Module 1 Flashcards
Differentiate between provisional diagnosis and “unspecified”/”other specified”.
Provisional: assume criteria will be met, but patient information is unavailable
Unspecified: Does not specify why a patient fails to meet criteria for a specific disorder
Other specified: Other specified eating disorder, insufficient frequency binge/purge
What is a mental disorder?
Disturbance of behavior, emotional regulation, cognition that leads to functional impairment (social, occupational, other important activities)
What is the final category of mental disorder in DSM?
Other focus clinical attention – not a mental disorder, but may benefit from clinical scrutiny or intervention (i.e. uncomplicated bereavement)
Differentiate between the old axis system and the new DSM-5 model.
Axis: bio-psycho-social
New: List of disorders to avoid implying that there is a fundamental distinction between psychiatric and medical illness
What are the 7 anxiety disorders?
- Panic
- Agoraphobia
- Social anxiety disorder
- Specific phobia
- Generalized anxiety disorder
- Separation anxiety
- Selective mutism
What is the general theme, cause and treatment for anxiety disorders?
Theme: inappropriate anxiety elicited by inappropriate cues, excessive in intensity/duration
Cause: overstimulation HPA axis
Treatment: CBT, Anxiolytic meds – Benzo/SSRI
What is classic conditioning?
Physical symptoms become associated with fear response; can trigger anxiety
What is on the differential for an anxiety disorder?
A medical condition (i.e. tumor, hyperthyroidism)
Substance induced anxiety (i.e. caffeine)
Define anhedonia
Inability to feel pleasure
Panic disorder
Recurrent, unexpected panic attacks greater than 1 month
Agoraphobia
Fear of escape
Specific phobia
Excessive, disproportional fear of object/situation (> 6 months)
Social anxiety disorder
Excessive, disproportional fear of object/situation
Generalized anxiety disorder
Uncontrolled anxiety about multiple events occurring majority of days
OCD
Recurrent obsessions (thoughts, impulses, images) and compulsions (actions/behaviors); don’t need to be related
PANDAS
Pediatric autoummune neuropsych disorder associated with strept infection
What is the Yale-Brown OCD Scale? (Y-BOCS)
Objective scale to qualify and quantify symptoms and severity of OCD. Useful for measuring changes over time
Hoarding disorder
Difficulty parting with possessions
BDD
Imagined/minor body defect - face
Excoriation disorder
Skin picking/lesions
Tricotillomania
Hair pulling
Differentiate between PTSD and ASD
Time – ASD usually starts/resolves within 1 month
What is adjustment disorder?
Psycho-social stressor – ordinary life experience; acute onset 3-6 months in duration; goes away once the person has adapted to the stressor?
Somatic symptom disorder
More than one somatic disorder; excessive thoughts, feelings, behavior; persistent symptomology
What are the 4 criteria for PTSD?
- Intrusion- dreams, recollection, recurring feelings
- Avoidance- thoughts, places, conversations
- Negative alterations cognition/mood
- Alterations in arousal/reactivity
Illness anxiety disorder
Preoccupation with having an illness despite no somatic symptoms
Conversion disorder
Incompatibility between symptoms and neurological findings
Factitious disorder vs. Malingering
No external incentive for factitious
What are the 2 major dissociative disorders?
- D Amnesia disorder +/- fugue
2. D Identity disorder
T/F Dissociative disorders are a way to cope with stress
True
What are the 3 types of dissociative amnesia?
- Localized (to time)
- Selective
- Generalized
How do you differentiate between physical vs. psychological amnesia?
Mental status exam; physical – anterograde
What is fugue?
Purposeful travel
What is the formal name for multiple personality disorder?
Dissociative identity disorder
Differentiate between depersonalization and derealization.
Depersonalization: thoughts, feelings, actions, sensation
Derealization: surroundings
What is the DDx for dissociative disorders
Metabolic, neuro, other pathology
How are dissociative disorders treated?
CBT +/- therapy
T/F Substance disorders affect males > females
True (young males)
What are the 5 major pillars of drug addiction
- Stimulation reward circuitry
- Stimulation reward pathway – prefrontal/alters self-control
- Physical withdrawal
- Decreaed dopamine availability (protracted abstin)
- Environment + internal cues
How does a clinician assess substance problems?
CAGE, FOY
What are the factors that contribute to the risk of becoming addicted?
- Genetics (50%)
2. Psycho-social: age, method admin, culture, job, other mental illness
What are the accepted number of drinks per day and week for men and women?
Men: 4, 14
Women: 3, 7
Formication
Bugs under skin (sedative withdrawal)
Cell bodies for neurons that release NE are in:
Locus ceruleus (trauma center)
Locus ceruleus is inhibited by
Opioids
Cell bodies for neurons that relase 5-HT are in:
Raphae nucleus
What is the difference between Schedule 1 & Schedule 5 drug?
Schedule 1: Cannot prescribe/administer
Schedule 5: Least harmful
What are the 3 major substance disorders?
- Intoxication
- Withdrawal
- Substance use disorder
What type of pharmacological therapy can be used for addiciton?
