Disorders

Question 0

Postpartum depression

Answer 0

characterized by depressed affect, anxiety, and poor concentration starting within 4 weeks after delivery
Last 2 weeks to a year or more
Treatment: antidepressants, psychotherapy

Question 1

Fetal alcohol Syndrome

Answer 1

Related to maternal consumption of alcohol during pregnancy
Fetal alcohol syndrome is most severe

Most preventable cause of intellectual impairment
Often damage to prefrontal cortex leading to: inhibition of planning, self monitoring and regulation and motivation
FAS: short eye openings, flat philtrum, relatively thin upper lip
Microcephaly, cognitive/behavior dysfunction
Growth failure
Confirmed maternal alcohol consumption >4 ounces per day

Infants: sensory and regulatory problems
Toddlers: motor delays, compliance problems, learning difficulties
School-age: regulatory problems persist, difficulty in executive functioning, connecting cause and effect
Adolescence: social understanding impulsivity and poor judgement

Increased risk for disrupted school experiences, alcohol/drug problems, trouble with the law, confinement

Question 2

Bipolar II disorder

Answer 2

Predominantly depressive episodes but at least one hypomanic episode (not causing significant impairment in daily functioning)

high suicide risk

Treatment: lithium, valproic acid, carbamazepine

Use of antidepressants (especially TCAs) can lead to mania

Question 3

Conduct

Answer 3

” no one matters but me”
More common in boys

Repetitive and pervasive behavior violating the basic rights of others (physical aggression, destruction of property, theft)
Physically cruel to animals/people, bullies, initiates fights, forced someone into sexual activity, deliberate fire setting, lies, sneaky, disobeys by staying out late at night, has runs away, plays hookie

Angry, and resentful when placed in adult world
Avg-poor school performance
Has a good time with friends
Appears tough/angry/rebellious but actiually feels worthless and doubts self.

Can proceed to antisocial personality behavior

Question 4

Major depressive disorder

Answer 4

Lasts 6-12 months
5 of 9 of: sleep disturbance, Loss of interest, guilt or feelings of worthlessness, energy loss and fatigue, concentration problems, appetite/weight changes, psychomotor retardation or agitation, suicidal ideations
Depressed mood

Must have anhedonia and self reported depressed mood

Sleep studies: decreased slow wave sleep, decreased REM latency, increased REM early in sleep cycle, increase in total REM sleep, repeated nighttime awakenings, early morning awakening (screen test)

Depressive episode: symptoms for at least 2 weeks
Causes significant impairment in daily functioning

Question 5

ADHD

Answer 5

Development of structure and function: stepwise but differential progression, connectivity

Behavior: Inattention, hyperactivity, and distractibility

Neuropsychological function: problems with:poor performance, slow reaction time, working memory, set shifting, planning, fluency, response inhibition (can’t inhibit actions toward immediate gratification)
Malfunctions in cognitive control

Anatomically: reduction in prefrontal volume, premotor areas, right hemisphere, basal ganglia, cerebellum, comparable reduction in all four lobes
Reduction in volume of cerebrum especially fronto-striatal and cerebellar regions-rich in dopamine projections

Able to develop inhibitory control as the child grows-ability to suppress information increases from 4-12 years

Treatment: methylphenidate, amphetamines, atomoxetine, behavioral inteventions

Question 6

Somatic Symptom Disorder

Answer 6

+ Review of Systems Patient (2 GI, 1 sex and 1 pseudoneurologic)
Diagnosis: 1 or more somatic symptoms that are distressing or result in significant disruption of daily life
Excessive thoughts, feelings, or behaviors related to the somatic symptoms
Disproportionate and persistent thoughts about the seriousness of one’s symptoms
Persistently high level of anxiety about health or symptoms
Excessive time and energy devoted to the symptoms or health concerns
Being symptomatic is persistent (> 6 months)
Specify with: pain symptoms, persistent, mild/moderate/severe

Treat with regular scheduled visits with same provider
Limit unnecessary workup and refferals
reassure serious illness has been ruled out
Legitimize symptoms but decrease stress
Promote healthy behavior
Mental health referral once relationship has been established

Question 7

Functional Neurological Symptom Disorder

Answer 7

Conversion Disorder
NOT aware they are faking it
Diagnosis: One more symptoms that alter motor or sensory function (paralysis, blindness, mutism)
Associated with acute strssor
Clinical findings provide evidence of incompatibility between symptoms and known conditions
Not better explained by another medical condition
Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Specify with: type of symptom, acute or chronic, and if associated with or without a psycholgical stressor

