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Psychiatry Shelf > Diagnoses I > Flashcards

Diagnoses I Flashcards

1
Q

Time requirement for

(a) scz
(b) brief psychotic d/o
(c) schizophreniform
(d) schizoaffective
(e) delusional d/o

A

Time requirement

(a) scz: 6+ mo of symptoms for illness. 2+ symptoms present for at leats 1 mo. 6 mo including prodrome or residual period
(b) brief psychotic d/o: at least 1 day, return to fxn w/in 1 mo
(c) schizophreniform: 1-6 mo
(d) schizoaffective: 2 weeks of positive symptoms (delusions/hallucinations) w/o mood symptoms
(e) delusional d/o: 1+ mo

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2
Q

Percent of scz pts that

(a) attempt suicide
(b) complete suicide
(c) M:F

Scz genetic component

(d) monozygotic twins
(e) first degree relatives

A

Scz

(a) 50% attempt suicide
(b) 15% complete suicide
(c) M = F (men have worse prognosis)

Genetics

(d) 50% incidence btwn monozygotic twins
(e) 10% incidence btwn first degree relatives

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3
Q

Neurotransmitter etiology of scz

(a) DA
(b) 5HT
(c) NE

A

Scz etiology

(a) Increased DA in limbic system => positive symptoms
(b) Increased 5HT in prefrontal cortex => negative symptoms
(c) Decreased NE => anhedonia

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4
Q

Brain image findings of scz

A
  • *Ventricular enlargement
  • cortical atrophy
  • hypoactivity of frontal lobes on PET scan
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5
Q

Prognosis of pts w/ schizophreniform

A
  • 1/3 recover

- 2/3 progress to schizophrenia

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6
Q

Tx for

(a) delusional d/o
(b) schizophreniform
(c) schizoaffective
(d) brief psychotic d/o

A

Tx

(a) delusional d/o- low dose antipsychotic
(b) schizophreniform- 3-6 mo. antipsychotics + supportive psychotherapy
(c) schizoaffective- concurrent antipsychotics + antidepressants
(d) brief hospitalization, supportive psychotherapy, short course of antipsychotics

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7
Q

What is pseudocyesis

A

Physiologic signs and symptoms of pregnancy in absence of pregnancy-cultural psychosis/common delusion

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8
Q

What is folie-a-deux?

A

Literally means “a madness shared by 2”-when delusions/hallucinations are transmitted from one to another

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9
Q

Age of onset for scz

A

Before 45 yoa
M: 15-25
F: 25-35

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10
Q

Lifetime prevalence of

(a) scz
(b) delusional d/o
(c) schizoaffective

A

Life prevalence of

(a) scz: 1-1.5%
(b) delusional d/o: .03%
(c) schizoaffective: less than 1%

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11
Q

Scz vs. schizoaffective

(a) link?
(b) prognosis
(c) tx
(d) time course
(e) features

A

Schizophrenia vs. schizoaffective

(a) Schizoaffective has no clear link to scz, but 6–80% of schizoaffective pts will progress to scz
(b) Schizoaffective has a better prognosis
(c) Scz- first line is atypicals, schizoaffective- use both antipsychotics + antidepressants
(d) Scz at least 6 mo, schizoaffective: at least 2 weeks of positive symptoms and no mood symptoms in absence of psychotic sx

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12
Q

Differentiate scz and delusional d/o

A

Delusional d/o: only delusions (no other symptoms) and function is NOT impaired

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13
Q

Differentiate the subtypes of scz

(a) disorganized
(b) paranoid
(c) catatonic
(d) residual
(e) undifferentiated

A

Subtypes of scz

(a) Disorganized: prominent disorganized speech, inappropriate affect,
- characterized by disorganized speech and flat/inappropriate affect
- NOT catatonic. Early onset

(b) Paranoid: preoccupied w/ particular delusion.
- characterized by delusions and AH
- NO: disorganized speech, catatonia, inappropriate affect. Later onset

(c) Catatonic- motor immobility, excessive motoric activity, rigidity, echolalia, echopraxia. Rarest

(d) Residual- absence of (+) symptoms for some time, but still have negative symptoms
- prominent negative symptoms

