Psych Exam I

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sashatom
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Psych Exam I
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2011-10-02 13:32:06
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Exam I flashcards
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  1. Avoidance of difficult realities by ignoring or refusing to recognize them, or minimizing the impact or effect something wil have on their life.
    Denial/minimization
  2. Attributing one’s own thoughts or impulses to another person.
    Projecting
  3. Feelings, emotions and conflicts are expressed behaviorally, rather than through language.
    Acting out
  4. Excessive reasoning of logic used to avoid painful emotions.
    Intellectualization
  5. Offering a socially acceptable or apparently logical explanation to justify or make acceptable otherwise unacceptable impulses, feelings, behaviors and motives.
    Rationalization
  6. Voluntary psychiatric hospitalization.
    Person signs themselves into the hospital and must give 72 hours notice of intent to leave.
  7. Involuntary psychiatric hospitalization.
    2 physicians determine that a person meets criteria and can be hospitalized without consent.
  8. Emergency petition for psych evaluation.
    Person can be taken to ED for evaluation.
  9. What is Transference?
    An unconscious response of patients in which they experience feelings and attitudes toward the nurse that were originally associated with significant figures in their lives- may be positive or negative
  10. What is Counter transference?
    An emotional response of the nurse that is generated by the patient’s qualities that stimulate emotions based on their own personal experience that results in behavior based that is not appropriate to the therapeutic relationship
  11. Psychiatric medication that is extremely addicting.
    Benzodiazepines
  12. Length of time by which an involuntary hospitalized patient must have a hearing.
    10 days
  13. Axis I Diagnosis
    Psychiatric Clinical Disorders
  14. Axis II Diagnosis
    Personality disorders, mental retardation
  15. Axis III Diagnosis
    Medical conditions
  16. Axis IV Diagnosis
    Psychosocial and environmental problems
  17. Axis V Diagnosis
    Global Assessment of Functioning (GAF)
  18. What Axis is MDD?
    Axis I
  19. What Axis is Schizophrenia?
    Axis I
  20. What Axis is poly-substance abuse?
    Axis I
  21. What Axis is obsessive compulsive personality disorder?
    Axis II
  22. What Axis is alcohol and drug dependence?
    Axis I
  23. What Axis is eating disorder?
    Axis I
  24. How old does a person have to be to be diagnosed with a personality disorder?
    At least 18 years old
  25. GAF Scale.
    0-100
  26. What GAF score is assigned to out of control behavior or danger to themselves?
    0-30
  27. What GAF score is assigned to in control, serious problems?
    31-70
  28. What GAF score is assigned to average or above average function?
    71-100
  29. Best predictor of suicide?
    Previous attempt
  30. Parts of the Mental Status Exam.
    • Appearance/Behavior
    • Orientation/LOC
    • Cognitive functioning
    • Mood/Affect
    • Speech
    • Thought Processes and content
    • Perception
    • Insight/judgment
  31. Tool used to assess cognitive functioning.
    Mini Mental Status Exam
  32. Difference between Mood and Affect.
    • Mood is what the patient tells you
    • Affect is what you observe
  33. What may waxing and waning of LOC indicate?
    Delerium
  34. Four areas of memory?
    • Immediate recall
    • Short-term
    • Long-term
    • Remote
  35. Five elements of speech assessment.
    • Quantity
    • Volume/tone
    • Rate
    • Rhythm
    • Impairments
  36. Loosening of Associations (LOA)
    Lack of connectedness in thoughts and ideas with sudden illogical shifts in topic without any relation to the preceding topic.
  37. Tangential
    Gets off topic very easily and ends up on a totally different topic though it may have had some relation to the original topic.
  38. Circumstantial
    Difficulty getting to the point because of lengthy unnecessary detail about the topic.
  39. Flight of Ideas
    Rapid thoughts that are often fragmented and shifting topics.
  40. Perseveration
    Excessive focus on a topic, activity, or idea which interferes with all interactions and activities.
  41. Delusions
    FIXED FALSE BELIEFS that are outside of the norms for the patient’s social, cultural or religious background. They often have a theme and can be classified as paranoid, religious, grandiose, somatic or erotomanic.
  42. Thought broadcasting
    The belief that others can read their mind or hear their thoughts.
  43. Thought insertion
    The belief that others are putting thoughts in their head.
  44. Ideas of influence
    The belief that someone/something is controlling their behavior.
  45. Hallucinations
    False sensory experiences. It’s not really there.
  46. Illusions
    Misperceptions or misrepresentations of real external sensory stimuli. It’s there but it’s not what you perceive it to be.
