Psychiatry Flashcards – First Aid for the USMLE STEP 1

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  • What is classical conditioning?
    Learning in which a natural response is elicited by a conditioned or learned stimulus that previously was presented in conjunction with an unconditioned stimulus
  • what is operant conditioning?
    Learning in which a particular action is elicited because it produces a reward
  • What is positive reinforcement?
    desired reward produces action
  • what is negative reinforcement?
    taught behavior is followed by removal of aversive stimulus
  • What is punishment?
    repeated application of aversive stimulus extinguishes unwanted behavior
  • what is extinction?
    discontinuation of reinforcement (positive or negative) eventually eliminates behavior
  • what is transference?
    patient projects feelings about formative or other important persons onto physician
  • what is countertransference?
    doctor projects feelings about formative or other important person onto patient
  • what are ego defenses?
    unconcscious mental processes used to resolve conflict and prevent undesirable feelings
  • what are the immature ego defenses?
    Acting Out; Dissociation; Denial; Displacement; Fixation; Identification; Isolation (of affect); Projection; Rationalization; Reaction formation; Regression; Repression; Splitting
  • what is acting out?
    unacceptable feelings and thoughts are expressed through actions
  • what is an example of acting out?
    tantrums
  • what is dissociation?
    "temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress"
  • what is an example of dissociation?
    multiple personality disorder
  • what is denial?
    avoidance of awareness of some painful reality
  • what is an example of denial?
    newly diagnosed AIDS and cancer patients
  • what is displacement?
    process whereby avoided ideas and feelings are transferred to some neutral person or object
  • what is an example of displacement?
    Mother yelling at child because husband yelled at her.
  • what is fixation?
    partially remaining at a more childish level of development (vs. regression)
  • what is an example of fixation?
    men fixating on sports games
  • what is identification?
    modeling behavior after another person who is more powerful (though not necessarily admired)
  • what is an example of identification?
    abused child identifies himself/herself with an abuser
  • what is isolation (of affect)?
    separation of feelings from ideas and events
  • what is an example of isolation of affect?
    describing murder in graphic detail with no emotional response
  • what is projection?
    an unacceptable internal impulse is attributed to an external source
  • what is an example of displacement?
    a man who wants another woman thinks his wife is cheating on him
  • what is rationalization?
    "proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self blame"
  • what is an example of rationalization?
    "after getting fired, claiming that the job wasn't important anyway"
  • what is reaction formation?
    process whereby a warded off idea or feeling is replaced by an unconsciously derived emphasis on its opposite
  • what is an example of reaction formation?
    a patient with libidinous thoughts enters a monastery
  • what is regression?
    turning back the maturational clock and going back to earlier modes of dealing with the world
  • what is an example of regression?
    "seen in children under stress such as illness, punishment, or birth of a new sibling (bedwetting)"
  • what is repression?
    involuntary withholding of an idea or feeling from conscious awareness
  • what is an example of repression?
    not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconscious
  • what is splitting?
    belief that people are either all good or all bad at different times due to intolerance of ambiguity.
  • splitting is seen in what?
    borderline personality disorder
  • what is an example of splitting?
    patient says that all the nurses are cold and insensitive but that the doctors are warm and friendly
  • what are the mature ego defenses?
    altruism humor sublimation suppression
  • what is altruism?
    guilty feelings alleviated by unsolicited generosity toward others
  • what is an example of altruism?
    mafia boss makes large donation to charity
  • what is humor?
    appreciating the amusing nature of an anxiety-provoking or adverse situation
  • what is an example of humor?
    nervous medical student jokes about the boards
  • what is sublimation?
    process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system
  • what is an example of sublimation?
    teenager's aggression toward his father is redirected to perform well in sports
  • what is suppression?
    voluntary withholding of an idea or feeling from conscious awareness
  • what is an example of suppression?
    choosing not to think about the USMLE until the week of the exam
  • what are the effects of long term deprivation of affection from an infant?
    "(decrease)muscle tone poor language skills poor socialization skills lack of basic trust anaclitic depression weight loss physical illness 4W's: Weak, Wordless, Wanting, Wary"
  • affection deprivation > 6mo can lead to what in an infant?
    irreversible changes
  • severe affection deprivation can lead to what in an infant?
    death
  • what evidence points to physical child abuse?
    "healed fractures on x-ray, burns, subdural hematoma, multiple bruises, retinal detachment or hemorrhage"
  • who is typically the abuser in physical child abuse?
    usually male caregiver
  • what is the prevalence of physical child abuse?
