PANCE Review

Question 1

Autism

Answer 1

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

Question 2

Conduct Disorder

Answer 2

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

Question 3

Oppositional Defiant Disorder

Answer 3

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

Question 4

ADHD

Answer 4

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

Question 5

Inattention Criteria

Answer 5

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

Question 6

Hyperactivity Criteria

Answer 6

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

Question 7

Mental Retardation

Answer 7

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

Question 8

Down’s Syndrome

Answer 8

General hypotonia
Oblique palpebral fissures
Slanted eyes, flat nose
Protruding tongue
Moro reflex - weak for absent
Single palmar transversal crease

Question 9

Fragile X Syndrome

Answer 9

Large, long head and ears
Short stature
Postpubertal macro-orchidsm
Intellectual function declines in the pubertal period

Question 10

Prader-willi Syndrome

Answer 10

Compulsive eating behavior
Hyperphagia
Obesity
Hypogonadism
Small stature
Hypotonia
Small hands and feet

Question 11

Cat’s Cry (CRI-DU-CHAT) Syndrome

Answer 11

Severly retarded
Microcephaly
Low-set ears
Oblique palpebral fissures
Hypertelorism
Micrognathia

Question 12

Phenylketonuria (PKU)

Answer 12

Hypereactive
Erratic
Eczema
Vomiting
Convulsions
Temper Tantrums
Perceptual difficulties
Poor concentration

Question 13

Mental Retardation Classification

Answer 13

Mild: 50 to 55-70
Moderate: 35 to 50-55
Severe: 20 to 35-40
Profound: below 20 or 25

Question 14

Anorexia Nervosa

Answer 14

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.

Question 15

SCOFF Questionaire

Answer 15

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?

Question 16

Bulimia Nervosa

Answer 16

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.

Question 17

Cluster A Disorders

Schizoid Personality Disorder

Answer 17

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

Question 18

Cluster A Disorders

Schizotypal Personality Disorder

Answer 18

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

Question 19

Cluster A Disorders

Paranoid Personality Disorder

Answer 19

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

Question 20

Cluster B Disorders

Antisocial Personality Disorder

Answer 20

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

Question 21

Cluster B Disorder

Borderline Personality Disorders

Answer 21

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

Question 22

Cluster B Disorders

Histrionic Personality Disorder

Answer 22

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

Question 23

Cluster B Disorders

Narcissistic Personality Disorder

Answer 23

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

Question 24

Cluster C Disorders

Avoidant Personality Disorder

Answer 24

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

Question 25

Cluster C Disorders

Dependent Personality Disorder

Answer 25

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

Question 26

Cluster C Disorders

Obsessive-compulsive Personality Disorder

Answer 26

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.