  47. Hallucinations often seen with brain tumors.
    Gustatory and olfactory
  48. Hallucinations often seen in schizophrenics.
    Auditory
  49. Insight
    Ability to understand cause and effect, especially concerning one’s own actions
  50. Judgment
    Ability to make accurate analysis of a situation and choose appropriate actions
  51. Anosognosia
    Person is unaware of their disability. Common in right hemisphere strokes.
  52. Location of Broca’s area.
    Left hemisphere, back of fronal lobe.
  53. Location of Wernicke’s area.
    Most people have it on left in temporal lobe.
  54. Location in brain where executive function occurs.
    Pre-frontal cortex
  55. Function in Precentral Gyrus
    Primary motor area
  56. Function of Prefrontal cortex
    • Executive function
    • higher cognition
    • working memor
    • personality
  57. What is Executive Function?
    Planning, organizing, and carrying out complex behavior
  58. Functional areas of Parietal Lobe
    • Postcentral Gyrus = Primary sensory cortex
    • Touch, pain, temperature, proprioception
  59. Functional areas of Temporal Lobe:
    • Primary auditory cortex
    • Wernicke’s area
  60. Connects left and right brain.
    Corpus callosum
  61. Relay station for most information going into the brain
    Thalamus
  62. Regulates blood pressure, body temperature and sex hormones.
    Hypothalamus
  63. Regulates heartbeat and other visceral functions, and processes the emotion fear
    Amygdala
  64. Helps establish long term memory in regions of the cerebral cortex.
    Hippocampus
  65. Control of breathing, heartbeat, circulation and digestion.
    Pons, Medulla
  66. Control system for movement and cognitive function.
    Basal ganglia
  67. Bradykinesia, hyperkinesia, and hypokinesia all suggest disease of, or damage to…
    Basal ganglia
  68. Neurotransmitter that regulates arousal, concentration, learning and memory, mood, stress response
    Norepinephrine (NE)
  69. Neurotransmitter that regulates stress response
    Epinephrine (E)
  70. Neurotransmitter that regulates arousal, concentration, learning and memory, mood, stress response
    Dopamine (DA)
  71. Neurotransmitter that regulates mood, appetite, eating behavior, sleep, depression and anxiety
    Serotonin (5-HT)
  72. Neurotransmitter that regulates sleep/wake
    Melatonin
  73. Percentage of psychiatric illness that is explained by genetics?
    No more than 50-70%
  74. What is the Diathesis Stress Model?
    Genetic vulnerability + stressor → expression of psychiatric disorder
  75. What is Serotonin syndrome?
    • hyperserotonergic state
    • Hyperreflexia, myoclonic jerking, confusion, autonomic dysfunction, muscle rigidity, ataxia
  76. What is a potentially lethal side effect of antipsychotics?
    Neuroleptic malignant syndrome
  77. S/S of neuroleptic malignant syndrome.
    Fever, tachycardia, sweating, muscle rigidity, tremor, incontinence, stupor
  78. Special considerations regarding children and medication.
    Have greater hepatic capacity and glomerular filtration rates, may be less able to store medication in body fat. Shorter half-life.
  79. Special considerations regarding the elderly and medication.
    • GI disease may decrease absorption
    • Slower metabolism increases toxicity risk
    • May have greater sensitivity to psychotropics
    • Multiple medication interaction
    • More susceptible to adverse effects
  80. Common side effects of Tricyclic Antidepressants
    • Arrhythmia
    • Orthostatic hypotension
  81. Atypical antipsychotics increase mortality among elderly patients with these conditions…
    dementia and psychosis
  82. Most psychotropics are this pregnancy category
    Category C, some are Category D (anticonvulsants).
  83. Psychotropics that pass through breast milk.
    All of them.
