Exam I Flashcards
1
Q
transference vs countertransference?
A
- Transference: pt projects feelings about others onto the physician
- Countertransference: clinician projects feelings about others onto pt
2
Q
Behavior:
what are mannerisms and specifically what are stereotypies?
A
- pacing, facial expressions
- persistent repetition of senseless acts or words
3
Q
repeated muscular contraction (either motor or vocal) that is involuntary and suppressible briefly
A
Tics
4
Q
actions reflecting an emotional state
A
gestures
5
Q
pervasive and sustained emotional state in the PATIENT’s own words
A
Mood (happy, sad, angry, etc)
6
Q
outward, observable expression of a person’s emotional state (blunted, flat, full range)–does not have to be MOOD CONGRUENT
A
Affect
7
Q
lack of feelings/emotions
A
apathy
8
Q
no pleasure in things
A
anhedonia
9
Q
Speech prosody vs. fluency
A
- rhythm, melody, articulation
- word finding, thought blocking
10
Q
Speech Terms:
- word salad:
- neologisms:
- clang associations
- perseveration
A
- an incoherent jumble of words
- meaning of word only known to pt
- series of rhyming words
- repeating same answer to different questions
11
Q
fixed false beliefs
A
delusions
12
Q
Examples of Delusions:
- Grandeur
- Persecutory
- Erotomania
- Nihilism
A
- grandiose identity
- intentional personal attack
- another is madly in love with them
- everything is nothingness/ meaningless
13
Q
intrusive thoughts that cannot be put out of mind
A
obsessions
14
Q
Thought Process:
- blocking:
- derailment:
- paralogia:
A
- congestion internally prevents communication
- slip from one topic to unrelated topic
- false reasoning
15
Q
Ganser Syndrome
A
pt gives approximate answers
(2+2 = 5)
16
Q
Illusions vs. Hallucinations
A
- misperception
- false perception (all 5 senses)
17
Q
Derealization vs. Depersonalization
A
- sense current scenario is not real (like watching a movie)
- observing self in the present scenario
18
Q
awareness of current condition and severity of the condition
A
insight
19
Q
word choice during interview; IQ and achievement tests
A
Intelligence
20
Q
Level of Consciousness vs. Orientation
A
- alert, lethargic, somnolent, coma
- person, place, time, purpose
21
Q
Pt with disorientation, amnesia, confabulation, lack of concern, perseveration
A
Korsakoff Syndrome
22
Q
Attention vs. Concentration
A
- sustain interest on a stimulus
- capacity to maintain attention despite distraction stimuli
23
Q
How to test for Immediate, Recent, and Remote Memory
A
- repetition of 3 words (no ifs ands buts)
- recall 3 words in 5 minutes, their last meal
- last 3 presidents, DOB, job list
24
Q
Capgras Syndrome
A
known person replaced with exact double with evil intent
25
known person replaced with exact double with evil intent
Capgras Syndrome
26
unconscious filling of gaps with false memory
confabulation
27
how to test for Abstraction (Executive function/cognition)
- Similars
- proverbs (people in glass houses should not throw stones)
28
Receptive vs. Expressive vs. Communicative Aphasia
- can't hear/read or understand
- can't speak/write correctly
- can understand and can read/hear but cannot repeat
29
______ assessment questions should be included in an initial psychiatric evaluation
spiritual
30
pt's reported emotional state
mood
31
observed emotional range of the pt and can be congruent or incongruent with reported mood
affect
32
capacity to maintain attention despite distracting stimuli
concentration
33
how to test for neurosyphilis
serum RPR and CSF VDRL
34
urine metanephrines:
- what does it test for
- and what's the triad?
- pheochromocytoma
- HA, sweating, tachycardia
35
what might a head CT show in schizophrenia, eating disorders, alcohol use, bipolar, dementia, and depression
enlarged ventricles
36
EEG findings in dementia?
decreased alpha in occipital
37
Psychological Assessment:
- Self-Report:
- Performance:
- diagnostic, sx specific and personality measures
- cognitive, neuropsychological measures
38
Psychological Assessment:
what differentiates Composite International Diagnostic Interview from SCID?
cross cultural validation!
39
self-administered inventories designed to assess general psychopathology
Minnesota Multiphasic Personality Inventory (MMPI)
40
semistructured interview that measures SEVERITY of psychotic symptoms
Positive and Negative Syndrome Scale (PANSS)
41
which Neuropsychological Screening exam is less sensitive for mild cognitive impairment?
Mini Mental State Exam (MMSE)
42
which Neuropsychological Screening exam is more sensitive AND specific for mild through severe cognitive impairment?
Montreal Cognitive Assessment (MOCA)
43
what does ANotherMEDICalCONDITion stand for?
