Human Growth, Developmentally disabled, Flashcards

Question

NCD d/t Prion disease

Answer 1

Rapid onset/course Motor features of prion dz (clonus, ataxia, biomarker evidence) Triphasic waves on EEG for CJD

Answer 2

AD, 50% inheritance - CAG trinucleotide repeat --> mutant protein --> neuronal death sx: - Abulia (lack of motivation), psychomotor slowing - Complex tasks first, memory/language later - Motor abnormalities (chorea) - Mood disturbances and/or psychosis is common Tx: antipsychotics, acetylcholinesterase inhibitors, mood stabilizers, SSRI

Answer 3

- α-synuclein or tau protein in substantia nigra; Lewy Body involvement common ** Distinguish from NCD w/Lewy Body by time frame (NCD PD requires cognitive decline ≥1 yr dx of PD) - think LBD if dementia happens quicker

Answer 4

= disruption in the experience of reality (includes delusions and hallucinations) * this is a sx, never a ddx! partial ddx for psychosis: - SLE, acute intermittent porphyria, Major Depressive Disorder, Bipolar Disorder, seizures (esp TLE), Schizophrenia, Schizoaffective disorder, substance intoxication, Delirium, Dementia, adverse drug reaction, etc.

Answer 5

= misperception of existing stimuli - fixed, false belief not consistent w/cultural or religious background. Can be bizarre or non-bizarre (thought broadcasting, ideas of reference, grandiose, alien chips, erotomanic, persecutory, partner cheating, etc)

Answer 6

= responding to stimuli that doesn't exist false sensory perception not associated with real external stimuli (auditory, visual, tactile, gustatory, olfactory) ** note: personality disorders don't have hallucinations (except for borderline)

Answer 7

= NOT split personality - est. 1% of population, men=women - Typical onset: late teens to late 20s, men earlier than women - Wide range of various mental disturbances - Increased suicide risk; higher medical co-morbidities – some stats say up to 50% (15-20 year shortened life span...) - More likely to be victim of violence Typically have prodromal period: - “first break” can be mild to severe - often results in someone acting strange, messy, pulling away socially DSM V Criteria for DDx: * * ≥2 of the following, each present for a significant portion of a 1-month period- prodrome (or less if successfully treated): - delusions - hallucinations - disorganized speech (e.g., frequent derailment or incoherence) - grossly disorganized or catatonic behavior - negative symptoms - social/occupational dysfunction * * signs persist for at least 6 months, including 1 mos of above sx ** The following must be ruled out: Schizoaffective, Mood Disorders, substances, general medical conditions, autism spectrum Pathophysiology: - ?? not sure: could be inflammatory, infectious, often genetic, d/t marjuana * * see ventricular enlargement of 3rd and lateral ventricles - prefrontal cortex may be involved...

Answer 8

Positive symptoms: - Hallucinations and delusions: Hallucinatory content varies greatly and usually auditory (AH) (visual hallucinations not as common) - Disorganized speech/behavior Negative symptoms: - Lack of motivation - Affective blunting – often blunted to flat - Cognitive blunting - Impaired social functioning and social withdrawal

Answer 9

1. “Dopamine hypothesis” – xs dopamine makes people psychotic! - supported by efficacy of antipsychotics 2. Seratonin hypothesis: - plays a role in negative sx! LSD causes psychosis 3. Glutamate hypothesis: - Hypo/hyperfunction at various receptors including NMDA

Answer 10

Major SE's of antipsychotic tx: - mvmt disorders (dystonia, akathisia, parkinsonism, tardive dyskinesia) - neuroepileptic malignant syndrome (NMS): – total dopamine blockade, causing rigidity of mm. and VERY high fever (must tx w/ dopamine agonist, and control psychotic behavior w/ Benzos) - anticholinergic SE's - sedation - weight gain * * Clozapine: BEST drug, but BAD SE’s - All of the above PLUS agranulocytosis (& others) --> restricted use - Can ↓ suicidality

Answer 11

"Schizo lite" - Similar to schizophrenia except symptom duration ** Symptoms of schizophrenia lasting >1 month but

Answer 12

Can be a difficult dx to make ** Features of both schizophrenia and depression or bipolar illness; Requires 2 weeks of schizophrenia symptoms in the absence of mood symptoms AND the presence of mood symptoms for a substantial part of the lifetime illness course Tx: psychosis with antipsychotics, mania with mood stabilizers, depression with antidepressants. Combine as necessary.

