Diagnosis Flashcards
What is the biggest risk factor for Bipolar Disorder?
Family history is the greatest risk factor. This is very inheritable.
What happens if bipolar condition is 45 years or older?
This is most likely a medical condition so do a medical consult?
Bipolar-DIGFAST
Distractibility/easy frustration
Irresponsibility/Impulsive
Grandiose
Flight of Ideas
Activity
Sleep
Talkative
Main symptoms for Mania/Hypomania?
a. Irritable mood
b. Uncooperative
c. Agitation
d. Self-inflated esteem
e. Pressured/rapid speech
What type of behaviors do borderlines display?
a. SH behaviors
b. Recurrent SI behavior
BPD have Intense interpersonal problems: True or false
False
For patients dx with BPD what do you suggest to them?
Keep dairy/journal of symptoms
Non pharm treatment for BPD? What can it decrease?
DBT- This is evidence that this can decrease SI behavior
What medication do we give BPD who presents with irritability, anger, and SH behaviors? (Katie)
Lithium
What medication do we give BPD who presents with depressed mood, emotional lability, interpersonal problems, rejection sensitivity, aggression, and hostility?
Depakote
What is Conversion Disorder?
This is a mental condition in which a person has neurological symptoms that can’t be explained by medical evaluation.
What are conversion disorder symptoms?
a. blindness
b. mutism
c. paralysis
d. parathesis
What do you call numbness or tingling which causes the patient to wear gloves on hands or socks on feet?
Glove socking syndrome
When do conversion disorder symptoms start?
Symptoms usually begin suddenly after a stressful experience – ex loss of loved one
It is an enduring pattern of angry or irritable mood. They are argumentative and defiant for at least 6 months with at least four of the main symptoms.
What is Oppositional defiant Disorder?
What are the main symptoms for ODD? (just read)
a. Losing temper
b. Touchy or easily annoyed
c. Angry or resentful
d. Actively defies or refuses to comply with rules from authority.
e. Blames others
f. Annoys intentionally
g. Spiteful
What is the main treatment for ODD?
Therapy
ODD-What does family therapy emphasis on?
Emphasis on child management skill. This teaches parents about positive reinforcement and boundary settings.
If ODD isn’t treated by therapy, what can this lead to?
Conduct disorder
What’s the difference between ODD and Conduct Disorder?
ODD- Not aggressive, just defiant
Conduct Disorder- Aggressive (children only)
What is Conduction disorder
A repetitive and persistent pattern of behavior in which the rights of others or rules are violated.
What are behaviors of Conduct Disorder?
Aggression towards animals and people.
Destruction of property
Deceit and theft
Other behaviors of Conduct disorder? (Just read)
Using weapons to harm, stealing while confronting victim, sexual abuse
Engaging in fire setting
Breaking into house and stealing
Conduct Disorder patients have: _________
Lack of Remorse
What does pharmacological treatment help with Conduct Disorder?
It targets mood and aggression.
This can be treated with antipsychotics, mood stabilizers, and SSRIs.
What are alpha agonists that can help with Conduct disorder?
Clonidine and Guanfacine
What is adjustment disorder?
An adjustment disorder is an emotional behavioral reaction to a stressful event or change in a person’s life.
The reaction is considered an unhealthy or excessive response to the event or change within 3 months of it happening.
Examples of stressful events in Adjustment Disorder? (Just read)
Stressful events or changes in the life of your child or adolescent may be a family move, the parents’ divorce or separation, the loss of a pet, or the birth of a sibling
They present with feelings of sadness, decreased interest, sleep disturbance, appetite changes (same as MDD except time/identify stressor)
Adjustment Disorder with depressed mood
A child has a mix of symptoms from all the above subtypes. For example, child may present with truancy, peer conflict, verbal altercations, insomnia, frequent crying
Adjustment Disorder with mixed disturbance of emotions and conduct:
What is the criteria to meet Tourette’s?
At least 2 motor tics and 1 vocal tic.
They wax and wane in frequency but have occur for more than a year.
They start to appear before the age of 18.
When do Tics start?
Tics are often caused by using a substance or other medical condition: True or False
False
Children’s motor tics are fairly common and can be temporary: True/false
True
What are the primary neurotransmitters in tourettes?
a. * Excessive dopamine
b. Norepinephrine
c. Serotonin
(DNS)
What type of antipsychotics can be used for Tourettes?
Atypical antipsychotics.
