Chapter 6 Flashcards
How are psychiatric disorders diagnosed?
on the presence or absence of subjective symptoms.
The Diagnostic and statistical manual of mental disorders (5th edition) DSM-V, has the dx criteria and classification of all psychiatric disorders.
A psychiatric attending physician statement contains five axes, noting the presence of absence of a diagnosis. What are these 5 axis’?
Axis 1- lists major psychiatric illness
Axis 2- for personality disorders
Axis 3- general medical conditions
Axis 4- psychosocial and environmental problems
Axis 5- a global assessment of function called the GAF score.
Define the term “mood” and provide examples of mood disorders
its a conscious state of mind or prevailing emotion or feeling.
- depression
- Dysthymia
- bipolar disorders 1 & 2
- cyclothymia.
There are undefined genetic components to certain mood disorders. Which has the strongest genetic component?
bipolar-
What is comorbidity?
when a disorder occurs together with specific linked impairments
What are diseases that are commonly associated with depression
heart disease cancer CNS endocrine disease connective tissue disease
What is the most common mood disorder?
who is most effected
depression
Women- linked to genetic predisposition
median age of onset 34, 20% in teenages
Depression is characterized by what 3 main sxs?
- loss of energy
- loss of ability to experience pleasure (anhedonia)
- loss of sexual desire
Without tx, what is the average duration of a MDD? (major depressive disorder)
8 mo.
50% recover in first year
70% in 5 yrs
85% in 15
When does Depression typically occur?
after a major life event, dx of medical condition, loss of loved one, divorce, loss of employment, bankruptcy or
situational
What is Dysthymia?
the presence of chronic depressive sxs for 2+ urs that are not severe enough to be dxed as a MDD.
What are treatment options for depression?
- psychotherapy
- electroconvulsive therapy (ECT)
- medications
What is psychotherapy?
the use of verbal and non-verbal communication to deal with depressive and other psychiatric disorders. There are two kinds
1) individual psychotherapy (IPT)
2) cognitive behavior therapy (CBT)
What is IPT?
uses skills of empathy, sensitivity, and listening accurately to intervene, give helpful and corrective information during patient session. This is mean to enhance the patients social functioning
What is CBT?
users principle of focusing on thoughts, emotions, and behaviors present at a specific time to appropriately intervene during patient encounter sessions. Goal is to help develop more +Ve and constructive tools to assess pt’s capabilities and circumstances.
What is ECT?
effective for tx severe depression resistant to medications.
Medications for depression can be divided into 6 various groups depending upon what 3 characteristics?
- chemical structure
- physiological effects
- proposed method of action
How to anti-depressants work?
It is difficult to predict which Rx will work for which pt’s and is quite a gamble. The exert benifical effects by affecting various transmitters.
Note anti-depressent use goes beyond just a MDD disorder.
There are 6 main groups of antidepressant medications, what are they and their features?
- TCA- tricyclic antidepresant- effective depression tx with undesirable side effects,
- phenylpiperaines, trazodone and nefazodine- sedating, used at night for sleep
- SSRI- frequently used- side effects +
- bupropion- not serotonin effectine, used when SSRIs fail.
- venlafazine- a phenethylamine, both SSRI and SNRI actions- fast onset, good for old people
- MAOI- monoamine oxidase inhibitors- increase levels of NE, Serotonin, Dopa= highly effective, but sig risk of HTN crisis, with specific foods. Last used
Depression treatment is recommended for how long
6-9 months, if there is MDD recurrances, long-term Rx is recommended.
What are the increased mortality risks for depression?
accdients, suicides, and adverse effects on other illnesses, ie heart disease, cancer, stoke, DM, and others.
What test is used to measure the severity of depression?
Beck Depression Inventory (BDI).
- self administered
- 21 items rated 0-4 depending how severe the sxs are. score are added together for a total score.
How would one characterize Bipolar Disorder?
characterized by depression and period of mania.
mania is distractibility, rapid flight of ideas, excessive involvement in pleasurable activities, loss of economic and social judgement and impaired social function.
There are two kinds of bipolar disorders. Define Bipolar 1.
makes by episodes of major depression and mania. Occurs equally in males and females
There are two kinds of bipolar disorders. Define Bipolar 2.
at least two major depression episodes and hypomanic episodes.
