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HY Psych
Pathology
| Question | Answer |
|---|---|
| increased NE, decreased GABA, decreased 5HT | anxiety |
| decreased NE, decreased 5HT, decreased dopamine | depression |
| decreased ACh | Alzheimer's |
| decreased GABA and decreased ACh | Huntington's |
| increased dopamine | Schizophrenia |
| decreased dopamine, increased 5HT, increased ACh | Parkinson's |
| increased NE, increased 5HT, increased dopamine | mania |
| waxing and waning consciousness with acute onset, hallucinations, sleep disturbances, and disorganized thinking; may be precipitated by anticholinergic drugs or UTIs | delirium |
| gradual decrease in cognition with no change in level of consciousness, loss of abstract though, and impaired judgment; no psychotic symptoms | dementia |
| delusions, hallucinations (usually auditory), disorganized speech (loose associations), disorganized/catatonic behavior, and negative symptoms for longer than 6 months and associated with a decline in functioning | schizophrenia |
| psychotic symptoms (e.g., hallucinations, delusions, flat affect) lasting for less than one month and usually precipitated by stress | brief psychotic disorder |
| psychotic symptoms lasting between 1 and 6 months | schizophreniform disorder |
| at least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic, or mixed episode; may be bipolar or depressive subtype | shizoaffective disorder |
| fixed, persistent non-bizarre belief system lasting more than 1 month; functioning is not impaired | delusional disorder (shared with another person= folie a deux) |
| What disorder has SIG E CAPS? What does it mean? | Depression: Sleep disturbance, Interest loss, Guilt/feelings of worthlessness, Energy loss, Concentration loss, Appetite/weight changes, Psychomotor retardation or agitation, and Suicidal ideation |
| What is the diagnostic criteria for a major depressive episode? | 5 SIG E CAPS symptoms with patient reported depressed mood or anhedonia for at least 2 weeks |
| What disorder has DIGFAST? What does it mean? | Manic episode: Distractibility, Irresponsibility, Grandiosity, Flight of ideas, increase in goal directed Activity/psychomotor Agitation, decreased need for Sleep, and Talkativeness or pressured speech |
| Milder form of depression lasting at least 2 years | Dysthymia |
| Mild form of bipolar disorder lasting at least 2 years | Cyclothymic disorder (dysthymia and hypomania) |
| What is the diagnostic criteria for bipolar I? | at least 1 manic episode (3 DIGFAST x 1 week) with depressive symptoms; manic episodes must last at least 1 week |
| What is the diagnostic criteria for bipolar II? | at least 1 hypomanic (like manic, but no impairment in social/occupational f'n and no psychosis) epidsode with depressive symptoms |
| Hypersomnia, hyperphagia, and extreme sensitivity to rejection | atypical depression |
| what is the treatment of choice for atypical depression? | MAO inhibitors and SSRIs |
| What is the most important question to ask when trying to assess a repeated suicide attempt risk? | "What did you do after you attempted to kill yourself?" If they just waited to die (vs calling for help), then they are at a high risk for a repeated attempt. |
| conscious faking of a medical disorder for intentional gain (monetary or otherwise); complaints cease after gain | malingering |
| consciously faking a disorder to fulfill a subconscious motivation to assume the sick role | factitious disorder (chronic= Munchausen's and chronic in a child at the hands of a caregiver= Munchausen's by proxy) |
| Patient comes in complaining of pain in at least 4 locations. Three months later, they have loss of sensation in their extremities and dyspareunia. You recall that one year ago, she complained of abdominal discomfort and dysphagia. | Somatization disorder |
| Patient develops blindness in one eye after his parent's divorce, but does not seem at all concerned. | Conversion disorder (more common in teens; think V for voltage=neuro problems) with la belle indifference (aware of sx, but doesn't really care) |
| Patient is afraid that his sinus headaches are being caused by brain cancer, even after a thorough workup that showed no evidence of malignancy. | Hypochondriasis |
| Young woman with BMI of 19.5 is concerned that her hips are too large and that she is very overweight. She is also disturbed by the bump on her nose. | Body dysmorphic disorder |
| Patient has unexplained pain lasting for 2 years. | Pain disorder. |
| weird, accusatory, aloof, awkward personality disorder cluster | Cluster A |
| Cluster A personalities | paranoid, schizoid, schizotypal |
| wild and bad to the bone personality disorder cluster | Cluster B |
| Cluster B personalities | antisocial, borderline, histrionic, narcissistic |
| worried, cowardly, compulsive, and clingy personality disorder cluster | Cluster C |
| Cluster C personalities | avoidant, obsessive compulsive, dependent |
| patient cuts themselves after breaking up with their latest on-again/off-again boyfriend; believes all men are evil and all women are victims | borderline (splitting is major defense mechanism) [B] |
| quiet, withdrawn man prefers to live on the outskirts of town where he doesn't have to interact with other people | schizoid [A] |