Benzos/ETOH (STM)
Decrease craving – block effect of drug
Aversion therapy
The major excitatory/inhibitory neurotransmitters in the brain…
Excitatory: Glutamate (NMDa)
Inhibitory: GABA
How many areas are in the association cortex for the cortex vs. limbic system?
Cortex: 2
Limbic: 3
What types of drugs utilize GABA channels?
Barbs and benzos
T/F Anti-anxiety drugs suppress the locus cereulus
True
What drug, if administered during a trauma, can decrease the risk of PTSD development in the future?
Morphine
Following anoxia, Glutamate is released from ____ into ______ which further stimulates more release of glutamate.
ICF into ECF
Differentiate between dorsolateral and orbital pre-frontal.
Dorsolateral: thinking – apathy, inactivity, planning
Orbital: Limbic connections (Gage), feelings, social behavior
When it comes to hypothetical thinking, there are 2 major routes in the brain…
PTO: L-language, sequential; R-spatial, facial recognition
Dorso-lateral pre-frontal: abstract thinking, memory, planning
Prosody; which hemisphere?
Subtle aspects of speech / R-hemisphere
The 4 major categories of drugs…
- Opioids - narcotics, analgesia, euphoria, heroin
- Sedatives - ETOH, benzo, barbs
- Hallucinogens - LSD, PCP, ketamine
- Stimulants - Amphetamines, cocaine
Differentiate between Naloxone and Naltrexone
Naloxone - treat an overdose – STM opioid R blocker
Naltrexone - long-acting opioid receptor blocker to block effects during relapse
Differentiate between methadone and buprenorphine
Methadone: Schedule 2 (can only be administered)
Buprenorphine: Schedule 3
T/F Withdrawal from opioids can be lethal
False – like the flu
3 potential pharmacological treatments for ETOH abuse:
Naltrexone -block pleasurable effects
Disulfiram (Antabuse)
Acamprosate (NMDA R antag); decreased unpleasant feelings with protracted abstinance
T/F Withdrawal from sedatives can be lethal
True
What are the 3 categories of hallucinogens? Which category has withdrawal?
Classic- LSD
Cannabis- Withdrawal!
Dissociative anesthetics- PCP
Pupils: dilated, red, nystagmus (Name that hallucinogen)
Dilated: LSD
Red: Cannabis
Nystagmus: PCP
T/F Withdrawal from stimulants can be life threatening.
False
Name 2 drugs that can be used for treatment of nicotine withdrawal
Buproprion (Zyban), Varenicline (Chantix)
Name the classes of anti-psychotic drugs
- Classic – Chlorpromazine, Haldol (EPS)
- Atypical – First (Clozapine, D3/D4 - EPS, + agranulocytosis); Newer (Olazepine, quetiapine, ziprasidone – less blood monitoriting)
Schizophrenia results from a functional deficit in the _______________ _____________ tracts from the ventral tegmental area to the pre-frontal cortex
Ascending dopamine
There are 4 major dopamine pathways, associated with 3 disorders
MB/ventral tegmentum: Schizophrenia
Nigrostriatal: Parkinson’s
Tuberoinfundibular: gynecomastia
Retina/Olfactory bulb
Binary vs. Continuous variables (chi2, t-test, Fisher’s exact, rank sum)
Binary: Fisher’s exact, chi2
Continuous: T-test, rank sum
T/F Schizophrenia is associated with too little DA in one tract, which is improved by blocking DA in another tract
True
Schizophrenia is associated with >= ___ of the following symptoms for one month, for a total duration of ____ months
2; 6
Active phase schizophrenia symptoms
Delusions, hallucinations, disorganized speech/thoughts, disorganized/catatonic behavior
Differentiate between good/bad prognosis Schzophrenia symptoms
Good: late onset, rapid, + symptoms
Bad: early, slow onset, - symptoms
Blocking D2 receptor can have the following side effects:
Non-adherence, weight gain, impotence, extrapyramidal symptoms
What are the key things to tell patients on anti-psychotics?
Not addicting, treat side effects (restlessness, nervousness), avoid amphetamines, L-dope, tardive dyskinesia
______________ (drug) blocks DA reuptake and can potentates the effect of DA
Cocaine
A pleasure center in the brain
Nucleus accumbens
____________ transporters are considered the brain’s cocaine receptors
DA
Delusional disorder
> 1 month, normal function, erotomania, grandiose, jealous, somatic
Brief psychotic episode
1 day-1 month (>=1 core symptoms)
Schizophreniform
1-6 months (>=2 core symptoms)
Schizoaffective disorder
Major mood disorder (active phase schizophrenia >=2 weeks)
Male hyopactive sexual desire disorder
Decreased libido
Female sexual interest/arousal disorder
Decreased libido
Female orgasmic disorder
Delay/low intensity orgasm
Genito-pelvic pain/penetration disorder
Pain during intercourse
How do you assess sexual dysfunction disorders?
Sexual history (psycho/phsyio) Medication side effect, drugs, medical problems
Snap gauge test
Roll of stamps/erection
What is sensate focus?
Focus on non-coital foreplay
What is the overall treatment strategy for sexual dysfunction?
