PATH - General Flashcards
Dissociative amnesia
Inability to recall important personal information, usually subsequent to severe trauma or stress.
May be accompanied by *dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances).
Korsakoff syndrome
Amnesia (anterograde > retrograde) caused by *vitamin B1 deficiency and associated destruction
of *mammillary bodies.
Seen in alcoholics as a late neuropsychiatric manifestation of Wernicke
encephalopathy.
*Confabulations are characteristic
Dissociative identity disorder
Formerly known as *multiple personality disorder
Presence of 2 or more distinct identities or
personality states
More common in women
Associated with history of sexual abuse, PTSD,
depression, substance abuse, borderline personality, somatoform conditions.
Depersonalization/derealization
disorder
Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and
actions (depersonalization) or one’s environment (derealization).
Delirium
“Waxing and waning” level of consciousness with acute onset
rapid DEC in attention span and level of arousal
Characterized by disorganized thinking, hallucinations (often visual),
illusions, misperceptions, disturbance in sleepwake
cycle, cognitive dysfunction.
Commonly, diffuse slowing EEG.
TX is aimed at identifying and
addressing underlying condition. *Haloperidol
may be used as needed.
Psychosis
Distorted perception of reality characterized by delusions, hallucinations, and/or disorganized
thinking
Can occur in patients with medical illness, psychiatric illness, or both.
Schizophrenia
Chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning lasting > *6
months
Associated with INC dopaminergic activity, DEC dendritic branching.
Diagnosis requires at least 2 of the following, and at least 1 of these should include 1–3
(first 4 are “positive sx”):
1. Delusions
2. Hallucinations—often auditory
3. Disorganized speech
4. Disorganized or catatonic behavior
5. Negative symptoms (affective flattening,
avolition, anhedonia, asociality, alogia)
*Ventriculomegaly on brain imaging
TX: atypical antipsychotics (
risperidone) are first line.
Brief psychotic disorder
lasting
Schizophreniform disorder
lasting 1–6 months.
Schizoaffective disorder
at least 2 weeks of
hallucinations or delusions with major mood episode (major depression or mania),
plus periods of concurrent major mood episode with schizophrenic symptoms.
Delusional disorder
Fixed, persistent, false belief system lasting > 1 month.
Functioning otherwise not impaired
Can be shared by individuals in close relationships (*folie à deux).
Manic episode
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently INC activity or energy lasting *at least 1 week
*Often disturbing to patient
Diagnosis requires hospitalization or at least 3 of the following (manics DIG FAST):
Distractibility
Irresponsibility—seeks pleasure without regard to consequences (hedonistic)
*Grandiosity—inflated self-esteem
*Flight of ideas—racing thoughts
*INC in goal-directed *Activity/psychomotor *Agitation
*DEC need for Sleep
Talkativeness or pressured speech
Hypomanic episode
Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization
*No psychotic features.
Lasts at least *4 consecutive days.
Bipolar disorder (manic depression)
- Bipolar I defined by presence of at least 1 manic episode +/− a hypomanic or depressive episode.
- Bipolar II defined by presence of a hypomanic and a depressive episode.
TX: mood stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics.
Cyclothymic disorder
milder form of bipolar disorder lasting at least *2 years, fluctuating between mild depressive and hypomanic symptoms.
Major depressive disorder
May be self-limited disorder, with major depressive episodes usually lasting *6–12 months
Episodes characterized by at least 5 of the following 9 symptoms for 2 or more
weeks (symptoms must include patientreported
depressed mood or anhedonia).
SIG E CAPS: -Depressed mood -*Sleep disturbance -Loss of *Interest (anhedonia) -*Guilt or feelings of worthlessness -*Energy loss and fatigue -*Concentration problems -*Appetite/weight changes -*Psychomotor retardation or agitation -*Suicidal ideations
following changes in their sleep stages: -DEC slow-wave sleep -DEC REM latency -INC REM early in sleep cycle -INC total REM sleep -Repeated nighttime awakenings -**Early-morning wakening (terminal insomnia)
TX: CBT and SSRIs are first line. SNRIs, mirtazapine, bupropion can also be
considered. Electroconvulsive therapy (ECT) in select patients.
Persistent depressive disorder (dysthymia)
depression, often milder, lasting at least *2 years
Depression with *atypical features
Characterized by mood reactivity (being able to
experience improved mood in response to positive events, albeit briefly), “reversed” vegetative
symptoms (hypersomnia, hyperphagia), leaden paralysis (heavy feeling in arms and legs), long-standing interpersonal rejection sensitivity
Most common subtype of depression
TX: CBT and SSRIs are first line. MAO inhibitors are effective but not first line because of their risk
profile.
Anxiety disorder
Inappropriate experience of fear/worry and its physical manifestations (anxiety) incongruent with the magnitude of the perceived stressor
Symptoms *interfere with daily functioning
Includes panic disorder, phobias, generalized anxiety disorder, and selective mutism
TX: CBT, SSRIs, SNRIs.
Panic disorder
Defined by recurrent panic attacks (periods of intense fear and discomfort peaking in
10 minutes with at least 4 of the following):
PANICS
Palpitations, Paresthesias, dePersonalization or
derealization, Abdominal distress or Nausea, Intense fear of dying, Intense fear of losing control or “going crazy,” lIght-headedness, Chest pain, Chills, Choking, Sweating,
Shaking, Shortness of breath
Diagnosis requires attack followed by 1 month (or more) of 1 (or more) of the following:
-Persistent concern of additional attacks
-Worrying about consequences of attack
-Behavioral change related to attacks
TX: CBT, SSRIs, and
venlafaxine are first line. Benzodiazepines
occasionally used in acute setting.
Agoraphobia
exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone.
Associated with panic disorder
TX: CBT, SSRIs, MAO inhibitors.
Generalized anxiety disorder
Anxiety lasting > *6 months unrelated to a specific person, situation, or event.
Associated with restlessness, irritability, sleep disturbance, fatigue, muscle tension, difficulty concentrating.
TX: CBT, SSRIs, SNRIs are first line. Buspirone, TCAs, benzodiazepines are second line.
Adjustment disorder
emotional symptoms (anxiety, depression) causing *impairment following an identifiable psychosocial stressor (eg, divorce, illness) and lasting 6 months in presence of chronic stressor)
TX: CBT, SSRIs.
Obsessive-compulsive disorder
Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress
relieved in part by the performance of repetitive actions (compulsions)
*Ego-dystonic: behavior
inconsistent with one’s own beliefs and attitudes (vs obsessive-compulsive personality disorder).
Associated with Tourette syndrome
TX: CBT, SSRIs, and clomipramine are first line.
Post-traumatic stress disorder
Exposure to prior trauma–>intrusive reexperiencing of the event (nightmares, flashbacks), avoidance of associated stimuli, changes in
cognition or mood (fear, horror), and persistently INC arousal.
Disturbance lasts > *1 month with *significant distress or *impaired social-occupational functioning.
TX: CBT, SSRIs, and
venlafaxine are first line.
Acute stress disorder
lasts between *3 days and 1 month.
TX: CBT; pharmacotherapy is
usually not indicated.
Sleep terror disorder
Periods of terror with screaming in the middle of the night
occurs during slow wave/deep (*stage N3) sleep.
Most common in children.
Occurs during non-REM sleep (no memory of arousal)
as opposed to nightmares that occur during REM sleep (memory of a scary dream).
