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Exam I Flashcards

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1
Q

transference vs countertransference?

A
  • Transference: pt projects feelings about others onto the physician
  • Countertransference: clinician projects feelings about others onto pt
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2
Q

Behavior:
what are mannerisms and specifically what are stereotypies?

A
  • pacing, facial expressions
  • persistent repetition of senseless acts or words
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3
Q

repeated muscular contraction (either motor or vocal) that is involuntary and suppressible briefly

A

Tics

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4
Q

actions reflecting an emotional state

A

gestures

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5
Q

pervasive and sustained emotional state in the PATIENT’s own words

A

Mood (happy, sad, angry, etc)

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6
Q

outward, observable expression of a person’s emotional state (blunted, flat, full range)–does not have to be MOOD CONGRUENT

A

Affect

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7
Q

lack of feelings/emotions

A

apathy

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8
Q

no pleasure in things

A

anhedonia

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9
Q

Speech prosody vs. fluency

A
  • rhythm, melody, articulation
  • word finding, thought blocking
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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
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11
Q

fixed false beliefs

A

delusions

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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
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13
Q

intrusive thoughts that cannot be put out of mind

A

obsessions

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14
Q

Thought Process:
- blocking:
- derailment:
- paralogia:

A
  • congestion internally prevents communication
  • slip from one topic to unrelated topic
  • false reasoning
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15
Q

Ganser Syndrome

A

pt gives approximate answers
(2+2 = 5)

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16
Q

Illusions vs. Hallucinations

A
  • misperception
  • false perception (all 5 senses)
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17
Q

Derealization vs. Depersonalization

A
  • sense current scenario is not real (like watching a movie)
  • observing self in the present scenario
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18
Q

awareness of current condition and severity of the condition

A

insight

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19
Q

word choice during interview; IQ and achievement tests

A

Intelligence

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20
Q

Level of Consciousness vs. Orientation

A
  • alert, lethargic, somnolent, coma
  • person, place, time, purpose
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21
Q

Pt with disorientation, amnesia, confabulation, lack of concern, perseveration

A

Korsakoff Syndrome

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22
Q

Attention vs. Concentration

A
  • sustain interest on a stimulus
  • capacity to maintain attention despite distraction stimuli
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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
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24
Q

Capgras Syndrome

A

known person replaced with exact double with evil intent

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25
Q

known person replaced with exact double with evil intent

A

Capgras Syndrome

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26
Q

unconscious filling of gaps with false memory

A

confabulation

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27
Q

how to test for Abstraction (Executive function/cognition)

A
  • Similars
  • proverbs (people in glass houses should not throw stones)
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28
Q

Receptive vs. Expressive vs. Communicative Aphasia

A
  • can’t hear/read or understand
  • can’t speak/write correctly
  • can understand and can read/hear but cannot repeat
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29
Q

______ assessment questions should be included in an initial psychiatric evaluation

A

spiritual

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30
Q

pt’s reported emotional state

A

mood

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31
Q

observed emotional range of the pt and can be congruent or incongruent with reported mood

A

affect

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32
Q

capacity to maintain attention despite distracting stimuli

A

concentration

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33
Q

how to test for neurosyphilis

A

serum RPR and CSF VDRL

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34
Q

urine metanephrines:
- what does it test for
- and what’s the triad?

A
  • pheochromocytoma
  • HA, sweating, tachycardia
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35
Q

what might a head CT show in schizophrenia, eating disorders, alcohol use, bipolar, dementia, and depression

A

enlarged ventricles

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36
Q

EEG findings in dementia?

A

decreased alpha in occipital

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37
Q

Psychological Assessment:
- Self-Report:
- Performance:

A
  • diagnostic, sx specific and personality measures
  • cognitive, neuropsychological measures
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38
Q

Psychological Assessment:
what differentiates Composite International Diagnostic Interview from SCID?

A

cross cultural validation!

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39
Q

self-administered inventories designed to assess general psychopathology

A

Minnesota Multiphasic Personality Inventory (MMPI)

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40
Q

semistructured interview that measures SEVERITY of psychotic symptoms

A

Positive and Negative Syndrome Scale (PANSS)

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41
Q

which Neuropsychological Screening exam is less sensitive for mild cognitive impairment?

A

Mini Mental State Exam (MMSE)

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42
Q

which Neuropsychological Screening exam is more sensitive AND specific for mild through severe cognitive impairment?

A

Montreal Cognitive Assessment (MOCA)

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43
Q

what does ANotherMEDICalCONDITion stand for?

A

Autoimmune
Nutritional deficit
Metabolic encephalopathy
Endocrine
Demyelination
Immune
Convulsions
Cerebrovascular Disease
Offensive Toxins
Neoplasm
Degeneration
Infection
Trauma

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44
Q

Certain lab studies help dx medical conditions presenting as psychiatric symptoms as well as monitor for side effects caused by a medication including… (4)

A
  • electrolytes (Na, K)
  • renal function
  • liver function
  • TSH
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45
Q

decreased alpha power in the occipital lobe on EEG is associated with

A

dementia

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46
Q

what assessment helps monitor symptoms in patient with schizophrenia

A

Positive and Negative Symptoms Scale (PANSS)

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47
Q

ANotherMEDICalCONDITion is used to ID relevant medical conditions that may be presenting with _____ symptoms

A

psychiatric

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48
Q

Herpes may present with what psychiatric symptom?

A

gustatory hallucinations

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49
Q

gustatory hallucinations are associated with what pathology?

A

herpes

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50
Q

Sigmund Freud’s Theory of Development

A
  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
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51
Q

Erik Erickson’s Theory of Development

A
  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)
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52
Q

Jean Piaget’s Theory of Development

A
  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)
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53
Q

Lawrence Kohlberg Theory of Development

A
  1. Preconventional
  2. Conventional
  3. Postconventional
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54
Q

Who and What?
Attachment Theory

A

Bowlby
emotional bond between caregiver and infant

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55
Q

Who did it?
Rhesus monkeys deprived of maternal contact –> increased infant mortality

A

Harry Harlow

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56
Q

Who and What?
Stranger Situation

A

Ainsworth
categorized attachment of infant and caregiver as secure or insecure

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57
Q

Theory that proposes development moves from undifferentiated and defuse toward greater complexity via differentiation and consolidation across subsystems

A

Orthogenic Principle

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58
Q

Systems Theory of Development:
Equifinality vs. Multifinality

A
  • same phenomenon results from different pathogen (i.e. autism)
  • one factor can result in several psychopathologic outcomes
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59
Q

Infancy (Birth-2yrs)
: increased exploration of self and outside world
- Freud:
- Erickson:
- Piaget:
- Ainsworth:

A
  • Oral, anal
  • trust vs. mistrust, autonomy vs. shame/doubt
  • sensorimotor
  • secure vs insecure
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60
Q

PreSchool (2-5yrs)
Define the Types of Play
- mimicry
- parallel
- associative
- cooperative

A
  • feeding baby, etc
  • solitary play despite being around others
  • sharing toys but still solitary
  • work together on common task
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61
Q

PreSchool (2-5yrs)
: increased symbolic thought
- Freud:
- Erickson:
- Piaget:
- Kohlberg:

A
  • 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
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62
Q

School Age (5-12yrs)
: increased ability to engage in concrete logical thinking
- Freud:
- Erickson:
- Piaget:

A
  • latency, genital
  • industry vs inferiority, identity vs role confusion
  • pre operational, concrete operations
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63
Q

Adolescence (13-20yrs)
: abstract logical thought
- Freud:
- Erickson:
- Piaget:
- Kohlberg:

A
  • genital
  • idenitfy vs. role confusion
  • formal operations
  • fully formed conscience, well developed sense of right and wrong, test parents
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64
Q

Adult (18+ yrs)
: leaving home, redefining relationship with parents, meaningful friendship
- Erickson:
- Piaget:

A
  • identity vs. role confusion, intimacy vs isolation, generativity vs stagnation
  • formal operations
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65
Q

Late Adulthood
: imparting wisdom, increased dependence on others
- Erickson

A
  • ego-integrity vs despair
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66
Q

what is the psychosexual stage associated with ages birth to 18 months?

A

oral

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67
Q

what is the Eriksonian stage for 60+ years old?

A

ego integrity vs despair

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68
Q

abstract thought and understanding underlying principles are possible in the developmental stage of _________ as categorized by Piaget

A

Formal Operations

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69
Q

what is possible in the Formal Operations stage (Piaget)

A

abstract thought and understanding underlying principles

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70
Q

what has provided several models for the development of psychopathology including risk factor identification?

A

systems theory

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71
Q

Systems theory has provided several models for the development of psychopathology including __________?

A

risk factor identification

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72
Q

define informed consent

A

Pt understands and agrees to evaluation and tx proposed by physician

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73
Q

what are the 3 components of informed consent?

A
  1. mental capacity
  2. adequate information
  3. voluntariness
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74
Q

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

A

civil commitment

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75
Q

Parens patriae

A

father of the country (legal basis involved in civil commitment)

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76
Q

what are the criteria for civil commitment? (3)

A
  1. serious psychiatric disorder
  2. significant risk of pt harming self or others
  3. hospitalization is least restrictive alternative (vs incarceration)
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77
Q

Involuntary Treatment:
court ordered is usually an involuntary treatment in the form of…

A

a long term medication

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78
Q

Privilege vs. Confidentiality

A
  • pt information that may not be disclosed in a legal setting
  • pt information that may not be disclosed to ANYONE (HIPPA)
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79
Q

pt information that may not be disclosed in a legal setting

A

privilege

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80
Q

pt information that may not be disclosed to ANYONE (HIPPA)

A

confidentiality

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81
Q

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

A

M’Naghten Rule (Cognitive Test)

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82
Q

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

A

Model Penal Code

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83
Q

Duty to Protect vs Duty to Warn

A
  • 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
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84
Q

clinician required to take steps to notify intended target person of threat

A

duty to warn

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85
Q

clinician required to take steps to protect patient from harming intended target person

A

duty to protect

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86
Q

capacity vs competency

A
  • 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
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87
Q

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

A

capacity

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88
Q

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

A

competency

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89
Q

4 elements of capacity?

A
  1. understanding
  2. expressing a choice
  3. appreciation
  4. reasoning
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90
Q

unilateral termination of the doctor-patient relationship without justification, leading to harm to the patient

A

abandonment

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91
Q

civil commitment requires…

A
  1. serious psych disorder
  2. risk of harm to self or others
  3. hospitalization is the least restrictive option
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92
Q

examples of reasons to terminate a patient relationship?

A
  • Failure to pay
  • Threatening behavior
  • Repeated failure to keep appointments
  • Non-compliance with treatment plan
  • Abuse of prescribed medication
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93
Q

Pt with…
* deficits in intellectual functions confirmed by both clinical assessment and individualized, standardized intelligence testing
* Failure to meet developmental and sociocultural standards

A

Intellectual Developmental Disorder (ID)

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94
Q

prenatal, perinatal, and postnatal causes of Intellectual Developmental Disorder (ID)

A
  • 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)
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95
Q

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

A

Speech Sound Disorder

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96
Q

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

A

Childhood Onset Fluency Disorder (Stuttering)

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97
Q

Pt with…
* difficulties in the social use of verbal and nonverbal communication
* deficits result in functional limitations in effective communication and social participation

A

Social (Pragmatic) Communication Disorder

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98
Q

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

A

Autism Spectrum Disorder

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99
Q

Genetic risk factors for autism?

A

tuberous sclerosis
fragile X syndrome

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100
Q

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.)

A

ADHD

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101
Q

ADHD:
- M or F more likely to have predominantly inattentive presentation?

A

females

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102
Q

3 groups of treatments for ADHD?

A
  1. stimulants
  2. SNRIs
  3. alpha 2 agonists
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103
Q

Pt with…
* Multiple motor and one or more vocal tics
* Persist for more than 1 year

A

Tourette’s Disorder

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104
Q

Tourette’s:
- M or F?
- tics increase with…
- tics decrease with…
- altered _____ functioning

A
  • M>F
  • anxiety, excitement, exhaustion
  • calm, focused activity
  • dopaminergic
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105
Q

Tourette’s treatment (3)

A
  • habit reversal training
  • antipsychotics
  • alpha 2 agonists
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106
Q

Autism spectrum disorder includes a diverse presentation population and treatment options include … (2)

A
  • behavioral analysis
  • 2nd generation antipsychotics
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107
Q

ADHD has three types and the best evidence treatment remains…

A

stimulant medication

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108
Q

Schizophrenia Criteria?
A) Two or more of the following…

A

TWO or more of the following:
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative sx (diminished emotional expression)

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109
Q

Schizophrenia Criteria?
B) signs of disturbance persist for at least _______
C) ______ and _____ have been ruled out

A
  • 6 months
  • schizoaffective disorder and depressive or bipolar disorders
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110
Q

fixed false beliefs that are not amenable to change in light of conflicting evidence

A

delusions

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111
Q

false perceptions, occur without an external stimulus (auditory most common in primary psychotic disorders)

A

hallucinations

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112
Q

examples of negative symptoms?

A
  • aprosody
  • apathy
  • avolition (decreased self initiated purposeful activities)
  • alogia (decreased speech and expression)
  • anhedonia (loss of pleasure from positive stimuli)
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113
Q

loss of intonation and inflection in speech

A

aprosody

114
Q

loss of emotional expression

A

apathy

115
Q

decreased self-initiated purposeful activities

A

avolition

116
Q

decreased speech and expression of thoughts and ideas

A

alogia

117
Q

loss of pleasure from positive stimuli

A

anhedonia

118
Q

Schizophrenia: Epidemiology
- prevalence?
- suicide risk?
- life expectancy reduction?
- _______ drift

A
  • 0.3-0.7%
  • 5%
  • 20% lower life expectancy
  • socioeconomic drift
119
Q

Schizophrenia: Etiology
- Dopamine Hypothesis suggests…

A
  • mesolimbic tract and striatum hyperactivity associated with positive symptoms
  • mesocortical tract hypodopminergia (D1) associated with negative symptoms
120
Q

Schizophrenia:
what is suggested to cause the positive symptoms?

A

mesolimbic tract and striatum hyperactivity (D2/3) associated with positive symptoms

121
Q

Schizophrenia:
what is suggested to cause the negative symptoms?

A

mesocortical tract hypodopminergia (D1) associated with negative symptoms

122
Q

Schizophrenia:
- neuroanatomic changes:

A

increased ventricle size

123
Q

Schizophrenia TX:
- positive sx
- negative sx

A
  • respond well to antipsychotics
  • no not respond to antipsychotics
124
Q

what is treatment resistant schizophrenia?

A

failure of 2 therapeutic trials of any antipsychotic medications

125
Q

FGA vs SGA

A
  • first gen antipsychotic
  • second gen antipsychotic
126
Q

Extrapyramidal System (EPS) Side Effects of FGAs (4)

A
  • Akathisia (restlessness, psychomotor agitation)
  • Parkinsonism
  • Dystonia
  • Tardive dyskinesia (involuntary rhythmic movements)
127
Q

what three receptors can FGAs antagonize?

A

histamine 1
alpha 1
muscarinic 1

128
Q

effects of FGAs antagonizing H1, alpha 1, M1?

A
  • H1: sedation, increased appetite
  • alpha 1: orthostatic hypotension, sedation
  • M1: blurry vision, dry mouth, constipation
129
Q

high potency FGAs have higher ____ side effects and lower ____ side effects

A
  • EPS
  • HAM
130
Q

low potency FGAs have higher ____ side effects and lower ____ side effects

A
  • HAM
  • EPS
131
Q

SGAs: Clozapine
- notable ADR
- treats + or - sx?
- decreased risk of which ADRs?

A
  • agranulocytosis
  • both!
  • suicides, tardive dyskinesia
132
Q

Schizophreniform Disorder Criteria that differentiates it from Schizophrenia?

A
  • episode lasts at least 1 month but less than 6 months (otherwise same criteria!)
133
Q

T or F? most pts with schizophreniform disorder progress onto a dx of schizophrenia

A

True!

134
Q

Brief Psychotic Disorder Criteria:
what differentiates it from Schizophreniform Disorder and Schizophrenia?

A
  • episode lasts at least one day but less than one month with eventual full return to premorbid level of functioning (otherwise the same)
135
Q

Peripartum Brief Psychotic Disorder occurs when?

A

during pregnancy or within 4 weeks postpartum

136
Q

SGAs are also called the…

A

atypical antipsychotics

137
Q

prototypical SGA?

A

Clozapine

138
Q

which SGA has been shown to reduce hospitalization

A

Aripiprazole

139
Q

Short Acting Injectable SGAs (3)

A

Olanzapine
Ziprasidone
Aripiprazole

140
Q

Long Acting Injecatable SGAs (4)–recommended in all non-compliant pts!!

A
  • Aripiprazole
  • Paliperidone
  • Risperidone
  • Olanzapine
141
Q

what are wrap around services?

A

comprehensive community based services (all schizophrenia pts should be referred to these!)
- housing, transportation, employment assistance
- occupational services
- adult day programs

142
Q

treatment of brief psychotic disorder?

A

rapid and complete resolution with antipsychotic (tx is 1-3 months)

143
Q

Criteria for Delusional Disorder?

A
  • 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
Q

treatment for Delusional Disorder?

A

SGA
supportive psychotherapy

145
Q

Schizoaffective Disorder Criteria

A
  • 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
Q

treatment for Schizoaffective Disorder?

A

SGA (psychosis)
Psychotherapy! (CBT)

147
Q

Catatonia Associated with Another Mental Disorder Criteria

A
  • 3 or more of the catatonia sx
148
Q

Treatment for Catatonia Associated with another Mental Disorder?

A
  • treat underlying condition
  • acute: benzos, ECT
149
Q

how does Catatonia DUE TO Another Mental Disorder differ from Catatonia ASSOCIATED WITH Another Mental Disorder?

A

disturbance is the direct pathophysiological consequence of another medical condition

150
Q

Criteria for Dissociative Identity Disorder

A
  • 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
Q

an adaptive defense used to cope with overwhelming psychological trauma

A

normal dissociation

152
Q

risk factors for Dissociative Identity Disorder

A

childhood physical and sexual abuse

153
Q

Treatment for Dissociative Identity Disorder?

A

Phasic Model of integrative therapy

154
Q

three phases of Phasic Model of Integrative Therapy to treat Dissociative Identity Disorder?

A
  1. safety and symptom stabilization
  2. trauma treatment
  3. reintegration and recovery
155
Q

Criteria for Dissociative Amnesia?

A
  • inability to recall important autobiographical information
156
Q

subtype of Dissociative Amnesia with purposeful travel or bewildered wandering that is associated with amnesia for identity

A

dissociative fugue

157
Q

risk factor for Dissociative Amnesia?

A

traumatic experiences (childhood abuse, war, natural disasters, etc)

158
Q

unique treatment for refractive Dissociative Amnesia?

A

narcoanalysis (amobarbital, benzodiazepine)

159
Q

Criteria for Depersonalization/Derealization Disorder?

A
  • presence and persistence of recurrent experiences of depersonalization, derealization or both!
  • reality testing remains intact
160
Q

experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, etc.

A

depersonalization

161
Q

experiences of unreality or detachment with respect to surroundings (dreamlike, foggy, lifeless)

A

derealization

162
Q

risk factors for Depersonalization/Derealization Disorder

A

emotional abuse / trauma

163
Q

treatment for Depersonalization/Derealization Disorder

A
  • CBT (desensitization)
  • AVOID antipsychotics!! (avoid benzos!)
164
Q

primary treatments of positive and disorganized psychotic conditions?

A

FGA
SGA

165
Q

what is the only drug that has significant success in addressing negative symptoms seen in psychotic conditions?

A

clozapine

166
Q

catatonia management can include ____, _____, and _____ treatment options

A

general
acute
malignant

167
Q

avoid antipsychotics and benzos in __________ disorder
- instead use…

A
  • depersonalization/derealization disorder
  • CBT or hyponosis
168
Q

Major Depressive Disorder Criteria?

A

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
Q

_____ accounts for 50% of all suicides?

A

MDD

170
Q

___% of MDD pts complete suicide

A

15%

171
Q

NT Hypothesis (an incomplete hypothesis) for MDD involves what NTs?

A

serotonin
NE

172
Q

Neuroendocrine Hypothesis for MDD suggests what as the mediator?

A

increased cortisol

173
Q

Psychotherapy Tx for MDD (3)

A
  • CBT
  • interpersonal psychotherapy
  • brief psychodynamic psychotherapy
174
Q

MDD:
- response rate to antidepressants:
- remission rate with antidepressants:
- antidepressant black box waning of ____ in what age group?

A
  • 66%
  • 33-44%
  • increased depression/suicidality in 12-24 y/o
175
Q

ADR of MAO-Is?

A

hypertensive crisis (secondary to increased NE)

176
Q

TCAs inhibit _____ > _____ reuptake

A

serotonin
NE

177
Q

Pt on SSRI presents with mental status changes, diaphoresis, labile pulse/BP, tremor, Babinski, hyperreflexia

A

Serotonin Syndrome

178
Q

Pt on SSRI presents with dizziness, insomnia, nervousness, irritability, “zaps” and nausea

A

think Discontinuation Syndrome!

179
Q

drug class of Bupropion

A

Selective NE and DA Reuptake Inhibitor (SNDRI)

180
Q

Advantages of SNDRIs (2)

A
  • no sexual dysfunction
  • no serotonin effects so can augment with SSRI or SNRI
181
Q

unique SE of Trazodone/Nefazodone (SSRI + 5HT R antag/ag)

A

priapism

182
Q

Criteria for Persistent Depressive Disorder

A
  • depressed mood for more days than not for at least 2 years
  • 2 or more of the same criteria for MDD
183
Q

risk factor for Persistent Depressive Disorder?

A

loss of a parent in childhood

184
Q

40% of pts with ____ meet the criteria for persistent depressive disorder

A

MDD

185
Q

Criteria for Disruptive Mood Dysregulation Disorder? (4)

A
  • 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
Q

Criteria for Premenstrual Dysphoric Disorder

A
  • 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
Q

Criteria for Bipolar I Disorder?

A
  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
Q

Bipolar I Disorder:
- suicide risk?
- 61% have comorbid ______

A

-15x increased risk (25% of all suicides)
- substance use

189
Q

Psychopharmacology for Bipolar I Disorder? (2)

A

Lithium (toxic >2mmol)
Carbamazepine
Oxcarbazepine
VA
Lamotrigine

190
Q

Criteria for Bipolar II Disorder?

A
  • 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
Q

is Bipolar mania or depression more refractory to treatment? (harder to treat)

A

depression

192
Q

Cyclothymic Disorder Criteria?

A
  • 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
Q

Criteria for Unspecified Mood Disorder?

A
  • every other mood disturbance that doesn’t classify into other mood disorders!
194
Q

duration of sx in
- MDD vs.
- PDD vs.
- PMDD
- disruptive mood dysregulation disorders

A
  • 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
Q

herbal/supplement options that have shown efficacy in treating MDD?

A
  • omega-3 FAs
  • folic acid
  • S-adenosyl-I-methionine (SAMe)
  • St Johns Wort
  • vitamin B12
196
Q

________ is one of two psychiatric medications that decreases suicide rates with therapeutic level 0.6-1.2 mmol/L

A

Lithium

197
Q

Criteria for Generalized Anxiety Disorder?

A
  • 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
Q

GAD:
- prevalence:
- M or F?
- risk factor?
- neuroanatomical associations?

A
  • 2-9%
  • F>M
  • 1st degree relative with GAD
  • dorsal raphe nuclei
199
Q

Psychotherapy for GAD?

A

CBT

200
Q

Psychopharmacology for GAD?

A
  • Buspirone (5HT1A partial ag)
  • SSRI and SNRI (paroxetine, escitalopram, duloxetine, venlafaxine)
201
Q

Selective Mutism Criteria?

A
  • failure to speak in specific social situations despite others speaking in other situations
  • duration of episode is at least one month
202
Q

Selective Mutism Treatment?

A

CBT

203
Q

Specific Phobia Criteria? (3)

A
  • fear or anxiety about a specific object or situation
  • phobic object or situation is actively avoided
  • lasts 6+ months
204
Q

Specific Phobia:
- prevalence?
- M or F?
- risk factor?

A
  • 8-12%
  • F>M
  • 1st degree relative with specific phobia
205
Q

Psychotherapy for Specific Phobia

A

CBT Exposure Therapy

206
Q

Psychopharmacology for Specific Phobia? (2)

A

Benzos
Propranolol

207
Q

Criteria for Social Anxiety Disorder? (5)

A
  • 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
Q

Social Anxiety Disorder:
- prevalence:
- risk factor
- neuroanatomical associations?

A
  • 7%
  • 1st degree relative with SAD
  • amygdala, insula, hippocampus
209
Q

Psychopharmacology for Social Anxiety Disorder?

A
  • SSRI, SNRI
  • MAOI, BBs, and benzos but NOT FDA
210
Q

Criteria for Panic Disorders

A
  • 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
Q

Panic Disorders:
- prevalence:
- M or F?
- risk factors (2)
- Panicogens:

A
  • 1-3%
  • F>M
  • childhood physical/sexual abuse, smoking
  • IV sodium lactate or inhaled CO2
212
Q

Treatment of Choice for Panic Disorders?

A

CBT

213
Q

Psychopharmacology for Panic Disorders? (2)

A
  • SSRIs, SNRIs
  • benzos
214
Q

Criteria for Agoraphobia

A
  • 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
Q

risk factor for Agoraphobia?

A

overprotective family environment

216
Q

TX for agoraphobia?

A

CBT exposure therapy

217
Q

Criteria for Separation Anxiety Disorder

A
  • 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
Q

Separation Anxiety Disorder:
- prevalence in children?
- risk factors?

A
  • 4%
  • life stressors (loss, divorce, move, etc)
219
Q

Treatment of Separation Anxiety Disorder?