  84. How cholinesterase inhibitors work.
    Decrease metabolism of ACh by cholinesterase
  85. How Monoamine Oxidase Inhibitors work.
    Decrease metabolism of transmitters by MOA
  86. How antipsychotic drugs work.
    Block dopamine from binding with receptors
  87. How atypical antipsychotics and some antidepressants work.
    Block specific serotonin receptor families
  88. How benzodiazepines work.
    Enhance the effects of GABA at the receptor
  89. Receptor sensitivity changes
    Receptor becomes more or less responsive
  90. Reuptake inhibition:
    Leaves more neurotransmitter in synapse
  91. Five key concepts of recovery.
    • •HOPE
    • •PERSONAL RESPONSIBILITY
    • •EDUCATION
    • •SELF-ADVOCACY
    • •SUPPORT
  92. Ragin’s Four Stages of Recovery
    • •HOPE
    • •EMPOWERMENT
    • •SELF – RESPONSIBILITY
    • •A MEANINGFUL ROLE IN LIFE
  93. 10 Fundamental Components of Recovery
    • Self direction
    • Individualized & Person-centered
    • Empowerment
    • Holistic
    • Non-linear
    • Strenghts-based
    • Peer support
    • Respect
    • Responsibility
    • Hope
  94. What is a more important criterion of recovery than being symptom free?
    Psychosocial functioning
  95. Personal process of recovery.
    The process of positive adaptation to the illness and living a satisfying life (patient’s role)
  96. Treatment process of recovery
    The external conditions that can facilitate personal recovery (practitioner’s role)
  97. Recovery oriented services are reimburseable by…
    Medical assistance. Not medicare.
  98. Biggest barrier to recovery according to 1999 Surgeon General’s Report on Mental Health.
    Stigma
  99. Percent of homeless population in US that suffers from some form of severe mental illness.
    20-25%
  100. Percent of Americans that are severely mentally ill.
    6%
  101. Third largest cause of homelessness for single adults.
    Mental illness
  102. What population is overrepresented in the US’s homeless population?
    African American Men
  103. How many years shorter is the life expectancy of a schizophrenic?
    10-20 years
  104. Percent of schizophrenics that attempt suicide? Succeed?
    • 20-50%
    • 10% succeed
  105. What changes brain development of a fetus that may increase vulnerability to schizophrenia?
    • Alcohol
    • Drugs
    • Poor nutrition
    • Stress
    • Viruses
  106. Percentage of patients with schizophrenia have a co-occurring substance abuse disorder (alcohol/cannabis).
    Nearly 50%
  107. What neurobiological findings in schizophrenia can be seen with a PET scan?
    • Decreased blood flow to frontal lobes
    • Decreased size of thalamus
    • Increased activity of basal ganglia
  108. What is the dysregulation hypothesis related to schizophrenia?
    There are overactive dopamine pathways to the mesolimbic areas of the brain and underactive pathways to the mesocortical areas and there is an imbalance between serotonin and dopamine neurotransmitter systems.
  109. Schizophrenia diagnosis criteria according to the DSM IV-TR:
    • At least two of the following signs/symptoms present for at least 6 months:
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Grossly disorganized/catatonic behavior
    • Negative symptoms
  110. What is schizophreniform disorder?
    Meets criteria for schizophrenia and episode lasts at least one month but less than 6 months.
  111. Positive symptoms of schizophrenia.
    • Delusions
    • Hallucinations
    • Thought disorder
    • Disorganized speech
    • Bizarre behavior
    • Inappropriate affect
  112. Negative symptoms of schizophrenia
    • Flat affect
    • Alogia
    • Avolition/apathy
    • Anhedonia/associality
    • Attention deficit
  113. Cognitive symptoms of schizophrenia.
    • Attention
    • Memory
    • Executive Functions impaired
  114. Mood symptoms of schizophrenia.
    • Dysphoria
    • Suicidality
    • Hopelessness
  115. Social/occupational dysfunction in schizophrenia.
    • Work/activity
    • Interpersonal relationships
    • Self-care
    • Mortality/morbidity
  116. Types of delusions:
    • Paranoid
    • Persecutory
    • Somatic
    • Nihilistic
    • Grandiose
    • Religious
  117. Schneiderian 1st Ranks Symptoms:
    • Thought broadcasting
    • Thought insertion
    • Thought withdrawal
    • Ideas/delusions of reference
  118. Positive symptoms of Schizophrenia
    • Hallucinations
    • Delusions
    • Disorganized thoughts
    • Other odd/unusual behaviors
  119. Some examples of disorganized thoughts:
    • Loosening of associations
    • Echolalia
    • Concrete thinking
    • Neologisms
    • Clang associations
  120. Negative syptoms of Schizophrenia
    • Flat affect
    • Alogia (poverty of speech)
    • Avolition
    • Anhedonia
  121. Cognitive Symptoms of Schizophrenia
    • Poor attention span
    • Memory
    • Executive function impairment
  122. Effect of nicotine/smoking on schizophrenics
    It is hypothesized that nicotine may help with cognitive functioning and negative symptoms.
  123. Mood symptoms with schizophrenia
    • Dysphoria
    • Hopelessness
    • Suicidality
  124. High risk times for suicide in schizophrenics.
    • 1. Periods when they are very psychotic and out of touch with reality.
