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Diagnostic criteria Flashcards

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1
Q

Generalized anxiety disorder

A

Excessive uncontrollable worry about multiple issues at least 6 months in duration

And at least 3 of the following symptoms

  • -feeling on edge
  • -muscle tension
  • -irritability

-fatigue
-difficulty concentrating
-sleep disturbance
(note last 3 are same as depression)

tx: CBT > SSRIs or SNRIs

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2
Q

Dysthymia

A
  • chronic depressed mood for at least 2 years
  • only 1 year if children or adolescent

-no symptom free period for over 2 months

with at least 2 of the following

  • appetite changes
  • sleep changes
  • low energy
  • **low self esteem, this is one not found in MDD
  • poor concentration
  • feelings of hopelessness

specifiers: pure dysthymic syndrome - MDD criteria never met
- w/ intermittent major depressive episodes
- with persistent major depressive episodes - all criteria met throughout 2 years

Tx: antidepressants, CBt

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3
Q

What needs to be r/o to diagnose schizo (5)

A
  • drug induced
  • mood disorder
  • other medical illness
  • autism
  • schizoaffective
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4
Q

Delirium w/ management

A

3C’s

  • Cognitive deficit-(2) 1 must be concentration
  • course (rapid onset fluctuation)
  • *cause: must be due to general medical condition or substance
I ❤️ LADY MACBETH 
Immunologic
Acute MI
LP
ABG
Drugs
Yaws (spirochete do RPR)
Malignancy
Ammonia
CMP,CBC,UA
B12, folate, thiamine, niacin
EEG (global slowing consistent with delirium) or r/o seizure
TSH and Trauma
HTN encephalopathy, head CT and Heavy metal poisoning

Delirium if HPI benign

  1. stat EKG
  2. Vital signs (acute hypoxemia or HTN encephalopathy)
  3. Drug screen (withdrawal from benzos or alcohol)
  4. Routine CBC, CMP, UA, TSH, RPR, HIV, B12, Folate, CXR
  5. EEG, head CT, LP, everything else
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5
Q

What are the 9 criteria of BPD

A

pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

(1) frantic efforts to avoid real or imagined abandonment.
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self

(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms

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6
Q

MY Very Educated Father Surfs Porn for Thrills

A

paraphilias

  1. Masochism
  2. Voyerism (peeping tom)
  3. Exhibitionism
  4. Fetish
  5. Sadist
  6. Pedophilia
  7. Fraughterism
  8. Transvestic (cross dressing)

Anyone positive for one on average has a total of 3-5

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7
Q

Antisocial personality disorder and conduct

A

CONDUCT
Diagnosis and DSM-5 Criteria
A pattern of recurrently violating the basic rights of others or societal norms, with at least three behaviors exhibited over the last year and at least one occurring within the past 6 months.

■ Aggression to people and animals: Bullies/threatens/intimidates others; initiates physical fights; uses weapon; physically cruel to people; physically cruel to animals; stolen items while confronting victim; forced someone into sexual activity.
■ Destruction of property: Engaged in Fire setting; destroyed property by other means.
■ Deceitfulness or Theft: Broken into a home/building/car; lied to obtain
goods/favors; stolen items without confronting a victim.
■ Serious violations of rules: Stays out late at night before 13 years old; runs away from home overnight at least twice; often truant (absent) from school before 13 years old

ANTISOCIAL

Three or more of the following should be present:
■
1. Failure to conform to social norms by committing unlawful acts
2. Deceitfulness/repeated lying/manipulating others for personal gain
3. Impulsivity/failure to plan ahead
4. Irritability and aggressiveness/repeated fights or assaults
5. Recklessness and disregard for safety of self or others
6. Irresponsibility/failure to sustain work or honor financial obligations
7. Lack of remorse for actions

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8
Q

COAT RACK

A 
Wernicke: 
Confusion 
Opthalmoplegia 
Ataxia 
Thiamine 
Korsakoff 
Retrograde amnesia 
Anterograde amnesia 
Confabulation
Korsakoff psychosis
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9
Q

Dissociative identity

A

Symptoms of dissociative identity disorder (criteria for diagnosis) include:

The existence of two or more distinct identities (or “personality states”). The distinct identities are accompanied by changes in behavior, memory and thinking. The signs and symptoms may be observed by others or reported by the individual.

Ongoing gaps in memory about everyday events, personal information and/or past traumatic events.

