Matilda Knowledge Abstraction Flashcards
Binge-Eating Disorder
A. Recurrent episodes of binge eating characterized by either (1) eating in discrete period of time (2 hrs) an amount of food that is larger than what most people would eat under similar circumstances, (2) sense of lack of control during episode (feeling can’t stop or how much one is eating)
B. Episodes associated with 3+ of the following (1) eating more rapidly, (2) eating until feeling uncomfortably full, (3) eating large amounts when not feeling physically hungry, (4) eating alone because of embarrassment, (5) feeling disgusted with oneself, depressed, or very guilty afterward
C. marked distress that binge eating is present
D. occurs at least 1X/week for 3 months
E. Not associated with bulimia or anorexia
Specify if in partial or full remission and severity (mild, moderate, severe, or extreme)
Narcolepsy
A. Current periods of irrepressible need to sleep, lapsing into sleep, napping during the day.
B. Must occur at least 3X/week over 3 months
C. Presence of at least 1 of the following: (1) episodes of cataplexy occurring a few times per month – (a) in individuals with long standing disease - brief episodes of bilaterally loss of muscle tone with maintained consciousness that is precipitated by laughter OR (b) children or newly diagnosed (6mo) spontaneous grimaces or jaw-opening episodes with tongue trusting or global hypotonia without emotional triggers, (2) Hypocretin deficiency in CSF, (3) Nocturnal sleep polysomnography - REM is less than or equal to 15 mins or multiple sleep latency test 8 mins and 2 or more sleep onset REM periods
Specify if:
(a) without cataplexy, with hypocretin deficiency
(b) with cataplexy, without hypocretin deficiency
(c) autosomal dominant cerebellar ataxia, deafness, and narcolepsy
(d) autosomal dominant narcolepsy, obesity, and type 2 diabetes
(e) secondary to another medical condition
Specify severity - mild, moderate, severe
Schizophrenia
Presence of two or more of the following for significant portion during 1 month period. One of them being positive symptom
- Delusions (+)
- Hallucinations (+)
- Disorganized speech (+)
- Grossly disorganized or catatonic behavior
- Negative symptoms: social withdrawal, flat affect, lack of emotional expression, silent, lack of communication, poor eye contact
Interferes with life and level of functioning in 1 or more major areas
Continuous signs of disturbance for at least 6 months, with 1 month of symptoms
If hx of autism spectrum disorder or communication disorder in childhood – dx can be made if prominent delusions or hallucinations with symptoms only present for 1 month
Borderline Personality Disorder
Pervasive pattern of instability of interpersonal relationships, self-image, and affects WITH marked impulsivity in adulthood. Indicated by 5 of the following
A. Frantic efforts to avoid real or imagined abandonment
B. Pattern unstable or intense interpersonal relationships with alternating between extremes of idealization and devaluation
C. Identity disturbance: markedly and persistently unstable self-image or sense of self
D. Impulsivity in at least 2 areas that are potentially self-damaging
E. Recurrent suicidal behavior, gestures, threats of self-mutilating behavior
F. Affective instability due to marked reactivity of mood - intense episodic dysphoria, irritability, anxiety lasting few hours
E. Chronic feelings of emptiness
F. Inappropriate intense anger or difficulty controlling anger
G. Transient, stress-related paranoid ideation or severe dissociative symtpoms
Factitious Disorder On Self or Another
exaggerated or falsified symptoms and/or signs of illness for purpose of assuming sick role in themselves or another person without any obvious gain
A. Falsification of physical or psychological s/sx or induction of injury or disease associated with identified deception
B. Presents to others as ill, impaired, or injuries
C. deceptive behavior evident in absence of obvious external rewards
D. Not better explained by another mental disorder - delusional disorder
Specify if single or recurrent episodes
Somatic Symptom Disorder
A. 1+ somatic symptoms that are distressing or result in significant disruption of life
B. Excessive thoughts, feelings, or behaviors related to somatic symptoms of associated health concerns manifested by one of the following
(1) Disproportionate and persistent thoughts about seriousness of one’s symptoms
(2) Persistently high level of anxiety about health or symptoms
(3) Excessive time and energy devoted to these symptoms of health concerns
C. State of being symptomatic is persistent - more than 6 months
Specify if with predominant pain, specify if persistent (more than 6 months), and severity (mild, moderate, or severe)
Persistent Depressive Disorder (Dysthymia)
A. Depressed mood for most of the day, more days than not, as indicated with subjective account or observation by others for at least 2 years [children at least 1 year]
B. Presence, while depressed, have 2 or more of the following: (1) poor appetite or overeating, (2) insomnia or hypersomnia, (3) low energy or fatigue, (4) low self-esteem, (5) poor concentration or difficulty making decisions, (6) feelings of hopelessness
C. During 2 year period, not without symptoms for 2 months at a time or may be continuously present
D. No manic or hypomanic episode, not cyclothymic
