6. Behavioral p128-p136
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- Substance abuse (p. 128)
- Disinhibition, emotional lability, slurred speech, ataxia, coma, and blackouts are symptoms of which drug?
- Alcohol
- CNS depression, nausea and vomiting, constipation, pupillary constriction, and seizures are the signs of which drug?
- Opioids
- Psychomotor agitation, impaired judgement, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefullness and attention, cardiac arrhythmias, delusions, hallucianations, and fever are side effects of which drug?
- Amphetamines
- Euphoria, psychomotor agitation, impaired judgment, tachycardia, pupillary dilation, hypertension, hallucinations, paranoid ideations, angina, and sudden cardiac death are symptoms of which drug?
- Cocaine
- Belligerance, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homocidality, psychosis, and delerium are side effects of which drug?
- PCP
- Anxiety, depression, del.usions, visual hallucinations, flashbacks, and pupil dilation are side effects of which drug?
- LSD
- Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawl, increased appetite, dry mouth, and hallucinations are symptoms of which drug?
- Marijuana
- Low safety margin and respiratory depression are characteristics of which drug?
- Barbiturates
- Amnesia, ataxia, somnolesence, minor respiratory effects, and addictictive effects with alcohol are the characteristics of which drug?
- Benzodiazepines
- Restlessness, insomnia, increased diuresis, muscle twitching, cardiac arrhythmias are the side effects of which drug?
- Caffeine
- Restlessness, anxiety, insomnia, and arrhytmias are the side effects of whicch drug?
- C2
- A craving for cheetos and the desire to watch "old school" are the side effects of which drug?
- marijuana
- What are the symptoms of alcohol withdrawl?
- Tremor, tachycardia, hypertension, malaise, nausea, seizures, DTs, agitation, hallucinations
- What are the symptoms of opioid withdrawl?
- anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea, and yawning
- What are the symptoms of amphetamine withdrawl?
- Post use crash of depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
- What are the symptoms of cocaine withdrawl
- Post use crash of suicidality, hypersomnolence, fatigue, malaise, severe craving
- What are the symptoms of PCP withdrawl
- Recurrance of symptoms due to reabsorption, with sudden onsets of severe random violence
- What are the side effects of barbiturate withdrawl?
- Anxiety, seizures, delerium, life threatening CV collapse.
- What are the side effects of benzodiazepine withdrawl?
- Rebound anxieety, seizures, tremor, insomnia.
- What are the side effects of caffeine withdrawl?
- Headache, lethargy, depression, weight gain
- What are the side effects of nicotine withdrawl?
- Irritabilty, headache, anxiety, weight gain, craving, tachycardia?
- When do DT's occur?
- 2-5 days after last drink
- What is the treatment for DTs?
- Benzodiazepines
- What is the sequence of symptoms experienced in DT's?
- Autonomic hyperactivity --> psychotic symptoms --> confusion
- What is a competetive inhibitor of heroin?
- Naloxone
- What diagnoses are associated with heroin addiction?
- hepatitis, abscesses, overdose, hemorrhoids, AIDS, right sided endocarditis.
- What drug is used for long term maintinence or heroin detox?
- methadone
- Delerium & Dementia (p. 129)
- What are the symptoms of delerium?
- Decreased attention span and arousal, disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction
- What is the pattern of onset of delerium?
- Rapid onset, waxing and waning.
- What class of drugs is associated with delerium?
- anticholinergics
- What are the symptoms of dementia?
- Multiple cognitive deficits- memory, aphasia, apraxia, agnosia, loss of abstract thought, behavioral or personality changes, impaired judgement.
- What are the differences between delerium and dementia?
- Dementia: alert patient, gradual onset.
- Dementia may mimic what other illness in the elderly?
- Depression
- Major depression (p. 129)
- What are the two main characteristics of major depression?
- Depressed mood, anhedonia
- What are the nine symptoms of depression?
- Sleep disturbances, loss of interest, guilt, loss of energy, loss of concentration, change in appetite, psychomotor retardation, suicidal ideations, depressed mood (SIG E CAPS)
- How many of those symptoms do you need and for how long?
- 5 symptoms for 2 weeks.
- What is the definition of recurrant major depressive disorder?
- 2 or more episodes with 2 month symptom free interval
- What is the lifetime prevalence of major depression in men?
- 5-12%
- What is the lifetime prevalence of major depression in women?
- 10-25%
- How long must a mild depressive episode last to be called dysthymia?
