Neurotic, Stress-related and Somatoform disorders (F4) Flashcards
1
Q
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Anxiety disorders
D/dx
A
GAD
Panic disorder
Social phobia, Agoraphobia
Specific phobia
MADD
2
Q
*
Stress-related disorders
A
Acute stress reaction (<1h – few days or 3d – 1m)
PTSD (onset <6m)
Adjustment disorder (<3m)
3
Q
*
Secondary stress disorders
A
Other psychiatric disorders: Eating disorder, depression, OCD, personality disorders, Schizophrenia
Medical: Thyroid, DYSPNEA, Brain trauma, Dementia BPSD
Drugs: stimulants, hallucinogens, alcohol
4
Q
*
Somatic and psychological symptoms of anxiety
A
6A
Apprehension, Arousal, Avoidance, Anticipatory avoidance, Autonomic Activation
5
Q
History taking questions for anxiety
A
6
Q
History taking questions for functioning in anxiety
A
7
Q
Classification of anxiety disorders (ICD-10)
A
Phobic = Agoraphobia, Social, Specific
Others = Panic, GAD, MADD
8
Q
GAD
Epidemiology
A
9
Q
*
GAD
Clinical features
A
Excessive persistent widespread worry
Psychological: Arousal, Irritability, poor concentration, noise sensitivity
Somatic: Autonomic Activation, Muscle tension, Hyperventilation, Sleep disturbance
10
Q
GAD
Clinical course
A
Gradual onset chronic fluctuating low remission rate
11
Q
*
GAD
Diagnostic criteria (DSM-5)
A
REDIMS
12
Q
GAD
Differentiation with depression
A
13
Q
GAD
Differentiate with panic disorder
A
14
Q
GAD
Differentiate with social anxiety disorder
A
15
Q
GAD
Differentiate with OCD
A
16
Q
GAD
Differentiate with stress-related disorder, hypochondriacal disorder, SA
A
17
Q
GAD
Differentiate with physical illnesses
A
18
Q
GAD
Biological factors/ pathophysiology
A
19
Q
GAD
Psychological factors
A
20
Q
GAD
Developmental factors
A
21
Q
*
GAD
Management
A
Stepped Care Approach
Self-help/ group psychoeducation»_space; CBT/ Applied relaxation»_space; Drugs
Acute: BZD, Buspirone, B-blocker
Chronic SSRI, SNRI, Pregabalin, Mirtazapine +/- SGA
22
Q
GAD
Psychotherapy methods
A
23
Q
GAD
Acute treatment
A
24
Q
GAD
Long-term treatment
A
25
Panic disorder
Epidemiology
26
Panic disorder
Clinical features
Recurrent (>1/month), Unexpected panic attacks
+ Worries/ maladaptive behaviour about occurrence
+ Worries about consequences of panic: losing control, dying, being judged
27
# *
Panic attack
Somatic and psychological symptoms
Head to toe physical symptoms
Derealization
Depersonalization
Fear of losing control, going mad, dying, catastrophic outcome
28
# *
Panic disorder
DSM-5 diagnostic criteria
29
# *
Panic disorder
D/dx
Anxiety disorders
Somotoform disorders: with multiple physical symptoms
Psychotic disorder, depression
Substance abuse
Medical: Endocrine, Seizure, Dyspnea
30
Panic disorder
Course and prognosis
31
Panic disorder
Biological factors
32
Panic disorder
Psychological factors
33
Panic disorder
Social factor
34
# *
Panic disorder
Management
Acute: BZD
Stable: SSRI, SNRI, Mirtazapine, TCA, MAOI for >6 months
Psychotherapy: Relaxation training, CBT
35
Phobic anxiety disorder
Triggers
Key features
Clinical syndromes
36
Specific phobia
Epidemiology
37
Specific phobia
Clinical features
38
# *
Specific phobia
DSM-5 criteria
Marked fear/ anxiety about ____
____ provoke fear/ anxiety
____ is actively avoided or endured with intense fear/ anxiety
____ is out of proportion to actual danger posed by situation
Fear/ anxiety lasts at least 6 months
Causes clinically significant distress/ functional impairment
Not better explained by another mental disorder, Not due to SA