Autoimmune
Nutritional deficit
Metabolic encephalopathy
Endocrine
Demyelination
Immune
Convulsions
Cerebrovascular Disease
Offensive Toxins
Neoplasm
Degeneration
Infection
Trauma
44
Certain lab studies help dx medical conditions presenting as psychiatric symptoms as well as monitor for side effects caused by a medication including... (4)
- electrolytes (Na, K)
- renal function
- liver function
- TSH
45
decreased alpha power in the occipital lobe on EEG is associated with
dementia
46
what assessment helps monitor symptoms in patient with schizophrenia
Positive and Negative Symptoms Scale (PANSS)
47
ANotherMEDICalCONDITion is used to ID relevant medical conditions that may be presenting with _____ symptoms
psychiatric
48
Herpes may present with what psychiatric symptom?
gustatory hallucinations
49
gustatory hallucinations are associated with what pathology?
herpes
50
Sigmund Freud's Theory of Development
1. Oral (birth-18 mo)—puts everything in their mouth
2. Anal (18 mo – 3 yr) –anal sphincter control
3. Phallic (3 yr – 5 yr) –masturbation
4. Latency (5 yr – 12 yr) –calm period with ego strength
5. Genital (12 yr – 18 yr) –coherent sense of self and ability to separate from parents
51
Erik Erickson's Theory of Development
1. Trust vs Mistrust (birth – 1 yr)
2. Autonomy vs Shame and Doubt (1-3 yr)
3. Initiative vs Guilt (3-6 yr)
4. Industry vs Inferiority (6-12 yr)
5. Identity vs Role Confusion (12-20 yr)
6. Intimacy vs Isolation (20-39 yr)
7. Generativity vs Stagnation (40-59 yr)
8. Ego Integrity vs Despair (60+ yr)
52
Jean Piaget's Theory of Development
1. Sensorimotor (birth-2 yr) –knowing an object by what you can do to it
2. Pre-Operational (2-7 yr) –symbolic thinking (language)
3. Concrete Operations (7-12 yr) –logic develops
4. Formal Operations (12 yr – adulthood) –abstract concepts (motivations, theory, etc)
53
Lawrence Kohlberg Theory of Development
1. Preconventional
2. Conventional
3. Postconventional
54
Who and What?
Attachment Theory
Bowlby
emotional bond between caregiver and infant
55
Who did it?
Rhesus monkeys deprived of maternal contact --> increased infant mortality
Harry Harlow
56
Who and What?
Stranger Situation
Ainsworth
categorized attachment of infant and caregiver as secure or insecure
57
Theory that proposes development moves from undifferentiated and defuse toward greater complexity via differentiation and consolidation across subsystems
Orthogenic Principle
58
Systems Theory of Development:
Equifinality vs. Multifinality
- same phenomenon results from different pathogen (i.e. autism)
- one factor can result in several psychopathologic outcomes
59
Infancy (Birth-2yrs)
: increased exploration of self and outside world
- Freud:
- Erickson:
- Piaget:
- Ainsworth:
- Oral, anal
- trust vs. mistrust, autonomy vs. shame/doubt
- sensorimotor
- secure vs insecure
60
PreSchool (2-5yrs)
Define the Types of Play
- mimicry
- parallel
- associative
- cooperative
- feeding baby, etc
- solitary play despite being around others
- sharing toys but still solitary
- work together on common task
61
PreSchool (2-5yrs)
: increased symbolic thought
- Freud:
- Erickson:
- Piaget:
- Kohlberg:
- anal, phallic, latency
- autonomy vs. shame/doubt, initiative vs guilt
- pre operational
- binary view of right and wrong, follow rules to avoid punishment, not age dependent
62
School Age (5-12yrs)
: increased ability to engage in concrete logical thinking
- Freud:
- Erickson:
- Piaget:
- latency, genital
- industry vs inferiority, identity vs role confusion
- pre operational, concrete operations
63
Adolescence (13-20yrs)
: abstract logical thought
- Freud:
- Erickson:
- Piaget:
- Kohlberg:
- genital
- idenitfy vs. role confusion
- formal operations
- fully formed conscience, well developed sense of right and wrong, test parents
64
Adult (18+ yrs)
: leaving home, redefining relationship with parents, meaningful friendship
- Erickson:
- Piaget:
- identity vs. role confusion, intimacy vs isolation, generativity vs stagnation
- formal operations
65
Late Adulthood
: imparting wisdom, increased dependence on others
- Erickson
- ego-integrity vs despair
66
what is the psychosexual stage associated with ages birth to 18 months?
oral
67
what is the Eriksonian stage for 60+ years old?
ego integrity vs despair
68
abstract thought and understanding underlying principles are possible in the developmental stage of _________ as categorized by Piaget
Formal Operations
69
what is possible in the Formal Operations stage (Piaget)
abstract thought and understanding underlying principles
70
what has provided several models for the development of psychopathology including risk factor identification?
systems theory
71
Systems theory has provided several models for the development of psychopathology including __________?
risk factor identification
72
define informed consent
Pt understands and agrees to evaluation and tx proposed by physician
73
what are the 3 components of informed consent?
