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Psychiatry

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  Psychiatry Developmental Stages    Anal phase  –  in psychoanalytic point of view, an obsessive-compulsive disorder is traceable in this developmental stage    Phallic    –  Oedipal complex (separation-individuation), ambivalence (object relations), initiative or guilt (psychosocial crises)    Erickson’s Conception of 8 Stages of Ego Development   Stage 1: Trust vs Mistrust (birth to 18 mo) Stage 2: Autonomy vs Shame & Doubt (18 mo to 3 yr) Stage 3: Initiative vs Guilt (3 to 5 yr) Stage 4: Industry vs Inferiority (5 to 13 yr) Stage 5: Identity vs Role Confusion (13 to 21 yr) Stage 6: Intimacy vs Isolation (21 to 40 yr) Stage 7: Generativity vs Stagnation (40 to 60 yr) Stage 8: Integrity vs Despair (60 yr to death) Id, Ego, Superego    Id  –  reservoir of unorganized instinctual drives, operating under domination of primary process, it lacks the   Capacity to delay or modify the instinctual drives with which an infant is born    Ego    –  spans all topographical dimensions of conscious, preconscious & unconscious; defense mechanism resides in the unconscious domain of ego; executive organ of psyche    Ego  –  psychological seat of anxiety    Repository of drives & instincts  –  not a function of the ego    Superego  –  3 rd  component of tripartite structural model; establishes & maintains moral conscience on the basis of complex system of ideals & values internalized from parents    Superego    –  heir to the Oedipus complex    Superego  –  its presence is observed from the moment of birth (even before birth)    Ego ideal    –  component of superego, an agency that prescribes what a person should do according to internalized standards & values    Repression    –  the force that keeps materials within unconscious General Principles    Regular scheduled lists w/ a single identified physician    –  treatment of patient w/ somatization disorder      Biological cause of conversion disorder    –  defects in the processing of endogenous somatic signals & integrating   Sensory motor signals    Stevens-Johnson Syndrome    –  associated w/ Carbamazepine    Bupropion  –  given to patient who does not want the sexual side effect of antidepressant    Basal ganglia  –  basic neuroanatomical structure involved in mood disorder    Pneumonia  –  Axis III    Social  –   family’s role in behavior      Waxy flexibility  –  not a Schneiderian symptom    Ambivalence  –  not considered a negative symptom    Koro  –  cultural belief where a person believes that retraction of the penis is a sign of impending death     Amygdala  –  fear    Mediobasal hypothalamus    –  location for the cell bodies of the principal histaminergic neurons in the brain    Chlopromazine  –  a tranquilizer    Schizophrenia  –  a disease believed that the mesocortical system of dopaminergic neurons is hyperactive    Retrograde amnesia  –   commonly precipitated by a blow on the head History    Chief complaint    –  recorded as verbatim (in patient’s own words)      HPI    –   provides a comprehensive & chronological picture of events leading up to current moment in px’s life ,   the most helpful in making a diagnosis    Past Illnesses    –  transition between the story of present illness & the px’s personal hx      Family History    –  alcohol, substance abuse or antisocial behavior; personalities & intelligence      Personal History    –  anamnesis      Dreams  –  royal road to the unconscious  MSE    MSE    –   describes the sum total of the examiner’s observa tions & impressions of the psychiatric patient at the   time of interview    Dysprosody    –  unusual rhythms      Mood    –   pervasive & sustained emotion that colors the person’s perception of the world      Affect    –   present emotional responsiveness, inferred from the patient’s facial expression      Schizophrenic  –  inappropriate affect      Hypnagogic hallucinations    –  occurring as a person falls asleep      Hypnopompic hallucinations    –  occurring as a person awakens      Depersonalization & derealization    –  extreme feelings of detachment from self or environment      Formication    –  feeling of bugs crawling on or under the skin, seen in cocainism      Thought process    –  the way in which person puts together ideas & associations, the form in which a person   thinks    Flight of ideas    –  rapid thinking carried to extreme    Flight of ideas    –  a succession of multiple associations so that thoughts seem to move abruptly from idea to idea; often expressed through rapid, pressured speech    Loose associations    –  ideas expressed seemed unrelated & idiosyncratically connected    Blocking    –  interruption of the train of thought before an idea has been completed; the patient may indicate an inability to recall what what was being said or intended to be said    Circumstantiality    –  loss of capacity for goal-directed thinking; in the process of explaining an idea, the patient brings in many irrelevant details & parathentical comments but eventually does get back to the srcinal point    Circumstantiality  –  overinclusion of trivial or irrelevant details that impede the sense of getting to the point    Tangentiality    –  patient loses the thread of conversation, pursues divergent thoughts stimulated by various external or internal irrelevant stimuli, never returns to the srcinal point    Word salad    –  incoherent or incomprehensible connections of thoughts    Clang associations    –  association by rhyming or assonance    Clang associations    –  thoughts are associated by the sound of words rather than by their meaning    Derailment    –  synonymous w/ loose associations; breakdown in both the logical connection between ideas and  the overall sense of goal-directedness; the words make sentences, but the sentences do not make sense    Punning  –  association by double meaning    Neologisms    –  new words created by the patient by combining or condensing other words; use of conventional words in idiosyncratic ways    Perseveration    –  repetition of out of context of words, phrases or ideas    Thought content    –  refers to what a person is actually thinking about: ideas, beliefs, preoccupations, obsessions    Thought content    –  obsession, compulsion, phobias, plans, intentions, recurrent ideas about suicide or homicide hypochondrial symptoms & specific antisocial urges    Delusions    –   fixed, false beliefs out of keeping w/ the patient’s cultural background      Ideas of reference    –   person’s belief that the television or radio is speaking to or about him or her      Ideas of influence    –  beliefs about another person or force controlling some asp ect of one’s behavior      Confabulation  –  unconsciously making up false answers when memory is impaired    Serial 7s    –  test for concentration      Attention    –  assessed by calculations or by asking the patient to spell the word world backward    Insight  –   patient’s degree  of awareness & understanding about being ill    Intellectual insight    True emotional insight    Remote memory  –  childhood data, important events known to have occurred when the patient was younger   or free of illness, personal matters, neutral material    Recent past - the past few months      Recent memory    –  the past few days, what the patient did yesterday, the day before, what the patient had for   breakfast, lunch, dinner    Immediate retention and recall  –   ability to repeat 3 words immediately and 3-5 min. later; digit span measures   PE & Diagnostic Tests      Hoover test    –  can rule out conversion disorder in a patient presented w/ paralysis; pressure noted on   e xaminer’s hand under paralyzed leg when attempting straight leg raise      Liver function test  –  regularly monitored in patient taking valproic acid    MMSE  Defense Mechanism    Projection  –  defense mechanism usually used in persecutory type of delusion    Intelectualization   Delirium & Dementia    Advanced age    –  one of the independent risk factors for delirium      Lasts for months to years –    not a characteristic of delirium      Alzheimer’s dementia –   most common type of dementia      Onset can be dated w/ precision  –   not a characteristic of dementia      Disorganized thoughts  –   can be seen in both dementia & delirium  Personality disorder    Grandiosity    –  outstanding feature of narcissistic in their behavior    Narcissistic  –  sense of entitlement     Repression & dissociation  –  defense mechanism typical of histrionic personality disorder    Avoidant  –   has “inferiority complex”      Cluster A Personality  - schizotypal, schizoid, and paranoid; odd, aloof features    Cluster B Personality  - narcissistic, borderline, antisocial & histrionic; dramatic, impulsive & erratic features    Cluster C Personality  - obsessive-compulsive, dependent & avoidant; anxious & fearful features    Obsessive-compulsive  –  orderly, neat & perfectionist, preoccupied w/ details    Magical thinking  –  not a feature of borderline personality (suicidal thinking, feelings of emptiness, identity disturbance)    Schizotypal  –  premorbid for schizophrenia    Schizotypal  –  ideas of reference, superstitious & having 6 th  sense    Projection  –  defense mechanism for paranoid personality disorder    Respect the need for space  –  advice that can be given in dealing w/ schizoid personality    Being constantly late    –  typical of passive-aggressive disorder    Stubbornness  –  not expected in a histrionic person (seductiveness, theatricality, suggestibility)    Antisocial  –  adolescent w/ conduct disorder is prone to develop this kind of disorder    Locus ceruleus  –  biological seat of anxiety    Fear  –  response to a stimulus that is external, known, non-conflicting in srcin    Anxiety  –  response to a threat that is unknown, internal, vague & conflictual in srcin    Anxiety neurosis  –  was changed to panic disorder in DSM-IV TR criteria    Alexithymia  –  inability to identify or verbalize emotional state    Psychotherapy  –  effective because it leads to neuronal & structural changes in the brain according to Kandel    Use of exploratory psychotherapy  –  may be harmful in patients w/ PTSD (Posttraumatic Stress Disorder)    SSRI  –  drug of choice for long term treatment of panic disorder    Splitting  –  not a defense mechanism in anxiety disorder ( repression, displacement, avoidance)    Obsession  –  refers to recurrent & intrusive thoughts, feelings, ideas & sensations    Panic disorder  –  discrete period of intense fear w/ autonomic symptoms    Panic disorder  –  excessive worry or dread about a number of events or activity associated w/ motor tension    Though of contamination followed by frequent washing  –  most common symptom pattern of OCD    Ego-dystonic    –  not a characteristic of personality disorder    Paranoid  –  fearful & anxious    Paranoia  –  personality disorder which are more common in males than females    Anti-social    –  highly represented in prison population Mood Disorders    Unipolar mania or pure mania    –  for pxs who are bipolar, but who do not have depressive episodes    Manic episode    –  distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week or any duration if hospitalization is necessary    Cyclothymia    –  represent less form of bipolar disorder    Cyclothymic disorder    –  at least 2 years of frequently occurring hypomanic symptoms that cannot fit the dx of manic episode & of depressive symptoms that cannot fit the dx of major depressive episode    Dysthymia    –  represent less form of major depression    Dysthymic disorder    –  at least 2 years of depressed mood that is not sufficiently severe to fit the dx of major depressive episode    NE & Serotonin    –  2 NTs most implicated in the pathophysiology of mood disorders
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