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Psychiatry Shelf > Diagnoses III > Flashcards

Diagnoses III Flashcards

1
Q

What is a personality d/o?

CAPRI

A

Personality d/o = deeply ingrained, inflexible pattern of relating to others that is maladaptive and causes sig. impairment
-axis II diagnosis

Pattern of behavior/inner experience which deviates from culture, 2+ (CAPRI)

  • cognition
  • affect
  • personal relations
  • impulse control
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2
Q

Cluster A d/o

(a) list from most to least severe
(b) gender difference
(c) mainstay of treatment

A

Cluster A: ‘mad’ or ‘weird’
-eccentric, peculiar, withdrawn

(a) Most severe: paranoid PD > schizotypal > schizoid
- schizoid has no ideas of reference (no loss of reality) while the other 2 do

(b) all 3 cluster A are more common in males
(c) psychotherapy for all 3 + pharmacotherapy PRN

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3
Q

Symptoms of schizoid personality d/o

A

Schizoid personality disorder

  • *prefer to be alone
  • no desire for close relationships
  • take pleasure in few activities
  • indifferent to criticism
  • emotional coldness, detachment, flat affect
  • choose solitary activities, gravitate to solitary jobs
  • *no loss of reality (no ideas of reference)
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4
Q

Symptoms of schizotypal personality d/o

A

Schizotypal personality d/o

  • *magical thinking: think their thoughts can have special powers on others
  • odd, eccentric behaviors, habits, or thinking
  • excessive social anxiety
  • unusual perceptive experiences
  • *ideas of reference
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5
Q

Symptoms of paranoid personality d/o

A

Paranoid personality d/o

  • hostile, angry
  • preoccupied w/ trustworthiness/loyalty of others
  • reluctance to confide in anyone
  • recurrent suspicious of infidelity of spouse
  • *ideas of reference
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6
Q

Differentiate paranoid personality disorder from schizophrenia paranoid type

A

Paranoid PD: ideas of references but NOT DELUSIONS

-while scz paranoid type, paranoia comes w/ delusions (false fixed believes)

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7
Q

Cluster B d/o

(a) Name 4
(b) treatment

A

Cluster B d/o: ‘bad’ ‘wild’
-emotional, dramatic, inconsistent

(a) Histrionic, narcissistic, antisocial, borderline
(b) Psychotherapy + pharmacotherapy PRN for all 4

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8
Q

Epidemiology of paranoid personality d/o

A
  • males
  • minorities, immigrants
  • relatives of schizophrenics
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9
Q

Symptoms of histrionic personality d/o

A

Histrionic personality d/o

  • *theatrical expression of emotion: temper tantrums
  • *uncomfortable when not the center of attention
  • inappropriate provocative, often uses physical appearance to gain attention
  • easily influenced by others
  • constant need for praise
  • use regression as defense mechanism
  • speech is impressionistic, lacks details

ex: Dani Warren? boobs out, emotionally theatrical, easily influenced

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10
Q

Histrionic personality d/o

(a) prevalence
(b) gender
(c) associated w/ what type of relationships
(d) common comorbidities

A

Histrionic personality d/o

(a) 2-3%
(b) females
(c) Superficial relationships
(d) Comorbid w/ somatization and depression

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11
Q

Symptoms of narcissistic personality d/o

A

Narcissistic PD

  • *lack of empathy
  • *sense of superiority
  • *takes advantage of others for self gain
  • preoccupied w/ unlimited wealth, power, success
  • envious of others, believes others are envious of them
  • believes they are special => only can associate w/ high-status ppl
  • inflated sense of entitlement
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12
Q

Differentiate pt’s motivation for taking advantage of others in

(a) narcissistic PD
(b) antisocial PD

A

Motivation for taking advantage of others

(a) Narcissistic PD: for self-gain, for status and recognition
(b) Antisocial PD: for material gain or subjugation of others

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13
Q

Describe the way that each of the 4 cluster B personality disorders deal w/ time

A

Histrionic: show less symptoms w/ age

Narcissistic: handle aging poorly

Antisocial: only a diagnosis after 18, symptoms since age 15, history consistent w/ CD. Course may increase or decrease w/ age

Borderline: ppl get worse w/ age (burnout)

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14
Q

Symptoms of antisocial personality d/o

A
  • *NO REMORSE for harmful actions
  • wont conform to society => violates laws
  • irritability, aggression
  • *Charming when first encountered, manipulative: con men, intelligent
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15
Q