1. mental capacity
2. adequate information
3. voluntariness
74
administrative or judicial process by which the state's power is used to identify and remove a mentally ill individual from society and place him or her in an institutional setting
civil commitment
75
Parens patriae
father of the country (legal basis involved in civil commitment)
76
what are the criteria for civil commitment? (3)
1. serious psychiatric disorder
2. significant risk of pt harming self or others
3. hospitalization is least restrictive alternative (vs incarceration)
77
Involuntary Treatment:
court ordered is usually an involuntary treatment in the form of...
a long term medication
78
Privilege vs. Confidentiality
- pt information that may not be disclosed in a legal setting
- pt information that may not be disclosed to ANYONE (HIPPA)
79
pt information that may not be disclosed in a legal setting
privilege
80
pt information that may not be disclosed to ANYONE (HIPPA)
confidentiality
81
To establish a defense on the ground of insanity, it must be clearly proved that the party accused was labouring under such a defect of reason (from disease of mind) that they did not know the nature and quality of the act they were doing
M’Naghten Rule (Cognitive Test)
82
If at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to he law
Model Penal Code
83
Duty to Protect vs Duty to Warn
- clinician required to take steps to protect patient from harming intended target person
- clinician required to take steps to notify intended target person of threat
84
clinician required to take steps to notify intended target person of threat
duty to warn
85
clinician required to take steps to protect patient from harming intended target person
duty to protect
86
capacity vs competency
- a person’s ability to make a decision; ability to utilize information about an illness and proposed treatment options to make a choice that is congruent with one’s own values and preferences
- ability for an individual to participate in legal proceedings or transactions and the mental condition a person must have to be responsible for his or her decisions or acts
87
a person’s ability to make a decision; ability to utilize information about an illness and proposed treatment options to make a choice that is congruent with one’s own values and preferences
capacity
88
ability for an individual to participate in legal proceedings or transactions and the mental condition a person must have to be responsible for his or her decisions or acts
competency
89
4 elements of capacity?
1. understanding
2. expressing a choice
3. appreciation
4. reasoning
90
unilateral termination of the doctor-patient relationship without justification, leading to harm to the patient
abandonment
91
civil commitment requires...
1. serious psych disorder
2. risk of harm to self or others
3. hospitalization is the least restrictive option
92
examples of reasons to terminate a patient relationship?
* Failure to pay
* Threatening behavior
* Repeated failure to keep appointments
* Non-compliance with treatment plan
* Abuse of prescribed medication
93
Pt with...
* deficits in intellectual functions confirmed by both clinical assessment and individualized, standardized intelligence testing
* Failure to meet developmental and sociocultural standards
Intellectual Developmental Disorder (ID)
94
prenatal, perinatal, and postnatal causes of Intellectual Developmental Disorder (ID)
* Prenatal: genetic syndromes, inborn errors of metabolism, maternal drugs, alcohol, toxins
* Perinatal: neonatal encephalopathy
* Postnatal: hypoxic ischemic events, TBI, infections, demyelinating disorders, seizures, social deprivation, toxic metabolic syndromes, toxins (lead, mercury)
95
Pt with...
* Persistent difficulty with speech sound production that interferes with speech intelligibility
* Disturbance interferes with social participation, academic achievement, and/ or occupational performance
* Difficulties are NOT attributable to congenital or acquired conditions
Speech Sound Disorder
96
Pt with...
* Disturbances in normal fluency with one or more of the following
- Sound syllable repititions
- Sound prolongations of consonants as well as vowels
- Broken words
- Audible or silent blocking
- Circumlocutions
- Words produced with an excess of physical tension
- Monosyllabic whole-word repititions (“I-I-I-I see him”)
* Disturbance causes anxiety about speaking or limitations
Childhood Onset Fluency Disorder (Stuttering)
97
Pt with...
* difficulties in the social use of verbal and nonverbal communication
* deficits result in functional limitations in effective communication and social participation
Social (Pragmatic) Communication Disorder
98
Pt with...
* Persistent deficits in social communication and social interaction
* Restricted, repetitive patterns of behavior, interests or activities as manifested by at least TWO of the following
- Stereotyped or repetitive motor movements or speech
- Insistence on sameness/inflexible to changes
- Highly restrictive, fixated interests
- Hyper or hyporeactivity to sensory input
Autism Spectrum Disorder
99
Genetic risk factors for autism?
tuberous sclerosis
fragile X syndrome
100
Pt with...
* Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning (characterized by…)
- Inattention: at least 6 of the following sx last at least 6 months
- Hyperactivity and Impulsivity: at least 6 of the following sx for at least 6 months
* Several inattentive or hyperactive-impulsive sx were present prior to age 12
* Several inattentive or hyperactive-impulsive sx are present in two or more settings (home, work, school, friends, etc.)
ADHD
101
ADHD:
- M or F more likely to have predominantly inattentive presentation?
females
102
3 groups of treatments for ADHD?
1. stimulants
2. SNRIs
3. alpha 2 agonists
103
Pt with...
* Multiple motor and one or more vocal tics
* Persist for more than 1 year
Tourette's Disorder
104
Tourette's:
- M or F?
- tics increase with...
- tics decrease with...
