PANCE Review Flashcards
Autism
Clinical Features: evident between 12-24 months with onset before 36 months
Signs: emotional detachment, no eye contact, unable to communicate, face scratching, head rubbing, impulsivity
Diagnostic: psych interview, psychological testing, family and social history, physical exam
Management: referral to child psychiatrist, intensive multi-discipline learning support services
Pharmacotherapy only used for specific symptoms
Conduct Disorder
Disruptive, willfully disobedient behaviors, violation of the rights of others, age-inappropriate patterns of behavior
ADHD and ODD often precede or coincide with the development of conduct disorder
Clinical Features: (demonstrate at least 3 of the following) stealing, lying, property destruction, running away from home, violating curfew, truancy, cruelty to animals, bullying, lack of remorse
Rule out common concurrent diagnosis (ADHD, anxiety, substance use)
Management: individual psychotherapy, behavior modification, parental counseling
Psychopharmacologic: methylphenidate, TCAs (desipramine), antihypertensives (clonidine), mood stabilizers
Oppositional Defiant Disorder
Definition: Milder form of chronic behavior problems than seen in conduct disorder
Etiology: Parental inability to reward good behavior or set firm, fair, consistent limits. boys over girls
Clinical Features: stubborn, negativistic, provocative, hostile, and defiant.
No typical violation of others’ rights
Diagnostic: psychiatric interview, psychologic testing to rule out low IQ or learning disability
Management: psychotherapy
ADHD
Etiology: 3-7% incidence in school age children
Clinical Features: six or more symptoms of hyperactivity or inattention
Diagnostic: structured psychiatric interview
cognitive testing
Management: behavioral intervention with the addition of pharmacologic treatment
Pharmacotherapy: Methylphenidate, Dextroamphetamine sulfate, atomoxetine
Inattention Criteria
Difficulty following instructions short attention span at work and play does not appear to be listenting loses things makes careless mistakes difficulty organizing forgetful avoids engaging in "effortful" mental activities
Hyperactivity Criteria
Fidgety or restless
Difficulty staying seated
Difficulty waiting in lines or awaiting his or her turn
Impulsive or intrusive speech
Difficulty playing quietly
Running about or climbing excessively in situations in which these activities are inappropriate
May display significant variabilty in symptoms
Potentially dangerous, impulsive behavior
Mental Retardation
IQ below 70
Etiology: genetic, chromosomal and inherited conditions, prenatal exposure to infections, toxins, fetal alcohol syndrome
Clinical Features: deficits in age-appropriate adaptive functioning (communication, self-care, home living, social skills, self-direction, work, health, safety)
Craniofacial, skeletal, cardiovascular, neurologic, and stature abnormalities may also be present.
Diagnostic: Vineland Adaptive Behavior Scales, Structured psych interview, intelligence testing, hearing and speech eval, clinical observation
Management: Primary - actions to eliminate or reduce the conditions that lead to development of the disorder (genetic counseling, family counseling)
Secondary- treatment to shorten the course of the illness (PKU, hypothyroid)
Tertiary - treatment to minimize the sequelae or consequent disabilities
Pyshocotherapy, pharmacotherapy, environmental interventions
Down’s Syndrome
General hypotonia Oblique palpebral fissures Slanted eyes, flat nose Protruding tongue Moro reflex - weak for absent Single palmar transversal crease
Fragile X Syndrome
Large, long head and ears
Short stature
Postpubertal macro-orchidsm
Intellectual function declines in the pubertal period
Prader-willi Syndrome
Compulsive eating behavior Hyperphagia Obesity Hypogonadism Small stature Hypotonia Small hands and feet
Cat’s Cry (CRI-DU-CHAT) Syndrome
Severly retarded Microcephaly Low-set ears Oblique palpebral fissures Hypertelorism Micrognathia
Phenylketonuria (PKU)
Hypereactive Erratic Eczema Vomiting Convulsions Temper Tantrums Perceptual difficulties Poor concentration
Mental Retardation Classification
Mild: 50 to 55-70
Moderate: 35 to 50-55
Severe: 20 to 35-40
Profound: below 20 or 25
Anorexia Nervosa
Self-induced starvation, relentless drive for thinness, morbid fear of fatness, medical signs and symptoms of starvation.
Clinical Features: BMI < 17, refusal to maintain body weight, absense of at least 3 consecutive menstrual cycles
Diagnostic Studies: full psych and physical exam, VS may reveal hypotension and bradycardia, significant skin and hair changes. CBC: leukocytosis, leukopenia or anemia,
hypokalemia, hypothyroid, ST segment and T-wave changes, hypercholesterolemia
Treatment: CBT, SSRIs, Cyproheptadine (periactin) may increase appetite.
SCOFF Questionaire
Do you make yourself sick because you feel uncomfortably full?
Do you worry you have lost control over how much you eat?
On average, have you lost over one pound per week during the last 3 months?
Do you believe yourself to be fat when others say you are too thin?
Would you say that food dominates your life?
Bulimia Nervosa
Compensatory purging behavior, pts are normal weight, overweight or have a history of obesity.