    ~3000 deaths/yr 80% <3yr
  • what evidence points to sexual child abuse?
    "genital, anal or oral trauma; STI's; UTI's"
  • who is the typical abuser in sexual child abuse?
    "known to victim, usually male"
  • what is the peak incidence of sexual child abuse?
    9-12 years of age
  • what is child neglect?
    "failure to provide a child with adequate food, shelter, supervision, education and/or affection"
  • what is the most common form of child maltreatment?
    child neglect
  • what evidence suggests child abuse?
    poor hygeine malnutrition withdrawal impaired social/emotional development failure to thrive
  • what are the childhood and early onset psychological disorders?
    ADHD Conduct disorder Oppositional defiant disorder Tourette's syndrome Separation anxiety disorder
  • onset of ADHD is when?
    before age 7
  • clinical features of ADHD?
    "limited attention span and poor impulse control characterized by hyperactivity, impulsivity, inattention in multiple settings"
  • intelligence level in ADHD?
    "normal intelligence, but commonly coexists with difficulties in school"
  • prognosis of ADHD?
    continues into adulthood in up to 50% of individuals
  • ADHD is associated with what neurological findings?
    (decrease)frontal lobe volumes
  • what is the treatment for ADHD?
    methylphenidate amphetamines atomoxetine behavioral interventions
  • what is conduct disorder?
    repetitive and pervasive behavior violating the basic rights of others
  • what happens to individuals with conduct disorder when they become adults?
    many meet criteria for antisocial personality disorder
  • what is oppositional defiant disorder?
    "enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms"
  • when is the onset of Tourette's syndrome?
    before 18yo
  • Tourette's syndrome is characterized by what?
    "sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist > 1 year"
  • what is the lifetime prevalence of Tourette's syndrome?
    0.1-1.0% in the general population
  • what is the incidence of coprolalia in Tourette's?
    10-20% of cases
  • Tourette's is associated with what condition?
    OCD
  • what is the treatment for Tourette's?
    antipsychotics and behavioral therapy
  • what is the common age of onset of separation anxiety disorder?
    7-9yo
  • what is separation anxiety disorder?
    overwhelming fear of separation from home or loss of attachment figure
  • separation anxiety disorder may lead to what?
    factitious physical complaints to avoid going to or staying at school
  • what is the treatment for separation anxiety disorder?
    SSRI's and relaxation techniques/ behavioral intervention
  • pervasive developmental disorders are characterized by what?
    difficulties with language and failure to acquire or early loss of social skills
  • what are the pervasive developmental disorders?
    autistic disorder Asperger's disorder Rett's disorder Childhood disintegrative disorder
  • what is autistic disorder?
    severe language impairment and poor social interactions greater focus on objects than on people
  • autistic disorder is characterized by what?
    repetitive behavior and usually below normal intelligence
  • autistic disorder is rarely accompanied by what?
    unusual abilities (savant)
  • autism is more common in who?
    boys
  • what is the treatment for autism?
    behavioral and supportive therapy to improve communication and social skills
  • when is medication appropriate in autistic disorder?
    disruptive/harmful behavior
  • what is Aperger's disorder?
    milder form of autism
  • Asperger's syndrome is characterized by what?
    "all-absorbing interests, repetitive behavior, and problems with social relationships children have normal intelligence and lack verbal or cognitive deficit"
  • what is the inheritance of Rett's disorder?
    X-linked disorder seen almost exclusively in girls
  • what are the symptoms of Rett's disorder?
    "regression characterized by loss of development, loss of verbal abilities, mental retardation, ataxia, stereotyped hand wringing"
  • what is the age of onset of Rett's disorder?
    1-4yo
  • what is the common age of onset of childhood disintegrative disorder?
    3-4yo
  • what is childhood disintegrative disorder?
    marked regression in multiple areas of functioning after at least 2 years of apparently normal development
  • symptoms of childhood disintegrative disorder?
    "significant loss of expressive or receptive language skills, social skills or adaptive behavior, bowel or bladder control, or motor skills"
  • childhood disintegrative disorder is more common in who?
    boys
  • what are the neurotransmitter changes in anxiety?
    (increase)NE (decrease)GABA (decrease)5HT
  • what are the neurotransmitter changes in depression?
    (decrease)NE (decrease)5HT (decrease)DA
  • what are the neurotransmitter changes in Alzheimer's dementia?
    (decrease)ACh
  • what are the neurotransmitter changes in Huntington's disease?
    (decrease)GABA (decrease)ACh (increase)DA
  • what are the neurotransmitter changes in Schizophrenia?
    (increase)DA
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