2 - Psychiatry Flashcards
What are the PD clusters and their different diagnosis?
1) Cluster A = Eccentric/Odd (Weird): Paranoid, Schizoid, Schizotypal
2) Cluster B = Dramatic (Wild): Antisocial, Borderline, Histrionic, Narcissistic
3) Cluster C = Anxious (Worried): Avoidant, Dependent, Obsessive-Compulsive
What are the defining characteristics of a Personality Disorder?
1) difficulties in multiple areas of functioning
2) pattern that is stable, enduring and has onset traceable to adolescence or early adulthood
3) creates clinically significant stress in important areas of functioning
4) not better explained by another mental disorder, general medical condition or substance abuse
Define Paranoid PD.
- Pervasive distrust and suspicion of other sucha that their motives are interpreted as malevolent
- Beginning by early adulthood
- 4 or more
1) suspicious of others w/o sufficient basis
2) preoccupied with the doubts about the loyalty of friends/family
3) relunctance to confide
4) hidden meanings in benign events
5) bears grudges
6) perceives attacks on his character that are not there
7) recurrent suspicion concerning the fidelity of the spouse
Define Schizoid PD.
Weird Loner
- pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings
- 4 or more
1) neither desires or enjoys close relationships
2) almost always chooses solitary activity
3) little/no interest in sexual experiences
4) takes pleasure in few, if any activities
5) no friends/confidants other than 1st order family
6) indifferent to praise or criticism
7) emotional coldness, detachment or flattened affect
Define Schizotypal PD.
Weird Gamer
- pervasive pattern of social/interpersonal deficits; marked discomfort w/ close relationships; perceptual/cognitive distortions; eccentricities of bx; beginning by early adulthood
- five or more
1) ideas of reference
2) odd beliefs/magical thinking
3) unusual perceptual experiences
4) odd thinking or speech
5) paranoid ideation
6) constricted affect
7) odd, eccentric or peculiar
8) lack of close friends/confidants
9) excessive social anxiety that does not diminish w/ familiarity and is based on paranoid fears vs negative impression of self
Define Anti-Social PD.
Serial Killer
- pervasive disregard for and violation of rights of others
- occurring since age 15 but individual is older than 18
- evidence of Conduct Disorder <15yrs
- 3 or more
1) failure to conform to social norms
2) deceitfullness/chronic lying
3) impulsivity
4) irritability/aggressiveness
5) disregard for safety of others/self
6) irresponsible
7) lack of remorse
Define Borderline PD.
- instability of interpersonal relationships, self-image and affects; marked by impulsivity
- 5 or more
1) frantic efforts to avoid real or imagined abandonment
2) unstable/intense personal relationships; idealization/devaluation
3) identity disturbance; unstable self-image
4) impulsivity in two areas that are self-damaging (spending, sex, drugs, etc)
5) suicidal bx, gestures, threats; self-mutilation
6) reactive mood
7) chronic feelings of emptiness
8) inappropriate/intense anger
9) transient, stress-related paranoid ideation/dissociative symptoms
Define Histrionic PD.
- excessive emotionality and attention seeking
- 5 or more
1) uncomfortable when not center of attention
2) inappropriate sexually seductive
3) rapidly shifting and shallow emotions
4) uses physical appearance to draw attention
5) speech impressionistic and lacking in detail
6) dramatic/exaggerated expression of emotion
7) suggestibility
8) sees relationships as closer than they are
Define Narcissistic PD.
- pattern or grandiosity, need for admiration and lack of empathy
- 5 or more
1) grandiose sense of self
2) preoccupied with fantasies of unlimited power/brilliance/beauty
3) believes to be “special”
4) requires excessive admiration
5) sense of entitlement
6) interpersonally explosive
7) lacks empathy
8) envious of others; believes others are envious of him
9) arrogant, haughty
Define Avoidant PD.
Nervous Recluse
- pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation; begins by early adulthood
- 4 or more
1) avoids interpersonal contact due to fear of criticism
2) unwilling to get involved unless certain of being liked
3) restraint w/in intimate relationships due to fear of being shamed
4) preoccupied with being criticized
5) feelings of inadequacy
6) view of self: socially inept, unappealing, inferior
7) reluctant to take personal risks that might be embarrassing
Define Dependent PD.