Clinical Features: Behaviors occur at least twice a week for 3 months
Diagnostic: hypotension, bradycardia, pitting or erosion of tooth enamel, calluses may be present on fingers, hypokalemia, hypomagnesemia, hyperamylasemia
Treatment: CBT, Prozac for underlying mood disorder, TCAs have been effective in reducing binge-purge cycle
TCAs: used with caution due to increased risk of cardiovascular side effects especially in electrolyte abnormalities.
Cluster A Disorders
Schizoid Personality Disorder
Inability to form relationships or respond to others in a meaningful way, social withdrawl, absense of clearly diagnosed thought disorder or delusional thinking
Absense of relatives with schizophrenia differentiates it from schizophrenia
May have successful work histories, differentiating it from schizotypal personality disorder and schizophrenia
Management: psychotherapy
Cluster A Disorders
Schizotypal Personality Disorder
laughs inappropriately during conversations, exquisitely sensitive to and aware of the feelings of others, especially negative feelings such as anger
Absense of psychosis, except rare “fragmented” episodes of psychosis while under stress, differentiates this disorder from schizophrenia
May be precursor of schizophrenia
Management: Psychotherapy, Pharmacotherapy: antipsychotics for symptom treatment
Cluster A Disorders
Paranoid Personality Disorder
Suspiciousness, systemized delusions of persecution or grandeur without hallucinations.
Clinical Features: Interprets other people’s actions as deliberately demeaning or threatening. “reads” hidden, demeaning, or threatening meanings into benign remarks or events. unforgiving of insults, injuries, or slights
Differentiated from paranoid schizophrenia by absense of hallucinations or formal thought disorders
Management: Psychotherapy (avoid interpersonal closeness)
Pharmacotherapy (benzodiazepines for anxiety, antipsychotics - thioridazine or haloperidol for agitation / quasi-delusional thinking
Cluster B Disorders
Antisocial Personality Disorder
Evidence of conduct disorder with onset is present before 15 years of age
Clinical Features: Inability to conform to the social norms, repeated infractions of the law, lack of remorse, reationalizing their actions, impulsivity, irritability and aggressiveness
Diagnostic: abnormal EEG, soft neurologic signs, history of brain damage in childhood
Management: psychotherapy, pharmacotherapy only with incapacitating symptoms
Cluster B Disorder
Borderline Personality Disorders
Pervasive pattern of instability in relationships, affect, and self-image, accompanied by chronic impulsivity in response to such. “state of crisis”, mood swings, repetitive self-destructive acts
Diagnostic studies: psychiatric interview, psychologic testing, diagnosed by early adulthood
Management: structured and directive psychotherapy, firm limit setting
pharmacotherapy: antipsychotics for anger and hostility and brief psychotic episodes. Antidepressants for depression. mood stabilizers for global functioning
Cluster B Disorders
Histrionic Personality Disorder
Clinical Features: excitable, emotional, colorful, dramatic, extroverted, attention-seeking behavior, reality testing becomes impaired under stress
Diagnostic Studies: structured psychiatric interview- cooperative and eager to provide a detailed history.
Management: psychoanalytically-oriented psychotherapy is treatment of choice
Cluster B Disorders
Narcissistic Personality Disorder
grandiose, excessive sense of self-importance
Diagnostic: psychiatric interview
Management: psychotherapy but often chronic and very difficult to treat. vulnerable to mid-life crisis
pharmacotherapy: lithium used in patients with mood swings
Cluster C Disorders
Avoidant Personality Disorder
inhibited social behaviors, feelings of inadequacy and insufficiency, hypersensitivity to rejection, need for unusually strong gaurantees of uncritical and unconditional acceptance
Diagnostic: psychiatric interview
Management: psychotherapy CBT
pharmacotherapy treat anxiety and depression, beta blockers to manage autonomic nervous system, serontonergic agents to help rejection sensitivity
Cluster C Disorders
Dependent Personality Disorder
pervasive and excessive expressed need to be cared for, nurtured, and emotionally protected. Difficulty making everyday descisions without an excessive amount of advice and reassurance from others.
Diagnostic: psychiatric interview
Differentiated from agoraphobia by the hgh levels of overt anxiety or even panic displayed in the latter.
Management: insight-oriented therapies, behavioral therapy, assertiveness training
Pharmacotherapy: treat anxiety and depression, imipramine for panic attacks or separation anxiety
Cluster C Disorders
Obsessive-compulsive Personality Disorder
Intense preoccupation with effecting orderliness in their lives, expressed perfectionism, and control over both mental thoughts (internal stimuli) and interpersonal (external) events and environments. The disorder itself created inefficiency and disruption in the lives of individuals by reducing flexibility and undermining true control over events and tasks. Background characterized by harsh disipline. When recurrent obsessions or compulsions are present, OCD is noted on AXIS I.
Diagnostic: psychotherapy
Management: nondirective therapy
pharmacotherapy: benzos can reduce sysptoms (short term)
Clomipramine and serotonergic agents useful with breakthrough symptoms.