39
Specific phobia
D/dx
40
Specific phobia
Etiology
41
# *
Specific phobia
Management
Exposure- based psychotherapy
- Graded exposure: In vivo, Imaginary, VR
BZD for acute
42
Social phobia
Epidemiology
43
Social phobia
Clinical features
44
# *
Social phobia
DSM-5 criteria
Marked fear/ anxiety about ____
____ provoke fear/ anxiety
____ is actively avoided or endured with intense fear/ anxiety
____ is out of proportion to actual danger
Fear/ anxiety lasts at least 6 months
Causes clinically significant distress/ functional impairment
Not better explained by another mental disorder, Not due to SA
45
Social phobia
D/dx
46
Social phobia
Etiologies
47
# *
Social phobia
Management
CBT: Psychoeducation, Cognitive restructuring, Exposure therapy
Drugs: SSRI/ SNRI >6 months, BZD/ B-blocker for acute, Pregabalin/ Gabapentin
48
Agoraphobia
Epidemiology
49
Agoraphobia
Clinical features
50
# *
Agoraphobia
Diagnostic criteria
51
Agoraphobia
D/dx
52
Agoraphobia
Etiologies
53
# *
Agoraphobia
Management
CBT: Exposure-based psychotherapy
Drug: SSRI/ SNRI, BZD for acute, TCA/ MAOI if needed
54
OCD
Epidemiology
55
# *
OCD
Clinical features
Repetitive stereotyped thoughts and acts with
- Sense of compulsion, resistance, ego-dystonic (senseless)
- With anxiety, depression
- With avoidance of OC tiggers
- Functional impairment
Associated with PRIORS - phobia, rituals, impulse, obsessional rumination, slowness
Obsessional ruminations (Internal debates), Impulse (urge to perform act), Rituals (Mental or senseless behaviour), Slowness, Phobias (avoidance behaviours)
56
Define obsessional ruminations
57
Define Obsessional impulse
58
Define obsessional rituals
59
Define obsessional slowness and phobia
60
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Common themes of obsessions and compulsions
**Orderliness**: rearranging/ counting
Cleanliness/ **Hygiene**
**Doubt**/ Checking
**Reprehensive thoughts**: Aggression, Blasphemous, Sexual
**Reprehensible acts**: seeking reassurance, redemption, avoidance
61
# *
OCD
Diagnostic criteria
Obesession, Compulsion or both
Obsession
- Recurrent and persistent thoughts, urges or images
- Intrusive and unwanted
- Cause marked anxiety
- Tries to ignore/ suppress/ neutralize with other thoughts or action
Compulsion
- Repetitive behaviour or mental acts
- Feel driven to perform/ according to rigid rituals
- Acts prevent/ reduce anxiety or prevent dreaded event
- Not connected in realistic ways and clearly excessive
Both: Time consuming, significant distress, functional impairment
Not due to SA or medical or another mental disorder
62
# *
OCD
D/dx
Anxiety, Depression, Psychosis (Delusions)
Other specific OCD: Hoarding, Body dysmorphia
Tics/ Stereotyped movements
Encephalitis lethargica
63
OCD
Course and prognosis
64
OCD
Biological factors
65
OCD
Psychological and social factors
66
# *
OCD
Management
Psychosocial intervention: Psychotherapy, Exposure and Response Prevention therapy, Cognitive therapy
Drug: SSRI>> SSRI/ SNRI >> Clomipramine >> SGA/ Combine Citalopram + Clomipramine
Surgery: Orbitomedial/ Cingulate lesioning, Deep brain stimulation
67
Define stress event
68
Define traumatic stress
69
Emotional response to stress
70
Coping strategies to stress
3 ways: Problem solving, emotion reducing, Maladaptive response
71
# *
Defence mechanisms to stress
R2D2 Is Stressed
Repress
Regress
Reaction formation
Rationalization
Denial
Displacement
Sublimation
Identification
72