Answer 13

Psychosis >1 day but

Answer 14

* * ≥1 month of a delusion (erotomanic, persecutory, grandiose, jealous, somatic) * *Does not meet basic schizophrenia criteria; behavior and function usu not affected Women > men, usu mid-late life R/O medical causes (eg, tumors, TLE, etc) Tx: psychotherapy; poor response to antipsychotics NOTE: - erotomanic = thinks a celebrity is in love with them - somatic = thinks something is growing out of body

Answer 15

= "a group of disorders in which a patient has sustained mood episodes in both directions (elevated or depressed)" - total BAD is more common in women, age of onset 25 y/o (men have earlier onset) ** Manic Episode ** = Presence of abnormally elevated, expansive, or irritable mood for at least one week : "bigger, faster, better" = + 3/7 characteristics -Inflated self esteem or grandiosity -Decreased need for sleep (more energy) -More talkative or pressured -Flight of ideas/subjective racing thoughts -Distractibility -Increased goal directed activity (more energy) -Excessive involvement in pleasurable activities Genetics: - parent gives 10-25% risk in pt. - family hx of MDD or BAD increases risk - concordance rate b/w twins is 70-90% differential ddx? - stimulants: amphet, PCP, cocaine, antidepressants - testosterone, hyperTH, pheo, FTD, schizo, ADHD, MDD

Answer 16

= a history of AT LEAST ONE MANIC EPISODE! - ANY manic episode = severe = BAD I - equal b/w genders - characterized by recurrent depressed and manic episodes w/ good functioning in between

Answer 17

= Hypomanic episodes and major depressive episodes. (more depressive episodes seen in general) - Symptoms do not meet full criteria for a manic episode - relatives of Bipolar II patients have higher rates of Bipolar II disorder than either Bipolar I or MDD ** Also has a higher rate of comorbidity with substance abuse disorders

Answer 18

= “Chronic, fluctuating disturbance” between periods of hypomanic symptoms and periods of some depressive symptoms - Minimum course of 2yrs - Number of episodes not defined but “numerous” * * NO EPISODES OF MANIA, HYPOMANIA or MAJOR DEPRESSIVE EPISODES - 30% have family hx of BAD - 1/3 will progress to MDD or BAD - 2/3 respond well to Li

Answer 19

- Have Manic or Hypomanic episode with significant depressive symptoms simultaneously. - Mood and symptom picture alternates rapidly - Significantly elevated suicide risk - Likely to have more lifetime episodes

Answer 20

= Presence of abnormally elevated, expansive, or irritable mood for AT LEAST ONE WEEK : "bigger, faster, better" NOTE: any psychosis = manic episode! = + 3/7 characteristics - Inflated self esteem or grandiosity - Decreased need for sleep (more energy) - More talkative or pressured - Flight of ideas/subjective racing thoughts - Distractibility - Increased goal directed activity (more energy) - Excessive involvement in pleasurable activities Mania course: - onset abrupt - lasts a week to months - briefer than depressive episode - significant risk of recurance - heightened risk of suicide in subsequent depressive episode

Answer 21

= Persistently elevated, expansive, or irritable mood, FOR AT LEAST 4 DAYS. - Accompanied by 3 or more manic symptoms but…. 1. Does not markedly impair social/occupational functioning. 2. No hospitalization needed 3. NO PSYCHOTIC FEATURES!