- 2 years.
- ECT is painful, true or false?
- FALSE
- What are the side effects of ECT?
- due to anesthesia, disorientation, anterograde and retrograde amnesia
- Manic episodes (p. 130)
- How long must abnormally elevated mood be present for to be called a manic episode?
- 1 week
- What are the symptoms of a manic episode?
- Distractability, insomnia, grandiosity, flight of ideas, increase in goal directed activity or psychomotor agitation, pressured speech, thoughtlessness (DIG FAST)
- How many of those symptoms must be present to be considered a manic episode?
- 3
- True or false: A hypomanic episode does not cause marked impairment in social or occupational function?
- TRUE
- What is the drug of choice for bipolar disorder?
- lithium
- How many manic episodes does it take to define bipolar disorder?
- 1
- How many hypomanic episodes does it take to define bipolar disorder?
- 1
- What type of bipolar disorder involves hypomanic episodes?
- Type II
- How long must a milder form of bipolar disorder last to be called cyclothymic disorder?
- 2 years.
- Munchausen's (p. 130)
- Is munchausen's syndrome involve conscious or unconscious motivation?
- Unconscious.
- Somatoform disorders (p. 130)
- What are the characteristics of conversion?
- Symptoms suggest motor or sensory neurologic or physical disorder, but physical exam and tests are negative
- True or false, somatoform disorders are more common in women?
- TRUE
- What is a prolonged pain that is not explained by an illness?
- Somatoform pain disorder
- What is the misinterpretation of normal physical findings leading to a persistent fear of serious illness in spite of medical reassurance?
- Hypochondriasis
- What are the characteristics of somatization disorder?
- A variety of complaints involving multiple organ systems
- What is the disorder where a patient believes their own anatomy is malformed?
- body dysmorphic disorder
- What is the false belief of being pregnant associated with objective physical signs of pregnancy?
- pseudocyesis
- What is primary gain?
- What a symptom does for a patient's internal psychic economy
- What is secondary gain?
- What a symptom gets a patient (sympathy or attention)
- What is tertiary gain?
- What the caretaker gets.
- Panic disorder (p. 131)
- How long does it take a panic attack to peak?
- 10 minutes
- What are the symptoms of panic attack?
- palpitations, abdominal distress, nausea, increased perspiration, chest pain, chills, and choking (PANIC)
- How many of those must be present to call it a panic disorder?
- 4
- What psychiatric disorder has a high prevalence during the step 1 exam?
- panic disorder
- Phobia (p. 131)
- What is a phobia?
- Excessive or unreasonable fear cued by presence or anticipation of a specific object or entity.
- True or false: a patient has insight into their own phobia
- TRUE
- Gamophobia is fear of what?
- marriage
- Algophobia is fear of what?
- pain
- Acrophobia is fear of what?
- heights
- Agoraphobia is fear of what?
- open places
- PTSD (p. 131)
- What are the symptoms of PTSD?
- Traumatic event is persistently reexperienced, a person persistently avoids stimuli associated with the traums, and experiences persistent increased arousal
- How long must the symptoms last to be called PTSD?
- 1 month
- PTSD often follows which disorder?
- Acute stress disorder
- Other anxiety disorders (p.131)
- What is adjustment disorder
- Emotional symptoms including anxiety or depression causing impairment following a psychosocial stressor, lasting less than 6 months
- True or false: general anxiety is related to a specific person, situation, or event?
- FALSE
- What are the symptoms of generalized anxiety disorder?
- GI symptoms, fatigue, and difficulty concentrating
- Personality (p.131)
- What is a personality trait?
- an enduring pattern of perceiving, relating to, and thinking about the environment and oneself.
- True or false: a personality disorder does not cause impairment of social or occupational functioning?
- FALSE
- True or false: a patient with a personality disorder is aware of their problem
- FALSE
- What are the cluster A personality disorders?
- Paranoid, schizoid, schizotypal (Weird)
- What are the cluster B personality disorders?
- Antisocial, borderline, histrionic, narcissistic (Wild)
- What are the cluster C personality disorders?
- Avoidant, obsessive compulsive, dependant (Worried)
- What cluster has a genetic association with anxiety disorders?
- C (worried)
- What cluster has a genetic association with mood disorders?
- B (Wild)
- What cluster has a genetic association with schizophrenia?
- A (weird)
- What are the characteristics of paranoid personality disorder?
