Diagnoses IV

Question 1

Differentiate primary and secondary gain

Answer 1

Primary gain- symptoms defend against unacceptable internal conflict (ex: self-justification for action or lack of action)

Secondary gain- symptoms that provide unconscious external benefit (ex: attention, decrease in responsibility, avoidance of law)

Question 2

Multiple, often nonspecific, physical symptoms involving many organ systems

Answer 2

= Somatic symptom (somatization) disorder

“SOMAtization have SO MAny physical complains”

Question 3

Criteria for somatic symptom d/o

Answer 3

• onset before age 30

- at least 4 pain symptoms: 2 GI, 1 sexual/reproductive, 1 pseudoneurological

Question 4

Neurological symptom not explained by organic cause

Answer 4

Conversion d/o

-convert psychiatric problem to a neurological problem, spontaneously conert back to normal

Question 5

La belle indifference is seen in which disorders?

Answer 5

-conversion d/o

Question 6

Criteria for illness anxiety disorder

Answer 6

Illness anxiety d/o = Hypochondriasis

• preoccupation w/ disease based on misinterpretation of bodily symptoms
• persists despite medical evaluation and reassurance
• 6+ months

Question 7

Another name for Munchausen’s syndrome

Answer 7

Factitious disorder

Question 8

Criteria for factitious disorder

Answer 8

-pts intentionally produce symptoms to assume the sick role (primary gain)

Question 9

Factitious d/o vs. malingering

Answer 9

Factitious d/o = primary gain (sick role)

Malingering = secondary gain

Question 10

Name the not sick d/o that involve

(a) unintentional production of symptoms
(b) intentional production of symptoms

Answer 10

D/o

(a) unintentional production of
symptoms =
somatic symptom d/o

(b) intentional production of symptoms = malingering + factitious d/o (Munchausen’s)

Question 11

How to distinguish substance-induced vs. primary mood d/o

Answer 11

Substance-induced mood symptoms improve during abstinence

Question 12

How is EtOH a CNS depressant

Answer 12

• activates GABA receptors and serotonin receptors

- inhibits glutamate receptors and voltage-gated calcium channels

Question 13

What pH disturbance can be caused by alcohol

Answer 13

Metabolic acidosis w/ increased anion gap

Question 14

Why do you give an alcoholic thiamine before glucose?

Answer 14

To avoid precipitating Wernicke-Korsakoff syndrome

-thamine is a coenzyme used in carbohydrate metabolism

Question 15

ETOH withdrawal

(a) 6-24 hr
(b) 6-48 hr
(c) under 72 hr

Answer 15

ETOH withdrawal

(a) 6-24h: irritability, insomnia, dysautonomia (HTN, tachy, diaphoresis), PMA, fever, hallucinations, delirium
(b) 6-48: tonic-clonic seizures
(c) DT

Question 16

Mechanism of cocaine lethality in overdose

Answer 16

Cardiac arrhythmia, MI (b/c vasoconstriction), seizure, respiratory depression

Question 17

Symptoms of amphetamine abuse

Answer 17

Dilated pupils, increased libido, perspiration, respiratory depression, chest pain

Question 18

2 signs of chronic amphetamine use

Answer 18

Acne and accelerated tooth decay (‘meth mouth’)

Question 19

Mechanism of opioid intoxication lethality

Answer 19

Respiratory depression (can be fatal)

Question 20

Symptoms of opiate intoxication

Answer 20

• N/V, sedation
• pupil constriction
• decreased GI motility => constipation

Question 21

What is the one opioid that acts differently on the pupils than other opioids

Answer 21

Meperidine is the expcetion to opioids producing miosis

‘Demerol Dilates pupils’

Question 22

Triad of opioid overdose

Answer 22

‘Rebels admire morphine’

• respiratory depression
• altered mental status
• miosis

Question 23

Symptoms of opiate withdrawal

Answer 23

• anxiety, insomnia, anorexia
• fever, rhinorrhea, piloerection

NOT life threatening