Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry Shelf > Diagnoses II > Flashcards

Diagnoses II Flashcards

1
Q

Name 3 pervasive developmental disorders

A

Pervasive developmental disorders (axis I)

  • Autism spectrum (includes old Asperger’s)
  • Rett’s d/o
  • Childhood disintegrative d/o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Autism

(a) Age of onset
(b) prevalence
(c) rate of comorbid MR
(d) gender difference

A

Autism (axis I pervasive developmental d/o)

(a) Almost always have symptoms before 3 years old
(b) 1/150 births (.6%)
(c) 70% have comorbid MR
(d) 3-4:1 boys:girls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Symptoms of Autism

-how many to qualify for dx

A

Autism: 6+ total symptoms

Social interaction impairment (2+)

  • impairment of nonverbal behavior (poor eye contact)
  • failure to develop peer relationships
  • lack of spontaneous seeking to share enjoyment

Social Communication problems (1+)

  • delay or lack of spoken language
  • stereotyped use of language
  • lack of varied or spontaneous play

Restrictive Behavior/Interests (1+)

  • intense preoccupation w/ object
  • inflexible adherence to rules
  • repetitive motor mov’ts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Rett’s disorder?

(a) population
(b) age of onset
(c) main symptoms
(d) prognosis

A

Rett’s d/o = pervasive developmental d/o

(a) only in females: MCP2 gene on X chromosome
- thought to be lethal in utero for males
(b) Normal development in first 5 mo. 5-38 mo = deceleration causing lifelong impairment

(c) decrease in head circumference growth velocity during 5-38 months
- loss of previously acquired hand skills => stereotyped hand mov’t
- impaired language, psychomotor retardation, gait or trunk abnormal mov’ts

(d) cognitive development never progresses beyondt hat of first year of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Childhood disintegrative d/o

(a) population
(b) age of onset
(c) symptoms

A

Childhood disintegrative d/o = pervasive developmental d/o

(a) Males 4:1
(b) Normal first 2 years, then onset before age 10
(c) Loss of previously acquired skill in 2+
1. language
2. social skills: bowel/bladder control, play, motor skills

2+ of the following

  • impaired social interaction
  • impaired use of language
  • restricted, repetitive, and stereotyped behaviors and interests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What to rule out when assessing for developmental d/o

A

Rule out an organic cause!

  • r/o vision problem, maternal health
  • lab testing: chromosomal analysis, lead levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dx of MR

A

MR now called intellectual disability- have to have both:

subaverage intellectual functioning w/ IQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Gender ratio of ID and possible explanation

A
  1. 5:1 M:F for ID

- Fragile X syndrome = most common inherited form of mental retardation (second overall) due to X chromosomal mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MR + obesity

A

Prader-Willi syndrome: MR, obesity, hypogonadism, almond-shaped eyes
-genetic cause of MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most common learning disorder

A

Reading disorder

4-10% of school-age children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Differentiate autism and asperger d/o

A

Both

  • impairments in social interaction
  • restricted or stereotyped interests and behaviors

Aspergers: no clinically sig delay in spoken or receptive language or cognitive development
-no delay in self-help skills or curiosity about environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Contrast Rett d/o and Childhood disintegrative d/o

A

-both have high rates of EEG abnormality and seizure d/o

Rett d/o
-earlier onset (before 1st year)

Childhood disintegrative d/o

  • head growth does not slow
  • unusual hand movements are not present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Criteria for Tourette d/o

(a) more common in which gender

A

Tourette d/o = most severe tic d/o- multiple daily motor and 1+ vocal tics w/ onset before age 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe types of

(a) motor tics
(b) vocal tics: coprolalia and echolalia

A

Tics

(a) motor tics- often involve face and head
ex: blinking eyes

(b) vocal tics often
- coprolalia = repetitive speaking of obscene words (uncommon in children)
- echolalia = exact repetition of words

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tourettes d/o

(a) more common in which gender
(b) peak age
(c) comorbidities
(d) neurochemial etiology

A

Tourettes d/o

(a) boys > girls
(b) peak in severity btwn 8-12, decreases w/ puberty
(c) high comorbidity w/ OCD (40%) and ADHD (50%)
(d) impaired regulate of dopamine in the caudate nucleus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pharmacologic tx for tourettes

A

Atypical neuroleptics (risperidone)

Alpha-2 agonists = clonidine, guanfacine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is selective mutism?

A

Girls > boys
Refusal to speak in certain situations for at least 1 month
ex: little girl will speak at home but not in school

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Parents w/ anxiety d/o predispose their children to what?