(e) Undifferentiated- NOS

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14
Q

Which subtype of scz is

(a) early onset
(b) late onset
(c) rarest

A

Subtype of scz

(a) early onset = disorganized
(b) later onset = paranoid
(c) rarest = catatonia

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15
Q

Prognosis of brief psychotic disorder

A

50-80% have no further psychiatric problems

-very rare diagnosis
Dx: pt meets scz criteria for btwn 1 day to 1 month

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16
Q

Differentiate

(a) thought insertion
(b) broadcasting
(c) thoughts of reference

A

Differentiate

(a) thought insertion- think others are putting thoughts in your head
(b) broadcasting- others can hear your thoughts
(c) thoughts of reference- from tv/radio, things are related to pt

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17
Q

What d/o are the following types of hallucinations associated with

(a) auditory
(b) visual
(c) tactile
(d) olfactory

A

Hallucinations

(a) Auditory- most commonly exhibited in schizophrenic pts
(b) Visual- less common in scz. May accompany drug intoxication, drug/alcohol withdrawal, or delirium
(c) Tactile- drug abuse or EtOH withdrawal
(d) Olfactory- common in seizures, usually an aura associated w/ epilepsy

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18
Q

ADHD

(a) Prevalence
(b) Gender difference
(c) Most common comorbidity
(d) Hormonal mechanism
(e) Prevalence of symptoms continuing into adulthood

A

ADHD

(a) 5-7% school aged children
(b) Boys > Girls (3-5:1)
(c) 2/3 comorbid w/ CD/ODD. 25% risk of ASPD
(d) Dysregulation of NE
(e) 60% have symptoms into adulthood

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19
Q

Age of onset for ADHD

A

Symptoms have to be present before age 7.

-onset may be as early as age 3

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20
Q

Signs of ADHD in

(a) Preschool
(b) Elementary
(c) Adolescents
(d) Adults

A

Signs of ADHD

(a) Preschool- temper tantrums
(b) Elementary- difficult peers/noncompliance
(c) Adolescents- internal sense of restlessness rather than motor
(d) Adults- chronic disorganization

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21
Q

Name the stimulants used to treat ADHD

A

Stimulants for ADHD

  • methylphenidates: Ritalin, Concerta
  • dexmethylphenidate: Focalin
  • dextroamphetamine: Dexedrine, DextroStat
  • dextroamphetamine/amphetamine: Adderall
  • Lysine-dextroamphetamine: Vyvanse
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22
Q

Name the non-stimulants used to treat ADHD

A

Nonstimulants for ADHD

  • Atomoxetine (Strattera): NE reuptake inhibitor
  • Buspirone (Buspar): 5HT1A partial agonist
  • alpha 2 agonists: clonidine, guanfacine
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23
Q

Requirements for diagnosis of ADHD

A

ADHD diagnosis:

  • symptoms present before age 7
  • must occur in two settings (ex: home and school)
  • Inattention type: 6+ features of inattention for 6+ months
  • Hyperactivity/impulsivity: 6+ features
  • Mixed = meet criteria for both
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24
Q

Name symptoms of inattention for ADHD

A

Inattention (6+ features for 6+ months)

  • inattention to detail
  • difficulty sustaining attention
  • does not follow through
  • organization fail
  • avoids tasks that require sustained effort
  • loses things, easily distracted
  • doesn’t listen
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25
Q

Name symptoms of the following for ADHD

(a) Hyperactivity
(b) Impulsivity

A

Hyperactivity/impulsivity (6+)

(a) Hyperactivity
- often leaves seat, runs or climbs
- difficulty playing or leisuring
- often ‘on the go’
- often talks excessively

(b) Impulsively
- often blurts out answers
- often has difficulty awaiting turn
- often interrupts

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26
Q

Tx besides meds for ADHD

A
  • psychotherapy

- parental counseling

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27
Q

Differentiate ODD vs. CD:

(a) time requirement
(b) symptoms

A

ODD vs. CD

(a) ODD: 4+ symptoms for 6+ months. CD: 3+ for 12+ months
(b) ODD: no violation of basic rights

28
Q

Percent of

(a) ppl w/ ODD who have ADHD
(b) ppl w/ CD who have ADD
(b) ppl w/ CD that develop ASPD

A

(a) 50% of ppl w/ ODD have ADHD
(b) 70% of CD have ADHD
(c) 40% of CD kids develop ASPD

29
Q

List the symptoms of ODD

A

ODD: (4+ for 6+ months)