- altered _____ functioning
- M>F
- anxiety, excitement, exhaustion
- calm, focused activity
- dopaminergic
105
Tourette's treatment (3)
- habit reversal training
- antipsychotics
- alpha 2 agonists
106
Autism spectrum disorder includes a diverse presentation population and treatment options include ... (2)
- behavioral analysis
- 2nd generation antipsychotics
107
ADHD has three types and the best evidence treatment remains...
stimulant medication
108
Schizophrenia Criteria?
A) Two or more of the following...
TWO or more of the following:
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative sx (diminished emotional expression)
109
Schizophrenia Criteria?
B) signs of disturbance persist for at least _______
C) ______ and _____ have been ruled out
- 6 months
- schizoaffective disorder and depressive or bipolar disorders
110
fixed false beliefs that are not amenable to change in light of conflicting evidence
delusions
111
false perceptions, occur without an external stimulus (auditory most common in primary psychotic disorders)
hallucinations
112
examples of negative symptoms?
- aprosody
- apathy
- avolition (decreased self initiated purposeful activities)
- alogia (decreased speech and expression)
- anhedonia (loss of pleasure from positive stimuli)
113
loss of intonation and inflection in speech
aprosody
114
loss of emotional expression
apathy
115
decreased self-initiated purposeful activities
avolition
116
decreased speech and expression of thoughts and ideas
alogia
117
loss of pleasure from positive stimuli
anhedonia
118
Schizophrenia: Epidemiology
- prevalence?
- suicide risk?
- life expectancy reduction?
- _______ drift
- 0.3-0.7%
- 5%
- 20% lower life expectancy
- socioeconomic drift
119
Schizophrenia: Etiology
- Dopamine Hypothesis suggests...
- mesolimbic tract and striatum hyperactivity associated with positive symptoms
- mesocortical tract hypodopminergia (D1) associated with negative symptoms
120
Schizophrenia:
what is suggested to cause the positive symptoms?
mesolimbic tract and striatum hyperactivity (D2/3) associated with positive symptoms
121
Schizophrenia:
what is suggested to cause the negative symptoms?
mesocortical tract hypodopminergia (D1) associated with negative symptoms
122
Schizophrenia:
- neuroanatomic changes:
increased ventricle size
123
Schizophrenia TX:
- positive sx
- negative sx
- respond well to antipsychotics
- no not respond to antipsychotics
124
what is treatment resistant schizophrenia?
failure of 2 therapeutic trials of any antipsychotic medications
125
FGA vs SGA
- first gen antipsychotic
- second gen antipsychotic
126
Extrapyramidal System (EPS) Side Effects of FGAs (4)
- Akathisia (restlessness, psychomotor agitation)
- Parkinsonism
- Dystonia
- Tardive dyskinesia (involuntary rhythmic movements)
127
what three receptors can FGAs antagonize?
histamine 1
alpha 1
muscarinic 1
128
effects of FGAs antagonizing H1, alpha 1, M1?
- H1: sedation, increased appetite
- alpha 1: orthostatic hypotension, sedation
- M1: blurry vision, dry mouth, constipation
129
high potency FGAs have higher ____ side effects and lower ____ side effects
- EPS
- HAM
130
low potency FGAs have higher ____ side effects and lower ____ side effects
- HAM
- EPS
131
SGAs: Clozapine
- notable ADR
- treats + or - sx?
- decreased risk of which ADRs?
- agranulocytosis
- both!
- suicides, tardive dyskinesia
132
Schizophreniform Disorder Criteria that differentiates it from Schizophrenia?
- episode lasts at least 1 month but less than 6 months (otherwise same criteria!)
133
T or F? most pts with schizophreniform disorder progress onto a dx of schizophrenia
True!
134
Brief Psychotic Disorder Criteria:
what differentiates it from Schizophreniform Disorder and Schizophrenia?
- episode lasts at least one day but less than one month with eventual full return to premorbid level of functioning (otherwise the same)
135
Peripartum Brief Psychotic Disorder occurs when?
during pregnancy or within 4 weeks postpartum
136
SGAs are also called the...
atypical antipsychotics
137
prototypical SGA?
Clozapine
138
which SGA has been shown to reduce hospitalization
Aripiprazole
139
Short Acting Injectable SGAs (3)
Olanzapine
Ziprasidone
Aripiprazole
140
Long Acting Injecatable SGAs (4)--recommended in all non-compliant pts!!
- Aripiprazole
- Paliperidone
- Risperidone
- Olanzapine
141
what are wrap around services?
comprehensive community based services (all schizophrenia pts should be referred to these!)
- housing, transportation, employment assistance
- occupational services
- adult day programs
142
treatment of brief psychotic disorder?
rapid and complete resolution with antipsychotic (tx is 1-3 months)
143
Criteria for Delusional Disorder?
- delusions with duration of 1 month or longer
- ruled out schizophrenia (doesn't have two of... hallucinations, disorganized speech grossly disorganized or catatonic behavior, negative sx (diminished emotional expression)
144
treatment for Delusional Disorder?
SGA
supportive psychotherapy
145
Schizoaffective Disorder Criteria
- uninterrupted period in which there is a major mood episode (major depressive or manic) concurrent with criterion A of schizophrenia
- delusions or hallucinations for 2 or more weeks in the absence of a major mood episode
146
treatment for Schizoaffective Disorder?
SGA (psychosis)
Psychotherapy! (CBT)
147
Catatonia Associated with Another Mental Disorder Criteria
- 3 or more of the catatonia sx
148
Treatment for Catatonia Associated with another Mental Disorder?
- treat underlying condition
- acute: benzos, ECT
149
how does Catatonia DUE TO Another Mental Disorder differ from Catatonia ASSOCIATED WITH Another Mental Disorder?
disturbance is the direct pathophysiological consequence of another medical condition
150
Criteria for Dissociative Identity Disorder
- disruption of identity characterized by 2+ distinct personality states
- recurrent gaps in memory recall
- disturbance is not a normal part of a broadly accepted cultural or religious practice
151
an adaptive defense used to cope with overwhelming psychological trauma
normal dissociation
152
risk factors for Dissociative Identity Disorder
childhood physical and sexual abuse
153
Treatment for Dissociative Identity Disorder?
Phasic Model of integrative therapy
154
three phases of Phasic Model of Integrative Therapy to treat Dissociative Identity Disorder?
1. safety and symptom stabilization
2. trauma treatment
3. reintegration and recovery
155
Criteria for Dissociative Amnesia?
- inability to recall important autobiographical information
156
subtype of Dissociative Amnesia with purposeful travel or bewildered wandering that is associated with amnesia for identity
dissociative fugue
157
risk factor for Dissociative Amnesia?
traumatic experiences (childhood abuse, war, natural disasters, etc)
158
unique treatment for refractive Dissociative Amnesia?
narcoanalysis (amobarbital, benzodiazepine)
159
Criteria for Depersonalization/Derealization Disorder?
- presence and persistence of recurrent experiences of depersonalization, derealization or both!
- reality testing remains intact
160
experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, etc.
depersonalization
161
experiences of unreality or detachment with respect to surroundings (dreamlike, foggy, lifeless)
derealization
162
risk factors for Depersonalization/Derealization Disorder
emotional abuse / trauma
163
treatment for Depersonalization/Derealization Disorder
- CBT (desensitization)
- AVOID antipsychotics!! (avoid benzos!)
164
primary treatments of positive and disorganized psychotic conditions?
FGA
SGA
165
what is the only drug that has significant success in addressing negative symptoms seen in psychotic conditions?
clozapine
166
catatonia management can include ____, _____, and _____ treatment options
general
acute
malignant
167
avoid antipsychotics and benzos in __________ disorder
- instead use...
- depersonalization/derealization disorder
- CBT or hyponosis
168
Major Depressive Disorder Criteria?
5 or more of the following during the same 2 week period (SIGECAPS)
- Depressed mood most of the day
- Sleep changes (insomnia/hypersomnia)
- Interest lost in things
- guilt
- Energy loss/fatigue
- concentration decrease
- appetite changes
- psychomotor changes
- suicidal ideation
169
_____ accounts for 50% of all suicides?
MDD
170
___% of MDD pts complete suicide
15%
171
NT Hypothesis (an incomplete hypothesis) for MDD involves what NTs?
serotonin
NE
172
Neuroendocrine Hypothesis for MDD suggests what as the mediator?
increased cortisol
173
Psychotherapy Tx for MDD (3)
- CBT
- interpersonal psychotherapy
- brief psychodynamic psychotherapy
174
MDD:
- response rate to antidepressants:
- remission rate with antidepressants:
- antidepressant black box waning of ____ in what age group?
- 66%
- 33-44%
- increased depression/suicidality in 12-24 y/o
175
ADR of MAO-Is?
hypertensive crisis (secondary to increased NE)
176
TCAs inhibit _____ > _____ reuptake
serotonin
NE
177
Pt on SSRI presents with mental status changes, diaphoresis, labile pulse/BP, tremor, Babinski, hyperreflexia
Serotonin Syndrome
178
Pt on SSRI presents with dizziness, insomnia, nervousness, irritability, "zaps" and nausea
think Discontinuation Syndrome!
179
drug class of Bupropion
Selective NE and DA Reuptake Inhibitor (SNDRI)
180
Advantages of SNDRIs (2)
- no sexual dysfunction
- no serotonin effects so can augment with SSRI or SNRI
181
unique SE of Trazodone/Nefazodone (SSRI + 5HT R antag/ag)
priapism
182
Criteria for Persistent Depressive Disorder
- depressed mood for more days than not for at least 2 years
- 2 or more of the same criteria for MDD
183
risk factor for Persistent Depressive Disorder?
loss of a parent in childhood
184
40% of pts with ____ meet the criteria for persistent depressive disorder
MDD
185
Criteria for Disruptive Mood Dysregulation Disorder? (4)
- severe recurrent temper outbursts
- outbursts occur 3 or more times per week
- dx should not be made before 6 or after 18
- age of onset is before 10 y/o
186
Criteria for Premenstrual Dysphoric Disorder
- majority of menstrual cycles, 5+ sx present in final week before onset of menses
- confirmed by prospective daily ratings during at least two symptomatic cycles
187
Criteria for Bipolar I Disorder?