- excessive need to be taken care or that leads to submission, clinging and fears of separation; beginning in early adulthood
- 5 or more
1) difficulty making everyday decisions without excessive amounts of advice/reassurance
2) needs other to assume responsibility for major areas of life
3) difficulty expressing disagreement; dear of loss of approval
4) difficulty initiating projects on his own
5) excessive lengths to obtain nuturance/support from others
6) uncomfortable/helpless when alone
7) urgently seeks another relationship when one ends
8) preoccupied with fears of being abandoned
Define Obsessive-Compulsive PD.
- preoccupation with orderliness, perfectionism, mental/interpersonal control
- 4 or more
1) preoccupied with rules, lists, details to the detriment of the overall goal
2) perfectionsism interferes with task completion
3) excessively devoted to work to exclusion of leisure
4) overconscientious, scrupulous, and inflexible on moral issues
5) hoarder
6) reluctant to delegate
7) miserly approach to money for self and others
8) rigidity and stubbornness
What are risk factors for suicide?
** lower CSF levels of 5-HIAA in completed suicides S - sex(male) A - age D - depression P - previous attempt E - EtOH/drugs R - rational loss S - social support lacking O - organized plan N - no spouse S - sickness
What is the definition of psychotherapy?
1) verbal
2) 2 person group
3) voluntary
4) one person is labeled as expert, the other as help seeker
5) expectation of help
6) purpose of finding areas of life that are particularly troublesome
Define Countertransference.
1) Complimentary: therapist experiences and empathizes with the feelings of an important person in the patient’s life
2) Concordant: therapist experiences and empathizes with the patient’s emotional position
What is psychological first aid?
- mechanism for fostering resilience and recovery from psychological insult (before they are mentally ready for therapy)
1) Safety - be safe, feel safe
2) Calming - rest, relax, sleep
3) Efficacy - skills and confidence
4) Connectedness - social support; emotional and instrumental
5) Hope - optimism
What is the purpose of the following instruments:
1) PHQ-9
2) GAD-2
3) PC-PTSD
- screening instruments meant to help objectively identify the likelihood of a given dx
1) PHQ-9: Depression screener-> cut-off score of 10 has 88% sensitivity and specificity; 15-19 = immediate therapy; >20 = high risk
2) GAD-2: two question general anxiety disorder screener
3) PC-PTSD
What are the typical symptoms of Psychosis?
Positive: Delusion, Hallucinations, Illusions, Disorganization
Negative: Apathy, Anhedonia, Alogia, Affective flattening
Define Schizophrenia.
1) 2 or more of the following symptoms for >1month: delusions, hallucinations, disorganized speech,m grossly disorganized/catatonic bx, negative symptoms (apathy, affective flattening, alogia)
2) causes a disturbance in one or more major areas of functioning
3) continuous signs of dx for 6 months(including 1 month of symptoms)
4) schizoaffective disorder, substance abuse and GMC excluded
What is the difference between schizophrenia, schizophreniform, and brief psychotic disorder?
1) Schizophrenia = >6months; Schizophreniform = 1-6 months; Brief Psychotic Disorder = 1day-1month
2) Schizophrenia and Schizophreniform share most of their diagnostic criteria, other than duration
3) Brief Psychotic Disorder requires ONE of more of the characteristic symptoms vice TWO as with the other dx
What is the current theory of the etiology of Schizophrenia?
1) thought to be genetic (though new evidence is pointing to genetic susceptibility vice causation)
2) due to efficacy of D2 blockade drugs, thought to be to due to Dopamine over-activity
3) Mesolimbic: increased Dopamine is associated w/ positive symptoms
4) Prefrontal Cortex: decreased Dopamine associated with negative symptoms
5) Nigrostriatal: blocking Dopamine influence on Striatum causes Parkisonian symptoms
6) Tubuloinfudibular: dysregulation of Dopamine leads to increased release of prolactin from pituitary gland (from hypothalamus)
Define Delusional Disorder.
1) non-bizarre delusions that last >1month (being followed vs alien invasion)
2) criteria for Schizophrenia has never been met
3) other than delusion, function is not significantly impaired and interactions are otherwise normal
4) if mood episodes occur, they are short compared to the duration of the delusion
What is Shared Psychotic Disorder (folie a deux)?
- delusion that develops in the context of a relationship with another person that has a long standing delusion
- ie: the spouse is convinced of her husband’s delusion
Define Schizoaffective.
1) during a defined period, there has been a Major Depressive Episode, Manic Episode or a Mixed episode CONCURRENT with meeting symptom criteria of Schizophrenia
2) during the same period, hallucinations or delusions must be present for 2 weeks in the abscense of prominent mood symptoms
3) mood symptoms are present for substantial portion of disease