  • loses temper (angry/resentful)
  • argues w/ adults
  • defies adults
  • deliberately annoys ppl
  • blames others for misbehavior
  • easily annoyed
  • spiteful
30
Q

Symptoms of CD

A

Conduct d/o:

  • aggression towards ppl/animals
  • destruction of property (fire setting)
  • deceitfulness or theft
  • serious violations of rules
31
Q

Treatment approach for disruptive d/o

A

Multimodal tx: school, family, community resources to clearly state and enforce behavioral expectations

32
Q

Gender disparity in ODD

A
  • before puberty: more common in boys

- after puberty: girls = boys

33
Q

Gender disparity in CD

A

12:1 boys:girls

Different symptoms

  • boys: high risk of fighting, stealing, fire-setting, vandalism
  • girls: high risk of lying, running away, sexually acting out
34
Q

Do ADHD pts generally have a lower IQ?

A

No, but ADHD symptoms may make it difficult for pts to sit thru neuropsychological testing long enough to obtain valid assessment

35
Q

Which ADHD symptoms tend to last into adulthood?

A

Impulsive > hyperactive

36
Q

Name the most common comorbidities of ADHD

A

Over 50% of children w/ ADHD have a comorbid psychiatric d/o

  • anxiety d/o
  • personality d/o
  • conduct d/o (30-50%)
  • ODD (30-40%)
37
Q

Differentiate

(a) delusion
(b) illusion
(c) hallucination
(d) use of neologisms

A

(a) Delusion = fixed false belief
(b) Illusion = misinterpretation of a present external stimulus
(c) Hallucination = perception in the absence of an external stimulus
(d) Neologism = use of words that have meaning only to the person using them

38
Q

Most common cause of psychosis in the lelderly

A

Elderly, medically ill pts presenting w/ psychotic symptoms (hallucinations, confusion, paranoia) should carefully be evaluated for delirium

-delirium much more common in elderly

39
Q

List some medical conditions that can cause psychosis

(a) CNS disease
(b) Endocrinopathies
(d) Nutritional deficiency

A

Psychosis secondary to general medical condition

(a) CNS disease: temporal lobe epilepsy, tertiary syphilis, MS, neoplasm, Alzheimers Parkinsons, Huntingtons encephalitis, prior disease
(b) Endocrinopathies: hyper/hypothyroid, Cushings/Addisons, hypopituiatry, hypocalcemia
(c) Vitamin deficiences: B12, folate (folic acid), niacin (B3)

40
Q

Name some prescription meds that can cause psychosis

A

Rx that can cause psychosis

  • corticosteroids
  • antiparkinson agents
  • anticonvulasants
  • antihistamines
  • anticholinergics
  • some antihypertensives: beta blockers, digitalis, methyphenidate, flouroquinolones

Then obv substances: EtOH, cocaine, hallucinogens (LSD, Ecstasy), MJ, benzos, PCP

41
Q

Positive symptoms of scz

A

Added on top of normal behavior

  • hallucinations
  • delusions
  • disorganized behavior or thought
  • disorganized speech
42
Q

Negative symptoms of scz

A

Subtracted/missing from normal behavior

  • social withdrawal/isolation
  • flat/blunted affect
  • anhedonia
  • apathy
  • alogia (poverty of speech): speech blocking, latency of response
43
Q

Cognitive symptoms of scz

A

-impairments in attention, executive fxn, and working memory

=> poor work and school performance

44
Q

Describe the residual phase of scz

A

3 phases of scz

(1) Prodrome- social isolation and irritability. may have physical complaints or newfound interest in religion or the occult (paranormal)
(2) Psychotic- positive symptoms predominate
(3) Residual- btwn episodes of psychosis. Negative symptoms (flat affect, social withdrawal, odd thinking/behavior) predominate. pts can continue to have hallucinations even w/ tx

45
Q

Features of scz cataonia type

A
  • stereotyped mov’t
  • bizarre posturing
  • muscle rigidity
46
Q

When may only one symptom of scz be enough to meet criteria for teh dx

A

Only one symptom required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on person’s behaviors or thoughts, or two or more voices conversing w/ each other

47
Q

Name the 5 A’s of schizophrenia

A

5 A’s = the negative symptoms

  • anhedonia
  • affect (flat)
  • alogia (poverty of speech)
  • avolition (apathy)
  • attention (poor)
48
Q