A

Separation anxiety d/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Differentiate the 3 anxiety disorders w/ identifiable stressor

A

Identifiable stressor of grave danger=> acute stress disorder vs. PTSD depending on timeline

  • acute stress d/o: begins w/in 1 month of stressor, lasts less than 1 month
  • PTSD begins anytime, lasts over 1 mo

Not life threatening identifiable stressor => adjustment d/o
-begins w/in 3 months, lasts less than 6 mo

Then free-floating anxiety, not fixed on a specific thing = GAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Differentiate bereavement and grief

A

Bereavement- must be the loss of a loved one, while grief can be from anything (ex: divorce)

-pathological if > 1 yr or overtly psychotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

4 features of PTSD

A

PTSD: begins anytime, lasts > 1 mo

  1. re-experiencing (flashbacks, nightmares)
  2. avoidance of stimuli associated w/ trauma
  3. numbing of responsiveness (affect, detachment)
  4. increased arousal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Differentiate adjustment d/o and GAD

A

Adjustment d/o: due to non-life threatening stressor, begins w/in 3 month of and ends less than 6 months after stressor

  • if it persists for 6 months after the stressor = GAD
  • or can be chronic adjustment d/o if the stressor recurs or persists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most effective tx for adjustment d/o

(a) gender disparity of adjustment d/o

A

Supportive therapy

(a) 2:1 F:M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

GAD

(a) gender disparity
(b) comorbidity
(c) lifetime prevalence
(d) time requirement
(e) prognosis

A

Generalized anxiety d/o

(a) 2:1 F:M
(b) 50-90% have MDD, phobia, panic
(c) 45% lifetime prevalence
(d) lasts 6+ months
(e) 50% completely recover, 50% have chronic lifelong symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Symptoms of GAD

A

GAD: excessive worry about daily events and activities

3+ associated symptoms

  • restlessness, fatigue, irritability
  • impaired concentration
  • muscle tension, sleep disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment for GAD

(a) acute
(b) chronic

A

GAD tx

(a) acute = benzos
(b) chronic: psychotherapy + pharma: Buspirone, SSRI, Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Panic d/o

(a) prevalence
(b) most common comorbidity
(c) 2 requirements for diagnosis

A

Panic d/o

(a) 2-5%
(b) 40-80% comorbid MDD
(c) Spontaneous recurrent panic attacks w/ no obvious precipitant
- followed by 1 month of fear of panic attack, worry, change behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Tx for panic d/o

(a) acute- rule out what first?
(b) maintenance tx

A

Tx for panic d/o

(a) acute- rule out organic cause (ex: MI), then benzos
(b) maintenance- CBT + 8-12 months of SSRI (higher dose than for depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the most common mental disorders?

(a) time requirement

A

Specific phobias

(a) 6+ months if

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Differentiate social phobia from agoraphobia

A

Agoraphobia = fear of being in a place where they can’t escape (ex: common w/ panic d/o)
=> avoidance of being in places or situations from which escape or help might be difficult

Social phobia = anxiety brought on by fear of embarassment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Tx for social phobia

A

SSRI- paroxetine

  • beta blocker if performance anxiety
  • CBT to correct autonomatic thoughts
32
Q

Differentiate OCD and OCPD

A

OCD: ego dystonic (have insight)- know their obsessions/compulsions are excessive and wish they could stop

OCPD: ego dystonic- don’fat think anything is wrong

33
Q

Tx for OCD

A

OCD:

  • high dose SSRI
  • CBT: exposure and response prevention
  • TCA: Clomipramine
34
Q

Define anxiety

A

subjective experience of fear and its physical manifestations

-pathologic when it is inappropriate (source not sufficient to the severity of symptoms) and symptoms interfere w/ daily functioning

35
Q

Panic attacks

(a) peak, duration
(b) trigger
(c) symptoms

A 
Panic attacks
(a) Peak w/in 10 minutes and usually last under 25 minutes
(b) can be provoked by triggers or come on spontaneously 
(c) PANICS
P- palpitations
A- abdominal stress
N- numbness, nausea
I- intense fear of death
C- choking, chills, chest pain
S- sweating, shaking, SOB
36
Q

What type of breathing pattern can induce a panic attack?

A

Hyperventilation

37
Q

What are the most common mental d/o in the US

A

Phobias

  • 5-10% of the population
    2: 1 W:M
38
Q

What percent of OCD pts have both obsessions and compulsions?

