Behavioral Sciences Pre-Midterm Flashcards
Panic disorder
Dx criteria: recurrent and UNEXPECTED panic attacks (# not specified). At least 1 month of fear of future panic attacks or its implications
Panic d/o is often accompanied by agoraphobia (fear of being in places from which escape may be difficult/embarassing -> avoid these situations). Must specify on Axis I if Panic d/o occurs w/ or w/o agoraphobia
Etiology: classical conditioning - physical sx’s of anxiety assoc w/fear response -> physical sx’s alone can now trigger anxiety
Social phobia
Xs and unrealistic fear of social or performance situations d/t fear of embarrassment.
Subtypes: Specific - anxiety only in certain social or performance situations)
Generalized - anxiety in most or all social or performance situations
OCD
1) Recurrent obsessions or compulsions
Obsessions - unwanted recurrent thought, impulses, or images that INCREASE anxiety
Compulsions - repetitive behaviors/mental acts that are performed to DECREASE anxiety
2) O/C are time-consuming or distressful
3) Insight is present (person knows the fears are irrational)
4) Sx’s not explained by another disorder
Yale-Brown OC Scale - used to qualify and quantify the sx’s and severity of OCD
OCD etiology
Prefrontal-striatal overactivity
Orbital prefrontal -> ant. cingulate -> caudate nuc -> thalamus “loop”
Serotonin deficiency
Rare cases - OCD begins after strep infxn, known as PANDAS (ped AI neuropsych d/o assoc w/strep infxns)
OCD txt
Standard: CBT and/or SSRIs
Addtn’l options for txt-resistant OCD - psychosurgery of ant. cingulate gyrus (cingulotomy) or ant. limb of int capsule (capsulotomy)
Deep brain stim - electrical impulses are delivered by brain electrode attached to implanted thoracic pacemaker
PTSD
Dx criteria: exposure (being involved, witnessing, or learning of) to traumatic event (death or serious injury). Person responded w/fear, helplessness, or horror to event
As a result, these 3 types of sx’s developed and LASTED for over 1 month:
1) Re-experiencing the event
2) Avoidance of stimuli or a numbing response
3) Hyperarousal
Onset: Sx’s USUALLY begin w/in 3 mos of trauma but can begin ANYTIME in the future. Often in young adults and orthopedic pts
Acute stress d/o (ASD)
Dx criteria: ASD involves similar sx’s to PTSD. Sx’s must last AT LEAST 2 days but resolve in 4 weeks or less.
To differentiate ASD from PTSD, one needs to know when sx’s started and how long the sx’s lasted
Generalized anxiety d/o (GAD)
Uncontrolled anxiety about multiple events occurring MOST days for 6 months or more.
Need 3 or more of the following: restless/on edge, decreased concentration, muscle tension, fatigued, irritability, insomnia
(Don’t dx this d/o if worry is better explained by another d/o)
Sx’s typically start at young age and are chronic unless tx’ed. Pts w/GAD are first seen by doctor d/t physical sx’s
Differentials: anxiety d/o d/t general medical condition (hyperthyroidism), substance-induced anxiety d/o
Somatoform d/o
Vs psychosomatic - addresses pts whose medical problems are exacerbated by mental problems (or vice versa) w/underlying medical basis
Transformation of psychological distress into physical sx’s that are not fully explained by underlying medical condition, and NOT faked
Etiology: physical sx’s emerge to keep distress out of conscious awareness (primary gain). Physical sx’s are maintained, in part, through societal reinforcement (secondary gain)
Tx: individual (pt learns to confront emotions and express feelings) and family (family learns to avoid reinforcing sick behavior) psychotherapy
Somatization d/o
Dx criteria: starting before age 30, ALL of the following sx’s have occured (not simultaneously)
- Pain (4)
- GI (2)
- Sexual/reproductive (1)
- Pseudoneurological (1)
Pts have multiple sx’s across different organ systems w/o medical basis
Conversion d/o
Dx criteria: pt experiences at least one pseudoneurological sx. Conversion has only this sx. Somatization has MORE sx’s than just a pseudoneurological one
Subtypes: w/motor sx’s; w/sensory sx’s; w/seizures
Onset and course: sudden, typically after a major stressor. Often a la belle indifference. Usually short sx duration w/o recurrence
Hypochondriasis
Dx criteria: pt is preoccupied w/false fear of specific illness (like HIV) for at least 6 mos. The fear is based on misinterpretation of bodily sx’s that they experience (like fatigue)
Pain d/o
Dx criteria: pt experiences severe pain that is not fully accounted for by a medical condition. If pt has medical basis for some pain, the amt of pain experienced is xs for condition
Body dysmorphic d/o (BDD)
Dx criteria: pt is preoccupied w/imagined or minor bodily defect (often facial). Preoccupation is not better accounted for by a different d/o (such as anorexia). Preoccupation must cause fxn’l impairment, otherwise preoccupation may be considered nml vanity
Malingering
Malingerers fake/induce their sx’s in order to gain something tangible OR to avoid something undesirable. “External” incentives are present
Factitious d/o
Pt fakes/induces sx’s to assume the sick role, directly (in oneself -> factitious d/o), or indirectly (in a dependent person, under his/her care -> factitious d/o, NOS)
Subtypes: w/physical sx’s, OR w/psychological sx’s
Txt - NONE. Usually won’t seek psychiatric help, even when caught. Goal is to stop further unnecessary medical care and prevent iatrogenic problems
Dissociative amnesia
Dx criteria: memory loss for personal info, which doesn’t occur as part of another d/o. Mem loss can be:
- localized - total loss of personal men during circumscribed period
- selective - some (but limited) recall of personal mems during circumscribed period of time
- generalized - loss of personal mem of entire life up to and including event
Vs. physically-based amnesia - during mental status exam, examine type of mem problem:
- If psych - greater loss of PAST mem (retrograde)
- If physical - greater difficulty learning NEW info (anterograde)
Dissociative fugue
Dx criteria - sudden onset of a dissociative amnesia, confusion about personal identity, purposeful traveling away
Common features - usually brief (hours to days), takes on unobtrusive lifestyle, spontaneous termination of amnesia, rarely recurs
Dissociative identity d/o
Dx criteria: 1) at least 2 distinct personalities control - primary (host) and alters (different extremes in personalities)
2) inability to recall personal info (as evidenced by freq mem gaps in host while alters take ctrl)
Depersonalization d/o
Feeling of having lost imp part of one’s identity (detached, outside of self as a 3rd party observer). Metab, neuro, or other pathological conditions may cause this sensation to be ruled out
Acceptable drinking limits
Men - 4 drinks/day, 14 drinks/week
Women - 3 drinks/day, 7 drinks/week
1 drink equivalents: 12 oz beer, 5 oz wine, or 1.5 oz liquor
Acute phase for drug txt
1) detox - requires in-pt txt so drug tapering can occur under medical supervision
2) associated medical conditions (skin ulcers, STDs, etc)
3) psychiatric co-morbidity (eg other substance addiction, mood or anxiety problems). THIS IS ESSENTIAL TO RECOVERY
Recovery phase
Focus on preventing relapse. Difficult to reverse engrained habits (and endure protracted abstinence syndrome). Successful txt can occur (even if legally compelled). Motivation DURING txt is key
DSM-IV categories for drug d/o
1) Substance-induced d/o
Axis I dx’s include: intoxication and withdrawal (and psychiatric disturbances that are INDUCED by drugs, such as alcohol-induced dementia)
2) substance-use d/o (2 patterns of use)
Axis I dx’s include dependence (addiction) and abuse