Why be careful when treating anxiety in ppl w/ antisocial personality d/o

A

Caution due to addictive personality

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16
Q

Symptoms of borderline personality disorder

A 
IMPULSIVE
I- impulsive: sex, substance, spending 
M- moodiness**
P- paranoid or disassociation under stress
U- unstable self image**
L- labile interpersonal relationships**
S- suicidal gestures or self-harm**
I- inappropriate anger
V- vulnerability to abandonment => desperately avoid real or perceived abandonment**
E- emptiness (feelings of)
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17
Q

Epidemiology of borderline personality do

A
  • 2-3% prevalence
  • 2:1 female
  • women: 3-10x likely to be victim of incest
  • 10% suicide
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18
Q

Cluster C personality d/o

(a) treatment
(b) Name 3

A

Cluster C personality d/o: ‘sad’ ‘wimpy/worried’
-anxious, fearful

(a) psychotherapy and pharmacotherapy in all
- individual psychotherapy for dependent
- encourage interaction for avoidant
- group therapy for obsessive compulsive

(b) Cluster C: dependent, avoidant, obsessive-compulsive

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19
Q

Symptoms of dependent personality d/o

A
  • *want others to make decisions
  • feel helpless when alone
  • difficulty initiating projects on their own
  • urgently seek new partner if one is lost
  • poor self-confidence and fear separation
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20
Q

Symptoms of avoidant personality d/o

A
  • *wants friendships, just hard to form
  • *fear of rejection
  • unable to interact unless assured that person will like them
  • avoid situations in which they may be rejected, seek jobs w/ little interpersonal contact
  • hypersensitivity
  • feelings of inadequacy
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21
Q

Fear of what in avoidant personality d/o vs. agoraphobia

A

Avoidant personality d/o- fear of rejection

Agoraphobia- fear of embarrassment

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22
Q

Risk factors for avoidant personality d/o

A
  • common in timid infants
  • genetic predisposition

-prone to depression

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23
Q

Symptoms of OCPD

A

Obsessive compulsive personality d/o

  • *preoccupation w/ details such that main point of activity is lost
  • perfectionism detrimental to completing task
  • will not delegate tasks
  • rigid, serious, formal
  • workaholic
  • hoard meaningless objects
24
Q

Differentiate obsessive compulsive and narcissistic personality d/o in ppl that overwork themselves

A

OCPD- workaholic, motivated by the activity itself

Narcissistic- workaholic, motivated by the success

25
Q

Relationship btwn Axis I and II diagnoses

A

Pts w/ personality d/o (axis II) are vulnerable to developing symptoms of axis I d/o during stress

26
Q

Common defense mechanisms used in

(a) histrionic personality d/o
(b) borderline personality d/o

A

Defense mechanisms

(a) histrionic- often use regression
(b) borderline- often use splitting

27
Q 
Familial association w/ what and cluster 
A
B
C 
disorders
A

Familial association w/ clusters of personality d/o

  • Cluster A and psychotic d/o
  • Cluster B and mood d/o
  • Cluster C and anxiety d/o
28
Q

Personality D/o

(a) insight
(b) age of onset
(c) prevalence

A

Personality D/o

(a) Pts lack insight into their illness- ego-systonic
(b) onset of symptoms must be before early adulthood
(c) international prevalence is 6%. many pts w/ PD will meet the criteria for > 1 d/o and should be classified as having all for which they qualify

29
Q

Give some example of magical thinking found in personality do

A

Magical thinking found in schizotypal personality d/o

  • belief in clairvoyance or telepathy
  • bizarre fantasies or preoccupations
  • belief in superstitions
30
Q

Differentiate schizotypal personality disorder vs. paranoid schizophrenia

A

Schizotypal personality d/o- pts are not frankly psychotic (tho can become transiently so under stress), don’t have fixed delusions

31
Q

Use of pharmacotherapy for personality d/o

A

Pharmacotherapy have minimal use in most personality d/o

-found to be more useful in borderline PD than any other PD: treat psychotic or depressive symptoms

32
Q

Schizoid vs. avoidant personality do

A

Schizoid pts prefer to be alone

Avoidant pts want to be w/ others but are too scared of rejection

33
Q

Time criteria for

(a) depressive episode
(b) manic episode
(c) mixed episode
(d) hypomanic episode

A

Time criteria

(a) depressive episode: 2+ weeks
(b) manic episode: 1+ week
(c) mixed episode: 1+ week of meeting criteria for both
- usually irritability is the predominant mood state
(d) hypomanic episode: 4+ days

34
Q

SIG E CAPS

(a) How many to meet criteria?

A

Depression: 5+ w/ depressed mood or anhedonia

Sleep (increased or decreased)
-sleep latency (takes longer to fall asleep)
-AM wakening
-hypersomnia in atypical depression 
Interest (lack of)
Guilt/hopelessness
Energy (decreased)
Concentration (impaired)
Appetite (increased or decreased)
Psychomotor slowling
Suicidal ideation
35
Q

DIG FAST

(a) How many to meet criteria?