Answer 22

** Mood stabilizers ** Lithium Valproate Carbamazepine ** maintenance ** (or BADII) = Lamotrigine

Answer 23

Prevalence: - 15% of people, 25% of women - 2/3 people don't know they have it, only 20% ddx get proper tx - rates of undetected depression in drug/alcohol users is at least 30% - 3rd most imp. disease burden in world! Epidemiology: - women>men - mean onset 40 y/o - not difft. b/w race or socioeceonomic Cause? - dysregulation of NE, serotonin and dopamine contribute - often see hypercortisol, abnormal thyroid regulation, blunted sleep d/t GH Genetics: 1st degree relatives 2-10x more likely! - 50% occurance in twins

Answer 24

Criteria: At least one of two: 1. depressed mood 2. anhedonia (lack of interest in pleasurable activities) >2 week period >4 symptoms: - decreased interest, - weight change, - sleep disturbance, - psychotmotor agitation, - loss of energy, - guilt, worthlessness, - poor concentration, - indecisiveness, - recurrent thoughts of death, suicidal NOTE: ALWAYS ASSESS FOR SUICIDAL IDEATION!!! differential ddx: - BAD, - dysthmia (long term depression) - cyclothymia (subthreshold chronic mood disorder w/ hypomanic moods) - schizo, anxiety disorder, personality disorder, seasonal affective disorder ** always assess for underlying medical condition: infection, endocrine, neuro disorder, neoplasm, vit deficiency

Answer 25

Course: - either chronic or relapsing - if untreated lasts for 6-13 mos (tx results in 8 weeks-3 month course) - often recurs Prognosis: prognosis if untreated: poor! - dysthmic disorder, alcohol abuse, anxiety, hospitalization,

Answer 26

= long term depression lasting at least two years!

Answer 27

= dysthymia + hypomania (lasting at least 2 years) | chronic mood disorder w/ subthreshold depression w/ hypomanic moods mild bipolar, not quite hypomanic disorder!

Answer 28

SAFETY IS NUMBER ONE!!! - always assess for suicidal thoughts and protect yourselves Suicide risk factors: male, elderly, caucasian, hx of attempts, co-morbid condition, drug/alcohol use, psychiatric illness, social isolation, low job satisfaction Treatment: 1 - Tricyclics (Nortriptyline, amitriptyline, impramine, desipramine): very effective but OD will result in DEATH, narrow TI **2 - SSRIs (Fluoxetine, Paroxetine, sertraline, citalopram) - safer, no risk of OD -- FIRST LINE TX! 3. MAOIs: tranylcypromine, phenelzine, Isocarbaxazid, selegiline (lots of problems, can cause HTN crisis w/ certain foods) **4. SNRI's (Venlafaxine, duloxetine) 5. Bupropion - also used for smoking, increased risk of seizures Dosing: - if don't respond, push AD up higher and make sure ddx is correct! - can combine but watch out for SSRIs and TCA together - can add lithium or thyroid to make them work better ``` SE's: GI Sexual Withdrawal “flu” (seen on w/drawal of SSRIs) Weight gain Seizure threshold HTN Sedation/Stimulation ``` ** ALWAYS INCLUDE PSYCHOTHERAPY IN TX AS WELL :)

Answer 29

Definition of Anxiety = - Excessive worry - Associated physical symptoms - Avoidant behavior - Unknown internal source vs. known external source - Sense of dread - Heightened apprehension ** Anxiety Disorders are the most common class of mental disorders present in the general population - Affecting 40 million adults in the US in a given year ** Sub-types of AD? - panic disorder, agorophobia, generalized anxiety, phobias, social anxiety, seperation anxiety, PTSD, OCD

Answer 30

= Recurrent, unexpected panic attacks - followed by at least on month of... - Persistent concern about having more attacks - Worry about the implications of the attacks - A significant change in behavior related to the attacks Panic Attack = A discrete period of intense fear or discomfort associated with multiple physical manifestations developing abruptly and reaching a peak within 10 min – ends quickly. **STARTS QUICK, ENDS QUICK** SX of panic attack: - Palpitations, Sweating, Tremor - Shortness of Breath, Chest pain and discomfort - Nausea, Dizziness - Fear of losing control, Fear of dying Prevalence: 2% of population, more common in females, onset early adulthood - attacks last a few minutes - associated w/ agoraphobia, depression and substance abuse - higher rate of suicide differential ddx: - CV disease, pulmonary disease, neuro disease, endocrine, drug intoxication, other mental disorder