| young woman is afraid to approach her classmates because she is afraid that they will reject her because she is not good enough | avoidant [C] |
| young woman prefers to date older men because they tend to take care of her and serve as a father figure that she can be submissive to; she has very low self esteem | dependent [C] |
| 19 yo male with a long and violent criminal record | antisocial [B] |
| aspiring actress wears provocative clothing to her doctor appointments and flirts excessively with her doctor as well as the other patients in the waiting room | histrionic [B] |
| a young man likes to dress up as an elf and believes that he can communicate with trees using a long-lost magical language; finds it difficult to interact with his co-workers | Schizotypal [A] |
| Woman has difficulty getting along with her co-workers because of her unrealistically high expectations, perfectionism, and controlling behavior. She cannot see anything wrong with her behavior and believes that her co-workers are just incompetent. | Obsessive-compulsive [C] |
| A young man on a date demands that he be seated at the best table in the restaurant, and consistently antagonizes the wait staff. When his date points out his poor manners, he becomes enraged and storms out of the restaurant. | Narcissistic [B] |
| Security guard becomes very suspicious of his doctor when it is suggested that he begin colon cancer screening. He accuses the doctor of conspiring with the insurance companies to take all of his money. | Paranoid [A] |
| A 50 yo woman is generally gloomy and unhappy and always expects the worst outcome. | Depressive personality disorder [no assoc'd cluster] |
| emotional lability, slurred speech, ataxia, coma, blackouts, elevated GGT | alcohol intoxication |
| what is the treatment for alcohol intoxication? | naltrexone or time w/fluids |
| What is the ratio of AST to ALT in alcohol intoxication? | 2:1 |
| Delirium tremens | severe alcohol withdrawal; life threatening |
| What is the treatment for delirium tremens? | Benzos |
| CNS depression, nausea, vomiting, constipation, pinpoint pupils, seizures | Opioid intoxication |
| Differential diagnosis for pinpoint pupils? | Opioid intoxication and organophosphate (or other cholinergic) poisoning |
| What symptoms of opioid intoxication can you NOT develop tolerance to? | Constipation and pinpoint pupils (miosis). |
| Sweating, dilated pupils, piloerection (cold turkey), diarrhea, and flu-like symptoms | Opioid withdrawal |
| Is opioid withdrawal life-threatening? What is the treatment? | No. Tx is symptomatic. For babies, give tincture of opium. |
| Is opioid overdose life-threatening? | Yes. It can cause respiratory depression and seizures. |
| What is the treatment for opioid overdose? | Naloxone or naltrexone |
| Marked respiratory depression with a low safety margin | Barbiturates intoxication |
| What is the treatment for barbiturate overdose? | symptom management by assisting respiration and increasing BP |
| delirium, life-threatening CV collapse | barbiturate withdrawal |
| Ataxia, minor respiratory depression, greater safety margin | benzo intoxication |
| What is the treatment for benzodiazepine intoxication? | Flumazenil, a competitive GABA antagonist |
| impaired judgment, pupillary dilation, prolonged wakefulness and attention, delusions, hallucinations, and fever | amphetamine intoxication |
| stomach cramps, hunger, hypersomnolence | amphetamine withdrawal |
| impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death (PACs or PVCs) | cocaine intoxication |
| suicidality, hypersomnolence, malaise, severe psychologic craving | lindsay lohanism (cocaine withdrawal) |
| What is the treatment for cocaine intoxication? | Benzos |
| restlessness, increased diuresis, muscle twitching | caffeine intoxication |
| restlessness | nicotine intoxication |
| irritability, anxiety, craving | nicotine withdrawal |
| What are the treatment options for nicotine withdrawal? | Nicotine patch, gum, or lozenges; buproprion/varenicline |
| belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium | PCP intoxication |
| depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep | PCP withdrawal |
| What is the treatment for PCP intoxication? | Benzos and haloperidol (calm those suckers down!) |
| marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation | LSD intoxication |
| Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, hallucinations | marijuana intoxication |
| irritability, depression, insomnia, nausea, anorexia | marijuana withdrawal |
| What is the differential diagnosis for pupillary dilation? | Amphetamines, cocaine, LSD, atropine poisoning |
| What is the CAGE screening test used for? What do the letters stand for? | Alcohol dependence screening. C= Have you ever tried to Cut back? A= Are you Annoyed by others questioning your drinking? G= Do you feel Guilty about drinking? E= Do you ever need an Eye opener? |
| What is the diagnosis for a major depressive disorder (not episode)? | 2 or more major depressive episodes with a symptom free interval of 2 months |
Created by:
sarah3148
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