Psych set 5
Terms
undefined, object
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- Classes of psychological tests
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1. Objective: multiple choice, scored by a computer
2. Subjective: no right answers, scored by the giver - Stanford-Binet test
- Objective, IQ test for adults
- Wechsler Intelligence Scale for Children test
- Objective, IQ test for children (4-17)
- Rorschach test
- Subjective, pts describe what they see in an inkblot
- Thematic Apperception Test
- Subjective, pts describe what is going on in a cartoon drawing of people
- Beck Depression Inventory
- Objective, screens for depression
- Minnesota Multiphasic Personality Inventory
- Objective, measures personality type
- Halstead-Reitan Battery test
- Used to determine the location and effects of specific brain lesions
- Luria-Nebraska Neuropsychological Battery test
- Assess a wide range of cognitive functions and tells you the patient's cerebral dominance (left or right)
- Diagnostic criteria for anorexia nervosa
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1. Body weight is 15% below normal
2. Pt has distorted body image
3. Amenorrhea - Cause of death in anorexia nervosa
- Electrolyte imbalance, cardiac arrhythmias, infection
- Treatment of anorexia nervosa
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1. Hospitalization to monitor weight and correct electrolyte imbalance
2. Psychotherapy - Hyperactive with short attention span; figety and cannot pay attention or wait for turn
- ADHD
- Age at which symptoms of ADHD must be present for diagnosis
- Before age 7
- Treatment of ADHD
- Psychostimulants (methylphenidate, dextroamphetamine)
- SE of Rx treatment of ADHD
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SE of methylphenidate & dextroamphetamine:
*growth suppression*
insomnia, abdominal pain, decreased appetite, tics - Three year old child with impaired social interaction and communication, and restricted activities and interest
- Autism
- Cause of Autism
- Idiopathic, but potential cause is congenital rubella
- DDx for Autism
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1. Schizophrenia (look for age and + s/s)
2. Deafness (look for parental love)
3. ADHD (look for language and communication skills) - Female adolescent with binge eating followed by purging; normal body weight
- Bulimia nervosa
- Physical findings of Bulimia nervosa
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1. tooth enamel erosion
2. scars on dorsal hand surfaces
3. enlarged parotid glands - Treatment for bulimia nervosa
- Psychotherapy and SSRI
- 17 y.o. boy with hx of aggressiveness, criminal record, and cruelty to animals
- Conduct d/o
- Conduct d/o vs Antisocial PD
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Conduct = age < 18
Antisocial = age > 18
Conduct d/o is required for making a dx of antisocial PD in adults. - 3 year old child with frequent bed-wetting; no other medical problems.
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Normal child
Bed-wetting is not a disorder in a child 3 or less. - Encopresis
- Involuntary passage of feces in a child after age 4
- First line treatment for encopresis/enuresis
- Behavioral therapy (using bell-and-pad aparatus)
- Second line treatment for encopresis/enuresis
- Imipramine (TCA)
- Impairement in math, reading, writing, speech, language, or coordination, but everything else is normal and normal IQ
- Learning d/o
- Diagnostic criteria for mental retardation
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1. onset < age 18
2. IQ < 70, with defects in functioning - Most common cause of mental retardation
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Fetal alcohol syndrome = #1 preventable cause
Down syndrome = #1 overall cause
(Fragile X is another common cause in males) - Severity of MR and IQ ranges
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Mild: IQ 55-70 (most cases)
Moderate: IQ 35-55
Severe: IQ 20-34
Profound: IQ <20 - Negative, hostile, and defiant behChild fears that something will happen to them or their parents if they separate.avior toward authority figures, but normal behavior toward peers; no criminal record.
- Opositional-defiant d/o
- Child fears that something will happen to them or their parents if they separate; exhibits multiple somatic complaints during times of separation.
- Separation anxiety disorder
- Male with motor tic that are exacerbated by stress and remit during activity or sleep, may have coprolalia.
- Tourette's d/o
- Percentage of pts with tourette's that have coprolalia
- 10-30%
- Treatment for tourette's d/o
- Antipsychotics (haloperidol)
- Presentation of depression in children
- Irritable instead of depressed mood
- Top three causes of adolescent deaths
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1. accidents
2. homicide
3. suicide
Together, they total 75% of teenage detahs - Amphetamine intoxication
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Psychotic symptoms
Pupillary dilation
Paranoia
Arrhythmia - Benzodiazepine/barbituate intoxication
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Sedation and drowsiness
Reduced anxiety and disinhibition
Overdose is fatal - respiratory depression - Treatment of acute benzodiazepine intoxication
- Flumazenil
- Benzodiazepine/barbituate withdrawal
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Seizure
Cardiovascular collapse
(both fatal) - Maintenance thereapy for benzodiazepine withdrawal
- Long-acting benzodiazepine
- Commonality between benzodiazepeine, barbituate, and alcohol
- All are CND depressants - caution with interactions
- Cocaine intoxication
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Sympathetic stimulation
Pulillary dilation
Paranoia
Arrhythmias
Formications ("cocaine bugs" - pts think that bugs are crawling on them) - Cause of death due to cocaine intoxication
- Arrhythmia, MI, seizure, stroke
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Sleepy, hungry, depression
*Depression can lead to suicide!* - Cocaine withdrawal
- Teratogenic eEuphoria, dizziness, slurred speech, a feeling of floating, ataxia, and/or sense of heightened sense of power; usually seen in young teenagers (11-15)ffect of cocaine
- Vascular disruption in fetus
- Euphoria, dizziness, slurred speech, a feeling of floating, ataxia, and/or sense of heightened sense of power; usually seen in young teenagers (11-15)
- Inhalant intoxication
- Cause of death in inhalant intoxication
- Respiratory depression, cardiac arrhythmias, asphyxiation
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Hallucinations and flashbacks
pupillary dilation, tachycardia, diaphoresis, perception/mood disturbances - Lysergic acid diethylamide (LSD) intoxication
- Hallucinations in LSD vs schizophrenia
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LSD: visual hallucinations
Schizophrenia: auditory hallucinations - Cause of death in LSD intoxication
- Not from drug itself, but usually from suicide (pts think that they can fly and proceed to jump off of a building).
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"Amotivational syndrome"
injected sclera
eating binge - Marijuana intoxication
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Pupillary constriction ("pinpoint pupils")
constipation, CNS depression - Opioid (heroin) intoxication
- Cause of death in opioid intoxication
- Repiratory depression
- Acute treatment of opioid intoxication
- Naloxone (IV); Naltrexone (oral)
- Comorbidities associated with opioid use
- Associated with injections as the route of delivery (endocardities, HIV, cellulitis, talc damage)
- Fever, nausea, stomach cramps, diarrhea, gooseflesh
- Opiod withdrawal
- Violent behavior, aggitation, vertical and/or horizontal nystagmus
- Phencyclidine (PCP) intoxication
- Cause of death in PCP intoxication
- Convulsions, coma, respiratory arrest
- Treatment of PCP intoxicaiton
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Supportive care
Urine acidification to hasten elimination - Headaches, irritability, fatigue
- Caffeine withdrawal
- Disinhibition, emotional lability, slurred speech, ataxia, hypoglycemia
- Alcohol intoxication
- Tremor, seizure, delerium tremens
- Alcohol withdrawal
- Cause of death in alcohol withdrawal
- Seizures
- Acute and chronic treatment of opioid withdrawal
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Acute: Clonidine
Chronic: Methadone - Enuresis
- Bedwetting in a child after age 5