The symptoms cause significant distress or problems in social, occupational or other areas of functioning.

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10
Q

Lit TANGy CAT

A

Lithium toxicity

Drugs that cause lithium toxicity:

Thiazides
Ace inhibitors
Nsaids (not aspirin)
- all decrease renal clearance

Early toxicity

GI: nausea, vomiting, diarrhea

Late toxicity

Confusion
Ataxia, agitation
Tremors (tx propanolol)

*also hyopcalcemia and hypoparathyrodism

Tx: hemodialysis if severe

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11
Q

If SSRI exposes mania?

A

D/c SSRI

If mania symptoms persist then can consider

  • lithium
  • valproate
  • quetiapine
  • lamotrigine
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12
Q

Social anxiety disorder

A

Marked anxiety about one or more social situation for at least 6 months

  • marked impairment
  • social situations avoided or endured with intense distress
  • subtype: performance only

Tx: SSRI/SNRI
Cbt
-subtype: propranolol

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13
Q

Adjustment disorder vs normal stress response

A

*adjustment - marked distress or functional impairment

If lack either, its normal stress response

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14
Q

Intermittent explosive disorder vs disruptive mood dysregulation

A

Intermittent explosive disorder:

Episodes last less than 30 min and provides immediate relief followed by regret, dysphoria, and embarrassment .

Verbal and physical aggression out of proportion to the provocation.

R/o other psych disorder

tx: CBT and SSRI

DMDD

  • severe recurrent temper outbursts at least 3 times a week out of proportion to provocation
  • *symptoms must start before 10
  • diagnosis can be made between ages 6-18
  • *constantly angry and irritable between episodes
  • symptoms must last at least 1 yr w/o 3 months of symptom free

Tx: 1st line psychotherapy
Stimulants, ssri, mood stabilizers : have been used but eh

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15
Q

The SSRIs/SnRI

SSRI’s increase suicidal thought, not completion

A

-setraline, escitalopram recommended after acute mi due to low interaction with cardiac drugs, basically the safest of the safe
-setraline - breast feeding
-avoid citalopram post MI as there is dose dependent QT prolongation
-generally avoid paroxetine (Paxil): anticholinergic, causes weight gain, inhibits p-450, most likely to cause withdrawal
- FLUOXETINE: indicated for children, PMS/PMDD, most studied for intermittent explosive disorder, bulimia nerviosa
———————————————-
-venlafaxine causes tachycardia and increased blood pressure
-venlafaxine and fluoxetine are both ACTIVATING

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16
Q

Borderline:

MISS DIANA

A

Mood reactivity (splitting)
Interpersonal dysfunction (can’t maintain a relationship)
Suicidal gestures
Self image disturbance (links to eating disorder)

Dissociative symptoms 
Impulsivity
Anger
Nothingness (link to depression)
Abandonment (frantic efforts against)
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17
Q

4 personality disorders remit with age

A

Antisocial
Avoidant
Borderline
Dependent

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18
Q

What differentiates pheo from panic disorder

A

The medical signs (pheo):

  1. Treatment resistant severe hypertension
  2. Episodic headaches
  3. Hyperglycemia

All in the context of a normal BMI

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19
Q

Tx of body dysmorphic disorder

A

Antidepressant -SSRI

AND

CBT

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20
Q

Diagnosis of manic episode

A

3 of 7
of
4 of 7 if mood is only irritable

  • inflated self-esteem or grandiosity (*includes grandiose delusions - messages from god)
  • decreased need for sleep
  • pressured speech
  • flight of ideas
  • distractibility
  • psychomotor agitation (anxious, restless)
  • self indulgent (hedonistic)

*note there is no psychosis in criteria! So don’t confuse with schizophrenia if only mention “talking quickly”. Are they highlighting mood or highlighting hallucinations/delusions

Tx:

atypical or second-generation antipsychotics
(e.g., olanzapine) + benzodiazepines for acute psychosis/agitation

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21
Q

Oppositional defiant disorder diagnostic criteria

A

at least 4 symptoms present for at least 6 months, with at least one idvidual who is not sibling

  • anger/irritable mood - looses temper, touchy, easily annoyed
  • defiance - breaks rules, argues with authority, annoys other
  • wants revenge 2x in past 6 months
  • disturbance causes distress in individual or others
  • not due to another mental disorder

tx: behavior therapy
- parent managment training
- medications…eh!