Answer 31

(seen w/ panic disorders) = Anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help may not be available in the event of having an unexpected panic attack

Answer 32

1. SSRI's - less SE, large TI (citalopram, fluoxetine, paroxetine, sertraline) 2. benzodiazepines - needed for rapid relief, given in beginning before SSRI's are able to work 3. Tricyclics 4. Venlafaxine Therapy! behavrioal therapy + Insight oriented psychodynamic psychotherapy

Answer 33

= irrational fear resulting in a conscious avoidance of the feared object, activity or situation ** single most common mental disorders in the US: 10-25% of population are afflicted - increased risk of depression and substance abuse - specific phobias run in families, w/ first degree relatives often affected Types: 1. social phobia = Fear of humiliation or embarrassment in either general or specific social situations - commonly involving public speaking, urinating in public restrooms, stage fright Clinical Features: - panic attacks occur w/ severe anxiety when exposed to such phobia Tx: - exposure therapy, insight pyscotherapy specific phobia: benzo or SSRI social phobia: Beta blocker, SSRIm, benzo, buspirone

Answer 34

- 2-3% of population, 4th most common disorder, men=women - 20 y/o age of onset - can occur in childhood Etiology: - dysregulation of seratonin - increased activity in frontal lobes, basal ganglia, and cingulum; treatment reverses this activity - Decreased size of caudates bilaterally Diagnosis: 1. Obsession: A recurrent and intrusive thought, feeling, idea, or sensation (increased anxiety) 2. Compulsion: A conscious, standardized, recurrent thought or behavior, such as counting, checking, or avoiding (decrease anxiety) * * if resist compulsion anxiety increases Examples: * Most common pattern compulsion: Obsession of contamination, compulsion of washing, avoiding * Next most common pattern: Doubt, followed by a compulsion of checking * Intrusive obsessional thoughts without a compulsion such as a sexual or aggressive act without * Need for symmetry or precision