A

75% of OCD pts have both obsessions and compulsions

-OCD, Tourette syndrome, and ADHD are frequently comorbid

39
Q

Define dissociative d/o

(a) differentiate from amnestic d/o

A

Dissociative d/o = loss of memory, identity, or sense of self (not due to medical or substance use)

(a) if due to medical reason or substance use = amnestic d/o

40
Q

Epidemiology of dissociative amnesia

A

Dissociative amnesia: pt not troubled by memory loss

  • F > M
  • young > old
  • common in child abuse
  • usually triggered by traumatic/stressful event
41
Q

Symptoms of dissociative amnesia

A

Dissociative amnesia = inability to recall important personal info, usually involving a traumatic/stressful event

  • amnesia as the only dissociative symptom (no loss of identity or sense of self)
  • not troubled by the memory loss despite that it causes marked impairment or distress
  • often reported as ‘gaps’ in recollection of a traumatic event (ex: rape)
42
Q

What is dissociative fugue?

A

Dissociative fugue (‘fug’ = fugitive)

  • sudden travel away from home w/ inability to remember parts of past or identity
  • often assume new identity
  • unaware of amnesia
43
Q

Dissociative identity d/o

(a) prevalence
(b) gender
(c) why dangerous

A

Dissociative identity d/o (previously multiple personality d/o)

(a) prevalence = very rare
(b) 90% female
(c) 1/3 attempt suicide

44
Q

In which dissociative d/o is the pt aware of his/her symptoms?

A

Dissociative d/o where pts are aware of his/her symptoms = depersonalization d/o: pts are aware and feel like they’re going crazy

While the other dissociative d/o, pts are unaware or not troubled by their symptoms:

  • dissociative amnesia: not troubled by memory loss
  • dissociative fugue: unaware of amnesia
  • dissociative identity d/o: personalities unaware of each other
45
Q

2 + 2 = 5

A

Ganser Syndrome = ‘prison psychosis’
= rare dissociative d/o, nonsensical or wrong answers or doing things incorrectly (previously considered a factitious d/o)

  • approximate answers to questions
  • can have somatic symptoms
  • reaction to extreme stress
46
Q

Dissociative identity d/o symptoms

A

2+ distinct personalities which alternate control of the person
-each are unaware of the other

47
Q

Treatment for dissociative disorders

A
  • Retrieve memory to prevent recurrence: hyponosis, amobarbital (truth serum), ativan
  • psychotherapy
48
Q

Sodium amobarbital

A

= barbiturate derivative, sedative hypnotic

-off label given slowly via IV as ‘truth serum’ b/c under its influence a person will divulge info they normally wouldnt

49
Q

Diagnostic criteria for Depersonalization D/o

A

Depersonalization d/o = recurrent feelings of detachment from self, environment, social status

  • feel like an outside observer
  • aware of symptoms, feel like they’re going crazy
  • however: reality testing remains intact during episode

-must be recurrent, not d/o if a single episode (single episode is a normal stress rxn)

50
Q

Treatment for depersonalization d/o

A

Anti-anxiety and antidepressants PRN

51
Q

Distinguish memory loss found in dissociative amnesia vs. dementia

A

Memory loss in
-dissociative amnesia: unable to recall common personal info but able to remember obscure details

-dementia: remember common personal info, can’t recall the obscure details

52
Q

What kind of dissociative d/o may be triggered by a rape?

A

Dissociative amnesia- disruption in continuity of memory of an event (often a traumatic one)

53
Q

What is abreaction?

A

Abreaction = the strong rxn pts often get when retrieving traumatic memories

-release of previously repressed emotion, achieved thru reliving the experience that caused it (ex: by hypnosis or suggestion)

54
Q

Theories on the mechanism of anorexia

(a) hypothalamic
(b) thyroid
(c) CCK

A

Mechanism of anorexia

(a) hypothalamic- lack of leptin
(b) low t3
(c) low CCK- hunger suppressant hormone

55
Q

Two prognostic indicators for anorexia

(a) Does anorexia or bulimia have a better prognosis?

A

Anorexia
-better prognosis: later age of onset, restricter (not binge/purge) subtype

(a) Bulimia has better prognosis than anorexia

56
Q

Differentiate anorexia vs. bulimeia

A

Anorexia binge/purge subtype can look a lot like bulimia

Body weight

  • anorexia: body weight below 85%
  • bulimia: normal weight or overweight

Normal hormone levels in bulimia (not in anorexia)

Ego-dystonic (bulimic) vs. ego-systeonic (anorexia)

57
Q

Russel’s sign

A

Russel’s sign- scaring on dorsum of hand, sign of forced vomiting
-anorexia binge-purge type or bulimia

