First Aid for the Psychiatry Clerkship, Third Edition I

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alcohol withdrawl: when does windrawl seizures vs DTs occur
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48 hours = withdrawl seizures 96 hours = DT
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what patients is hypnosis contraindicated in
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psychotic disorders
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components of decisional capacity
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1. comprehends issues/choices 2. understands consequences 3. able to weigh the facts
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dusky vs united states
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need ability to rationally consult attorney, understand proceedings in rational/factual terms
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when to involuntarily admit a patient
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imminent harm to self or others, or gravely disabled
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elements of informed consent
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1. capactiy to make decision 2. explaination of risks/benefits 3. discussion of alternatives 4. ability to understand information presented 5. absence of condition taht would impair ability to make decision
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relationships with former psychiatric patients (as their providing physician) relationships with former medical/surgical patients
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current or former patients unethical to have relationship with unethical if patient is current, do not exploit the power differential if they are a past patient, and at very least terminate physician-patient relationship
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habeas corpus
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state shall not deprive person of life, liberty, or property without due processes of law — patients have the right to petition to court if they are being held against their will
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ganser syndrome
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patient responds to questions with approximate or ridiculous answerse— seen mostly in prison population = dissociative disorder NOS
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fixation
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defense mechanism overattachement to a person or object
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why are MAOIs CI in pregnancy, which antidepressant should be used in pregnancy
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MAOIs exacerbate pregnancy hypertension, fluoxetine is safe, maintenence ECT is safe
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anticholinergic toxicity clinical presentation
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occurs when patient being treated with neuroleptics + being given antichoinergics ex. benztropine –> flushing/dec. secretions, dry skin, flushing,hyperthermia, tachycardia,
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hallucinosis
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hallucination in patient who is alert and oriented usually occurs in withdrawl or alcohol abuse
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testamentary capcity
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1. understanding of nature of will 2. knowledge of ones assets 3. knowledge of natural heirs 4. absence of mental illness 5. freedom of influence/coercion
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therapeutic privilege
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dont have to tell patient what diagnosis is if think it will make the patient kill/harm themselves VERY RARELY USED***
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what neurotransmitter is associated with drug induced delirium + what drugs classically cause this
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acetylcholine anticholinergics – diphenhydramine, cimetidine, furosemide
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which psychotropic class is safe for patient to remain on during ECT
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typical antipsychotics
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how many parents are required to consent for treatment of a child
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only one parent even if they are in disagreement
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when to hospitalize a patient for psychiatric reason
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SI, HI, grave disability, gross disorganization, agitated or threatening behavior, severe substance intox/withdrawl
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female sexual arousal disorder
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inability to achieve/maintain lubrication/swelling during sexual contact
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how long must a patient who experienced mania stay on mood stabilitzer ie. lithium
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at least a year, and if asymptomatic after a year the lithium can be tapered
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key feature of MDD in children
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psychomotor agitation
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treatment of tourettes/tic disorders
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haloperidol/pimozide, clonidine
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how to differentiate ADHD vs mania in a child
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ADHD has low self esteem while mania is grandiose
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which psychiatric illness has the strongest genetic link
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bipolar disorder
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what is major side effect of clonidine
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sedation
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psychotherpy doesn’t work for patients with impaired reality testing ex. psychotic/cluster A/B
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…..
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what is most important r/o before administering antidepressant
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bipolar disorder ~~ SSRI will trigger mania
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why does BUN increase in anorexia
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due to increased catabolism
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post partum psychosis managmenet
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must admit to the hospital
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dexamethasone suppression test and TRH response test in patients who are depressed
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more likely to have poor dexamethasone suppression test and less likely to show TSH rise with TRH response test
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lithium side effects
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hypothyroid, polyuria, tremor, ECG changes
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anterograde amnesia
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inability to form new memories- patient will forget what happended just a moment ago, or yesterday
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masochism sadism
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arousal after recieving punishing acts arousal after giving punishing acts
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which SSRI is safe in pregnancy
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fluoxetine
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left frontal vs right frontal stroke clinical features
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left frontal = depression right frontal = mania
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short term memory defecits, unstable smooth eye pursuit, decreased ability to habituate to repeated sensory stimuli – what psychiatric disorder
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schizophrenia
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localized amnesia generalized amnesia depersonalization
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loss of memory around a traumatic event forgetting all events of life prior to a trauma feelign that persons identity is lost or feeling unreal/strange
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areas of the brain with abnormal EEG activity in OCD
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caudate, frontal lobes, cingulate gyrus
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MRI findings in vascular dementia
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hypodensities on neuroimaging
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treatment for agitation in patient with autonomic instability
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benzo ~ not neuroleptic
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labs before starting lithium
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CBC, electrolytes, thyroid, BUN/Cr, urinalysis
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which NSAID doesnt change p450 metabolism
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aspirin, sulindac
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which SSRI most useful for borderline PD
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fluoxetine
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which SSRI inhibits p450 raising levels of other drugs
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fluoxetine
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lithium ECG changes
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T wave flattening/inversion, AV block
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venlafaxine effects at low/high doses
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low dose = SSRI high does = SNRI
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which neuroleptic has the least alpha adrenergic blockade
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haloperidol
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first line treatment for neuropathic pain TCA or SSRI
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SSRI because safer in overdose