Answer 35

``` Pharmacotherapy: Clomipramine SSRIs Lithium Benzodiazepines ``` Psychotherapy: Behavioral therapy (exposure, response and flooding) Family therapy

Answer 36

Cause: - Experience an emotional stress of potentially life threatening magnitude that would be traumatic for almost anyone - Re-experiencing of the trauma through dreams and waking thoughts - Persistent avoidance of reminders of the trauma - hyperarousal - sx > 1 mos Epidemiology: 1-3 % of population (more in high risk groups) - Men usually combat related - Women usually related to assault Course: - Delay can be as short as a week to as long as 30 years - Symptoms fluctuate over time - Good prognosis predicted by a rapid onset of symptoms, short duration of symptoms, good premorbid functioning, strong support, absence of other psychiatric, medical, or substance disorder (very young and very old have harder time!) ``` treatment: SSRIs Mood stabilizers Hypnotics Anxiolytics Antipsychotics ```

Answer 37

= An excessive and pervasive worry accompanied by a variety of somatic symptoms, that cause significant impairment in social or occupational functioning or marked distress - person finds it difficult to control the anxiety epidemiology: - 3-8% - often co-exist w/ other psych disorders - more common women, often with other mental disorders - seek tx in 20's "i have been anxious for as long as i can remember" CF's: - Anxiety, motor tension, autonomic hyperactivity - Shakiness, restlessness, and headaches - Shortness of breath, excessive sweating, palpitations, GI symptoms - Easy startle, irritability - Usually seek out primary care physicians with somatic complaints - Chronic condition, usually life long Frequently co morbid depression, panic disorder, substance abuse ``` tx: Benzodiazepines Buspirone Mood stabilizers Antipsychotics SSRIs ```

Answer 38

- immature defense Temporarily or transiently inhibiting thinking. Affects and impulses may also be involved. Blocking closely resembles repression but differs in that tension arises when the impulse, affect, or thought is inhibited.

Answer 39

- immature defense : Expressing aggression toward others indirectly through passivity, masochism, and turning against the self.

Answer 40

- immature defense Attempting to return to an earlier libidinal phase of functioning to avoid the tension and conflict evoked at the present level of development. It reflects the basic tendency to gain instinctual gratification at a less-developed period. "turning back maturational clock" ex. seen in children under stress such as illness (begins bedwetting again when hospitalized)

Answer 41

- immature defense involuntarily holding an idea or feeling from consciousness (vs. suppression which is intentional withholding, mature response) ex. 20 y/o doesn't remember going to counseling during parents divorce

Answer 42

- mature defense alleviating negative feelings through unsolicited generosity (Using constructive and instinctually gratifying service to others to undergo a vicarious experience) i.e. mafia boss makes large donation to charity

Answer 43

- mature defense Using comedy to overtly express feelings and thoughts without personal discomfort or immobilization and without producing an unpleasant effect on others. It allows the person to tolerate and yet focus on what is too terrible to be borne

Answer 44

- mature defense intentionally w/holding an idea or feeling from conscious awareness (vs. repression which is NOT intentional); temporary

Answer 45

- psychotic/immature defense Avoiding the awareness of some painful aspect of reality by negating sensory data. Although repression defends against affects and drive derivatives, denial abolishes external reality. Denial may be used in both normal and pathological states. i.e rxn in newly ddx AIDs pt. Clinical Example: A baby dies in a fire after the unsuccessful attempt by the mother to save the child. The mother later insists that the child has been saved by a neighbor. Normal in children In adults may be indicator of severe pathology such as psychosis ** often observed in clinical syndromes with patients w/ fatal illnesses or parents with severely ill children

Answer 46

- psychotic/immature defense Attributing one’s own personally unacceptable feelings to others Clinical Syndromes: Paranoid delusions and hallucinations. Normal in childhood: the imaginary playmate On a psychotic level, this defense mechanism takes the form of frank delusions about external reality (usually persecutory) and includes both perception of one's own feelings in another and subsequent acting on the perception (psychotic paranoid delusions). ex. a man who wants another woman thinks his wife is cheating on him

Answer 47

- immature defense Avoiding painful feelings by behaving in an attention-getting socially inappropriate manner The unconscious fantasy is lived out impulsively in behavior, thereby gratifying the impulse, rather than the prohibition against it. Acting out involves chronically giving in to an impulse to avoid the tension that would result from the postponement of expression. ex: tantrums, A person may act out through substance use or sexual promiscuity

Answer 48

