Psychiatry Comprehensive Review

Flashcards covering key terms and concepts from psychiatric lecture notes including diagnostic criteria, defense mechanisms, and pharmacological interventions.

Transference

The unconscious displacement of feelings, attitudes, and fantasies from a patient onto their doctor.

Counter-transference

The unconscious displacement of feelings, attitudes, and fantasies from a doctor onto their patient.

Catharsis

The process of ‘venting out’ or releasing emotional tension.

Abreaction

A sense of relief achieved by reliving or re-experiencing a memory during psychoanalysis.

Id

Part of Freud’s structural theory of mind centered on the pleasure principle.

Ego

Part of Freud’s structural theory of mind centered on reality.

Super-ego

Part of Freud’s structural theory of mind centered on morals.

Transtheoretical Model of Change

A psychological model of behavioral change involving six stages: 1. Precontemplation, 2. Contemplation, 3. Preparation, 4. Action, 5. Maintenance, 6. Relapse / Termination.

Maslow's Hierarchy of Needs

A hierarchy of human needs categorized into: Physiological (basic), Safety (basic), Belongingness and love (psychological), Esteem (psychological), and Self-actualization (self-fulfillment).

Minnesota Multiphasic Personality Inventory (MMPI)

A type of objective test used in personality assessment.

Projective Tests

Tests like the Rorschach ink blot and Thematic Apperception Test (TAT) that reveal a person's unconscious intentions.

Mature Defense Mechanisms (S-A-A-S-H)

Constructive ways to handle stress: Suppression, Anticipation, Altruism, Sublimation, and Humour.

Sublimation

A mature defense mechanism where an individual canalizes potentially maladaptive feelings into socially acceptable behavior/hobbies, such as a short-tempered person taking up kick-boxing.

Narcissistic Defense Mechanisms (D-P-S)

Defense mechanisms including Denial, Projection, and Splitting (most commonly associated with Borderline Personality Disorder).

Neurotic Defense Mechanisms

Defense mechanisms including Repression, Intellectualisation, Rationalisation, Displacement, Reaction formation, Undoing, Isolation of affect, and Idealisation.

Repression

A primary neurotic defense mechanism where an individual does not remember traumatic events, such as a child not remembering counseling during a parental divorce.

Reaction formation

A defense mechanism where a person treats someone they resent with excessive nurturing or overprotection.

Pavlov's Behavioral Conditioning

Learning by association involving involuntary responses.

Skinner's Behavioral Conditioning

Learning by consequences involving voluntary responses.

Mental State Examination (MSE): Mood vs. Affect

Mood is the emotional state over a period of time, while Affect is the cross-sectional, observable emotional expression (e.g., ‘Labile’ or ‘Flat’).

Insight Grade $1$

Complete denial of illness.

Insight Grade $5$

True emotional insight, where the patient understands the illness and its impact on future behavior.

Delirium Hallmark

Impaired consciousness coupled with an acute, fluctuating course.

Carphologia (Floccillation)

A symptom of delirium involving picking at covers or clothes.

Sundowning

A phenomenon where symptoms of delirium or dementia worsen at night.

Circumstantiality

A thought disorder where the patient reaches the answer after giving excessive, unnecessary detail.

Tangentiality

A thought disorder where the patient moves from one topic to another and never reaches the point or answer.

Capgras Syndrome

A misidentification delusion where the patient believes family members have been replaced by identical-looking imposters.

Cotard Syndrome

A nihilistic delusion where the patient believes they are dead, do not exist, or their organs are rotting.

Cluster A Personality Disorders

Paranoid (suspiciousness), Schizoid (content with social isolation), and Schizotypal (odd beliefs/magical thinking).

Cluster B Personality Disorders

Antisocial (criminality/hostility), Borderline (unstable relationships/splitting), Histrionic (attention-seeking), and Narcissistic (grandiosity).

Cluster C Personality Disorders

Avoidant (hypersensitive to rejection), OCPD (perfectionism/ego-syntonic), and Dependent (low self-confidence).

MacDonald Triad

Early indicators of Conduct Disorder: animal cruelty, fire setting, and bed wetting.

DSM-5 Criteria for Schizophrenia

$\ge 2$ symptoms for $\ge 1$ month (must include Hallucinations, Delusions, or Disorganized Speech) and continuous disturbance for $6$ months.

Eugene Bleuler's 4As of Schizophrenia

Autism, Ambivalence, Affective flattening, and Association lost.

Schneider's First Rank Symptoms (FRS)

$3$ auditory hallucinations, $3$ made phenomena (Impulse, volition, affect), $3$ thought processes (Insertion, withdrawal, broadcast), Somatic passivity, and Delusional perception.

