Case Files 1 Flashcards
1
Q
% of people with ID that have another psychiatric disorder
A
30-40%
2
Q
Fragile x mutation
A
Xq27.3
3
Q
What kind of ID can hold a job
A
Only mild
4
Q
When must ID be diagnosed
A
Onset must be before age of 18
5
Q
Medical conditions that cause pain can cause what in severe ID
A
Aggressive or self-destructive behavior in an individual with limited means of communicating
6
Q
MCC of ID
A
Idiopathic or unknown
7
Q
Characteristic of impairment associated with ID
A
Global and fairly consistent across all areas of function
8
Q
ASD key features
A
- Difficulty with social reciprocity
- Poor peer interaction
- Poor language development
- Repetitive and odd play
9
Q
What is Rhett disorder
A
Progressive encephalopathy, loss of speech, gait problems, microcephaly, and poor social interaction only seen in women who were normal in infancy
10
Q
Autism MRI
A
Increased cortical thickness
11
Q
What separates ASD from ID
A
ID children generally do not exhibit restricted activities and interests or impairments in communication and social skills
12
Q
What drug may help with irritability symptoms of ASD
A
Aripipazole
13
Q
Focus on one certain kind of toy works with what part of ASD
A
Stereotyped behavior
14
Q
Best predictor of future outcome in ASD
A
Language development
15
Q
First line ADHD drug in families with a hx of substance abuse
A
Atomexetine (SNe transporter inhibitor)
also 24 hour half life
16
Q
3 major things for ADHD
A
Distractibility, hyperactivity, impulsivity
17
Q
ADHD timing
A
Symptoms for at least 6 months
Begin before age 12
Be observed in more than one setting
18
Q
What should be ruled out in a child with hyperactivity
A
Lead poisoning
19
Q
Stimulants to treat ADHD can lead to development of
A
Tics
20
Q
Imipramine AE
A
QT prolongation
21
Q
How long to have Tics to dx Tourettes
A
At least 1 year
need multiple motor and vocal
22
Q
Only FDA approved Tourettes drugs
A
Haloperidol and Pimozide
not most often used though
23
Q
What are athetoid movements
A
Slow, irregular, writhing movements
24
Q
What is coprolalia
A
Vocal tic involving involuntary vocalization of obscenities
25
What are hemiballistic movements
Intermittent, coarse, large-amplitude unilateral movements of the limbs
26
Best non-drug therapy for TD
Habit reversal training
27
Drugs for ADHD/Tourette's combo
Clonidine (alpha 2 agonist)
28
What other disorder is very common in Tourettes families
OCD
29
Tics worse in winter and early spring months could be
PANDAS (group A strep)
30
Key to schizoaffective disorder dx
Psychotic episodes occur during the mood episodes, but the mood symptoms do not always occur during the psychosis
31
What is Anergia
Lack of energy
32
What is anhedonia
lack of interest in one's usually pleasure seeking activities
33
Schizoaffective disorder dx criteria
Must meed criteria for a major mood episode for the majority of the illness and have delusions or hallucination for 2 or more weeks in the absence of a major mood episode
(sometimes present with just psychosis and other times present with mood and psychosis)
34
Tx for Schizoaffective and manic? schizoaffective and mood?
S and Manic: Mood stabilizer and antipsychotic
| S and Mood: Antipsychotic alone
35
What is catatonia
Three or more of stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, grimacing, and friends
36
What are ideas of reference
Thinking something is meaningful to you and a message "like where a care is parked"
37
Schizophrenia timing
6 months and at least 1 month of active phase symptoms including delusions, hallucinations, or disorganized speech
38
Delusional disorder timing
One month of delusions with no other psychotic sypmtoms
39
What sets apart schizophrenia from other psychiatric disorders
Negative symptoms causing extreme social dysfunction
40
Brief psychotic disorder timing
1 day to 1 month
41
Schizophreniform disorder timing
1-6 months
42
Mood disorder with psychotic features
Psychosis occurs only in the context of mood symptoms
43
Most AE from what 2nd gen antipsychotics
Clozapine and olanzapine
44
Lest AE with what 2nd gen antipsychotics
Ziprasidone and ariprazole
45
Most effective drug for schizophrenia
Clozapine (but AE so bad its not first line)
46
Dystonia treatment
Benztropine of diphenhydramine (anticholinergics)
47
Thing you always forget as AE of typical antipsychotics
Hyperprolactinemia
48
Only antipsychotic with antisuicidal properties for schizophrenia
Clozapine
49
What is formacation
Tactile hallucination of insects crawling on or under the skin
*can be caused by coke or meth use*
50
First line tx for non-psychotic mania
Lithium or divalproex (under 12)
51
Bipolar type I vs II
I: complete manic symptoms occurring during course of the disorder
II: hypomanic episode + major depressive episode
52
What is hypomania
Like diet mania, pt's do no usually exhibit psychotic symptoms, racing thoughts, or marked psychomotor agitation
*at least 4 days*
53
What is rapid cycling bipolar disorder
Occurrence of at least four mood episodes (depression or mania) in a year
54
What are episodes of mania often accompanied by
Psychotic features and hospitalization
55
Measure what in lithium patients
Thyroid and kidney functions
56
Measure what in carbamazepine pathients
Monitor for aplastic anemia or agranulocytosis
57
No what in manic patients
Antidepressants, will make worse
58
Manic like episode lasting less than 4 days
Cyclothymic disorder
59
Weight gain without increase in appetite in depression suggest
Depressive disorder due to another medical condition
60
Decreased need for sleep with no decrease in energy level is highly suggestive of
bipolar disorder
61
What are somatic delusiosn
False beliefs about one's body (someone in depression thinks they have cancer)
62
What are vegetative symptoms in depression
Physiologic or related to body functions (sleep, appetite, energy, sexual interest)
63
What is needed to add "with psychotic features" to major depressive disorders
Must meet criteria for MDD and in addition have evidence of delusions and/or hallucinations appearing AFTER the onset of depressive symptoms
64
How long can normal bereavement last
4 months
65
Patient on antipsychotic and antidepressant who is now better routine
Antipsychotic for 3 months and then taper
| Continue the anti-depressant for 6-12 months
66
How do children with major depression often present
As angry or mad as opposed to sad or depressed
67
SSRI AE
GI symptoms, sweating, dizziness, tremor, sexual dysfunction (only one that occurs later in medicine course)
68
Best antidepressent for sexual dysfunction? MOA?