- immature defense transferring avoided ideas and feelings to a neutral person or object (ex. mother yells at child, b/c her husband yelled at her) Example: A man whose son was killed by a drunk driver attacks and seriously injures a drunken street person. clinically apparent in phobias

Answer 49

Excessively using intellectual processes to avoid affective expression or experience. Undue emphasis is focused on the inanimate in order to avoid intimacy with people, attention is paid to external reality to avoid the expression of inner feelings, and stress is excessively placed on irrelevant details to avoid perceiving the whole. Intellectualization is closely allied to rationalization. Clinical Example: A physician with a diagnosis of pancreatic cancer excessively discusses the statistics of the illness with his colleagues and family.

Answer 50

- immature defense = separating feelings from ideas and events Example: A person who expresses no emotion when discussing the loss of a loved one – isolating her emotion from the sad event May occur in some obsessional states

Answer 51

- immature defense temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress Separation of function of mental illnesses; mentally separating part of consciousness from reality; “forgetting "events have occurred Example: A woman sexually abused as a child has two distinct personalities in adulthood. Clinical manifestation: Dissociative Disorders

Answer 52

- immature defense Transforming an unacceptable impulse into its opposite ex. person obsessed with sex enters a monastery Denying unacceptable feelings and adopting opposite attitudes Examples: Unconsciously behaving in a friendly fashion towards someone one does not like; the quiet, meek, “perfect” high school student who commits murder Clinical examples: obsessive compulsive disorders or personality Normal behavior in the three year old child

Answer 53

- mature defense replacing an unacceptable wish w/ a course of action that is similar to the wish but does not conflict w/ one's value system and is socially acceptable (vs. reaction formation which is doing the opposite) ex. teens aggression toward father redirected towards sports Clinical Example: A man whose son was killed by a drunk driver regularly speaks to high school students about the dangers of drunk driving

Answer 54

- mature defense Realistically anticipating or planning for future inner discomfort. The mechanism is goal-directed and implies careful planning or worrying and premature but realistic affective anticipation of dire and potentially dreadful outcomes

Answer 55

- immature defense Believing people or events are either all bad or all good because of intolerance of ambiguity Example: A woman who believed that her physician was godlike – begins to think that he is a terrible physician when he is late for an appointment with her. Clinical example: Borderline Personality Disorder

Answer 56

immature defense Adopting acts which symbolically cancel or reverse a previous unwanted act or thought or event. A woman who was an immaculate housekeeper develops a hand washing compulsion after her child develops pneumonia. Normal: knocking on wood, saying Gesundheit, “I’m sorry. Clinical: compulsive acts, obsessional thoughts

Answer 57

Splitting, projection, acting out

Answer 58

Undoing, magical thinking

Answer 59

- immature defense Offering rational explanations in an attempt to justify attitudes, beliefs, or behavior that may otherwise be unacceptable, to avoid self-blame ex. after being fired claiming the job wasn't good anyways

Answer 60

Undoing, magical thinking

Answer 61

= physical symptoms w/ no identifiable physical cause - both illness production and motivation are UNCONSCIOUS. ** patient is concerned about the symptom, this is the biggest thing that they dwell on - persistent thoughts and anxiety about the symptoms (vs. illness anxiety where they make leaps for drastic ddx w/ hardly any sx) * symptoms not intentionally produced, unconscious motivation for illness - more common in women - often have persistent thoughts about seriousness of illness along w/ high anxiety about health - persistence symptoms = at least 6 mos - Health concerns override all other concerns - not reassured for long, utilize lots of care - Preoccupation with symptoms starts early and often spans many years

Answer 62

= Preoccupation with having serious disease (w/ very little sx present) = "hypochondriasis" ** sx not intentionally produced, no conscious motivation - there are hardly any somatic sx, just misinterpretation of normal body functions - tend to not be reassured - Excessive health related behaviors or avoidance - Duration 6 months or greater - prognosis fair, middle/older aged - lots of doctor shopping, and checking behavior

Answer 63

= loss of sensory or motor function (paralysis, blindness, mutism) often following an acute stressor ** symptom NOT intentionally produced (unconscious), no conscious gain - clinical findings not compatible w/ medical or neuro conditions - pt. is aware of but sometimes indifferent toward symptoms ex: there is a emotional precipitant – i.e. in auto wreck and at scene of two people dying he knew, he was driving and on being found he reports he can’t move his arms … there are often psychologic underpinnings Prevalence: - often monosymptomatic - highly prevalent in neuro wards - much more common in females and adolescents - good prognosis - Conforms to pt’s understanding of disease, not physiology Management: - utilize benzos in short term and focused therapy