A

CBT Exposure Therapy

220
Q

OCD Criteria?

A
  • 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
Q

OCD:
- prevalence
- F or M?
- ____ have an earlier age of onset

A
  • 1.2-3%
  • F>M
  • males
222
Q

OCD Presentaions:
- 50% of OCD pts have…
- 40% of OCD pts have…
- 30% of OCD pts have…
- 60% of OCD pts have…

A
  • contamination fear
  • pathologic doubt
  • unwanted sexual concerns
  • checking and/or decontamination rituals
223
Q

what is the psychological testing for OCD?

A

Yale-Brown Obsessive Compulsive Scale (YBOCS)

224
Q

OCD TX:
- relapse following medication d/c is decreased with…
- psychopharmacology (2)

A
  • CBT
  • SSRIs, TCA
225
Q

Body Dysmorphic Disorder Criteria? (2)

A
  • Preoccupation with perceived defects in physical appearance that are not observable to others
  • performed repetitive behaviors
226
Q

Body Dysmorphic Disorder:
- prevalence:
- other doctors pts present to?
- risk factor?

A
  • 2.4%
  • dermatology, plastics, oromaxillofacial surgery
  • childhood neglect/abuse
227
Q

Body Dysmorphic Disorder TX?

A

CBT

228
Q

Criteria for Hoarding Disorder? (3)

A
  • 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
Q

Hoarding Disorder:
- M or F?
- risk factor?
- TX?

A
  • M>F
  • 1st degree relative with hoarding (50% of cases)
  • CBT
230
Q

Trichotillomania Criteria? (2)

A
  • pulling out of one’s hair –> hair loss
  • repeated attempts ate decrease or stop hair pulling
231
Q

Trichotillomania:
- M or F?
- risk factor?
- TX? (2)

A
  • F»>M
  • OCD
  • N-Acetyl-L-Cysteine (NAC)
232
Q

Excoriation Disorder Criteria (2)

A
  • recurrent skin picking resulting in skin lesions
  • repeated attempts to stop or decrease skin picking
233
Q

Excoriation Disorder:
- M or F?
- risk factor?
- TX:

A
  • F>M
  • OCD
  • CBT (maybe fluoxetine)
234
Q

Reactive Attachment Disorder Criteria (3)

A
  • 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
Q

Reactive Attachment Disorder:
- risk factors
- Tx?

A
  • severe social neglect (although only occurs in <10% of neglected children)
  • CBT
236
Q

Disinhibited Social Engagement Disorder Criteria

A
  • child actively approaches and interacts with unfamiliar adults
  • child has experienced extremely insufficient care
  • child is 9+ months old
237
Q

Disinhibited Social Engagement Disorder:
- risk factor:
- DDX (1)
- TX:

A
  • severe social neglect
  • ADHD
  • CBT
238
Q

PTSD Criteria (6)

A
  • 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
Q

PTSD:
- prevalence:
- 40% of cases associated with…
- 30% of cases associated with…
- 25% of cases associated with…
- suicide risk?
- risk factor?

A
  • 6-8%
  • assaultive violence
  • combat exposure
  • sexual violence
  • 3-6x increased
  • prior trauma
240
Q

what is resilience?

A

healthy adaptation to negative experiences (optimism, humor, etc.)

241
Q

PTSD:
- best tx option?
-psychopharmacology (2)
- do NOT use:

A
  • cognitive processing therapy (CBT is first line)
  • Sertraline, Paroxetine
  • Benzos!
242
Q

Criteria for Acute Stress Disorder (3)

A
  • 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
Q

Adjustment Disorders Criteria

A
  • sx in resone to an identifiable stressor occurring within 3 months of the stressor
244
Q

Prolonged Grief Disorder Criteria

A
  • 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
Q

Prolonged Grief Disorder:
- risks (3)
- TX (2)

A
  • loss of a child, violent/unexpected death, economic stressors
  • complicated grief tx (70-80% response rate–focuses on loss and restoration); CBT
246
Q

FDA approved tx options for GAD (5)

A
  • paroxetine
  • escitalopram
  • duloxetine
  • venlafaxine
  • buspirone
247
Q

_____ reduces relapse rates following medication d/c in pts with OCD

A

CBT

248
Q

despite prevalent use, _____ should not be used in PTSD tx d/t progression of trauma related sx

A

benzos

249
Q

Criteria for Somatic Symptom Disorder

A
  • one or more somatic sx
  • excessive thoughts, feelings or behaviors related to somatic sxs
  • state of being symptomatic is persistent (typically 6+ months)
250
Q

Somatic Symptom Disorder:
- demographic:
- treatment:

A
  • 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
Q

Illness Anxiety Disorder Criteria

A
  • 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
Q

Illness Anxiety Disorder:
- increased incidence in ______ (learned behavior?
- most pts refuse psych consult (PCP is important!