- Distrust, suspiciousness, and projection as a defense mechanism
- What personality disorder involves limited emotional expression and voluntary social withdrawl?
- Schizoid
- What personality disorder involves interpersonal awkwardness, odd thought patterns and appearance?
- Schizotypal
- What personality disorder involves a disregard for others, crimality, and conduct disorders?
- Antisocial
- What personality disorder involves unstable mood and behavior, impulsiveness, emptiness, and occurs more often in women?
- Borderline
- What personality disorder involves excessive emotionality, somatization, attention seeking, and sexually provocative?
- Histrionic
- What PD involves grandiosity, a sense of entitlement?
- Narcissistic
- What PD is sensitive to rejection, socially inhibited, timid, and has feelings of inadequacy?
- Avoidant
- What PD is preoccupied with order, perfectionism, and control?
- Obsessive-compulsive
- What PD is submissive and clinging, excessively needs to be taken care of, and has low self confidence?
- Dependant
- Childhood disorders (p. 133)
- What disorder is characterized by repetitive behaviors, unusual abilities, and below normal intelligence?
- Autism
- What is the treatment for autism?
- Communication skill and social skill training
- What is the name of a mild form of autism?
- Aspberger syndrome?
- True or false: Children with aspberger's syndrome has normal intelligence and lack social or cognitive defects?
- TRUE
- What is the only X-linked childhood personality disorder?
- Rett disorder
- Rett syndrome starts at which age?
- 4
- What are the symptoms fo rett disorder?
- Loss of development, and mental retardation?
- Why does Rett disorder appear only in women?
- Male fetuses die in utero.
- True or false: Children with ADHD have normal intelligence
- TRUE
- What is the treatment for ADHD
- Methyphenidate (ritalin)
- What is the name given to continued behavior violating social norms?
- Conduct disorder
- What is oppositional defiant disorder?
- A noncompliant child in the absence of criminality
- What is the age of onset of tourette's syndrome?
- Before 18
- What is the treatment for tourette's syndrome?
- Haloperidol
- What is the name given to a fear of loss of attachment figure leading to factitious physical complaints?
- Seperation anxiety disorder
- What is the typical age for seperation anxiety disorder?
- 7 or 8
- Eating disorders (p.133)
- What are the symptoms of anorexia nervosa?
- Excessive dieting, body image distortion, increase in exercise. Sever weight loss, amenorrhea, anemia, and electrolyte disturbances.
- What are the symptoms of bulimia nervosa?
- Binge eating followed by self-induced vomiting or use of laxatives. Parotitis, enamel erosion, increase in amylase, and esophageal varices from vomiting
- True or false: Bulimia nervosa involves normal body weight?
- TRUE
- Hallucination vs. illusion vs. delusion (p.133)
- What is a hallucination?
- A perception in the absence of actual external stimuli.
- What is an illusion?
- A misinterpretation fo actual external stimuli
- What is a delusion?
- A false belief that is not shared with other members of culture or subculture, which is firmly maintained in spite of evidence to the contrary
- True or false: A delusion is a disorder in the content of thought?
- TRUE
- True or false: A loose association is a disorder in the form ot thought?
- TRUE
- Hallucinations (p. 133)
- True or false: Visual hallucinations are rare in schizophrenia?
- FALSE
- What type of hallucination occurs as an aura of psychomotor epilepsy?
- Olfactory
- What type of hallucination is rarest?
- Gustatory
- What type of hallucination is common in DT's and in cocaine abusers?
- Tactile
- What type of hallucination occurs while going to sleep?
- Hypnagogic
- What type of hallucination occurs while waking from sleep?
- Hypnopompic
- Schizophrenia
- p.134
- periods of psychosis and disturbed behavior last how long?
- 6 months
- 4 positive symptoms?
- hallucinations, delusions, strange behavior, loose associations
- 4 negative symptoms?
- flat affect, social withdrawal, thought blocking, lack of motivation
- 4 A's (described by Bleuler) + 1
- 1.ambivalence (uncertainty), 2. autism (self-preoccupation and lack of communication), 3. affect (blunted), 4. associations (loose), 5. auditory (hallucinations)
- 5 subtypes
- disorganized, catatonic, paranoid, undifferentiated, residual
- etiology
- genetic factors > environmental factors
- lifetime prevalence
- 1.5%; males>females; blacks>whites
- different presentation in men and women
- presents earlier and more often in men
- schizophrenia + mood disorder = ?
- schizoaffective disorder
- Structural theory of the mind
- C2
- how many structures?
