Beta2 nAchR partial agonist.mimics & prevents w/d
-Bupropion(Zyban)=antidepress, partial agonist, inhib DE reuptake
PCP action & intoxication-antag. NMDA receptor & activates DE neurons
-Belligerence, impulsiveness, fever, psychomotor agitation, vertical, rotary and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirium
PCP withdrawalDepression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep [w/drawal from what?]
Halluc(ex.LSD)
intoxication
Marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation
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Question Answer
Marijuana intox.Euphoria, anxiety, paranoid delusions, perceptions of slowed time, impaired judgement, social withdrawal, ↑ appetitie, dry mouth, hallucinations, conjunctival injection
Marijuana w/d,peak,UA-Irritability, depressions, insomnia, nausea, anorexia.
-Most sx peak in 48 hours and last for 5-7 days.
- Can be detected in urine up to 1 month after use.
Heroin addiction1. Users at risk for hepatitis, abscesses, overdose, hemorrhoids, AIDS and R sided endocarditis
2. Look for track marks (needle sticks in vein)
3. Sx of opioid intoxication (pinpoint pupils, respiratory depression, coma)
Tx for heroin overdoseNaloxone and Naltrexone [competitively inhibit opioid rcptrs; used in cases of overdose and for dependence treatment, respectively]
Tx for heroin addictionMethadone, Suboxone (naloxone + bupre-norphine)
Methadonelong-acting oral opiate; used for heroin detoxification or long-term maintenance
Suboxonenaloxone + buprenorphine (partial agonist); long acting with fewer w/d sx than methadone and naloxone is not active when taken orally
Alcoholism complicationscirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy
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Question Answer
Wernicke-Korsakoff syndrome-Caused by thiamine deficiency
- Triad of confusion, ophthalmoplegia and ataxia (wernicke’s encephalopathy)
- may progress to irreversible memory loss, confabulation, personality change (Korsakoff’s psychosis)
- assoc w/periventricular hemorrhage/necrosis of Mami-llary bodies.
Wernicke-Korsakoff txIV vitamin B1 (thiamine) [tx for?]
Mallory - Weiss syndrome-Longitudinal lacerations at the gastroesopageal junction caused by excessive vomiting
- often presents with hema-temesis
- a/w pain (vs. esophageal varices)
Mallory-Weiss syndrome txDisulfiram (to condition pt to abstain from alcohol use), supportive care. Alcoholics Anonymous and other peer support groups are helpful in sustaining abstinence
Delirium tremens-Life threatening alcohol wi/d sx that begins 2-3 days after last drink.
- Sx in order of appearance: tachycardia, tremors, anxiety, seizures, psychotic sx (hallucinations, delusions), confusion
EtoH w/d sx-Earliest sx=6-24hrs after last drink

-Tonic-clonic seizures occur b/w 6-24rs after last drink and peaks 13-24hrs

-seizure predisposition=low Mg
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