Psychiatry USMLE

What is classical conditioning?

Natural response elicited by a conditioned stimulus: like Pavlov.

What is operant conditioning?

Learning in which an action is elicited because it produces a reward.

What is extinction as it pertains to operant conditioning?

Extinction refers to reduced frequency of a behavior if it is not followed by consequence.

What is transference?

Transference is the projection of unconscious feelings from patient's life onto the therapist. Eg. mistrust someone who resembles an ex-spouse or be overly compliant to someone who resembles a childhood friend.

What is countertransference?

Countertransference is the projection of unconscious feelings from the therapist's life onto the patient.

What is fixation (defense mechanism)?

Partially remaining at a more childish level of development (eg. adult men fixating on sports games).

What is identification (defense mechanism)?

Modeling behavior after another person who is more powerful (eg. abused child identifies himself with an abuser).

What is reaction formation (defense mechanism)?

Doing the opposite of an unacceptable impulse.

What is sublimation (defense mechanism)?

Mature defense mechanism whereby one channels objectionable impulses in an acceptable manner.

What are the four mature defense mechanisms?

SASH: Suppression, Altruism, Humor, Sublimation

What are the effects of depriving an infant of affection?

4 W's: Weak, Wordless, Wanting (socially), Wary

What features characterize ADHD?

Inattention, hyperactivity, impulsivity in multiple settings with onset before age 7.

What features characterize autistic disorder?

Problems with social interaction, impairments in communication, repetitive and stereotyped patterns of behavior and activities

What is Rett's disorder?

X-linked disorder in girls characterized by normal psychomotor development during first 5 months followed by decreasing rate of head growth and loss of hand skills between 5 and 30 months. Also presents with seizures, gait abnormalities, cyanotic spells,

What is Asperger's disorder?

Mild form of autism characterized by impaired social interaction and restricted or stereotyped interests/actions/behaviors. Communication is normal.

What is childhood disintegrative disorder?

Disorder characterized by marked regression in multiple areas after 2 years of normal development.

What neurotransmitter changes typify anxiety?

Increased NE, decreased GABA and 5-HT

What neurotransmitter changes typify depression?

Decreased NE, 5-HT, DA

What neurotransmitter changes typify Alzheimer's dementia?

Decreased ACh

What neurotransmitter changes typify schizophrenia?

Increased DA

What neurotransmitter changes typify Huntington's disease?

Decreased GABA and ACh, increased DA.

What neurotransmitter changes typify Parkinson's disease?

Decreased DA, increased 5-HT and ACh

What is Korsakoff's amnesia?

Anterograde amnesia caused by thiamine deficiency and the associated mammillary body destruction.

What is a dissociative amnesia?

An inability to remember personal identifying information usually in the context of trauma or stress.

What is psychosis?

Break from reality involving delusions, perceptual disturbances, and/or disordered thinking.

What is treatment for delirium?

treat underlying cause, optimize brain condition, antipsychotics (esp. haloperidol)

What features typify delirium?

Acute onset waxing and waning level of consciousness, disordered thinking, cognitive dysfunction usually in the setting of other illness. Accompanied by abnormal EEG.

What features typify dementia?

Gradual decrease in cognition without affecting level of consciousness. Typified by memory deficits, aphasia, apraxia, agnosia. Accompanied by normal EEG.

What does hypnagogic and hypnopompic mean?

Hypnagogic: occurs while going to sleep. Hypnopompic: occurs while waking from sleep.

What are negative symptoms of schizophrenia?

5 A's: Affect flattening, Alogia, Asociality, Apathy, Attention impairment

What is schizoaffective disorder?

Patient has symptoms of both psychosis and mood disorder. Patient must have had psychotic symptoms for two weeks in absence of mood disorder symptoms.

What is delusional disorder?

Fixed, persistent belief in nonbizarre delusions for at least one month without impaired functioning in life.

What is folie a deuz?

Development of delusions in a patient who is in a close relationship with someone who has a delusional disorder.

Brief psychotic disorder?

Schizophrenia symptoms for <1 month

Schizophreniform disorder?

Schizophrenia symptoms for 1-6 months

What is dysthymia?

Chronic, mild depression for 2 years without discrete episodes

What is atypical depression?

Subtype of depression characterized by mood reactivity, hypersomnia, hyperphagia, weight gain, leaden paralysis, hypersensitivity to personal rejection

What are the symptoms of mania?

DIG FAST: Distractability, Insomnia, Grandiosity, Flight of ideas, Activity/agitation, Speech, Thoughtlessness

What is a hypomanic episode?

Period of expansive mood for at least four days, meets three criteria, does not impair functioning, no psychotic features.

What is a manic episode?

Period of expansive mood of at least one week, meets three criteria for mania, impairs functioning, often with psychosis.

What is cyclothymic disorder?

Alternating periods of hypomania and periods of mild to moderate depressive symptoms for at least two years but never with a major depressive or manic episode.

What is depersonalization disorder?

Persistent or recurrent feelings of detachment from one's self, environment, or social situation. Patients feel separated from their bodies and are aware of their symptoms.

What is dissociative identity disorder?

Also known as multiple personality disorder, this disorder is characterized by presence of 2 or more distinct identities. It is more common in women and in those with prior trauma like physical/sexual abuse.

What is bipolar disorder?

Defined by presence of at least one manic (bipolar I) or hypomanic (bipolar II) episode.

What is ECT indicated for?

Refractory MDD, MDD w/pregnancy, depression with psychotic features, catatonia, acute suicidality.

What are main side effects of ECT?

disorientation and temporary anterograde/retrograde amnesia resolving fully within 6 months

What is a panic attack?