Answer 64

= patient CONSCIOUSLY creates psychologic and/or physical sx in order to assume "sick role" and get medical attention for PRIMARY GAIN ** conscious sx production w/ unconscious motivation - primary gain: get psychologic benefit - secondary gain: get tangible benefits of being sick, such as vicodin Prevalence: - typically socially conforming young females - Higher socioeconomic class - Intelligent, educated, employed in medically related field - Usually associated with personality disorder ``` Common sx/diseases: Intestinal bleeding Hematuria Fever Diarrhea Hypoglycemia Cancer Non-epileptic seizures Iron deficiency anemia Renal stones ``` Management: - Confrontation by both primary physician/psychiatrist

Answer 65

= chronic factitious disorder w/ predominantly physical signs and sx - characterized by a history of multiple hospital admission and willingness to undergo invasive procedures triad of: - Fabrication of disease - Ever-shifting complaints - intense frequenting of different hospitals Prevalence: - Typically men of lower socioeconomic class - Socially maladjusted - Average age of 30 - POOR PROGNOSIS

Answer 66

illness in a child or elderly pt. caused or fabricated by the caregiver. motivation is to assume a sick role by proxy - this is a form of child/elder abuse

Answer 67

- intention production of illness guided by secondary gains (i.e. financial, avoiding military, avoiding criminal prosecution, obtaining controlled substances, obtaining shelter) * * CONSCIOUS SX w/ CONSCIOUS MOTIVATION majority are male, lack of cooperation, often w/ antisocial personality disorder

Answer 68

"weird" = odd or eccentric; inability to develop meaningful social relationship. NO PSYCHOSIS; often genetically associated w/ schizophrenia 1. Paranoid: Pervasive distrust and suspiciousness of others such that their motives are very often interpreted as malevolent 2. Schizoid: (distant) - voluntary social w/drawal, limited emotional expression, content with social isolation (vs. avoidant) - emotionally cold and detached 3. Schizotypal: (magical thinking) - eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness

Answer 69

"wild" = dramatic, emotional, erratic; genetic assoc. w/ mood disorders and substance abuse 1. Antisocial: (sociopath) disregard for and violation of rights of others, criminality, impulsivity, males>females; must be 18> y/o and have hx of conduct disorder before 15 y/o. * * considered conduct disorder if 2. Borderline: unstable mood and interpersonal relationships, impulsive, self-mutilation, boredom, more common in females, emptiness, splitting is defense mechanism - seen as borderline b/w schizo and depression * * filled w/ turmoil and intensity, roller coaster of mood swings 3. HIstrionic: excessive emotionality and excitability, attn seeking, sexually provocative, overly concerned w/ appearance, overly dramatic, don't seen how they appear to others 4. Narcissistic: grandiosity, sense of entitlement, they deserve the best and admiration

Answer 70

"worried" - anxious, fearful; genetic assoc. w/ anxiety disorder 1. avoidant: hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships w/ others (vs. schizoid) 2. Obsessive-compulsive: preoccupation w/ order, perfectionism, control; ego-syntonic: behavior consistent w/ one's own beliefs and attitudes 3. Dependent: submissive and clings, need to be taken care of, low self confidence

Answer 71

lorazepam, benztropine, amantadine (NOT L dopa)

Answer 72

aripiprazole (no weight gain) or risperidone (has increased PRL AND EPS)

Answer 73

bromocriptine (dopa agonist) | diazepam/dantrolene (mm. relaxant)

Answer 74

switch to quietapine or clozapine!

Answer 75

1. Have excessive individuation, tend to be apathetic, can no longer find a basis for existence in life. 2. Tend to be skeptical, disillusioned and give a “matter of factness” to their distress these people have excessive ego, they are apathetic, skeptical, disillusioned, no religion, they are matter of fact

Answer 76

1. Insufficient individuation. Has much will or energy. 2. Has eastern-like thought process, mayattempt to achieve “nirvana”. 3. Common in soldiers, religious martyrs,Hara-Kiri, Kamikaze. Strong sense of duty. don't have much individuation - kill themselves for duty

Answer 77

1. Literal meaning is “deregulation”. Has a lack of restraint, irritation, disgust, anger 2. Often violent, i.e. murder-suicide 3. Unregulated emotions lead to violent actions against life in general 4. May have abrupt social change: divorce, loss of job, economic crisis, death of mate. "impulsive, irratable, angry, violent"

Answer 78

1. Excessive regulation. Too much against them to be able to cope. 2. Common in prisoners and slaves 3. May be seen in very young husbands,new fathers etc. who are inexperienced and become easily overwhelmed by life.

Answer 79

``` S = sex (male gender) A = age (older) D = depression P = previous attempt E = Ethanol (ETOH) abuse R = rational thinking loss S = social support lacking O = organized plan N = no spouse S = sickness ``` 0-2 Outpatient follow-up 3-4 Supervised outpatient follow-up 5-6 Consider hospitalization 7-10 Hospitalization