Question 8

Psychological Factors Affecting Other Medical Conditions

Answer 8

Diagnosis: medial symptom or condition is present
Factors have influenced the course of medical condition shown by a close temporal association
Factors interfere with treatment of medical condition
Factors constitute additional well established health risks for the individual
Factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention

Specify with: mild moderate, severe, and extreme

Question 9

Factitious Disorder imposed on self (Münchausen syndrome)

Answer 9

Aware they are faking it-for attention
Falsification of physical or psychological signs or symptoms, or induction of injury or disease
Individual presents himself or herself as ill, impaired, or injured
Evident in the absence of external rewards
Multiple hospital visits with willingness for invasive procedures
Specify: single episode or recurrent episodes

Question 10

factitious disorder imposed on another

Answer 10

Aware they are faking it-for attention
falsfication of physical or psychological sings or symptoms, induction of injury or disease in another person (form of abuse)
Individual presents another individual to others as ill, impaired, or injured
No obvious external rewards
Specify: single episode or recurrent episodes

Question 11

Anorexia Nervosa

Answer 11

Presentation: Ammenorrhea, infertility, spontaneous abortions, miscarriages
Constipation, fainting, easy bruising, feeling cold, insomnia, stress fractures, moodiness, loss of interest, lethargy, weakness, hair loss, poor concentration, body checking

Signs: low weight (check accuracy), cardiac (bradycardia, hypotension, arrhythmias), hypothermia, lanugo, orange skin tones, hair loss, dry skin, brittle nails, elevated cholesterol, anemia, osteoporosis, elevated cortisol, decreased T3, peripheral edema, hypophosphatemia, petechiae
Ammenorrhea due to loss of pulsatile GnRH release which cocurs when level of body fat falls below a certain leading to decreased FSH and LH and decreased estrogen

Cardiac atrophy, cardiomyophathy arrhythmia
Hypotension, hypothermia and bradycardia

Criteria: restriction of energy intake relative to requirements
intense fear of gaining weight or becoming fat
Lack of recognition of seriousness of current low body weight

Severity: BMI plus clinical symptomss, degress of functional disability and need for supervision
Mild: 17 Moderate:16-16.99 Severe: 15-15.99 Extreme:

Question 12

Malingering

Answer 12

Intentional production of feigning of signs or symptoms to achieve personal gain
Multiple vague complaints that do not conform to a known medical condition yet they get better when their objective is obtained
Pretend they are ill with an obvious external incentive
Legal reasons

Question 13

Autism Spectrum Disorder

Answer 13

Diagnosis: persistent deficits in social communication and interaction across contexts
Restricted, Repetitive patterns of behavior, interest or activities
Symptoms present in early childhood
Symptoms impair and limit daily function
Symptoms not better explained by intellectual disability or global developmental delay

Clinical: Impaired social interactions, impaired ability to communicate, restricted activities and interests, abnormal development soon after birth, 3-6 months abnormal smiling/response to cuddling,
First sign is language in 1st or 2nd year of life
Unusual sensory response to hot, cold, pain, itching etc
Don’t hit normal milestones in saying words or speaking in sentences
Seem aloof, withdrawn, detached
Self stimulation
Impaired social interaction is hallmark of disorder
Displays of love/affection don’t happen
Commitment to routines
70% show ID but may have normal intelligence
Occasional exceptional talent
Primitive reflexes, excess of nonrighthandedness, left brains less often side of language dominance

Epidemiology: Strong genetic heritability
Boys>girls
Fathers >50
Siblings of autistic kids have increased rate of autistic disorder

Mechanism: Chromosomal, monogenic, and epigenetic causes
maternal exposure to child abuse, maternal stress, BPA, maternal obesity, folate deficiency
Teratogens: maternal rubella, valproic acid use, thalidomide, misoprostol
Abnormalities in gyral formation (polymicrogyria), cerebellar vermis, temporal lobes, hippocampal complex and cerebal symmetry
Overall impairment of connectivity in brain networks used for attention, consciousness and self awareness