P- permission
LI- limited sex edu
SS- specific suggestions, sensate
IT- intensive therapy
When does a paraphilia become a disorder?
When it is done on non-consenting people
Frotteuristic
Touching/rubbing in crowded places
T/F Serotonin dysregulation can be associated with paraphillic disorders
True
What is covert sensitization?
Aversion therapy – imagining an unpleasant situation
What is medroxyprogesterone acetate (Depo Provera)?
Anti-androgen, can be used to decrease testosterone levels and libido
Differentiate between anorexia and bullimia with respect to weight.
Bullimia: normal or over-weight
What are the clinical questions to ask about eating disorders?
Sick / induce vomiting Control / lose control? One stone (14 lbs) Fat / believe fat? Food / dominate?
Differentiate between bipolar I and II and cyclothymic disorder
Bipolar I: at least 1 manic
Bipolar II: at least 1 hypomanic & major depressive episode
Cyclothymic: mild hypomania/depression
Differentiate between a manic and hypomanic episode.
Manic: 3 of 7 days, + self-esteem, no sleep, talkative, flight ideas, distractable
Hypomanic: 4 days, no psychotic features, no impairment in function
What is the minimum time for a major depressive episode?
2 weeks
What are symptoms of a major depressive episode?
> =5 – Depressed mood or loss of interest
+ sleep, guilt, energy, concentration, appetite, psychomotor, suicide
What is persistent depressive disorder?
2 years; chronic major depressive disorder/dysthmia
What is disruptive mood dysregulation?
Persistent irritability (age 6-18); starts at age 10
Reactive sadness and bereavement are…
Normal reactions to minor/major loss that does not interfere with function
The trauma center in the brain is _________________, which is inhibited by these types of drugs ___________________.
LC, which is inhibited by opioids
Intra/Extracellular: MAO, COMT
MAO-intraneurally
COMT- extraneurally
NE cell bodies are located here:
locus cereuleus
T/F NE is upregulated in mania and decreased in depression (along with 5-HT)
T
How is bipolar disorder treated pharmacologically?
Lithium/Anti-epileptics – mood stabilizers
Quetiapine: atypical anti-psychotics
How are mood disorders treated?
Psychotherapy, SSRI, tricyclics, MAOI
T/F ECT can induce new neuron generation in the hippocampus
T
Narcolepsy is characterized by these 3 features:
Cataplexy (loss of muscle tone), decreased hypocretin (hypothalamic neuropeptide), PSG anormalities (decreased REM, but sleep onset REM)
Differentiate between hypnogogic and hypnompic.
Hypnogogic: sleep onset hallucinations
Decreased/Incresed/Dysregulated: NE, 5-HT
Mania vs. Depression
Depression: NE decreased
Mania: NE increased
Piaget’s 4 factors that influence cognitive development
- Nervous system maturation
- Experience/Environmental stimulation
- Social transmission of information
- Equilibration: assimilation/accommodation; exisiting constructs are changed as a result of new experiences
What are effects of insecure attachment in early childhood?
- Deprivation/ socially incompetent
- Traumatic sepn/ anaclitic depression
- Lack of human contact –> failure to thrive
.
Language 2-3 months, 3-4 months, 10 months, 12 months, 24 monts
2-3: coo 3-4: babbling 10: babbling household jargon 12: one word 24: two words 24+: sentences
What are the four categories of attachment and their causes?
- Securely attached
- Insecurely – anxious avoidant (comfort denied to child), anxious resistant (parental inconsistency), disorganized (abuse/parental depression)
T/F Echolalia is a red flag for development. What is it?
True; repeating communicative speech
The 4 categories of the Denver development scale
- Gross motor
- Fine motor
- Personal/social
- Language
Worldwide causes of death (neonate - 5 yrs old)
- Neonatal deaths
- Acute respiratory infection
- Diarrhea
US infant deaths < 1 y.o.
- Congenital abnormalities
- LBW
- SIDS
US deaths 1-4; 5-16; 16-19
1-4
- Unintentional injury
- Congenital abnormality
- Homicide
5-16
- Unintentional injury
- Malignant neoplasm
- Congenital abnormality
16-19
- Unintentional injury
- Homicide
- Suicide
What is the single most important determinant of health?
Poverty
Describe Piaget’s 4 stages of cognitive development.
- Sensorimotor (senses and actions)
- Preoccupational (lacks logic)
- Concrete operational (logical reasoning)
- Formal operational (abstract reasoning)
Describe Kohlberg’s stages of moral reasoning.
Punishment orientation, reward orientation, good boy/good girl, authority orientation, social contract orientation, ethical orientation
Avoid punishment
Obtain rewards
Conform to avoid disapproval
Uphold social rules to avoid guilt
What are the 5 stages of dying process?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What are the 3 stages of grief?
- Acute disbelief
- Grief work
- Resolution
What is the most common complaint of the terminally ill patient?
Pain
How do the following people mourn:
- Infant
- Children
- Adolescent
- Adult
- Elderly
Infant - withdrawn
Child - cliniging, hyperactivity, self-blame
Adolescent - impulsive, substance x, sex
Adult - illness, substance x, grieving
Elderly - withdrawn, high death rate within 1 year