1. Manic Episode (at least one week) with 3+ of the following sx (DIGFAST):
- distractibility
- involvement in risky behaviors
- grandiosity (inflamed self esteem)
- flight of ideas (racing thoughts)
- activity (goal-directed)
- sleep (decreased need)
- talkative
188
Bipolar I Disorder:
- suicide risk?
- 61% have comorbid ______
-15x increased risk (25% of all suicides)
- substance use
189
Psychopharmacology for Bipolar I Disorder? (2)
Lithium (toxic >2mmol)
Carbamazepine
Oxcarbazepine
VA
Lamotrigine
190
Criteria for Bipolar II Disorder?
- Hypomanic and Major Depressive episode
- 3+ of the DIGFAST sx from BP I for 4+ days for manic episode
- 4 days of depressed mood
191
is Bipolar mania or depression more refractory to treatment? (harder to treat)
depression
192
Cyclothymic Disorder Criteria?
- 2+ years with hypomanic sx that do not meet criteria for hypomanic episode and numerous periods with depressive sx that do not meet criteria for a major depressive episode
- symptoms do not subside for more than 2 months at a time
193
Criteria for Unspecified Mood Disorder?
- every other mood disturbance that doesn't classify into other mood disorders!
194
duration of sx in
- MDD vs.
- PDD vs.
- PMDD
- disruptive mood dysregulation disorders
- 2 weeks
- 2 years
- symptoms present in final week before onset of menses confirmed by 2 cycles
- 3+ times per week (onset before 10 years old)
195
herbal/supplement options that have shown efficacy in treating MDD?
- omega-3 FAs
- folic acid
- S-adenosyl-I-methionine (SAMe)
- St Johns Wort
- vitamin B12
196
________ is one of two psychiatric medications that decreases suicide rates with therapeutic level 0.6-1.2 mmol/L
Lithium
197
Criteria for Generalized Anxiety Disorder?
- excessive anxiety and worry occurring more days than not for at least 6 months, about events or activities
- 3+ of the following: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
198
GAD:
- prevalence:
- M or F?
- risk factor?
- neuroanatomical associations?
- 2-9%
- F>M
- 1st degree relative with GAD
- dorsal raphe nuclei
199
Psychotherapy for GAD?
CBT
200
Psychopharmacology for GAD?
- Buspirone (5HT1A partial ag)
- SSRI and SNRI (paroxetine, escitalopram, duloxetine, venlafaxine)
201
Selective Mutism Criteria?
- failure to speak in specific social situations despite others speaking in other situations
- duration of episode is at least one month
202
Selective Mutism Treatment?
CBT
203
Specific Phobia Criteria? (3)
- fear or anxiety about a specific object or situation
- phobic object or situation is actively avoided
- lasts 6+ months
204
Specific Phobia:
- prevalence?
- M or F?
- risk factor?
- 8-12%
- F>M
- 1st degree relative with specific phobia
205
Psychotherapy for Specific Phobia
CBT Exposure Therapy
206
Psychopharmacology for Specific Phobia? (2)
Benzos
Propranolol
207
Criteria for Social Anxiety Disorder? (5)
- fear or anxiety about social sociations
- fears they will act in a way that will be negatively evaluated
- avoids social situations
- fear or anxiety is out of proportion to the actual threat posed
- 6+ months
208
Social Anxiety Disorder:
- prevalence:
- risk factor
- neuroanatomical associations?
- 7%
- 1st degree relative with SAD
- amygdala, insula, hippocampus
209
Psychopharmacology for Social Anxiety Disorder?
- SSRI, SNRI
- MAOI, BBs, and benzos but NOT FDA
210
Criteria for Panic Disorders
- recurrent unexpected panic attacks (surge of intense fear or intense discomfort with 4+ sx)
- following the attack, 1+ months of worry about additional panic attacks
211
Panic Disorders:
- prevalence:
- M or F?
- risk factors (2)
- Panicogens:
- 1-3%
- F>M
- childhood physical/sexual abuse, smoking
- IV sodium lactate or inhaled CO2
212
Treatment of Choice for Panic Disorders?
CBT
213
Psychopharmacology for Panic Disorders? (2)
- SSRIs, SNRIs
- benzos
214
Criteria for Agoraphobia
- fear or anxiety about 2+ of the following (public transport, open spaces, enclosed spaces, crowds, outside alone)
- avoids these situations in which escape may be difficult
- fear is out of proportion to the actual danger posed by the agoraphobic situations
- 6+ months
215
risk factor for Agoraphobia?
overprotective family environment
216
TX for agoraphobia?
CBT exposure therapy
217
Criteria for Separation Anxiety Disorder
- developmental inappropriate fear of separation from those who they're attached to (3+ sx)
- fear lasts at least 4 weeks in children and adolescents and typically 6+ months in adults
218
Separation Anxiety Disorder:
- prevalence in children?