- Freud had 3
- primal urges, sex, aggression - things you want
- Id
- moral values, conscience - you know you can't have it
- Superego
- bridge and mediator between unconscious mind and external world - conflict mediator
- Ego
- Topographic theory of the mind
- p.134
- *also 3
- Name the components of this theory
- CPU - Conscious, Preconscious, Unconscious
- Conscious
- what you're aware of
- Preconscious
- what you are able to make conscious with effort (like phone number or SSN)
- Unconscious
- what you are not aware of (what you don't know you don't know)
- the central goal of Freudian psychoanalysis
- to make the patient aware of what is hidden in his/her unconscious
- Oedipus complex
- p.134
- define oedipus complex
- repressed sexual feelings of a child for the opposite sex parent, accompanied by rivalry with same-sex parent - described by Freud
- Ego defenses
- p.135
- Your --- has many ---, or automatic and unconscious reactions to psychological stress.
- ego defenses
- Name the mature ego defenses
- Mature women wear a SASH: Sublimation, Altruism, Suppression, Humor
- using ---, one replaces an unacceptable wish with a course of action similar but not conflicting with one's values
- sublimation
- --- is unsolicited generosity toward others that alleviates guilty feelings
- altruism
- unlike other defenses, this is a voluntary withholding of an idea or feeling from conscious awareness
- suppression
- one uses ---, or appreciates the amusing nature to alleviate anxiety-provoking or adverse situations
- humor
- Acting out, dissociation, denial, displacement, fixation, identification, isolation, projection, rationalization, reaction formation, regression, repression, splitting are all ---.
- immature
- the three D's of immaturity
- Dissociation, Denial, Displacement
- by --- --- or throwing a tantrum, unacceptable feelings and thoughts are expressed through actions
- acting out
- the extreme forms of these temporary, drastic changes in personality memory, consciousness, or motor behavior can result in multiple personalities, or --- --- ---.
- dissociation; dissociative identity disorder
- this is a common reaction in which one avoids awareness of some painful reality
- denial
- a mother might transfer avoided anger at her husband by yelling at her child
- displacement
- partially remaining at a more childish level of development, like men's fascination with sports games
- fixation
- victim of child abuse becomes abuser
- identification
- separation of feelings from ideas and events like describing murder in graphic detail with no emotional response
- isolation
- when a man who wants another woman thinks his wife is cheating on him, he is ---.
- projecting
- when one wants to avoid self-blame, one might say a job wasn't important anyway after not getting it
- rationalization
- this is described by someone with libidinous thoughts enters a monastery
- reaction formation
- --- occurs when one turns back the maturational clock, going back to earlier modes of dealing with the world - like children in stress who wet the bed
- regression
- involuntary withholding of an idea or feeling from conscious awareness
- repression
- belief that people are either good or bad
- splitting
- Transference and countertransference
- p.136
- sometimes a patient projects feelings stemming from personal life onto his or her physician, and sometimes the physician projects feelings stemming from personal life onto the patient
- transference and countertransference, respectively
- Classical conditioning
- p.136
- salivation (a natural response) is elicited by a bell (a --- stimulus) that has been associated with food (a natural stimulus), not necessarily a reward
- conditioned, or learned
- Operant conditioning
- p.136
- a particular action is elicited because it produces a ---.
- reward
- an action (pressing a button) is produced because, for example, a mouse wants food
- positive reinforcement
- an action (pressing a button) is produced because, for example, a med student wants to avoid shock
- negative reinforcement - NOT punishment
- Reinforcement schedules
- p.136
- pattern of reinforcement determines what?
- how quickly a behavior is learned and extinguished if not rewarded
- how quickly is a behavior on a continuous schedule (i.e., vending machine use) extinguished when not rewarded?
- most rapidly
- what schedule shows the slowest extinction when not rewarded?
- variable ratio (gambling)
- Intelligence testing
- p.136
- How does the Stanford-Binet test calculate IQ?
- mental age/chronological age * 100
- How does the Wechsler Adult Intelligence Scale calculate intelligence?
- 11 subtests - 6 verbal, 5 performance
- What is the mean IQ?
- 100, standard deviation = 15
- what are the IQ values for profound, severe, and moderate to mild mental retardation?
- <20, <40, and <70 (or two standard deviations below the mean)
- What determines IQ scores - based on correlation?
- most highly correlated with school achievement, also correlated with genetic factors
- Are intelligence tests objective or projective?
- objective