A

Mania: 3+ w/ elevated mood or irritability

Distractibility
Insomnia/impulsive behavior 
Grandiosity 
Flight of ideas (racing thoughts) 
Activity (increase)
Speech (pressured)
Thoughtlessness/talkativeness
36
Q

What percent of manic episodes

(a) recur
(b) have psychotic features

A

Manic episodes

(a) 93% recur
(b) 75% have psychotic features

37
Q

Distinguish hypomania from mania

A

Hypomania- same in that it meets 3+ manic symptoms, shorter duration, less severe

  • no psychotic symptoms
  • *no impairment of fxn
38
Q

MDD

(a) Average age of onset
(b) Duration if untreated
(c) MZ twin concordance
(d) Percent who have SI

A

Major depressive d/o

(a) 40 yoa
(b) lasts 6-12 mo if left untreated
(c) 90% MZ twin concordance
(d) 2/3 have SI

39
Q

Distinguish the subtypes of MDD

(a) melancholic
(b) atypical
(c) catatonic
(d) psychotic
(e) seasonal affective

A

Subtypes of MDD

(a) melancholic: early morning awakening, anhedonia, anorexia
(b) atypical = most common subtype
- hypersomnia, reactive mood, hyperphagia
(c) catatonic- hypomotorism, echolalia/echopraxia, negativism, rigidity
(d) psychotic
(e) seasonal affective- only during winter months

40
Q

Treatment of MDD

(a) duration
(b) atypical

A

MDD treatment
first line = SSRIs (second TCAs)

(a) for a MINIMUM of 16 weeks
(b) atypical depression = MAOIs

41
Q

When is ECT indicated for MDD?

(a) Is ECT more effective in MDD or bipolar d/o?

A

Use ECT for MDD when

  • acutely suicidal
  • 2-3 failed medical trials
  • catatonia, malnutrition

(a) ECT has higher efficacy in bipolar

42
Q

Time criteria for

(a) bipolar I
(b) bipolar II
(c) cyclothymia
(d) dysthmia

A

Time criteria for

(a) bipolar I: 7+ days of mania
(b) bipolar II: 2+ weeks of major depressive episode + at least one hypomania episode (4+ days)
(c) cyclothymia: 2+ years
(d) Dysthymia: 2+ years

43
Q

What is the most common subtype of depression?

A

Atypical: hypersomnia, reactive mood, hyperphagia

lol, misnomer much

44
Q

Criteria for cyclothymia

(a) common comorbidity

A

Cyclothymia: mild depression + hypomania for 2+ years w/ no normal 2 mo

(a) often co-existant w/ borderline PD

45
Q

Prognosis of dysthmia, percent that get

(a) MDE
(b) bipolar
(c) lifelong symptoms

A

Dysthymia

(a) 20% get MDE
(b) 20% get bipolar
(c) 25% get lifelong symptoms

46
Q

Criteria for dysthymia

(a) prevalence

A

Dysthymia = mild depression for 2+ years w/ no 2 months euthymic
-never have psychotic features

2 D’s: dysthymic disorder, 2 years of depression, 2 listed criteria, no 2 mos w/o symptoms

(a) 6% prevalence

47
Q

What is double depression?

A

Double depression: dysthymia + MDE

48
Q

Most effective treatment for dysthymia

A

CBT + psychotherapy

49
Q

Incidence of

(a) postpartum depression
(b) postpartum psychosis

A

Incidence of

(a) postpartum depression = 15% of pregnancies
(b) postpartum psychosis = 2% of pregnancies

50
Q

Time component and criteria for

(a) postpartum depression
(b) postpartum psychosis

A

(a) Postpartum depression: w/in 4 weeks of delivery
- same criteria for MDD met

(b) Postpartum psychosis: usually w/in 2 weeks of delivery
- can have bipolar type manic symptoms and/or psychotic delusions

51
Q

Treatment for

(a) postpartum depression
(b) postpartum psychosis

A

Treatment

(a) Postpartum depression: SSRIs (but caution for breastfeeding), CBT
(b) Postpartum psychosis: hospitalization, antipsychotics

52
Q

Define rapid cycling

A

Rapid cycling = 4+ mood episodes in a year

53
Q

What disorder has the highest rate of suicide

A

MDD

54
Q

Diseases that carry a very high risk for developing depression

(a) CNS
(b) Type of cancer

A

(a) Stroke

(b) Pancreatic cancer

55
Q

Best treatment for manic woman in pregnancy

A

ECT

56
Q

Triad for seasonal affective d/o symptoms

A
  • irritability
  • carbohydrate craving
  • hypersomnia

Psychiatry Shelf (6 decks)

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