Assessment: Chromosomal microarray

Question 14

Rett syndrome

Answer 14

X-linked
Affects mostly females-boys die in utero or shortly afterwards
Small hands and feet
Microcephaly
wringing, putting hands in mouth-hands kept in midline
GI disorders
80% have seizures
No verbal skills
scoliosis, growth failure and constipation
Loss of development, loss of verbal abilities, intellectual disability, ataxia

Question 15

Body dysmorphic disorder

Answer 15

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable to others

repetitive behaviors (mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (comparing)

may have had plastic surgery but is often dissatisfied with the results

Suicidal ideation and attempts are common

Question 16

Schizophrenia

Answer 16

2 or more of delusions, hallucinations, disorganized speech, grossly disorganized or catanoic behavior or negative behaviors (flat affect, social withdrawal, lack of motivation lack of speech or thought)
must cause social/occupational dysfunction
Must have 6 months of characteristic symptoms
Mood symptoms are minority of total illness

Types: paranoid, disorganized, catatonic, undiferrentiated (combo of 3)-most common

Clinical: chronic disruption of capacity to think clearly and feel normal emotion
Lifelong pattern of acute psychotic episodes with chronically poor psychosocial adjustment
Symptoms appear in late teens
Cognitive deficits: may appear years before psychotic symptoms
inability to plan/organize, slow verbal learning and memory, poor attention and working memory, loss of executive function, slowing of thought process

Associated with increased ventricular size and reduced GM brain volume
High rate of suicide
Associated with excessive use of cannabis

Course: Childhood-mild minor impairments
Adolescence-nonspecific behavioral changes
Adulthood-development of positive and negative cognitive symptoms
Middle age- unremitting, psoitve and negative cognitive symptoms

Greater risk of death from coronary artery disease or stroke

negative prognostic factors: early and insidious onset, male gender, single marital status, positive family history, obstetric trauma, impaired intellect, comorbid substance abuse

Question 17

Binge Eating Disorder

Answer 17

Criteria: recurrent episodes of binge eating
Associated with 3 or more of: eating more rapidly than normal, until uncomfortably full, large amount when not physically hungry, alone due to embarrassment, feeling disgusted, distressed or very guilty afterward
Marked distress regarding binge eating
Not associated with recurrent compensatory behavior

Associated symptoms: may have current body image concerns
Onset of dietary restraint AFTER binging begins
May have history of inappropriate compensatory behaviors
Role impairment, decreased satisfaction with life

May become obese

Question 18

Oppositional

Answer 18

“no one gets to be the boss of me”
Twice as common in boys

Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social

Question 19

Trichotillomania

Answer 19

Recurrent pulling out of one’s hair resulting in hair loss

Repeated attempts to decrease or stop hair pulling

patients who also engage in pica may get trichobezoars

Question 20

Bulimia Nervosa

Answer 20

Presentation: menstrual irregularity, fatigue, digestive problems, bloating, sore lips, sore throat, mood swings, sleep problems, relationship struggles, difficulty with attention or performance at work

Signs: parotid gland enlargement, weight fluctuation, loss of dental enamel, sores on moth and lips, pallor, injected conjuctiva, callous on knuckles, dark-sunken-or puffy area around eyes, edema, hypokalemia, increased serum amylase, metabolic acidosis (laxatives), metabolic alkalosis (vomiting)

Criteria: recurrent episodes of binge eating
Inappropriate compensatory behaviors (vomiting, diuretics, laxatives, other medication, fasting, excessive exercise)
Occurs at least once a week for 3 months
Self evaluations influenced by body shape and weight

Associated symptoms: anxiety, avoidance, impulse management problems, substance abuse or dependency, PTSD (child sex or physical abuse), bipolar disorder, personality (borderline) disorder

Severity: Frequency of inappropriate compensatory behaviors, other symptoms and level of disability
Mild: 1-3/week Moderate:4-7/week Severe: 8-13/week Extreme:14+
Normal BMI

Question 21

Paraphilias

Answer 21

Sexual arousal caused by or dependent on less-conventional thoughts or fantasies

Recurrent, intensely sexually arousing fantasies, urges, behaviors
Involve non-human objects suffering, children or non-consenting partners

Sustained for at least 6 months

Causes distress or dysfunction

Types: exhibitionism, voyeruism, sadism, masochism, pedophilia, fetishism, fortteruism, tranvestistic, NOS

Severity:
Relatedness: alone vs clearly negotiated
Requirement: absolute or enhancing
Compuslivity/Impulsivity: out of control vs controlled