-more common in female.
How is Cyclothymia characterized?
fluctuating periods of depressive and hypomanic sxs for at least 2 yrs, with the sxs not meeting the criteria for a major depressive episode or mania episode.
What the treatment options for bipolar disorder?
lithium is the most common Rx
mild side effects, including hypothyroidism.
other medications used are Valproate, oxcabazepine and carbamazepine.
tx is usually life long.
What are common comorbidities for bipolar disorder?
OCD panic disorder eating disorder schizo ETOH abuse/ substance abuse
What is anxiety?
a feeling of fear and apprehension and a sense of dread, unease and foreboading.
As an illness, anxiety is associated with what 5 disorders
- panic disorder
- phobias
- generalized anxiety disorder (GAD)
- obsessive-compulsive disorder (OCD)
- PTSD
WHo does panic disorders affect?
there is some undefined genetic component.
- 2x more likely in females
- usually in young adulthood.
- follows some social dysfunctions
What are the sxs of a panic attack?
acute anxiety characterized by palpitations, CP, SOB, sweating, lightheadedness, choking, flushing, GI sxs and fear of dying.
What is the typical tx for panic disorders?
psychotherapy and medication
either anti-depressants of the SSRI group and the benzodiazepines are used for imeediate sxs relief.
What are the comorbidities of panic disorders?
depression (50-60%)
33% substance abuse
33% agoraphobia.
suicide attempts with 20% of people
Define phobias
excessive fear surrounding a specific event or object.
Exposure provokes anxiety and impairment of social function.
What is the tx of phobias?
psychotherapy.
cognitive therapy and desensitization
Rx used- but not as effective. SSRI, bezodiazepines, and newer anticonvulsants, gabapentin and pregabalin.
What are some common cormorbidities with phobias?
1/3 mood disorders
1/4 substance abuse
eating disorders
What is Generalized anxiety disorder (GAD) and its sxs?
its a chronic, continuous low-grade excessive worry leading to various sxs such a tension, irritability, fatigue, sleep disturbance and mild impairment of social function.
What is the tx for GAD?
consists of psychotherapy and Rx. benzodiazepines, antidepressants and buproprion.
What is OCD?
obsessions are intrusive thoughts or ideas, compulsions are repetitive behaviours performed to reduce the anxiety associated with obsessive thoughts.
Who does OCD affect?
- more common in males and first borns
- genetic compoenent
- young aldulthood onset
- 10% develop significant chronicity.
What sre the most common areas of obsessions?
- contamination due to germs
- fear of harming ones self or others
- symmetry-
- somatic- obsession regarding the body
What is the treatment suggested for OCD?
medications and psychotherapy.
SSRIs, (fluvoxamine) and TCAs, clomipramine. Rx is not typically enough
Define PTSD
the mental stress and axiety following a witnessed or experienced event such as a violent accident, violent crime, in military combat, a natural disaster, being assaulted, being sexually abused, being physically abused, being kidnapped, being tortured, or being dx’ed with life threatening disease.
What are some risk factors and sxs for PTSD?
risks: psychiatric dx and undefined genetic component
sxs: intrusion sxs (flashbacks), avoiding stimulia associated with the trauma, increased automatic arousal- enhanced startle.
With out treatment, what is the typical prognosis of PTSD?
30% recover
40% mild sxs
20% moderate sxsx
10% severe sxs
How is PTSD treated?
psychotherapy and Rx
SSRIs, benzodiazepines, carbamazepine, and valproate.
What are personality disorders?
maladaptive behaviour patterns to personal and social stress.
What are the typical behavioural patterns with someone with personality disorders?
low directedness and low cooperativeness and tend to elicit stong emotional reactions from others.
What are the general 3 groups of personality disorders?
- odd/ecentric group- schizoid, paranoid, patterns. Antidepressants and low-dose antipsychotic rx is tx
- dramatic/impulsive group- anti-social, borderline, histrionic, and narcissistic - anti-social personaly disorder, is 4x more common in males. Rx: carbamazepine, valrpoate and MAOIs
- Anxious/fearful group- dependent, avoidant, obessive, passive-aggressive and depressive. Rx: Antidepressants, benzodiazepines, buproprion tx- and psychotherapy.