Bupropion
Blocks NE and Dopa reuptake
*also used for anxiety and to stop smoking*
69
Biggest TCA AE
Anticholinergic (dry eyes, mouth, constipation)
70
How long can baby blues last
Up to a week
71
MDD recurrence risk
85% lifetime risk
| 40% in on year
72
Venlafaxine at higher doses risk
Elevated blood pressure
73
One of the symptoms for MDD must be what
Depressed mood or anhedonia (loss of interest)
74
How long to be diagnosed with persistent depressive disorder? What can it be viewed as
At yeast 2 years
| Can be viewed as a less intense, longer lasting depressive illness (often with onset in teenage years)
75
When can persistent depressive disorder be diagnosed in children
1 year time (as opposed for 2 years in adults)
76
PMDD diagnostic criteria
Symptoms for half of their cycles in a year
77
SSRIs work the fastest in what disorder
PMDD
| *Use OCPs w/ caution in this disorder b/c they may affect mood*
78
Panic disorder diagnostic criteria
At least one panic attack followed by 1 month of concern about having additional attacks, worrying about the consequences of the attacks, or maladaptive change in behavior related to the attacks
79
Panic disorder hallmark vs other panic inducing things? Tx?
Unexpected panic attacks not provoked by any particular stimulus
Tx SSRIs
80
Agoraphobia vs Social Anxiety Disorder
Agoraphobia is multiple fears of public things, Social anxiety disorder is one specific phobia (related to public things)
81
Best tx for specific phobia
Cognitive behavioral therapy with exposure
82
Separation anxiety disorder peak age? tx?
9-10 years old
| Tx is multicentric -- but NO benzos, SSRIs instead for attacks
83
Separation anxiety disorder kids can develop what
Panic diorder and generalized anxiety disorders
| Also MDD
84
Treatment of choice for social anxiety disorder
CBT
85
Single most common mental disorder in US
Phobias (mostly specific)
86
B blockers that an be used for social anxiety disorder
Atenolol and Propranolol
87
Part of the brain involved in anxiety
Amygdala
88
How long before you can diagnose social anxiety disorder
> 6 months
89
GAD diagnostic requirements
Persistent, excessive, uncontrollable anxiety about various domains of life for the majority of a 6 month time period
90
GAD life course
Chronic condition that can worsen with life stressors
| Tx is SSRI
91
What is clompiramine
Serotonin and dopaminergic neurotransmitter inhibitor
| For OCD when SSRIs don't work
92
Mean age of OCD presentation
20 years
93
OCD commonly seen with what disorder
Tourettes
94
Sertraline most common AE
Nausea and diarrhea
95
OCD presentation in children
May no see symptoms unreasonable yet (developmental thing)
96
PTSD features
Ongoing symptoms of re-experiencing, avoidance of reminders, negative alterations of thoughts and mood, and symptoms of increased arousal
97
% of PTSD patients who have another psych disorder
80%
| *symptoms lasting > 3 months after incident unlikely to resolve without treatment*
98
Good drug for re-experiencing and arousal symptoms of PTSD
Prazosin (alpha 1 blocker)
99
Adjustment disorder timing? tx?
Symptoms less than six months duration
Within 4 months of the stressor
Tx is psychotherapy
100
Irritability unique to depression in what age group
Young ones
101
3 subtypes of adjustment disorder symptoms
Depressed mood
Anxiety
Disturbance of conduct
102
Acute stress disorder timing and criteria
More than 3 days, less than 4 weeks (PTSD when after 4 weeks)
With Intrusion symptoms, negative mood, dissociative symptoms, avoidance symptoms, and arousal symptoms
103
Drug for short term tx of insomnia in Acute stress disorder
Zolpidem
104
Most patients with dissociative identity disorder have experienced
Significant physical and sexual trauma often during childhood
105
Negative and additive symptoms in DID
Neg: amnesia
Pos: derealization and depersonalization
106
Most patients with DID develop what
PTSD
107
Illness anxiety disorder diagnostic criteria
Preoccupation with having or acquiring a serious illness that has been present for at least 6 months where nay somatic symptoms that are present of mild intensity
108
*Illness anxiety disorder vs delusional disorder somatic type vs somatiform disorder*
Delusional disorder somatic type will be worry about one specific illness every time but CANNOT be reassured and will not reconsider
IAD can change over time (BUT WORRY ALWAYS WITH ILLNESS), always mild, and patient can usually be reassured for a short time (misinterpretation of bodily functions)
Somatic disorder will be long term with worry always about complaint (i.e pain)
109
Pseudo seizures likely
Conversion disorder
110
Distinctive feature of illness anxiety disorder
Feat of having serious illness based on misinterpretation of bodily sensations
111
Essential feature of factitious disorder
Falsification of medical or psychological signs and symptoms in oneself or others that are associated with an identified deception
*conscious but no motivation for external reward - desire to play the patient role*
112
What personality disorder is most likely to occur with factitious disorder
Borderline