E. Not better explained by schizoaffective disorder, schizophrenia
F. Not related to substance use or another medical conditions
G. Cause significant distress or impair social, occupational, or other areas of functioning
Dissociative Identity Disorder
A. disruption of identify with 2+ distinct personality states described as disruption involves discontinuity in sense of self/agency with alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning
B. Recurrent gaps in recall of everyday events, important personal information or traumatic events inconsistent with ordinary forgetting
C. clinical significant distress or impairment in social, occupation, or other important areas of life
D. Not part of normal accepted culture or religious practice
E. Not attributably to physiological effects of substance or another medical conditions
Child Abuse
Delayed presentation to ED, injury doesn’t match up with reported mechanism
General appearance: distressed, malnourished
Skin: bruise away from bony prominences, hair loss, stock and glove burns, cigarette burns
MSK: limping
HEENT: retinal hemorrhages, hypehma, missing teeth
Mental status: altered LOC
Xray
Long term follow up, report to CPS, report to authorities
Generalized Anxiety Disorder
A. Excessive anxiety and worry, more days than not at least 6 months about number of aspects in life
B. Difficult to control worry
C. Associated with 3+ symptoms in adults (1+ in children)
- Restlessness
-Easily fatigued
-Difficulty concentrating
-Irritability
-Muscle tension
-Sleep disturbance
D. Impair daily daily living
E. Not explained by other medical condition (hyperthyroidism), drug abuse, medication, psych disorder (panic disorder)
Panic Disorder
A. Recurrent panic attacks (1 or more) by at least 1 month of fear of another or significant maladaptive behavior related to the attacks . B. Abrupt intense fear or discomfort with at least 4 of the following 13 symptoms: - Depersonalization - Fear loosing control - Fear dying -Dizzy -Chest pain -SOB -Palpitations -Trembling -Choking -Sweating -Nausea -Paresthesia -Chills/Hot flashes C. not related to substance (drug/med) or medical condition (hyperthyroidism, cardiopulmonary disorders ) D. Not explained by another mental disorder (social anxiety disorder)
Phobia
A. Marked fear or anxiety about specific object or situation (children can show crying, tantrums, freezing, clinging)
B. Phobic object or situation provokes immediate fear or anxiety
C. Phobic object or situation is actively avoided or endured with intense fear or anxiety
D. Fear or anxiety is out of proportion to actual danger posed by object or situation
E. Fear, anxiety, or avoidance typically lasts for 6+ months
F. Clinical significant distress
G. Not explained about another mental disorder (agoraphobia, OCD, PTSD)
Examples:
- Animals: spices, insects, dogs
- Natural environments: heights, storms, water
- Blood-injection-injury: needles, invasive medical procedures
- Situational: airplanes, elevators, enclosed spaces
- Other: Choking or vomiting in children - loud sounds, costumed characters
Bipolar Type I
A. Criteria met for 1 manic episode
B. Not explained by schizoaffective disorder
C. severe impairment in daily life
D. Not attributable to effects of substance or another medication condition
Manic episode criteria: distinct period of abnormal and persistent elevated, expansive, irritable mood AND increased activity/energy for at least 1 week, present most of the day
3+ of the following
- Increased self-esteem/grandiosity
-Decreased need for sleep
-More talkative
-Flight of ideas
-Distractibility
-Goal directed activity or psychomotor agitation
-Excessive involved in activities with high potential for painful consequences
Bipolar Type 2
A. one hypomanic episode and at least one MDD episode
B. never been manic episode
C. Not better explained by schizophrenia
D. Clinically significant distress or impairment in social, occupational, important areas of functioning
Hypomanic Episode:
-elevated, expansive or irritable mood AND abnormally
Lithium Labs to Draw Before Prescription
-Serum BUN/Cr: baseline, Q2-3 months during first 6 months of treatment, then annually if stable
Rationale: Nephrotoxic
-Serum electrolytes: baseline, then periodically
Rationale: Medication is nephrotoxic, places pt at higher risk for decrease electrolyte levels
-Serum calcium: baseline, 2-6 weeks after initiation, then every 6-12months
Rationale: can cause hypercalcemia
-Thyroid: baseline, 1-2 times within first 6 months of treatment, then annually if stable
Rationale: can cause hyperthyroidism
-bHCG: for all females not known to be sterile
Rationale: Category D drug - cardiac malformations in infant
-EKG: baseline for all patients over 40 years old OR if underlying cardiac risk factors, repeat as clinically indicated
Rationale: Can cause arrhythmias (abnormal T waves, bradycardia, sinus node dysfunction)
-CBC with diff: baseline, repeat as clinically indicated
Rationale: Toxicity can cause leukocytosis
-Serum lithium levels: twice weekly until clinical status and levels are stable, repeat every 1-3 months
Rationale: narrow therapeutic window, monitor for lithium toxicity levels
-Weight: baseline, periodically during treatment
Rationale: nephrotoxicity of the drug
-Monitor for polyurea
S/Sx associated with nephrogenic diabetes insipidus