FDA: Haldol, Pimozide (Orap), and Abilify
What medications can help with behavioral symptoms such as impulse and rage attacks? (Tourettes)
Clonidine and Guanfacine
What is Acute Stress Disorder? (ASD)
A psychiatric disorder that may occur in patients within 4 weeks of a traumatic event.
Acute Stress Disorder symptoms include: (just read)
a. anxiety
b. insomnia
c. poor concentration
d. Intense fear, helplessness
e. Reexperiencing the event
f. Avoidant behavior
*They startle
What is the difference between ASD and PTSD?
ASD= 4 weeks within the traumatic event. (3 days to a month)
PTSD = longer than a month
What are the main symptoms of PTSD
a. Intrusive re-experiencing of an extremely traumatic event
b. Increased arousal (hyperarousal)
c. Avoidance of the stimuli.
What antidepressants to use for PTSD?
a. Sertraline and Paxil (SSRIs- Searching for Parrots)
b. TCAs
What medication to help with nightmares?
Prazosin
What are the main non-pharm treatments for PTSD?
a. *EMDR
b. CBT
Bonus: Open-ended questions- therapeutic rapport
What are the phases of EMDR?
a. Desensitization phase
b. Installation phase
c. Body Scan phase
What neurotransmitters are involved for ADHD?
Dopamine
Norepinephrine
Serotonin
The frontal cortex and basal ganglia are involved on which type of disorder?
ADHD
Abnormalities causing ADHD?
Abnormalities of reticular activating system
Abnormalities in the prefrontal cortex cause what?
ADHD inattentive type
If parents are anxious about their kid having ADHD, what should you try to do?
If parents are anxious, temporarily stop teaching and try addressing anxiety.
NO false reassurance
How many setting to assess ADHD symptoms in?
At least two settings.
Example: Teacher and parent feedback.
What to assess before placing a patient on stimulants for ADHD?
Assess cardiac history. Stimulants can increase HR/BP = increased risk for heart attack and stroke.
Stimulants- Which medication are approved for ages 3 and older?
Amphetamines
Stimulants- Which medication are approved for ages 6 and older?
Methylphenidates
What do you do if you see signs of stimulant abuse?
Discontinue and give a non-stimulant.
Main signs of stimulant abuse
a. Insomnia
b. Tremors
c. Increased HR/BP
d. Heart palpitations
Other signs of stimulant abuse (four of them)
Agitation
Anxiety
Irritability
Mood swings
Non-Stimulants that are FDA approved in ages 6-17 yo with ADHD?
Guanfacine and Clonidine
What non stimulant medication is approved for children ages 6 and older with ADHD?
Strattera
Remember if a child has a tic after a stimulant, DC stimulant and place on non stimulant.
Just read
What part of the brain does the dorsolateral prefrontal cortex function?
a. Executive function.
b. Cognitive process such as planning, working memory.
c. Problem solving
d. How to direct/maintain attention to a task
What neurotransmitters are used in OCD?
Serotonin and Norepinephrine
What is the definition of OCD
The presence of anxiety-provoking obsessions or compulsions (tics) that function to reduce the person’s subjective anxiety level.
What are examples of anxiety-provoking obsessions?
Recurrent and persistent thoughts, impulses or images.
What is PANDAs and why should it be considered in all children?
a. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
b. Should be considered in all children with sudden onset of OCD symptoms
The difference between OCD and Tourette’s
OCD = persistent thoughts and tics
Tourette’s = tics only
What is factitious disorder?
This is usually presented with physical or mental symptoms that a re induced (no reason).
Ex: Someone falsely claims that another person has physical/psychological symptoms caused by another person with intention to deceive others.
a. Drinking contaminated urine samples
b. Taking hallucinogens
c. Injecting fecal material to produce abscesses and similar behavior.
Factitious disorder examples
What is malingering?
Similar to factitious disorder, symptoms are faked because of the motive for secondary gain.
ex: getting out of jail time.
If a child is brought in and their symptoms seem factitious that are caused by parents, what should you do?
Report to CPS.
What is Reactive Attachment Disorder?
It is when there is severely dysfunctional early relationship between main caregiver and child.
Reactive Attachment Disorder- What happens when caregivers disregard the child’s physical and emotional needs consistently?
The child fails to develop a secure and stable attachment with them.
Reactive Attachment Disorder- What happens when failure to meet child’s needs causes severe disturbance?
This affects the child’s ability to relate to others causing behavioral and interpersonal problems.
