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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

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