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gabapentin use
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bipolar disorder, neuropathic pain,
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which SSRI does pimozide interact with
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citalopram
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satyriasis
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insatiable sexual desire
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patient on SSRI is responding good to treatment, but experiencing sexual side effects what to do
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add buproprion
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which antipsychotics can cause agranulocytosis
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chlorpromazine and clozapine
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1. catharsis 2. ventilation 3. automatic thoughts
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expression of ideas, thoughts accompanied by emotional response and produces a state of relief ventilation – expression of suppressed ideas, feelings or events constant ways of percieving situations and oneself in relation to the environment
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what kind of psychotherapy for borderline patients
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group, AND group because these patients develop intense transference
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behavior therapy
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set of procedures that enhance learning of of adaptive behaviors + unlearn maladaptive behaviors — ex. make kid with ADHD enjoy learning
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interpersonal psychotherapy
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communication analysis – to see if communication is problem in relationship
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cognitive therapy
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focuses on altering cognitive errors
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psychoanalysis
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interprets transference neurosis, and dreams (dreams = unconsious workings of the mind)
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brief psychotherapy
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single focal area of conflict, spends time interpreting transference specifically how it effects that situation
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what should be done if family disagrees with living will
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first discuss with family then consult ethics committee
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single episode of major depression tx
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SSRI for 6 months if multiple episodes treat indefinatly
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how long must single manic episode vs >3 manic episodes be treated
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SINGLE = 1 YEAR >3 = LIFETIME ~~ single depression treat at least 6 months – 1 year
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which type of conditioning is defined “a natural response learned to be elicited by a conditioned stimulus”
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classical conditioning
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what type of conditioning is defined “particular action learned to be elicited bc it produces a reward”
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operant conditioning
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which type of conditioning is the Pavlov’s experiment an example of?
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classic conditioning
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define positive reinforcement
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elicit behavior to gain reward
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define negative reinforcement
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elicit behavior to avoid aversive stimulus
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define punishment
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not behavior by causing aversive stimulus
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define extinction
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stopping reinforcement stops behavior
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define transference
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pt projects feelings onto physician
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define countertransference
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physician projects feelings onto pt
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what are the 4 mature ego defenses?
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1) altruism 2) humor 3) sublimation 4) suppression
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give an example of sublimation
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teenager’s aggression toward father is redirected to perform well in sports
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what is the difference between repression and suppression?
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repression- involuntary suppression- voluntary
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define displacement
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feelings are transferred to neutral person/object
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define projection
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unacceptable internal impulse is attributed to an external source
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give an example of displacement
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mother blames child bc she is mad at her husband
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give an example of projection
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man who is wants another woman thinks his wife is cheating on him
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what is the difference between fixation and regression?
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fixation- stuck at childish level of development regression- going back to earlier modes of dealing w the world
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define dissociation
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temporary, drastic change in personality, memory, consciousness or behavior to avoid emotional stress
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define isolation of affect
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separate feelings from the event that caused them
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give an example of isolation of affect
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describe murder in graphic detail w no emotion
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define identification
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modeling behavior after someone who is more powerful
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give an example of identification
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abused person acts like abuser
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define reaction formation
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unwanted feeling is replaced by its opposite
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give an example of reaction formation
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pt w libidinous thoughts enters monastery
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define splitting
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belief that ppl are all good or all bad at different times bc of an intolerance of ambiguity
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give an example of splitting
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pt says all nurses are mean and all doctors are nice
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in what psychological disorder is splitting seen?
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borderline personality disorder
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what are the signs of child abuse?
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classic metaphyseal corner lesions, cigarette burns, subdural hematomas, mult bruises, retinal hemorrhage or detachment
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what are the signs of child neglect?
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poor hygiene, malnutrition, withdrawal, impaired social/emotional devel, failure to thrive
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how do you tx ADHD?
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methylphenidate, amphetamines, atomoxetine (nonstim SNRI)
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what is the psychological disorder that reflects antisocial personality disorder, but occurs in children (<18) instead of adults?
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conduct disorder
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define oppositional defiant disorder
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hostility toward authority w/o violating social norms
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what are the clinical sx of Tourette’s syndr
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sudden, rapid, recurrent, nonrhythmic, sterotypes motor mvmts or vocalizations; coprolalia (obscene speech), assoc w OCD
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how do you tx Tourette’s syndr?
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haloperidol (antipsychotics)
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what is the difference between autism and Asperger’s disorder?
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autism- incl language impairment, below-nl intelligence Asperger’s- milder form of autism; no language impairment, nl intelligence
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who is affected w Rett’s syndr?
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females; affected males die in utero (X-linked)
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what are the clinical sx of Rett’s syndr?
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presents 1-4yo; regression, loss of development, loss of verbal abilities, mental retardation, ataxia, hand-wringing

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