Youthful offender commonly have background with neglect/abuse
Exhbitonism more prevalent than rape

Etiology: brain abnormalities: reduction in awareness of/control over unconventional or abnormal urges
evidence of frontal/temporal/limbic involvement, DA regulation
Mental retardation, dementia, seizure disorder, cerebral palsy, ADHD, traumatic brain injury

Loss of access to normative caretaking-develops sense of sense and ability to empathize
Access to sexually arousing material before it is developmentally appropriate

Assessment: some use of penile plethysmography
Careful clinical interview

Often chronic
Vulnerable to stressors that strain self control
Ability to develop empathy and acknowledge others’ rights/autonomy is good prognostic sign

Treatement: megan’s laws (supervision/societal prevention), reduction of sexual drives (SSRI, medroxyprogesterone), treatment of comorbid psychiatric conditions
Cognitive Behavioral training
Psychodynamic therapy: attempting to help patient connect early expereinces and ideas about relationships/sexuality

Question 22

seasonal affective disorder

Answer 22

clear assoication of symptoms with a time of year (usually winter)
improves in response to full spectrum bright light exposure

Question 23

Postpartum blues

Answer 23

depressed affect, tearfulness, and fatigue
starts 2-3 days after delivery
Usually resolves within 10 days
Treatment is supportive
Follow up to assess for possible postpartum depression

Question 24

Premenstrual depressive disorder

Answer 24

worsening symptoms of several days before menses
mood lability, irritability, anger, feeling “keyed up”, depressive symptoms
significant impairment in daily functioning

Question 25

Dysthymic disorder (persistent depressive disorder)

Answer 25

depressed mood on more days than not for past two years

At least 2 of the depressive symptom cluster

Question 26

Symptoms of Schizophrenia (just read)

Answer 26

Positive symptoms: auditory hallucinations, delusions (paranoid-false beliefs), disorganized speech/behavior (word salad), agitation
Negative symptoms: blunted affect, apathy, alogia (absence of speech), lack of spontaneity and pleasure, avolition (absence of drive), asociality (absence of social interest), Aprosody (flat speech)
Affective symptoms: depresion, irratability, hoplessness, suicidal ideation, insomnia
Impulsive symptoms(bring to clinical presentation): irritability, anger outbursts, erratic behavior
Neurocognitive deficits (respond well to treatment): attention/vigilance, speed of processing working memory, verbal learning, visual learning, reasoning and problem solving, social cognition
Social cognitive deficits: emotional processing, social perception, social knowledge, attributional bias, showing empathy
Motor symptoms: catatonia, stereotypy, dyskinesia, tics, posturing

Question 27

Postpartum psychosis

Answer 27

characterized by delusions, hallucinations, confusion, unusual behavior and possible homicidal/suicidal ideations or attempts
lasts days to 4-6 weeks
Treatment:antipsychotics, antidepressants, possible impatient hospitalization, assessment of child safety

Question 28

Illness Anxiety Disorder

Answer 28

Diagnosis: preocupation with having or acquiring a specific serious illness
Somatic symptoms are not present or mild
High level of anxiety about health and the individual is easily alarmed about personal health status
Performs excessive health-related behaviors or exhibits maladaptive avoidance
Present for at least 6 months (specific illness can change)
Not better explained by another mental disorder
Specify with: Care seeking type or care avoiding type

Question 29

Manic episode

Answer 29

Distinctly elevated mood (>1 week/requiring hospitilization)
3 of the following:
grandiosity/elevated self esteem
poor need for sleep
pressured speech
flight of ideas-racing thoughts
increased goal-directed behavior
excess involvement in pleasure/risky behavior
distractibility
Agitation

Causes significant impairment in daily functioning

Treatment: lithium, valproate or carbamazepine wit atypical antipsychotic

Question 30

Bipolar I disorder

Answer 30

At least one manic episode may or may not have hypomanic or depressive episode
Mixed features of depression and mania at same time
Rapid cycling: 4 or more changes per year

High suicide risk

Treatment: lithium, valproic acid, carbamazepine

Use of antidepressants (especially TCAs) can lead to mania

Question 31

Adjustment disorders

Answer 31

Symptoms of depressed mood (or mania) are clearly attributed to specific event/stressor
Lasting less than 6 months

Question 32

Cyclothymic disorder

Answer 32

both hypomanic and minor depressive episodes for 2 years or more
Episodes present more than half the time

Question 33

Hypoactive sexual desire disorder

Answer 33

Disorder of desire
Persistent absence of fantasies/thoughts/desire and related distress

Patterns: lifelong/acquired, generalized/situational, psycholigical only/combined

Causes: psycohoigical (fears, self-confidence)
Life circumstances (negative experience, conflict)
Organic (testosterone central DA block, endocrine dysregulation-thyroid, adrenal)

Clinical: social unneasiness, lack of self confidence, avoidance of social situations

Question 34

Erectile dysfunction

Answer 34

Disorder of arousal

Psychological (stress, relational)
Psychiatric causes (anxiety disorders, major depression, dementia, schizophrenia)
Physiologic: endocrine (diabetes, acromegaly, addison’s, hyper or hypo-thyroidism, pituitary adeoma), vascular disorders, neurological (MS, Parkinson’s), Physical trauma/neurological injury, infectious (syphillis)
Pharmacology: Tricycic antidepressants, antihyperstensives, diuretics, barbiturates, anticholinergics, alcohol, opioids

Question 35

Sexual Aversion disorder

Answer 35

Desire phase disorder

Persistent and recurrent aversion to and avoidance of genital contact with a sexual partner
Not due to OCD, major depression or another condition

Sometimes associated with sexual victimization

Causes: psychological (fear)
Life circumstances (trauma, painful coitus)
Antihypertensives, antipsychotic meds, anxiolytics, SSRIs, MAO-I, H2 Receptor antagonists, opioids

Question 36

Female orgasmic disorder (anorgasmia)

Answer 36

Delay in or absence of orgasm following a normal sexual excitement stage
Clinician also judges women’s orgasmic capability to be less than expected for her age, sexual experience and amount of sexual stimulation received
5% prevalence overall, 39% in unmarried

Causes: most often psychological, pregnancy, rejection, hostility, guilt, association w/lack of control, cultural expectations
Organic: radical pelvic surgery, advanced diabetes, neurological, meds (SSRIs, MAO-I, a-antagonists)

Late diabetes and late vascular diseases affect orgasmic phase

Question 37

Male orgasmic disorder

Answer 37

when a mane achieves ejaculation during sexual acitivty only with great difficulty, if a t all
Clinician must take into account man’s age, sexual experience and amount of sexual stimulation received

Prevalence increased in OCD

Physiological: post-surgical, neurological, antihypertensives,
Psychological (not common): rigid, puritanical background, difficulty with closeness, relational difficulties

Question 38

Premature ejaculation

Answer 38

Self defined

30% prevalence

Physiological causes: increased sympathetic tone
Psychological: anxiety, guilt, parent-child conflict, hypersensitivity, unrealistic expectations

Question 39

Gender dysphoria

Answer 39

Strong and persistent cross gender identification

Persistent discomfort with ones own sex or discomfort with gender role of own sex

Transition requires many steps
Assuming roles of other sex
Hormonal treatment-gonadal inhibitors prevent pubertal change, estrogen and testosterone
Surgical interventions: breast removal/silicone breast implantation, testical/ovarian removal, genital reconstruction

Question 40

Separation Anxiety Disorder

Answer 40

excessive anxiety regarding separation from places or people with a strong emotional attachment
May be normal stage for young children
Majority of adults have first onset in adulthood
Children most attached to parents, adults to spouse or friend

3 types of worry: distress away from home, worry that harm will come to others, worry that event will cause separation

3 types of behaviors: school or work refusal, sleep refusal, clinging

2 physiological: nightmares, physical such as headache or nausea

Treatment: SSRIs and relaxation techniques/behavioral interventions

Question 41

Panic Disorder

Answer 41

Recurrent, unexpected panic attacks
at least 1 of the attacks has been by followed by 1 month (or more) of 1 (or both) of the following:
Persistent worry about having additional attacks or their consequences
significant change in behavior related to the attacks (avoidance)
First degree relatives 10x more likely to develop a panic disorder
comorbid with depression and alcohol use

Significant mitral valve prolapse, asthma, and IBS

Symptoms:
10 mins of 4 of the following:
palpitations, paresthesias, abdominal distress, nausea, intense fear of dying or losing control, light headedness, chest pain, chills, choking, disconnectedness, sweating, shaking, shortness of breath

Hyperventilation can lead to decreased pCO2 which leads to decreased cerebral perfusion
respiratory alkalosis
Treatment: cognitive behavioral therapy, SSRIs, venlafaxine, benzodiazepines