Which subtype of scz is

(a) often higher functioning
(b) poor functioning type
(c) older age of onset
(d) earlier onset

A

Subtype of scz

Paranoid type: often higher functioning and older age of onset

Disorganized type: often poor functioning type and early osnet

49
Q

Do scz have

(a) abstraction
(b) insight into their disease
(c) intact memory
(d) intact orientation

A

Scz pts

(a) often have concrete understandings of idioms
(b) little or no insight into their disease
(c) intact memory and orientation

50
Q

Common comorbidity in scz pts

A

Substance abuse

  • 30-50% EtOH
  • 15-20% cannabis
  • 5-10% cocaine
51
Q

Monozygotic twin accordance for scz

A

50%

52
Q

Describe the mechanism by which cocaine can induce psychosis

A

Cocaine (and amphetamines) increase dopamine activity => can induce scz-like symptoms

-scz partly related to increased DA in certain neuronal tracts

53
Q

Nt involvement in scz

(a) DA
(b) 5HT
(c) NE
(d) GABA
(e) glutamate

A

Nt involvement in scz

(a) Increased DA activity in certain tracks => positive symptoms
(b) Increased 5HT activity
- another reason why atypicals may help
(c) Elevated NE
(d) Decreased GABA
- decreased expression of enzyme used to make GABA in the hippocampus of scz pts
(e) Decreased levels of glutamate receptors- scz pts have fewer NMDA receptors
- correlates w/ psychotic symptoms observed from NMDA antagonists (ex: ketamine)

54
Q

Percent of scz pts who

(a) Respond to antipsychotics
(b) Attempt suicide

A

(a) 70% of scz pts improve on antipsychotics

(b) 50% of scz pts attempt suicide

55
Q

Factors for better prognosis in scz

(a) Onset
(b) Type of symptoms
(c) sex
(d) Time course of onset

A

Factors associated w/ better prognosis for scz

(a) later onset
(b) Positive symptoms
(c) female sex
(d) acute onset

56
Q

Name two important Rx meds that can exacerbate psychosis in predisposed pts

A

Beta blcokers and digoxin

57
Q

Describe the diagnostic criteria for schizoaffective d/o

A
  • delusions or hallucinations for 2 weeks in absence of mood d/o symptoms
  • mood symptoms present for substantial portion of psychotic illness
  • meet the criteria for a major depressive, manic, or mixed episode (during which criteria for scz is also met)
58
Q

Loss of what sense predisposes to psychosis

A

Deafness

59
Q

What population is delusional d/o more common in?

A
  • Older pts (> 40 yoa)
  • immigrants
  • hearing impaired
60
Q

Prognosis for delusional d/o

A

Prognosis for delusional d/o

  • 50% full recovery
  • 20% decreased symptoms
  • 30% no change
61
Q

Treatment for shared psychotic d/o

A

Shared psychotic d/o = folie a deux = pt develops same delusional symptoms as someone they are in a close relationship w/ (often family members)

Tx = separate pt from source of the shared delusion (usually family member w/ underlying psychotic d/o)

  • psychotherapy
  • antipsychotics if symptoms not improved 1-2 weeks after separation
62
Q

Koro

A

Culture-specific pyschosis
-specific to Asia

= pt believes that his penis is shrinking and will disappear causing his death

63
Q

Amok

A

Culture-specific pscyhosis
-Malaysia, Southeast Asia

= sudden unprovoked outbursts of violence of which the person has no recollection
-person often commits suicide afterward

64
Q

Brain fag

A

Culture-specific psychosis
-Africa

= headache, fatigue, and visual disturbances in male students

65
Q

List the prognosis from best to worst

  • brief psychotic d/o
  • schizophreniform
  • scz
  • schizoaffective
  • mood d/o
A

Best to worst prognosis:

Mood d/o > brief psychotic d/o > schizoaffective d/o > schizophreniform > scz

66
Q

Distinguish scz from schizotypal

A

Schizotypal personality d/o- criteria for true psychosis are not met

  • paranoid, odd, or magical beliefs
  • eccentric, lack of friends, social anxiety
67
Q

Distinguish schizotypal from schizoid

A

Both are socially isolative

Schizotypal: magical thinking, odd beliefs

Schizoid: lack of enjoyment from social interactions

Psychiatry Shelf (6 decks)

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