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22
Q

Minimental Status Exam - scoring

A

anything greater than 24 points (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10–18 points) or mild (19–23 points) cognitive impairment.

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23
Q

Neuroimaging of schizophrenia

A
    • bilateral enlargement of ventricles with atrophy of cortical volume
  • also decreased volume of hippocampus and amygdala
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24
Q

Trazodone vs tramadol

A

-tramadol is a narcotic, used to treat pain, besides being an opiod it is also a serotonin–norepinephrine reuptake inhibitor (SNRI) > look out for serotonin syndrome

-Trazodone, is an antidepressant medication.[8] It is used to treat major depressive disorder, anxiety disorders,
Trazodone is generally described as acting as a potent serotonin 5-HT2A and α1-adrenergic receptor antagonist, a weak serotonin reuptake inhibitor (SRI),

25
Q

Drugs that can cause serotonin syndrome

A

-tramadol
-linezolid
-meperidine
ondansetron,
-MAOI

26
Q

Acute intermittent porphyria 6 P’s

A

-porphobilinogen deaminase deficiency
painful abdomen
-peripheral neuropathy (numbness, paresthesias)
-psychologic sx (depression, anxiety, confusion, agitation, hallucination)
-pee abnormality, dark urine
-precipitated by drugs (barbituates, oral contraceptives)
*autosomal dominant (look for family members)

27
Q

Transient global amnesia vs Dissociative Fugue

A

TGA - Patients are often disoriented in regard to time and place but usually not personal identity.

28
Q

When are opiods indicated for pain management (even if they have hx of opiod dependence)

A

Opioids are indicated for acute trauma (aka car accident) and chronic cancer pain.

29
Q

Bedwetting tx

A

Under age of 5

  • bed alarm
  • waking up each night to go to bathroom
  • reassurance

When he is over 5 years old and still wetting the bed, then you consider using medication. Desmopressin is first line and imipramine is either 2nd/3rd line, can’t remember

30
Q

correlates to what psych condition

  • increased sensitivity to lactate infusion
  • serology positive for HLA-DR2
A
  • lactate: Panic Disorder -perhaps increased anticipation and anxiety
  • HLA-DR2 (narcolepsy)
31
Q

tx of schizoaffective

A

if depression sxs: antipsychotic only; try SSRI if ineffective

if manic sxs: antipsychotic AND mood stabilizer

32
Q

tx of sleep terror

A

nothing, keep the child safe from injury but this is a self limited condition

33
Q

Criteria of PTSD

A

Criterion A: The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence,

Criterion B (at least one):
The traumatic event is persistently re-experienced in the following way(s):
Unwanted upsetting memories
Nightmares
Flashbacks
Emotional distress after exposure to traumatic reminders
Physical reactivity after exposure to traumatic reminders

Criterion C (at least one): 
Avoidance of trauma-related stimuli after the trauma, in the following way(s):

Trauma-related thoughts or feelings
Trauma-related external reminders

Criterion D: negative alterations in cognitions and mood (two required)
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect
34
Q

Rett syndrome

A

X-linked dominant, degenerative neurological disorder
Results in reversal of language and dexterity development
Linked to a defect in the methl-CpG-binding protein 2 (MeCP2) gene

sxs
-apraxia
loss of purposeful movements in the hands
often the first sign of the disease
-mental slowing (i.e. signs of dementia)
-abnormal breathing
-difficulty ambulating
-seizures
abnormal sleeping patterns
-avoids social contact

Physical exam
apraxia
develop repetitive, purposeless hand movements that may differ for each person. Hand movements may include hand-wringing
abnormal gait
scoliosis
decreased head circumference
usually starts to become evident at 5-6 months
poor circulation indicated by cold, blue extremities

no tx

35
Q

Tourettes syndrome

A

for at least a year, hx of multiple motor tics and at least one vocal tic (don’t have to coincide)
-onset prior to age 18yrs

  • psychoeducation
  • behavioral therapy
  • guanfacine (1st choice), clonidine (more sedating)
  • co-tx of ADHD
  • in severe cases can tx with atypical antipsychotic (ex risperidone).