58
Q

Metabolic disturbances of anorexia nervosa

(a) pH distburance
(b) EKG changes
(c) Hormones
(d) BUN
(e) bone changes

A

Metabolic disturbances of anorexia nervosa

(a) hypochloremic hypokalemic metabolic acidosis
(b) Inverted or flattened T wave on EKG. arrhythmia (especially QTc prolongation)
(c) Hormones: euthyroid, increased cortisol and GD
(d) BUN elevated due to protein catabolism
(e) osteoporosis

59
Q

Treatment for anorexia

A

Treating anorexia

  • psychotherapy: CBT
  • SSRI adjunct: helps gain weight and for comorbid depression
60
Q

Reasons to hospitalize an anorexic pt

A

Hospitalize if

  • under 80% ideal BMI (BMI under 18.5)
  • bradycardia or other arrhythmia (1/2 of deaths are heart related)
  • altered mental status
  • suicidal ideation
  • severe metabolic disturbance
  • hypothermia
61
Q

Psychological symptoms of anorexia

A

Anorexia

  • intense fear of gaining weight
  • disturbed perceptions of weight/image
62
Q

Psychological symptoms of bulimia

A

Bulimia

  • recurrent episodes of binge eating followed by compensatory behavior
  • perception of self-worth excessively influenced by body weight
  • ego-dystonic
63
Q

Diagnostic criteria for bulimia nervosa

(a) differentiate the two types: purge vs. nonpurge

A

Binge 2+ times/week for 3+ months

(a) differ by type of compensatory behavior
- purge: vomiting, laxatives, diuretics
- nonpurge: excessive exercise or fast

64
Q

Prognosis for bulimia

A

1/3 improve
1/3 stay the same
1/3 get worse

65
Q

Diagnostic criteria for eating disorder NOS (binge-eating d/o)

A

Binge 2+ days/week for 6 months

  • recurrent episodes of binge eating but binge not followed by compensatory behavior
  • emotional distress over binge eating but don’t try to control weight by purging or restricting
  • eat rapidly, a lot, alone
  • feel uncomfortably full
  • feel depressed, guilty, or disgusted after binge
66
Q

Treatment for bulimia

A

Treating bulimia

  • usually nonresponsive to psychotherapy/CBT
  • SSRIs, TCAs: reduce by 50%
67
Q

When to treat a bulimic pt

A
  • suicidal

- severe metabolic disturbance

68
Q

Diagnostic criteria for feeding disorder of infancy

A

1+ month, onset before 6 yoa
-persistent failure to eat w/ decreased weight
(not due to lack of available food)

69
Q

Pica

A

= eating of non-nutritive substances for 1+ mo, onset btwn 1-2 years

  • usually remits by adolescence
  • 1/4 of institutionalized mentally retarded children
70
Q

Rumination disorder

A

= repeated regurgitation

  • possibly: pleasure, tension-relieving, learned attention-getting
  • 1+ month
  • rare
  • most common in 3 mo-1 year and MR children/adults
71
Q

Bimodal age of onset of anorexia

A

Bimodal age of onset

Age 13-14: hormonal influences
Age 17-18: environmental influences

72
Q

Mortality rate of anorexia

A

Cumulative, about 10% due to starvation

-1/2 of cases are related to cardiac reason

73
Q

Possible explanation for why SSRIs are ineffective in tx of anorexia

(a) why to refeed anorexic pts gradually

A

Inadequate dietary intake of tryptophan (serotonin precursor

(a) Avoid refeeding syndrome: too abrupt of a shift in metabolism from catabolism to anabolism => electrolyte abnormalities

74
Q

Define binge eating episode

A

Excessive food intake w/in a 2 hour period accompanied by a sense of lack of control

75
Q

Bulimia

(a) FDA approved medication
(b) Contraindicated medication

A

Bulimia

(a) FDA approved: Fluoxetine 60-80 mg/day
(b) Buproprion- or any med that could further lower seizure threshold

76
Q

Why are eating d/o pts at an increased risk for developing arrhythmias

A

Anorexic and bulimic pts have increased risk of cardiac arrhythmias due to electrolyte disturbances

ex: hypokalemia, hypochloremia

77
Q

Treatment for binge-eating disorder

(a) Stimulants
(b) Orlistat
(c) Sibutramine

A

Binge-eating d/o: psychotherapy, behavioral therapy w/ strict diet and exercise program

(a) Stimulants to suppress appetite
(b) Orlistat = inhibits pancreatic lipase => decreases fat absorption from GI tract
(c) Sibutramine inhibits NE, 5HT, and DA reuptake (by unique mechanism) = oral anorexiant

Psychiatry Shelf (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions