Mental Disorders

Question 0

Agorophobia

Answer 0

Excessive and persistent fear of >2 of the following:
public transportation
being in open or enclosed spaces
being in a line or crowd
leaving the house

Often seen in patients with panic disorder, but can stand alone.

Question 1

Panic Disorder

Answer 1

Recurrent unexpected panic attacks

For at least 1 month individual show:
Fear of future panic attacks OR change in behavior to avoid triggers

Question 2

Generalized Anxiety Disorder (GAD)

Answer 2

Persistent uncontrolled anxiety about multiple events

Symptoms typically start at a young age and patients are often first seen by physicians due to physical symptoms.

Causing several (>3) of the following:
Restlessness
Decreased concentration
Muscle tension
Fatigue
Irritability
Insomnia

Question 3

Differentials of Anxiety Disorders

Answer 3

Anxiety due to other medical conditions (ex, hyperthyroidism)

Substance-Induced anxiety (caffeine, sedative withdrawal)

Question 4

Obsessive-Compulsive Disorder

Answer 4

Recurrent obsessions (intrusive thoughts that increase distress) or compulsions (repetitive acts to decrease distress) that are time consuming or disruptive

Compulsions do not have to be logically related to obsession

“with absent insight (Delusional Beliefs)” = Person convinced OCD beliefs are true

Question 6

Dissociate Amnesia

Answer 6

Psychogenic amnesia

Localized: events of a certain period
Selective: Some recall of events of a certain period
Generalized: All memory prior to and including event.

Differential: Mental Status Exam (MSE)
If Physical - Difficulty learning new information plus memory loss.
If Psychologic - Just past memory loss

Question 7

Fugue State

Answer 7

Purposeful travel or bewildered wandering associated with amnesia.

Rare in occurrence, brief in duration
Spontaneous termination of amnesia

Question 8

Dissociative Identity Disorder

Answer 8

“Multiple Personality Disorder”
Characterized by ≥ 2 distinct personalities.

Memory gaps in host when alter personality is present

Question 9

Depersonalization/Derealization Disorder

Answer 9

Depersonalization: Being an outside observer in relation to one’s own body and thoughts.

Derealization: Detachment with respect to ones environment (dreamlike state)

-Patients knows that the experience is just a misperception (reality testing intact)

Question 10

Treatment of Dissociate Disorders

Answer 10

Psychotherapy

Hypnosis to recover memories.

Question 11

Major Depressive Episode (MDE)

Answer 11

Lasting > 2 weeks with ≥ 5 symptoms characterized by affective (1 or 2 below must be one of them), Physical (neurovegetative), and cognitive

1. Depressed Mood
2. Anhedonia (feeling gray, or Blah)

Question 12

MDE Symptoms

Answer 12

SIGECAPS

Sleep Change
Interest Loss
Guilt
Energy Loss
Concentration loss
Appetite Change
Psychomotor changes
Suicidal Ideation

Question 13

Major Depressive Disorder (MDD)

Answer 13

“Unipolar Depression”

≥1 MDE without a history of Mania or Hypomania

Question 14

Major Depressive Disorder (MDD) Specifiers

Answer 14

“with Melancholic features” - severe Anhedonia, weight loss, early morning awakenings

“with Atypical features” - weight gain, increased sleep, mood reactivity, leaden paralysis (heavy limbs/body)

“with Psychotic features” - Congruent or incongruent hallucinations &?or delusions

“with Catatonia” - waxy flexibility or other odd posturing

“with Anxious distress”

“with Peripartum onset”

“with Seasonal onset” - seasonal affective disorder

Question 15

MDD general course

Answer 15

Peak incidence in 20s
MDEs persist 6-12mo. if untreated
Recurrent

MDD worsens co-morbid physical illnesses.

Question 16

MDD Etiology

Answer 16

Genetic: MZ 30%, relative 20%, population 10%
Neuroendocrine dysfunction (HPA axis overactivity)
Decreased monoamines (serotonin, dopamine, Epi, NE)
Environmental Stressors

Question 17

HPA Axis in MDD

Answer 17

Cortisol toxicity results in failure of negative feedback loop in hypthalamus production of CRH => Chronic HPA Axis activation

Causes:

• Anxiety (Cortisol/Catecholamines from adrenals)
• Depressive Symptoms (over-activation of Raphe N. and Locus Ceruleus => Decreased monoamines)
• Immune system dysfunction (affects cytokine production)

Question 18

OCD Etiology and Treatment

Answer 18

Prefrontal-striatal overactivity
Serotonin Deficiency

*Rare cases of OCD after streptococcal infection in pediatric population - PANDAS

Treatment: Cognitive-Behavioral Therapy (CBT), SSRIs
Treatment resistant options include: psychosurgery and deep brain stimulation

Question 19

Hoarding Disorder (HD)

Answer 19

OCD-related

Difficulty parting with possessions due to need to save, or distress over discarding them. Causes significant functional impairment.