*chronic motor or vocal tic disorder (solely one not both for at least a year)
Provisional tic disorder - single or multiple motor and/OR vocal tics less than a year

36
Q

undoing defense mechanism

A

Performing an act to “undo” a previous unacceptable action or thought

  • someone cuts someone in line but holds the door open for them
  • fueled by guilt

Reaction formation:
To express an unacceptable thought in the exact opposite
*more unconscious

37
Q

Kluver-Bucy Syndrome

A

Klüver–Bucy syndrome is a syndrome resulting from BILATERAL lesions of the medial temporal lobe (including amygdaloid nucleus (ex Herpes Encephalitis).
Klüver–Bucy syndrome may present with compulsive eating, hypersexuality, insertion of inappropriate objects in the mouth (hyperorality), visual agnosia (inability to recognize familiar objects or people), anterograde amnesia, , and docility (loss of fear response) .

38
Q

How to tx intoxication with barbiturates?

A

Akalinize the urine with sodium bicarbonate to promote renal excretion
*withdrawal from barbituates of all kinds of drugs withdrawals has the highest mortality rate

39
Q

Ectasy vs Meth

A 
Ectasy =
euphoria
mild sympathetic sxs
profound hyponatremia
serotoninergic syndrome
Methaamphetamine =
sympathetic sxs
agressive behaviour
Neuropsychiatric sxs: agitation, combativeness
hallucinations
40
Q

SSRI + CBT 1st line tx for

A
  • social anxiety disorder (non performance type)
  • separation anxiety disorder (SSRI useful adjunct)
  • panic disorder and agoraphobia
  • post traumatic stress disorder
  • bulimia/binge eating disorder
  • generalized anxiety
  • major depressive disorder/dysthymic disorder
  • intermittent explosive disorder (impulse disorders)
  • kleptomania (impulse)
  • obsessive compulsive disorder
41
Q

Which are the long acting benzodiazepines

A

Chlordiazepoxide (Librium®
Diazepam (Valium
Flurazepam

everything else is kind of short acting
intermediate:
Clonazepam (klonipin) - comfortable to PCPs

42
Q

delusions unspecified

A

Capgras delusion will have an irrational belief that someone they know or recognize has been replaced by an imposter.

The Fregoli delusion is a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise
(like Matrix, more severe capgras )

43
Q

Findings in anorexia nerviosa

A

Hypercholesterolemia is common in anorexia
nervosa. Other findings associated with the
starvation state are mild normocytic normochromic
anemia and leukopenia. If vomiting
is induced, hypokalemia, hypochloremia, and
metabolic alkalosis may be seen.
Hypercarotenemia, causing yellowing of the skin, may
be seen if many carrots are eaten in an attempt
to satisfy the appetite with a low-calorie food.
TSH is not typically altered.

44
Q

Normal social development order

A

10 months: says mama and dada
2 years: 200 words, 2 word sentences
3 years: 1000 words
4 years: uses complete sentences and prepositions, can tell complete stories (legendary)

45
Q

Normal relational development

A

-A vital task of infancy (0-18 months) is to establish a secure sense of trust that occurs in the relationship with one’s
responsive caregiver.

-Toddlers (1.5-3 yrs) struggle with the increasing understanding that they are a separate being from their caregiver, and
they practice separating and reuniting with
their caregiver as a way to consolidate their
sense of separateness and autonomy.

Preschool (3-6 yrs) children’s identification with strong and powerful characters such as superheroes helps
them cope with their own feelings of smallness
and inadequacy (as compared to their parents).
This stage is also called the Oedipal phase; at
this time children typically experience longings
toward the parent of the opposite sex and
jealousy and hostility toward the same sex parent.

-School age (7-12 yrs) children develop the ability
to think more logically and concretely and
thus can identify that equal amounts of liquid
in two differently shaped containers hold the
same amount; once they are able to grasp this
concept of conversation of liquids, children
have progressed into the stage of concrete
operations, where they can consistently hold
onto more than one dimension at a time.

Adolescents (13-17) further advance in cognitive abilities, finally developing the ability to think in
an abstract fashion (reaching the stage Piaget
described as formal operations).

46
Q

Avoidant/ restrictive food intake

disorder (ARFID)

A

ex: This can be due to a lack of interest in eating or food, avoidance of certain foods due to taste/texture or anxiety about health consequences or choking

  • no issue with body image, do not fear weight gain
  • aware they are losing weight
47
Q

Mature defense mechanisms

A

Humor is considered a mature
defense mechanism that emphasizes the amusing
or ironic aspects of a stressor

Suppression is where a person consciously holds back unwanted behavior or thought to carry out daily function

Sublimation - taking social unacceptable thoughts and expressing them in a socially expressible way.
(ex. taking up kickboxing)

48
Q

What happens if an SSRI has no response?