# *
Define the stress-vulnerability model
73
# *
Classification of reaction to stressful event
74
# *
Define timing of stress disorders
Reaction <1h – few days
Disorder 3d – 1month
Adjustment <3months
PTSD <6months
75
Risk factors of acute stress disorder
76
Risk factors of PTSD
77
# *
PTSD
Clinical features
RAAA! Reaction After An Assault <6 months
Re-experience: Intrusive images, Dissociative flashbacks, Recurrent dreams
Avoidance: Dissociative amnesia, Emotional detachment, Avoidance of reminders
Arousal: Hypervigilance, Irritable, Behavioural
Associated: Depression, Dissociation
78
PTSD
Associated symptoms
Time frame
Course
79
Acute stress disorder
DSM-5 criteria
80
# *
PTSD
DSM-5 criteria
81
PTSD
D/dx
82
PTSD
Biological, psychological, social factors
83
# *
Acute stress disorder
Management
Trauma-focused CBT: Psychoeducation, Cognitive restructuring, Exposure therapy
Critical incident stress debrief
Pharmacotherapy
84
# *
PTSD
Management
Trauma- focused CBT
Eye movement desensitization and reprocessing (EMDR)
CBT: Coping skills, stress management, hypnotherapy, IPT
Drug: SSRI/ SNRI/ SGA/ a-blocker, BDZ
85
# *
Adjustment disorder
Clinical features
86
# *
Adjustment disorder
DSM-5 criteria
87
Adjustment disorder
D/dx
88
# *
Adjustment disorder
Management
Problem solving counselling
Psychotherapy
Pharmacotherapy - anxiolytics, hypnotics only
89
Somatoform disorder
Define medically unexplained symptoms
90
# *
D/dx medically unexplained symptoms
Somatoform
- Somatic symptom disorder: somatic symptom with distress/ functional impairment
- Conversion disorder: neurological symptoms unexplained
- Hypochondriacal disorder: fear of underlying serious disease
- Body dysmorphic disorder: defect in physical appearance (not weight)
Fake:
- Factitious disorder: Intentional fabrication of symptoms
- Malingering: fabrication for secondary gains
Secondary to:
- Delusion disorder
- Physical symptoms of depression and anxiety disorders
91
# *
Medically unexplained symptoms
Features
92
Somatoform disorder
Define somatization, functional somatic symptoms, medically unexplained symptoms
93
Somatoform related disorders
Classification
94
Somatoform disorder
Epidemiology
95
# *
Somatoform disorder
Clinical presentation
96
Somatoform disorder
Clinical course
97
# *
Conversion disorder
Pathogenesis
S/S
Mx
Neurological symptom +/- Belle indifference
98
# *
Somatoform disorder
DSM-5 criteria
99
# *
Somatoform disorder
D/dx
100
Somatoform disorder
Biological, psychological and social factors
101
# *
Somatoform disorder
Management
Reassurance: real symptoms, explain psychosocial factor, allow time for questions, agree on treatment plan, treatment of minor ailments and psychiatric disorder
Refractory: Relaxation training, CBT, Antidepressants
102
Hypochondiracal disorder
Epidemiology
Clinical presentation
103
# *
Hypochondriachal disorder
DSM-5 criteria
Preoccupation with having serious illness
Mild/ absent symptoms
Preoccupation is clearly excessive/ disproportionate
Anxiety about health, easily alarmed by personal health
Excessive health-related behaviours
Maladaptive avoidance
>6 months
Not another mental disorder
104
# *
Hypochondriachal disorder
Management
CBT
Mindfulness based cognitive therapy
Antidepressants
105
Compare somatoform, factitious disorder, malingering
106
Factituous disorder
Presentation
107
Malingering
Features
108
# *
Body dysmorphic disorder
Clinical features
109
# *
Body dysmorphic disorder
Diagnostic criteria
Management
