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Question 1

Schizophrenia criteria:

Answer 1

must have at least 1 of these and it has to interfere w/ daily living

Delusions, hallucinations, disorganized speech x 6 months

*If >1 month and <6 months: Schizophreniform disorder!!
NOT Schizophrenia!!

Question 2

Atypical antipsychotics for schizophrenia

Answer 2

Better for neg sx and cog dysfxn

Clozaril - reduces depression! :D
ADR: agranulocytosis, sz!
Monitor: WBC every week for 1st 6 months and every 2 wks forever :[

Question 3

Schizoaffective disorder criteria

Answer 3

Schizophrenia + major mood disorder x 2 wks

Question 4

Brief psychotic disorder

Answer 4

Delusions/hallucinations/ disorganized speech or behavior that returns to previous level of fxn x 1 day and < 1 month

Question 5

Delusional disorder criteria

Answer 5

Delusion + no other sx of schizophrenia x 1 month

Question 6

Substance/Med Induced Psychotic Disorder

Answer 6

Psychosis sx during or soon after substance intoxication or as part of w/drawal sx

Question 7

Major Depressive Disorder Criteria

*most resolve spontaneously in 6 months w/o tx

Answer 7

At least 5 of 9 sx x 2 wks
+ one must be Depressed mood or Anhedonia
+ exclude other medical conditions or substance abuse
+ no evidence of mania, hypomania or mixed episode
+ must cause sig stress and disturb normal fxn

*If >2 yrs: Persistent Depressive d/o

Question 8

Insomnia types

Answer 8

Initial: difficulty falling asleep
Middle: wake up in middle of night
Terminal: cannot make it through the night → *sign of severe depression!

Question 9

Manic Episode Criteria

Answer 9

DIGFAST

3 listed sx or 4 if mood is irritable
+ Abnml persistent elevated, expansive or irritable mood x 1 wk [Any duration of elevated mood if hospitalization is required] + exclude other medical conditions and substance abuse + causes sig distress

Question 10

Bipolar I Criteria

Answer 10

*more severe than Bipolar II

1 manic episode or mixed episode

Question 11

Bipolar II Criteria

Answer 11

1+ major depressive episode + 1 hypomanic episode
*no full blown manic episode - if it does occur, they are now Bipolar I
Rapid cycling: 4+ episodes/yr

Question 12

Mood disorder Criteria

Answer 12

Episodic + switch to opposite state or 2+ months of partial or full remission after an episode

Question 13

Most common elderly complaint of MDD

Answer 13

New somatic complaint, loss of interest, panic attack

*⅕ of severely depressed will have psychotic sx!

Question 14

MDD Rx regimen

Answer 14

Rx x 4-8 wks before inc dose or changing to different antidepressants
Once recovered: therapeutic dose x16-36 wks
*always check half lives to know how to taper!
If [+] psychotic sx: + antipsychotic

Question 15

Hypomanic Episode Criteria

Answer 15

Abnml persistent elevated, expansive or irritable mood x 4 days but < 7 days

Similar sx to manic but less severe and briefer
No delusions, hallucinations, hospitalizations, and doesn’t impair social fxn

Question 16

Cyclothymic Disorder Criteria

Answer 16

Mild swings b/w mild depression and hypomania x 2 yrs and not w/o sx for > 2 mths
No evidence of psychotic sx, no sig stress or social impairment

Question 17

Persistent Depressive Disorder Criteria

Answer 17

2 of 6 sx + Depressed mood x 2 yrs most days than not

Question 18

When to do full workup before referring to psych

Answer 18

No previous hx, lower SES, elderly

Question 19

Alcohol Use D/o

Indirect tests [long term damage]

Answer 19

CBC,
CMP
carbohydrate deficient transferrin [low after excessive consumption]
Thiamine [Wernike!]
Folate [anemia, HA, fatigue, glossitis]

Question 20

Alcohol use

Answer 20

Direct Test to evaluate for alcoholism
BAC
> 300 mg/dL: abuse d/o!
> 150 mg/dL w/o gross evidence of intoxication
> 100 mg/dL upon routine exam

Question 21

Most common sx for alcohol withdrawal

Answer 21

delirium

Confusion and autonomic hyperarousal

Question 22

Alcohol use d/o tx

Answer 22

Disulfiram - for committed pts who want to stop drinking

Naltrexone - not for liver dz!

Acamprostate: reduces craving

Question 23

Substance-related Disorders Criteria

Answer 23

2 of 11 behaviors x 12 mths + interfering w/ life

Assessment: PHQ-9 and CAGE questions, complete MSE, social hx, hx from fam/friends,

Question 24

EARLY Physical exam for alcohol use

Answer 24

rosacea
palmar erythema
palpable liver from fatty liver dz
resp infxn
Easy bruising

Question 25

Late Physical exam for alcohol use

Answer 25

caput medusae
ascites
jaundice
esophageal varices/hemoptysis/hematochezia

Question 26

What is the CIWA

what is the max score

Answer 26

clinical institute withdrawal assessment of alcohol

Max score of 67

Question 27

Most common time of relapse

Answer 27

During 1st 6 mths following initial tx

Question 28

Somatic Sx D/O Criteria

Answer 28

Somatic sx: any sx that disrupts life + excessive thoughts + disproportionate & persistent thoughts about seriousness of one’s sx x 6 mths

Question 29

Conversion disorder criteria

Pop: Women, lower income, lower educational level, rural areas

Answer 29

Voluntary motor or sensory fxn loss and not consistent w/ any known illness
x 6 mths [acute is < 6, chronic is > 6]

If pt’s main complaint is limited to PAIN: Somatic Symptom D/O!

Question 30

Illness Anxiety Disorder Criteria

Answer 30

Preoccupation w/ having or acquiring a serious illness

Disrupts life x 6 mths

Question 31

Factitious disorder

Answer 31

Falsification of physical or psychological s/sx or induction of injury or dz
Get psych consult!
If [+] external gain: malingering

Question 32

Dissociative identity d/o

Answer 32

2+ distinct personality states, marked discontinuity in sense of self, memory gaps, disrupts life
Pop: women, childhood, sex abuse

Question 33

Dissociative amnesia

Answer 33

Can’t recall important info usually hx traumatic event

Question 34

Depersonalization/

derealization d/o

Answer 34

Cut off from own thoughts, “outside observer” of their life