A

Switch to another SSRI or an SNRI. Can consider ECT as well.

this is different from PARTIAL response where you would use augmentation therapies such as atypical, lithium or T3.

49
Q

Criteria of schizo

A

For at least 6 months, 1 of the following
1. Delusions
2.Hallucinations
3. Disorganized SPEECH
+
4. Grossly disorganized behavior (ex disheveled)
5. Apathy, alogia, avolition, anhedonia, attention deficit

50
Q

Other than antipsychotics which other drugs can cause EPS?

A

Anti emetic agents like Procholrperazine, Metoclopramide can cause Extra pyramidal symptoms.

51
Q

Misleading Marijuana

A

“Bad trip”: 20 minutes of getting high > cotton mouth, anxious ‘affect’ (not anxiety), paranoia, impaired concentration and repeating herself is losing STM,conjunctival injection, tachycardia (from anxiety)

52
Q

Catanoia

A

This is a case of catatonia.
Patient doesn’t follow commands, resist movement, flat affect, echolalia (meaningless repetition), echopraxia (meaningless repeitition), mutism, all these are symptoms of catatonia.

**treat with Lorazepam.
if the patient begins
to become unstable or requires high doses of
lorazepam (>20 mg/ d), or if his blood pressure/
pulse do not tolerate the titration of
lorazepam, ECT would be the appropriate
course of action.

53
Q

How to tx HTN crisis?

A

Phentolamine or Nitroprusside

54
Q

FAS vs Down syndrome

A

FAS:

  • smooth, long philtrum
  • thin vermillion border
  • microcephaly (small forehead)
  • SHORT palpebral fissures (short eye width)

Down syndrome:

  • epicanthal folds (not specific)
  • small low set ears
  • large tongue
  • short extremities, neck
  • UPSLANTING palpebral fissures
55
Q

REM Sleep behavior disorder

Nightmare disorder

N-REM Sleep Arousal disorder

A

REM Sleep Behavior: Dream enactment can occur if the muscle atonia that usually accompanies REM sleep is absent or incomplete. These behaviors are more likely to occur during the latter part of the night, when the percentage of REM sleep is higher. Patients can be awakened quickly, and after very transient confusion can become fully alert. They may not recall their movements during sleep but can recall their dreams.
REM sleep behavior disorder is more likely to occur in older adult men. If frequent and recurrent, it may be a prodromal sign of neurodegeneration in patients with Parkinson disease or dementia with Lewy bodies.

Nightmare disorder: vivid recall of disturbing dream content. However, unlike REM sleep behavior disorder, it is not associated with motor activity or sleep-related injury

NREM Sleep Arousal Disorder: Sleep terrors and SLEEPWALKING are examples of non-REM sleep arousal disorders that typically occur in younger patients during deep non-REM sleep. In contrast to REM sleep behavior disorder, they typically occur during the first third of the sleep period. There is a longer period of confusion before becoming fully alert, and individuals do not recall any concurrent dreams.

56
Q

Delusional disorder vs schizophrenia

A

-usually NONbizarre delusions
-daily function not impaired
(if they are hearing voices that satisfies schizophrenia)

57
Q

Doxepin

A

TCA derivative used for insomnia, depression

  • extremely strong antihistamine
  • anticholinergic
58
Q

PMDD vs PMS

A

PMS:

  • mood swings, anxiety
  • difficulty concentrating
  • decreased libido
  • irritability

PMDD

  • prominent irritability
  • hopelessness
  • depressed mood
  • self critical thoughts
  • greater functional impairment
59
Q

Medical therapy of NMS

A

Lorazepam, a benzodiazepine, is used 1 to 2 mg IM or IV every four to six hours.

●Dantrolene is a direct-acting skeletal muscle relaxant and is effective in treating malignant hyperthermia. \ Efficacy includes reduction of heat production as well as rigidity, and effects are reported within minutes of administration. There is associated risk of hepatotoxicity, and dantrolene should probably be avoided if liver function tests are very abnormal.

●Bromocriptine, a dopamine agonist, is prescribed to restore lost dopaminergic tone. It is well tolerated in psychotic patients.

●Amantadine has dopaminergic and anticholinergic effects and is used as an alternative to bromocriptine. An initial dose is 100 mg orally or via gastric tube and is titrated upward as needed to a maximum dose of 200 mg every 12 hours.

Psych (7 decks)

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