What are the comorbidities associated with personality disorders
depression Alcoholism eating disorders panick attacks phobias - criminal and aggresive behaviors are often associated with anti-social personality
Define Somatoform disorders
These are sxs and complaints that cannot be explained by a known medical condition, medication, or mood altering substance. the DSM-V seperates these unexplained sxs into 4 organ areas.
What are the four recognized types of somatoform disorders are there?
- conversion disorder- the transformation of an emotion into a physicial manifestation
- hypochondriasis- when an individual believes he has an ilness or chronic pain when they dont
3- body dysmorphic disorder- when an individual has a distorted view of his/her physical body.
4- factitious disorder- feigning illness and assuming the role of a sick person
What are thought disorders?
a group of psychiatic disorders chracterized by delusions. The two main types of delusional and schizophrenia.
Define delusional disorders
characterized by delusions for at least one month, but without bizarre behaviour or marked impairment of functions.
delusions are abN mental state of false belief regarding self or individuals outside of ones self.
How is schizophrenia dxed?
by exclusion
- sxs must have been present for at least 6 mo.
- delusions, hallucinations, disorganized speech -ve sxs.
- loss of function, pleasure, emotional expression, and concentration, also decreased social engaement.
Schizophrenia can be arbitrarily divided into 4 subtypes, depending on sxs. Name these groups
- Catatonic subtype has profound changes of motor activity
- paranoid subtype has a prominent preoccupation with a delusional system
- disorganized subtype has disorganized speech and behavior and a superficial sometimes silly affect
- residual subtype is characterized by -ve sxs without delusions, hallucinations or decreased motor activity.
How are thought disorders treated?
anti-pschotic rx
What are the types of eating disorders? (4)
anorexia nervosa
bulimia nervosa
binge eating
obesity
What is anorexia nervosa?
refusal to maintain a minimal body weight and denial of the seriousness of the low body weight.
- there is disturbance in the individuals won perception of weight and body shapre.
-
What is bulimia nervosa?
Characterized by a preoccupation with food, binges of excessive eating, and inappropriate compensatory behaviours, such as self-indiuced vomiting/purging, fasting and excessive exercise.
problems with induced vomiting are dental enamel erosin, esophagitis, reflux and aspiration.
What is the definition of obesity?
defined as excessive eating wihtout appropriate or inappropriate compensatory mechanism and leading to an increased BMI
Who commits suicide?
12 attempts to one success
4x more common in males,
females attempt more, but males succeed.
What are the associations to suicide?.
depression, ETOH, and substance abuce or other mental disorder.
comorbidity is present in 75% of cases.
What are some suicide risk factors?
male gender divorce unemployement Fx of suicide prior attempt, recent discharge from psychiatric unit serious spousal argement, psychiatric dx hx of abuse CNS disease medical illness
What are the two hallmarks of ADHD?
- inattention/attention deficit
2. hyperactivity/ impulsivity
What are the genetic predispositions for ADHS?
genetic risk factors associated with mutations in the dopamine receptors and the serotonin transporters genes.
non-genetic postylated causes include lead contamination, complications during pregnancy, low birth weight, brain injury, maternal smoking, and severe maltreatment during childhood.
What are the tx options for ADHD?
successful 90% of the time with neuro-stimulating Rx such as methylphenidate and amphetamines. Psychotherapy and behaviour modifications are also used.
Define Autism
a spectrum of disorders previously known as the pervasive developmental disorders. The two core dx impairements are deficits in social communication and restricted and repetitive behaviours.
Who and when is Autism dx’ed?
childhood, 4x more common in boys
- genetic disposition (15% of cases have a known genetic mutaiton)
0 usually 3.1 yo, aspergers dx at 7.2 yrs.
The main impairements of concern are depression, bipolar disorder, schizophrenia and eating disorders. Why?
associated with increased mortality and suicide risks.
What should an underwriter consider when underwriting a mental disorder?
- what is the dx
- how pervasice or frequewnt are sxs? is it episodic, intermittent, or chronic?
- how severe is it/
- are they well followed
- is the pt compliant with tx
- is there more than one psychiatric disorder?