PANIC:
-Palpitations
-Abdominal distress
-Numbness, nausea
-Intense fear of death
-Choking, chills, chest pain, sweating, shaking, shortness of breath

What is specific phobia?

Strong exaggerated fear of specific object or situation that interferes with normal function. Treat with systemic desensitization.

What is treatment for panic attack?

Benzodiazepines acutely. SSRIs (paroxetine and sertraline) or venlafaxine for maintenance.

What is treatment for OCD?

SSRIs and clomipramine (TCA)

What is OCD?

Disorder characterized by recurring intrusive obsessions that are distressing but relieved by performance of compulsions. The disorder is ego-dystonic.

What is the difference between obsessive-compulsive personality disorder and obsessive-compulsive disorder?

Obsessive-compulsive PD is ego-syntonic whereas OCD is ego-dystonic.

What is the difference between PTSD and acute stress disorder?

In PTSD, the disturbance lasts more than one month and the event could have occured at any point in the past. In acute stress disorder, the disturbance lasts less than one month and the even occurred less than one month ago.

What is generalized anxiety disorder?

Persistent, excessive anxiety for at least 6 months that is unrelated to specific situation/event.

What is adjustment disorder?

Development of maladaptive or emotional symptoms within 3 months of the event and ending within 6 months. Not a true anxiety disorder.

How does bulimia nervosa present?

Normal range body weight. Parotitis, enamel erosion, eletrolyte disturbances, alkalosis, dorsal hand calluses.

How does anorexia nervosa present?

Low body weight, decreased bone density, amenorrhea,anemia, electrolyte disturbances, metatarsal stress fractures.

What is somatization disorder?

Disorder characterized by multiple complaints: 4 pain, 2 GI, 1 neurologic, over the course of years.

What is conversion disorder?

Sensory or motor neurological symptom that cannot be explained by a medical disorder; patients are aware but may be indifferent.

What is factitious disorder?

Intentional production of medical/psychological symptoms in order to assume the role of a sick patient (primary gain).

What is substance abuse?

Maladaptive pattern of use for at least one year with 1+ of following:
1. failure to fulfill obligations
2. use in dangerous situations
3. recurrent legal problems
4. continued use despite associated social problems

What is substance dependence?

Substance use leading to 3+ following:
1. tolerance
2. withdrawal
3. using substance more than intended
4. persistent desire to cut down
5. significant time spent using or obtaining substance
6. decreased social/occupational activities as a result
7. cont

What is tardive dyskinesia?

Side effect of traditional antipsychotics characterized by repetitive choreoathetoid movements of mouth and tongue. It is caused by an increase in dopamine receptors in response to blockade, leading to lower acetylcholine levels.

What is treatment for tardive dyskinesia?

Suppress with cholinomimetics and anxiolytics. Discontinue antipsychotic if possible or switch to an atypical like clozapine.

What is neuroleptic malignant syndrome?

Averse reaction to neuroleptics characterized by FALTER:
-Fever
-Autonomic instability
-Leukocytosis
-Tremor
-Elevated CPK
-Rigidity

How is neuroleptic malignant syndrome treated?

dantrolene (decreases intracellular Ca), bromocriptine (DA agonist), amantadine (DA release)

What are EPSE?

Extrapyramidal side effects include Parkinsonism, akathisia, dystonia.

What are signs of lithium toxicity?

hypothyroidism, nephrogenic DI, tremor, sedation, metalic taste, can cause Ebstein anomaly and malformation of great vessels

How is alcohol metabolized?

Alcohol to acetaldehyde (via alcohol dehydrogenase) then to acetic acid (via aldehyde dehydrogenase)

How does delirium tremens present?

Autonomic instability, psychotic symptoms (hallucinations/delusions), gross tremor, confusion that begins 2-5 days after last drink. Treat with benzos.

What is Wernicke-Korsakoff syndrome?

Combination of Wernicke's encephalopathy (ataxia, ophthalmoplegia, confusion) plus anterograde amnesia, confabulation, personality changes.

What is Wernicke's encephalopathy?

Triad of ophthalmoplegia, ataxia, confusion.

How does cocaine intoxication present?

Mydriasis, euphoria, hallucinations, paranoid ideation, impaired judgment, chills, sweating. Remember coke is an indirect sympathomimetic.

How does amphetamine intoxication present?

Similar to cocaine: mydriasis, euphoria, tachycardia, impaired judgment, euphoria

How does PCP intoxication present?

Impulsiveness, belligerence/violence, vertical/horizontal nystagmus, psychosis, delirium

How does LSD intoxication present?

Perceptual distortion (visual, auditory), anxiety, paranoia, psychosis.

How does marijuana intoxication present?

Euphoria, impaired coordination, mild tachycardia, increased appetite, dry mouth.

What is ketamine? how does intoxication present?

Ketamine is an NMDA receptor antagonist that produces hallucinations, euphoria, vivid dreams/nightmares along with tachycardia, tachypnea.

What happens if you use benzos and barbiturates together?

They are synergistic (BDZs increase frequency and barbs increase duration) and have risk of respiratory depression.

How does opioid intoxication present?

Drowsiness, N/V/C, miosis, seizures, respiratory depression.

How does opioid withdrawal present?

Sweating, fever, rhinorrhea, yawning, nausea, diarrhea, flu-like symptoms, mydriasis.

What is the mechanism of action of amphetamines?

Stimulates release of dopamine and NE from nerve endings at synaptic cleft.

What is treatment for bipolar disorder?

Lithium, anticonvulsants (carbamazepine or valproic acid), olanzapine