A
  • family members
253
Q

Functional Neurological Sx Disorder (Conversion Disorder) Criteria

A
  • altered voluntary motor or sensory function
  • clinical findings provide evidence of incompatibility between the sx and recognized neurological or medical conditions
254
Q

Functional Neurological Sx Disorder:
- expectancy of resolution based on..

A

hypnotic suggestion of return to health

255
Q

Factitious Disorder Imposed on Self Criteria?

A
  • 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
Q

Factitious Disorder Imposed on Another Criteria?

A
  • 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
Q

Intentional production of false or exaggerated physical/psychological sx motivated by external incentives

A

Malingering

258
Q

Anorexia Nervosa Criteria

A
  • restriction of energy intake leading to significantly low birthweight
  • fear of gaining weight
  • disturbance in the way on’e body is experienced
259
Q

Anorexia Nervosa:
- M or F?
- P.E. Finding:
- acid/base disturbances:
- TX for medically unstable (ortho hypo, arrhythmia, hypothermia):

A
  • F»>M
  • Russel’s Sign (dorsal hand excoriation)
  • metabolic all from vomiting; met acid from laxatives
  • hospitalize
260
Q

Anorexia Nervosa:
- what is metabolic resistance?
- what is refeeding syndrome?

A
  • energy wasting; increased resting energy expidenture
  • hypophosphatemia, hypomagnesemia, hypoCa, fluid retention
261
Q

Anorexia Nervosa:
- NO FDA drugs!
- bone loss tx?
- psychotherapy:

A
  • NOT effective! (estrogen, bisphos)
  • family based treatment has best evidence
262
Q

best psychotherapy technique for Anorexia Nervosa

A

family based tx

263
Q

Bulimia Nervosa Criteria

A
  • recurrent episodes of binge eating
  • recurrent compensatory behaviors to prevent wt gain
  • behaviors occur at least once a week for 3 months
264
Q

Bulimia Nervosa:
- TX (only 1 FDA approved option)

A
  • Fluoxetine (best if combined with CBT)
265
Q

Binge Eating Disorder Criteria

A
  • bing eating in a discrete period of time and lack of control
  • binge eating occurs at least once a week for 3 months
266
Q

Binge Eating Disorder Tx and remission rate?

A

CBT (61% at 1 month)

267
Q

Avoidant / Restrictive Food Intake Disorder Criteria

A
  • eating or feeding disturbance with significant wt loss, nutritional deficiency, etc.
268
Q

PICA Criteria

A
  • persistent eating of nonfood substances for at least 1 month
  • inappropriate to the developmental level
269
Q

Ruination Disorder Criteria

A
  • repeated regurgitation of food for 1+ months
270
Q

Enuresis Criteria

A
  • 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
Q

Enuresis:
- prevalence in 5/o
- prevalence in 10 y/o
- prevalence in 15 y/o

A
  • 5-10%
  • 3-5%
  • 1%
272
Q

risk factors for Enuresis

A
  • 3.6x increased risk if mother was enuretic, 10x increased risk if father was enuretic
273
Q

TX for Enuresis (2)

A
  • Alarm Pad triggered by moisture (80% cure rate)
  • Imipramine (30% success rate)
274
Q

Encopresis Criteria

A
  • repeated passage of feces into inappropriate places
  • one event each month for at least 3 months
  • age is at least 4 years old
275
Q

somatic symptom disorder is typically managed by __________ through regularly scheduled brief appointments

A

PCPS instead of psychiatrists

276
Q

what differentiates factitious disorder, conversion disorder, and malingering?

A

conscious or unconscious intention

277
Q

conscious or unconscious intention helps differentiate what disorders? (3)

A

factitious disorder, conversion disorder, and malingering

278
Q

weight restoration in anorexia nervosa pts is challenged by needing to overcome ________ and avoid ________

A

metabolic resistance
refeeding syndrome

279
Q

primary treatments for Enuresis? (3)

A
  • behavioral systems
  • alarm pads
  • imipramine
280
Q

What drug treats negative sx of schizophrenia better than other antipsychotics?

A

Clozapine

Psych (4 decks)

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