“with absent insight (delusional beliefs)”

Question 20

Body Dysmorphic Disorder (BDD)

Answer 20

Preoccupation with a perceived flaw in physical appearance (often minimal or non-observable). Repetitive behaviors/mental acts performed in response that cause functional impairment (otherwise may be considered normal vanity)

“with muscle dysphoria” - more common in men
“with absent insight”

Question 21

Excoriation Disorder

Answer 21

Recurrent skin picking resulting in lesions. Attempts to stop. Results in sig. distress/functional impairment.

(isn’t better explained by other disorder such as BDD.)

Question 22

Trichotillomania

Answer 22

Recurrent pulling out of one’s hair, resulting in hair loss. Causes sig. distress/functional impairment.

Usually occurs during sedentary activities.

Question 23

Etiology of trauma and Stress-related disorders

Answer 23

Response to traumatic or stressful event.

Traumatic stressor: involves actual/threatened death or serious injury.

Non-traumatic stressor: situation in which a person perceives that environmental demands exceed one’s resources to cope.

Can manifest as anxiety, dysphoria, anger, dissociation, etc.

Question 24

Post Traumatic Stress Disorder (PTSD)

Answer 24

Exposure to traumatic stressor resulting in the development of 4 types of symptoms at any time in the future, Lasting LONGER than 1 MONTH:

• Intrusion symptoms: dreams, recollections, feeling event will reocccur
• Avoidance Symptoms: Avoiding thoughts places, conversations that are reminders of events.
• Negative Alterations in Cognition and Mood
• Alterations in Arousal and Reactivity

Question 25

Acute Stress Disorder

Answer 25

Exposure to traumatic stressor with symptoms of PTSD but ONLY LASTING 3 DAYS to 1 MONTH

Question 26

Adjustment Disorder

Answer 26

Development of sig. emotional/behavioral symptoms due to an identifiable stressor.

• Acute onsent (within 3 months of stressor)
• Brief duration (resolved within 6 months of stressor termination)

Subtypes:

• Anxiety
• Depression
• Disturbance of conduct
• Mixed
• Unspecified

Question 27

Serotonin Syndrome

Answer 27

Hyperthermia, tachycardia, hypertension, delerium

Often presents when antidepressants are switched without proper washout.

Question 28

Persistent Depressive Disorder (PDD)

Answer 28

Depressed mood for >2 years.

“with persistent MDE” - MDE ≥2 years
“with pure dysthymic syndrome/disorder” - sub-threshold for MDE
“with intermittent MDEs”

Question 29

Premenstrual Dysphoric Disorder (PMDD)

Answer 29

Mood lability, irritability, anxiety, anhedonia, physical symptoms, causing significant distress and functional impairment above PMS

Question 30

Disruptive Mood Dysregulation Disorder (DMDD)

Answer 30

Severe temper outbursts at least 3x/week. Sad, irritable or angry mood almost daily. Disproportionate reaction to situation.

Symptoms must begin before age 10 but diagnosis NOT before age 6 or after age 18.

**Different than EPISODIC irritability seen in bipolar disorder.

Question 31

Bipolar I Disorder

Answer 31

“Manic-Depression”

Must exhibit at least 1 manic episode lasting at least 1 week that cause marked impairment in functionality.

Patient commonly experience intermittent MDEs. (not needed for diagnosis of BP I. )

Symptoms last approx. 3 months.

Question 32

Bipolar I specifiers

Answer 32

“with mixed features” - Mania and MDE occur at same time
“with rapid cycling” - ≥4 episodes/year
“with psychotic features” - delusions, hallucinations

Question 33

Bipolar I Etiology and Treatment

Answer 33

Highly heritable (MZ 80%)
Increased monoaminergic activity. 

Treatment:
Mood stabilizers - Lithium, antipsychotics, anticonvulsants, Electroconvulsive Therapy (#1 use)

*Antidepressants induce a manic state in BPI

Question 34

Bipolar II Disorder

Answer 34

At least 1 MDE and 1 hypomanic episode. Hypomania must last at least 4 days.

MDE is the more disruptive problem.

Treatment is same as BPI

Question 35

Cyclothymic Disorder

Answer 35

Periods of hypomania with periods of dysthymia (depressive symptoms)

Similar to BPI but less extreme, no Mania or MDE.

Treatment: mood stabilizers.