- risk factors?
- 4%
- life stressors (loss, divorce, move, etc)
219
Treatment of Separation Anxiety Disorder?
CBT Exposure Therapy
220
OCD Criteria?
- Obsessions, Compulsions OR both
- Obsessions: recurrent intrusive and unwanted thoughts; pt attempts to ignore or suppress thoughts
- Compulsions: repetitive behaviors or mental acts that the pt feels driven to perform; behaviors are aimed to prevent distress/anxiety
- take up 1+ hours a day
221
OCD:
- prevalence
- F or M?
- ____ have an earlier age of onset
- 1.2-3%
- F>M
- males
222
OCD Presentaions:
- 50% of OCD pts have...
- 40% of OCD pts have...
- 30% of OCD pts have...
- 60% of OCD pts have...
- contamination fear
- pathologic doubt
- unwanted sexual concerns
- checking and/or decontamination rituals
223
what is the psychological testing for OCD?
Yale-Brown Obsessive Compulsive Scale (YBOCS)
224
OCD TX:
- relapse following medication d/c is decreased with...
- psychopharmacology (2)
- CBT
- SSRIs, TCA
225
Body Dysmorphic Disorder Criteria? (2)
- Preoccupation with perceived defects in physical appearance that are not observable to others
- performed repetitive behaviors
226
Body Dysmorphic Disorder:
- prevalence:
- other doctors pts present to?
- risk factor?
- 2.4%
- dermatology, plastics, oromaxillofacial surgery
- childhood neglect/abuse
227
Body Dysmorphic Disorder TX?
CBT
228
Criteria for Hoarding Disorder? (3)
- difficulty discarding or parting with possessions, regardless of their actual value
- perceived need to save the items
- accumulation of possessions that congest and clutter active living rooms
229
Hoarding Disorder:
- M or F?
- risk factor?
- TX?
- M>F
- 1st degree relative with hoarding (50% of cases)
- CBT
230
Trichotillomania Criteria? (2)
- pulling out of one's hair --> hair loss
- repeated attempts ate decrease or stop hair pulling
231
Trichotillomania:
- M or F?
- risk factor?
- TX? (2)
- F>>>M
- OCD
- N-Acetyl-L-Cysteine (NAC)
232
Excoriation Disorder Criteria (2)
- recurrent skin picking resulting in skin lesions
- repeated attempts to stop or decrease skin picking
233
Excoriation Disorder:
- M or F?
- risk factor?
- TX:
- F>M
- OCD
- CBT (maybe fluoxetine)
234
Reactive Attachment Disorder Criteria (3)
- consistent pattern of emotionally withdrawn behavior toward adult caregivers (both child doesn't seek comfort when distressed and rarely responds to comfort)
- social and emotional disturbance
- child has experienced extremely insufficient care
235
Reactive Attachment Disorder:
- risk factors
- Tx?
- severe social neglect (although only occurs in <10% of neglected children)
- CBT
236
Disinhibited Social Engagement Disorder Criteria
- child actively approaches and interacts with unfamiliar adults
- child has experienced extremely insufficient care
- child is 9+ months old
237
Disinhibited Social Engagement Disorder:
- risk factor:
- DDX (1)
- TX:
- severe social neglect
- ADHD
- CBT
238
PTSD Criteria (6)
- exposure to actual or threatened death, serious injury, or sexual violence
- 1+ intrusion sx associated with traumatic events (dreams, flashbacks, etc)
- avoidance of stimuli associated with traumatic events
- negative cognitions and mood associated with traumatic event
- alterations in arousal and reactivity associated with the traumatic event
- more than 1 month
239
PTSD:
- prevalence:
- 40% of cases associated with...
- 30% of cases associated with...
- 25% of cases associated with...
- suicide risk?
- risk factor?
- 6-8%
- assaultive violence
- combat exposure
- sexual violence
- 3-6x increased
- prior trauma
240
what is resilience?
healthy adaptation to negative experiences (optimism, humor, etc.)
241
PTSD:
- best tx option?
-psychopharmacology (2)
- do NOT use:
- cognitive processing therapy (CBT is first line)
- Sertraline, Paroxetine
- Benzos!
242
Criteria for Acute Stress Disorder (3)
- exposure to actual or threatened death, serious injury, or sexual violence
- 9+ sx from the following categories of sx (intrusion, negative mood, dissociative, avoidance, arousal)
- duration of disturbance is 3 days-1 mo after trauma exposure
243
Adjustment Disorders Criteria
- sx in resone to an identifiable stressor occurring within 3 months of the stressor
244
Prolonged Grief Disorder Criteria
- death at least 12 months ago
- persistent grief response since the death
- since the death, 3+ sx have been present most days to a clinically significant degree (identity disruption, disbelief, emotional pain, etc.)