    • 2. Periods when they are very depressed
    • 3. In the first 6-9 months after they have started first taking meds
  125. Features of paranoid schizophrenia.
    Pre-occupation with 1 or more delusions or frequent auditory hallucinations. No disorganized thoughts
  126. Features of disorganized schizophrenia.
    • Disorganized speech
    • Disorganized behavior
    • Flat of inappropriate affect
    • Does not meet criteria for catatonic schizophrenia
  127. Features of catatonic schizophrenia.
    • At least two of the following:
    • 1.motor immobility
    • 2.excessive motor activity
    • 3.extreme negativism or mutism
    • 4.peculiarities of voluntary movement
  128. Feature of undifferentiated schizophrenia.
    Symptoms meeting general criteria are present byt criteria for other types are not met.
  129. Features of residual schizophrenia.
    Criteria for schizophrenia are not met, nor are those for any other subtype.
  130. Risk factors for poor outcome in people with schizophrenia.
    • Early onset
    • Insidious onset
    • Poor premorbid adjustment
    • Inappropriate affective response:
    • Enlarged cerebral ventricles
    • Reduced blinking rates
    • Poor response to meds
  131. Criteria for schizoaffective disorder:
    Has signs/symptoms of BOTH schizophrenia and a mood disorder and the mood and psychotics symptoms are concurrent.
  132. Criteria for delusional disorder:
    • Non-bizarre delusions at least 1 month
    • No symptoms characteristics of schizophrenia
    • May function well
  133. Criteria for Brief psychotic disorder
    Psychotic symptoms for more than 1 day and less than 1 month
  134. How do typical antipsychotics work?
    Block dopamine (D2) receptors
  135. Indications for typical antipsychotics:
    • Psycosis
    • Manic excitation
    • Severe agitation
    • Tourette’s
  136. Effect of typical antipsychotics on positive and negative symptoms:
    • Decrease positive symptoms
    • Can worsen negative symptoms
  137. How long it takes for an antipsychotic medication to take effect…
    7-10 days
  138. Time it takes for typical antipsychotic to take full therapeutic effect….
    4-6 weeks
  139. Difference in side effects between high and low potency typical antipsychotics:
    • High potency = greater risk of EPS, less sedation and anticholinergic effect
    • Low potency = greater sedation and anticholinergic effect, lower risk of EPS
  140. Common adverse effects of typical antipsychotics:
    • orthostatic hypotension
    • Anticholinergic symptoms
    • Increased prolactin
  141. Treatment for EPS from typical antipsychotics
    Anticholinergic agents (cogentin and artane)
  142. Extrapyramidal symptoms
    • Muscle stiffness
    • Cogwheel rigidity
    • Shuffling gait
    • Stooped posture
    • Drooling
    • Slow resting tremor
  143. Treatment for acute dystonic reaction:
    • Anticholinergics (cogentane and artane)
    • Antihistamines (Benadryl)
  144. Symptoms of Neuroleptic malignant syndrome:
    • Motor/behavioral: muscular rigidity, dystonia, akinesia, mutism, obtundation, agitation
    • Autonomic: hyperpyrexia, sweating, increased pulse and BP
  145. Treatment of neuroleptic malignant syndrome:
    • Immediate discontinuation of dopamine receptor antagonist
    • Medical support to cool patient
    • Monitor vitals, electrolytes, fluid balance, renal output
  146. How atypical antipsychotics (SDAs) work:
    • Block serotonin(5HT) and dopamine(DA) at the post-synaptic receptors
    • Low risk of EPS and improves negative symptoms
  147. Time before psychotic symptoms improve with atypical antipsychotics…
    1 week
  148. Time until full therapeutic effect on behavior takes effect with atypical antipsychotics (SDAs)…
    4-12 weeks
  149. Common side effects of SDAs:
    • Weight gain
    • Metabolic syndrome
    • Insulin resistance/type II DM
    • Sedation
  150. More serious side effects associated with SDAs:
    • Agranulocytosis
    • EPS (lower risk)
    • Mild-moderate prolonged QT interval (Geodon)
    • Increased prolactin (Risperdal)
  151. Adverse effects associated with Clozaril:
    • Increased risk for diabetes and dyslipidemia
    • Increased salivation
    • Sweating
    • Agranulocytosis
    • Seizures
    • Hyperglycemia with ketoacidosis
    • Pulmonary embolism
    • Myocarditis
    • Neuroleptic malignant syndrome
  152. Relationship between serotonin, dopamine and schizophrenia….
    • Decrease in serotonin causes negative symptoms: Depression, decreased energy
    • Increase in dopamine causes positive symptoms: Hallucinations, delusions, altered thinking/behavior/perceiving

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