Question 42

Psychosis

Answer 42

A syndrome that includes
delusions: disturbances of thought; persistent beliefs that are illogical and probably wrong
Hallucinations: sensory perceptions that do not result from an external stimulus
Disordered speech and behavior: rational conversation difficult, behaviors range from catatonia to excitement and stereotypies
Distortions of reality

Associated with drug abuse: cocaine, amphetamines, phencyclidine
Schizophrenia
Severe depression, dementias, manic phase of bipolar disorder

Question 43

Specific phobia

Answer 43

Irrational fears about a specific object or situation often leading to avoidance

Animal, natural environment, blood injection injury, situational

Onset in childhood or early adolescence

Predisposing factors: traumatic events, or unexpected panic with exposure

Treatment is exposure

Question 44

Agoraphobia

Answer 44

scared to leave house
anxiety about being in places or situations…
from which escape might be difficult (or embarrassing) or which help may not be available in the event of having panic like symptoms or other embarrassing events

Being outside the home alone, being in a crowd or standing in a line, being in enclosed spaces, being in open spaces, using public transportation

Situations are avoided, endured with marked distress about having a panic attack or require the presence of a companion

Person recognizes fear is excessive

Treat with systemic desenstization

Question 45

Social anxiety disorder

Answer 45

Marked fear of social or performance situations in which the person is exposed to possible scrutiny by others
Individual fears that he/she will act in an embarrassing manner
Exposure to the feared situation provokes anxiety, which may manifest itself as a situationally bound panic attack
social situations are avoided or endured with intense anxiety or fear
onset in mid-teens

May be associated with avoidant personality
Most fear public speaking
May appear ill at ease with interview situation
Most common anxiety disorder for teenage school dropouts

Person is aware that fear is excessive

Treatment: SSRIs or systemic desensitization

Question 46

Obsessive compulsive disorder

Answer 46

Obsessions: recurrent, persistent, and intrusive thoughts urges, or images
Individual attempts to ignore, suppress, or neutralize with compulsion
patient recognizes that actions are odd

Compulsions: repetitive behaviors or mental acts driven to perform by obsessions
attempts to reduce anxiety or prevent dreaded event but not logically connected to or excessive

Obssesssions or compulsions:
occupy more than 1 hour or significantly interfere with normal routine, occupational (or academic) functioning decreased, cause marked distress
Are recognized by patient as excessive or unreasonable

Basal ganglia: overactive cortico-striatal-thalamic-cortical circuit (orbitofrontal cortex and anterior cingulate gyrus)

Bimodal onset (9 male/12 female-second mode in late adolescence) 
Gap of 17 years between onset of symptoms and appropriate treatment 
may be associated with eating disorders, tics, tourrettes and OCPD, avoidant, and dependent personality disorders

PANDAS-in children following streptococcal infection

Treatment: SSRIs, clomipramine

Question 47

Hoarding disorder

Answer 47

persistent difficulty discarding with possessions, regardless of value
Emotional attachment to possessions
accumulate large number of possessions that fill up living areas
Families most distressed

Question 48

Atypical depression

Answer 48

characterized by mood reactivity (improved mood in response to positive events)
Reverse vegetative symptoms (hypersomnia and weight gain)
leaden paralysis (heavy feeling in arms and legs)
long standing interpersonal rejection sensitivity-increased sensitivity to criticism
treatment: MAO inhibitors, SSRIs (phenylzine and Tranylcypromine)

Question 49

Dyslexia

Answer 49

Most common learning disability
Persistent
Independent of intelligence 
Heritable with loci on chormosomes 2, 3, 6, 15 and 18
Linguistic deficit (not visual problem) 
Does not switch to fast neural pathway

Question 50

Tourrette Syndrome

Answer 50

Onset before 18

Characterized by sudden, rapid, recurrent, nonrhythmic sterotyped motor or vocal tics that persist for greater than 1 year
Can be preceded by an urger and can be temporarily suppressible

Associated with OCD and ADHD

Treatment: antipsychotics (haloperidol) and behavioral therapy

Question 51

Delirium

Answer 51

Waxing and waning level of consciousness with acute onset

Rapid decrease in attention span and level of arousal

Characterized by disorganized thinking, hallucinations (often visual), delusions, anxiety, agitation, illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction

Secondary to CNS disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention

Abnormal EEG (as opposed to dementia)

Treatment: identify and address underlying cause
Optimize brain condition
Antipsychotics (haloperidol)

Question 52

Schizophreniform Disorder

Answer 52

Schizophrenia for 1-6 months

Question 53

Brief Psychotic disorder

Answer 53

Psychosis for less than 1 month usually stress related

Question 54

Schizoaffective disorder

Answer 54

at least 2 weeks of stable mood with psychotic symptoms plus a major depressive, manic or mixed episode

Delusions in absence of mood symptoms (as opposed to major depressive or bipolar disorder with delusions)

Symptoms present most of the time (as opposed to schizophrenia)

Question 55

Delusional disroder

Answer 55

Fixed persistent untrue (but could be true) belief system lasting greater than 1 month

functioning otherwise not impaired

Specific theme

No hallucinations

Question 56

Dissociative identity disorder

Answer 56

Formerly known as multiple personality disorder

Presence of 2 or more distinct identities or personality states

More common in women

Associated with history of sexual abuse, PTSD, depression, substance abuse, borderline personality, and somatofrom conditions

Question 57

Depersonalizatiotn/derealization disorder

Answer 57

Persistent feeling of detachment or estrangement from one’s own body, thoughts, perceptions, and actions or one’s environment

Question 58

Hypomanic episode

Answer 58

Like manic episode but mood disturbance not severe enough to cause marked impairment and/or occupational functioning to necessitate hospitilization

No psychotic features

lasts at least 4 consecutive days

Question 59

Persistent depressive disorder (dysthymia)

Answer 59

Depressed mood for at least 2 years

2 of the following:
Poor appetite, insomnia/hypersomnia, decreased energy, decreased self esteem, poor concentration, feeling hopeless

Responds well to antidepressants

Question 60

Pathologic Grief

Answer 60

Normal:
characterized by shock, denial, guilt and somatic symptoms
duration 6-12 months
May experience hallucinations (name being called)
Children with hallucinations of recently deceased relatives are using normal grief

Pathologic:
prolonged grief lasting greater than 6-12 months
grief that is delayed, inhibited, or denied
May experience depressive symptoms, delusions, and hallucinations

Question 61

Post traumatic stress disorder

Answer 61

Persistent reexperiencing of a previous traumatic event

May involv nightmares or flashbacks intense fear, helplessnes, or horror

Leads to avoidance of stimuli associated with truama and persistentl increased arousal

Disturbance lasts greater than one month

Treatment: psychotherapy, SSRIs

Question 62

Acute stress disorder

Answer 62

Same symptoms as PTSD but only lasts between 3 days and 1 month

Question 63

Long term deprivation of affection for children results in…

Answer 63

decreased muscle tone
Poor language skills
poor socialization skill
lack of trust
Withdrawn/unresponsive
weight loss
Physical illness

Deprivation for greater than 6 months leads to irreversible changes
Severe deprivation can result in infant death

Question 64

Child neglect

Answer 64

Failure to provide child with adequate food, shelter, supervision, education and/or affection

Evidence: poor hygiene, malnutrition withdrawal, impaired social/emotional development, failure to thrive

Report to child services

Question 65

Child Abuse

Answer 65

Evidence:
Historical inconsistencies, significant sociofamilial history

Physical: Healed fractures (spiral fractures), burns, subdural hematomas, pattern marks/bruising, rib fractures, retinal hemorrhage or deatchment, excessive compliance, psedomaturity, injuries in different staging of healing
Usually biological mother

Sexual: genital, anal, or oral trauma; STDs, UTIs
Usually known to victim and male

Always contact child protective services

Adult abuse: first interview patient and ask 3 questions

1. do you feel safe at home?
2. who handles your checkbook?
3. Who prepares your meals?

Question 66

Generalized anxiety disorder

Answer 66

excessive anxiety and worry (more days than not for at least 6 months) about life events/activities

Difficult to control the worry

3 or more symptoms (1 for children): restlessness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance

Not attributable to a substance use disorder, medical condition, or another mental disorder

At least one other psychiatric disorder (90%)-often followed by major depression

IBS and Headaches may accompany
predictor of functional impairment and overuse of medical services
Seen with chronic medical disorders -increased service use
decreased productivity and attendance at work

Treatment: SSRIs, SNRIs, buspirone, cognitive behavioral therapy, BDZs, venlafaxine