245
Prolonged Grief Disorder:
- risks (3)
- TX (2)
- loss of a child, violent/unexpected death, economic stressors
- complicated grief tx (70-80% response rate--focuses on loss and restoration); CBT
246
FDA approved tx options for GAD (5)
- paroxetine
- escitalopram
- duloxetine
- venlafaxine
- buspirone
247
_____ reduces relapse rates following medication d/c in pts with OCD
CBT
248
despite prevalent use, _____ should not be used in PTSD tx d/t progression of trauma related sx
benzos
249
Criteria for Somatic Symptom Disorder
- one or more somatic sx
- excessive thoughts, feelings or behaviors related to somatic sxs
- state of being symptomatic is persistent (typically 6+ months)
250
Somatic Symptom Disorder:
- demographic:
- treatment:
- females with concurrent chronic physical illness or psychiatric disorder
- usually refuse psych consult! PCP is gatekeeper and should have frequency, scheduled, brief appointments (AVOID unnecessary diagnostic and therapeutic interventions)
251
Illness Anxiety Disorder Criteria
- preoccupation with having or acquiring a serious illness
- somatic sx are not present or if present are only MILD
- 6+ months but the specific feared illness may change over time
252
Illness Anxiety Disorder:
- increased incidence in ______ (learned behavior?
- most pts refuse psych consult (PCP is important!
- family members
253
Functional Neurological Sx Disorder (Conversion Disorder) Criteria
- altered voluntary motor or sensory function
- clinical findings provide evidence of incompatibility between the sx and recognized neurological or medical conditions
254
Functional Neurological Sx Disorder:
- expectancy of resolution based on..
hypnotic suggestion of return to health
255
Factitious Disorder Imposed on Self Criteria?
- falsification of signs/sx associated with identified deception
- the individual presents as ill, impaired or injured
- deceptive behavior is evident even in the absence of obvious external rewards
256
Factitious Disorder Imposed on Another Criteria?
- falsification of signs/sx associated with identified deception
- presents another individual to others as ill
- deceptive behavior is evident even in absence of obvious external rewards
257
Intentional production of false or exaggerated physical/psychological sx motivated by external incentives
Malingering
258
Anorexia Nervosa Criteria
- restriction of energy intake leading to significantly low birthweight
- fear of gaining weight
- disturbance in the way on'e body is experienced
259
Anorexia Nervosa:
- M or F?
- P.E. Finding:
- acid/base disturbances:
- TX for medically unstable (ortho hypo, arrhythmia, hypothermia):
- F>>>M
- Russel's Sign (dorsal hand excoriation)
- metabolic all from vomiting; met acid from laxatives
- hospitalize
260
Anorexia Nervosa:
- what is metabolic resistance?
- what is refeeding syndrome?
- energy wasting; increased resting energy expidenture
- hypophosphatemia, hypomagnesemia, hypoCa, fluid retention
261
Anorexia Nervosa:
- NO FDA drugs!
- bone loss tx?
- psychotherapy:
- ----
- NOT effective! (estrogen, bisphos)
- family based treatment has best evidence
262
best psychotherapy technique for Anorexia Nervosa
family based tx
263
Bulimia Nervosa Criteria
- recurrent episodes of binge eating
- recurrent compensatory behaviors to prevent wt gain
- behaviors occur at least once a week for 3 months
264
Bulimia Nervosa:
- TX (only 1 FDA approved option)
- Fluoxetine (best if combined with CBT)
265
Binge Eating Disorder Criteria
- bing eating in a discrete period of time and lack of control
- binge eating occurs at least once a week for 3 months
266
Binge Eating Disorder Tx and remission rate?
CBT (61% at 1 month)
267
Avoidant / Restrictive Food Intake Disorder Criteria
- eating or feeding disturbance with significant wt loss, nutritional deficiency, etc.
268
PICA Criteria
- persistent eating of nonfood substances for at least 1 month
- inappropriate to the developmental level
269
Ruination Disorder Criteria
- repeated regurgitation of food for 1+ months
270
Enuresis Criteria
- repeated voiding of urine into bed or clothes
- at least 2x per week for at least 3 months
- age is at least 5 years old
271
Enuresis:
- prevalence in 5/o
- prevalence in 10 y/o
- prevalence in 15 y/o
- 5-10%
- 3-5%
- 1%
272
risk factors for Enuresis
- 3.6x increased risk if mother was enuretic, 10x increased risk if father was enuretic
273
TX for Enuresis (2)
- Alarm Pad triggered by moisture (80% cure rate)
- Imipramine (30% success rate)
274
Encopresis Criteria
- repeated passage of feces into inappropriate places
- one event each month for at least 3 months
- age is at least 4 years old
275
somatic symptom disorder is typically managed by __________ through regularly scheduled brief appointments
PCPS instead of psychiatrists
276
what differentiates factitious disorder, conversion disorder, and malingering?
conscious or unconscious intention
277
conscious or unconscious intention helps differentiate what disorders? (3)
factitious disorder, conversion disorder, and malingering
278
weight restoration in anorexia nervosa pts is challenged by needing to overcome ________ and avoid ________
metabolic resistance
refeeding syndrome
279
primary treatments for Enuresis? (3)
- behavioral systems
- alarm pads
- imipramine
280
What drug treats negative sx of schizophrenia better than other antipsychotics?
Clozapine