Symptoms child displays with Reactive Attachment Disorder
a. Fearful, inhibited, withdrawn,
b. Apathetic, shows no emotions towards caregivers.
c. Others can show aggression, disruptive mood and are disorganized.
What is GAD?
Excessive worry, apprehension, or anxiety about events or activities occur more than for a period of at least 6 months.
An abrupt surge of intense fear or discomfort that reaches a peak within minutes and during that time psychological and physical symptoms occurs.
Panic attack definition
Main symptoms of panic attack include:
Abrupt surge of intense fear and sense of impending doom.
Other symptoms for panic attack (just read)
a. Rapid heart rate
b. Sweating, shaking
c. hot flashes/lightheadedness
d. Chills, nausea, abdominal pain,
e. chest pain, HA, Numbness/tingling
What kind of medications can you give for panic attacks?
a. First line of treatment is Beta Blockers.
b. SSRIs
c. Give Benzos as a last resort since it is habit forming.
If a patient has albuterol, can you give them a beta blocker for panic attack?
No. It’s contraindicated for patients with a bronchodilator because it causes bronchospasms.
When is panic disorder diagnosis given?
It is given for people who experience recurrent unexpected panic attacks that can appear out of nowhere.
Treatment for panic disorders: SSRI
FDA approved medications include
a. fluoxetine (Prozac)
b. paroxetine (Paxil/Pereva)
c. Sertraline (Zoloft)
Treatment for panic disorder: SNRI
Venlafaxine (Effexor XR) is FDA approved for panic disorder.
What is Disruptive Mood Dysregulation Disorder and what age is it diagnosed?
This a condition in which children or adolescents experience persistent irritability and anger and frequent, intense temper outbursts. Occurs at ages 6-17.
Main symptoms for DMDD include:
a. Chronic dysregulated mood (moody)
b. Frequent intense temper outbursts/temper tantrums
c. Severe irritability and anger
Anorexia Nervosa definition
An eating disorder causing people to obsess about weight and what they eat.
This is characterized by a distorted body image, with an unwarranted fear of being overweight.
Main symptoms for Anorexia nervosa
a. Low BMI
b. Amenorrhea
c. Emaciation (abnormally thin)
d. Bradycardia/Hypotension
Anorexia nervosa- What happens if a patient’s BMI is less then 15?
Refer out for medical evaluation/hospitalization.
Anorexia Nervosa- If a kid comes in with BMI of 12 and parents are non-compliant with treatment of medical evaluation what should you do?
Get CPS involved
In bulimia the patient’s BMI is under 15: True or false
False: BMI is normal range
What is Autism Spectrum Disorder (ASD)?
Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests.
What are the neurotransmitters for ASD?
a. Glutamate
b. GABA
c. Serotonin
ASD: Patients display persistent deficits in social communication and social interaction across multiple settings: True or False
True
a. No response when called by name
b. Nonverbal communication
c. Little or no eye contact
Main symptoms for ASD
*What do children with ASD often do?
They often like to line up, stack, or organize objects and toys in long tidy rows.
This theory claims that a dysfunction of the mirror neuron system may be a cause of poor social interaction and cognition in individuals with ASD.
Broken Mirror Theory of ASD
What is Delirium?
Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable.
Acute disturbance of LOC, cognition, and inattention (sudden onset).
What do you do if a patient with delirium has agitation and psychotic symptoms?
These symptoms can be treated with a low dose of Haldol.
What can Delirium be caused by?
It can be caused by substance or ETOH use.
Infections can also cause delirium in older patients.
You can give benzos to a patient with delirium: True or false
True
What do you order if a 70-year-old patient came to office confused and delirious?
Order UA with culture and sensitivity
What is Dementia?
Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life.
What do patients with dementia usually have?
They usually have a premorbid history of slowly declining cognition.
Symptoms of dementia
Progressive mental decline
Irritability and agitation.
What do you check if you suspect dementia?
Check Vitamin B12 and folic acid levels.
What types of Dementia are there?
a. Subcortical
b. Cortical
Motor symptoms- lack of coordination, tremors, ataxia, and dystonia
Depression
Irritability
Apathy
Symptoms for Subcortical dementia
Symptoms for Subcortical dementia?
Language (aphasia)
Memory Impairments (amnesia)
Nonpharmacological treatment for Psychosis and agitation in Dementia
Try moving them to a quiet environment first
What should be used as first line agents in patients with psychotic symptoms of dementia?
Atypical antipsychotics
