Mental Disorders Flashcards
Agorophobia
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.
Panic Disorder
Recurrent unexpected panic attacks
For at least 1 month individual show:
Fear of future panic attacks OR change in behavior to avoid triggers
Generalized Anxiety Disorder (GAD)
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
Differentials of Anxiety Disorders
Anxiety due to other medical conditions (ex, hyperthyroidism)
Substance-Induced anxiety (caffeine, sedative withdrawal)
Obsessive-Compulsive Disorder
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
Dissociate Amnesia
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
Fugue State
Purposeful travel or bewildered wandering associated with amnesia.
Rare in occurrence, brief in duration
Spontaneous termination of amnesia
Dissociative Identity Disorder
“Multiple Personality Disorder”
Characterized by ≥ 2 distinct personalities.
Memory gaps in host when alter personality is present
Depersonalization/Derealization Disorder
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)
Treatment of Dissociate Disorders
Psychotherapy
Hypnosis to recover memories.
Major Depressive Episode (MDE)
Lasting > 2 weeks with ≥ 5 symptoms characterized by affective (1 or 2 below must be one of them), Physical (neurovegetative), and cognitive
- Depressed Mood
- Anhedonia (feeling gray, or Blah)
MDE Symptoms
SIGECAPS
Sleep Change Interest Loss Guilt Energy Loss Concentration loss Appetite Change Psychomotor changes Suicidal Ideation
Major Depressive Disorder (MDD)
“Unipolar Depression”
≥1 MDE without a history of Mania or Hypomania
Major Depressive Disorder (MDD) Specifiers
“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
MDD general course
Peak incidence in 20s
MDEs persist 6-12mo. if untreated
Recurrent
MDD worsens co-morbid physical illnesses.
MDD Etiology
Genetic: MZ 30%, relative 20%, population 10%
Neuroendocrine dysfunction (HPA axis overactivity)
Decreased monoamines (serotonin, dopamine, Epi, NE)
Environmental Stressors
HPA Axis in MDD
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)
OCD Etiology and Treatment
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
Hoarding Disorder (HD)
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)”
Body Dysmorphic Disorder (BDD)
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”
Excoriation Disorder
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.)
Trichotillomania
Recurrent pulling out of one’s hair, resulting in hair loss. Causes sig. distress/functional impairment.
Usually occurs during sedentary activities.
Etiology of trauma and Stress-related disorders
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.
Post Traumatic Stress Disorder (PTSD)
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
Acute Stress Disorder
Exposure to traumatic stressor with symptoms of PTSD but ONLY LASTING 3 DAYS to 1 MONTH
Adjustment Disorder
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
Serotonin Syndrome
Hyperthermia, tachycardia, hypertension, delerium
Often presents when antidepressants are switched without proper washout.
Persistent Depressive Disorder (PDD)
Depressed mood for >2 years.
“with persistent MDE” - MDE ≥2 years
“with pure dysthymic syndrome/disorder” - sub-threshold for MDE
“with intermittent MDEs”
Premenstrual Dysphoric Disorder (PMDD)
Mood lability, irritability, anxiety, anhedonia, physical symptoms, causing significant distress and functional impairment above PMS
Disruptive Mood Dysregulation Disorder (DMDD)
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.
Bipolar I Disorder
“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.
Bipolar I specifiers
“with mixed features” - Mania and MDE occur at same time
“with rapid cycling” - ≥4 episodes/year
“with psychotic features” - delusions, hallucinations
Bipolar I Etiology and Treatment
Highly heritable (MZ 80%) Increased monoaminergic activity.
Treatment:
Mood stabilizers - Lithium, antipsychotics, anticonvulsants, Electroconvulsive Therapy (#1 use)
*Antidepressants induce a manic state in BPI
Bipolar II Disorder
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
Cyclothymic Disorder
Periods of hypomania with periods of dysthymia (depressive symptoms)
Similar to BPI but less extreme, no Mania or MDE.
Treatment: mood stabilizers.