Schizophrenia Genetics (Prevalence)

General population: $1\%$, Dizygotic twin: $12\%$, Monozygotic twin: $47\%$, both parents affected: $$40\% – 46\%.”

Extra-Pyramidal Symptoms (EPS): Acute Dystonia

Sudden, sustained muscle contractions (e.g., Torticollis, Trismus) occurring within hours of antipsychotic use.

Akathisia

Subjective restlessness and inability to sit still; the most common Extra-Pyramidal Symptom.

Neuroleptic Malignant Syndrome (NMS)

A life-threatening reaction to antipsychotics characterized by fever, muscle rigidity, and high CPK; treated with Dantrolene Sodium.

Clozapine

The drug of choice for refractory psychoses; requires monitoring for agranulocytosis (WBC $< 3000\text{/mm}^3$, ANC $< 1500\text{/mm}^3$).

Depot Injections Technique

The Z-technique, used for long-acting antipsychotics like Penfluridol.

Waxy Flexibility

A catatonic symptom where a patient's limbs stay in the position they are placed by the examiner, like a candle.

SIGE CAPS (Depression Mnemonic)

Sleep, Interest deficit, Guilt, Energy deficit, Concentration deficit, Appetite, Psychomotor retardation, Suicidality.

Rapid Cycling Bipolar Disorder

Bipolar disorder characterized by $> 4$ mood cycles per year.

Postpartum Blues

Mild depression and tearfulness appearing $2 – 3$ days after birth and resolving within $10$ days.

Highest Risk Factor for Suicide

A previous suicide attempt.

Lithium Prophylaxis Level

$0.5 – 0.8\,mEq/L$.

Lithium Levels for Acute Mania

$0.8 – 1.2\,mEq/L$.

Ebstein Anomaly

A teratogenic effect of Lithium causing atrialization of the right ventricle.

Generalized Anxiety Disorder (GAD) Timeline

Excessive anxiety and worry occurring more days than not for $\ge 6$ months.

Agoraphobia

Fear of being in spaces from which escape might be difficult.

Obsessive-Compulsive Disorder (OCD)

Ego-dystonic disorder characterized by obsessions (intrusive thoughts) and compulsions (repetitive behaviors) that are time-consuming.

Post Traumatic Stress Disorder (PTSD) Timeline

Symptoms of sense of threat, avoidance, and re-experiencing lasting $> 1\text{ month}$ after a life-threatening trauma.

Acute Stress Disorder Timeline

Symptoms of stress lasting $< 1\text{ month}$ after an event.

Anorexia Nervosa BMI

Characterized by a BMI $< 18.5$, distorted body image, and potential amenorrhea.

Bulimia Nervosa Physiologic Findings

Recurrent bingeing and purging often accompanied by parotitis, tooth decay, and Russell sign (knuckle calluses).

Dissociative Fugue

Amnesia for personal identity accompanied by wandering or a new identity, without confusion.

Ganser Syndrome

Also called ‘pseudo-stupidity,’ seen in prisoners, characterized by giving approximate answers (‘Vorbeireden’).

Autism Spectrum Disorder Onset

Symptoms of social impairment and repetitive behaviors appearing before age $3$.

Rett Syndrome

An X-linked dominant condition (MECP-2 gene) in girls characterized by microcephaly and hand-wringing stereotypy starting at $6\text{ months} – 3\text{ years}$.

ADHD Diagnosis Age

Symptoms must be present for $> 6\text{ months}$ in at least two settings before age $12$.

Gender Dysphoria Onset

Gender identity generally begins to form at age $3$.

Stage N2 Sleep

The largest portion of sleep ($45\%$), characterized by sleep spindles and K-complexes; bruxism occurs here.

Stage N3 Sleep

Deep, restorative sleep ($25\%$) characterized by Delta waves; bedwetting, sleepwalking, and night terrors occur here.

Narcolepsy Tetrad

Profound sleepiness ($\ge 3$ times/week for $3\text{ months}$), Cataplexy, Hypnagogic/pompic hallucinations, and decreased REM latency; caused by decreased Hypocretin from the lateral hypothalamus.

Sleep Apnea/Insomnia Timeline

Symptoms must occur $\ge 3\text{ nights/week}$ for $\ge 3\text{ months}$.

Conversion Disorder

Unintentional, unexplainable neurological symptoms (like paralysis or seizures) often following a stressor, sometimes accompanied by ‘La Belle Indifference.’

Munchausen Syndrome (Factitious Disorder)

Intentional production of symptoms to assume the ‘sick role’ without external secondary gain.

Beck’s Cognitive Triad

Component of CBT for depression: Helpless, Hopeless, and Worthless (Automatic negative thoughts).

PANDAS

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Group A Streptococcus.