Psych Flashcards
What is the abuse work out for all patients
Report to CPS,
Direct contact consult with social work, specialist, trauma team
In child abuse, when should you order a head CT
Infants < 6 months
Infants 6-12 months w/ external head trauma, skulls fx, rib fx, or metaphyseal fx.
Child of any age with signs suggesting intercranial hem.
In child abuse, what pts should get radiographs
All children <2 yrs
Children <5 years w/ neuro impairment or distracting injury or index fractures
In child abuse, which pts require screening for abdominal injury (AST ALT Lipase)
Infants < 6mon
Child with trunk bruising or significant injury
In child abuse, which pts should be screened for bleeding DO
Any child with bruising or bleeding
In child abuse, who should be screened for Metz D/o
And child with intracranial bleeding
in child abuse, what pts should get a optho consult within 72 hours
Any child with suspected abusive head trauma, peri orbital bleeding, or eye injury
In child abuse, which pts should be screened for Met Bone Dz
Child with concern of abuse for to fracture
What labs are ordered in osteogenesis imperfecta is suspected
COL 1a1, COL 1a2, Gene sequencing
What children should be screened for menkes d/o
Male infant <6 months with a fracture
When should children with symptomatic neuro injury get an MRI
2 days post injury
When should repeat radiographs be ordered in child abuse
2 weeks post injury, OMIT skull, lateral spine and pelvis
What are the 4 types of elder abuse
Physical
Emotional
Verbal
Nonverbal
How should questions be asked in evaluating domestic abuse
Specific, matter of factly, Direct
Who can you report domestic abuse to in the military
FAP, Chain of command Chaplains Local police CPS Women’s shelters
What is the DO criteria for specific phobia
Marked fear or anxiety about a specific object or situation
Object is actively avoided, and almost always invokes immediate fear/ anxiety
Fear out of proportion
Is persistant for 6 months or more
Causes clin sig distress
What is the key feature of specific phobia
A phobic stimulus with active avoidance
What is the Tx for Specific phobia DO
CBT!
Desensitization
SSRI/ SNRI (great in long term Tx)
Gabapentin
Propranolol ( performance anxiety)
What is the DO criteria for Social Anxiety/ Social phobia
Marked fear/ anxiety in one or more situations where the individual is exposed to the scrutiny of others
Social situations provoke fear/ anxiety
Avoidance of society
OOPT actual threat
Clin sig
Not attributable to drugs, or medications
How must social anxiety DO present in children
In childern the anxiety must occur in peer settings, not just with adults
How is fear and anxiety often presented in children
Crying, tantrums, freezing, clinging , shrinking, or failing to speak in social situations
What is the time frame for social anxiety DO
At least 6 months
What is the key feature of Social anxiety DO
Key feature is fear of a social situation where one may be scrutinized by others
What is the Tx for social anxiety DO
CBT
Desensitization
SSRI/ SNRI
Gabapentin
Propranolol ( performance or test anxiety)
What is the DO criteria for Panic DO
Recurrent unexpected panic attacks
ie Palapations Pounding HR Sweating Trembling Shaking Feeling choking Chest pain Nausea Dizzy Chills/ hot cold Tingling Fear of going crazy Fear of dying
At least one attack followed by 1 month of one or both:
Persistant concern of attacks
Avoidance behaviors of attack triggers
What is the key feature of Panic DO
Unexpected attack with 4 associated s/s that are not culturally normal
With concern about more attacks, or active avoidance of triggers
What is the Tx for panic DO
CBT
Relaxation training
SSRi, SNRI, TCA
BZD (ACUTE MANAGMENT)
Propranolol for peripheral symptoms
What is the DO criteria for agoraphobia
Fear and anxiety of 2 or more of:
Public transportation Being in open spaces Being in enclosed spaces Standing in line Being crowded Being outside of the home
Agoraphobia is associated with
Considerable disability and living alone
What is the Tx for agoraphobia
Peer support groups
SSRI, SNRI, Gabapentin
What is the DO criteria for GAD
General anxiety on more days than not x 6 months
3 of 6 s/s: Restlessness or on edge Easily fatigued Difficulty concentrating Irratibilty Muscle tension Sleep disturbance
What is the key feature of GAD
Key feature is the excessive worry about multiple things
The intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual likelihood or impact of the anticipated event
What is the Tx for GAD
CBT!
Relaxation coaching
SSRi, SNRI, TCA
BZD (acute tx)
Busprione
Gabapentin
Propranolol
What is the GAD 7
Screening tool for GAD
5-9 mild
10-14 moderate
15-21 severe
Needs a interview and exam to r/o other causes of anxiety
What is the definition of dissociation
Dissociation: mental process of disconnecting from one’s thoughts, feelings, memories or sense of identity
What is depersonalization
Depersonalization: experience of feeling detached from and an outside observer of one’s mental processes or body
Like being in a dream; sense of unreality of self or body or of time moving slowly
What is derealization
Derealization: experiences of unreality of surroundings
world around an individual is experienced as unreal, dreamlike, distant, or distorted
What is the DO criteria for acute stress DO
Exposure to actual or threatend death, serious injury or violence
(First responders collecting remains)
Nine S/s from the categories of. Intrusive, Negative mood, dissociation, avoidance, arousal
Time: 3 days to 1 month post exposure
What are the intrusive symptoms of acute stress
Recurrent or involuntary memories or dreams
Dissociative reactions/ flashbacks
Intense or prolonger psych distress in response to triggers
How can intrusive symptoms present in children with acute stress DO
Frightened dreams with out recognizable content
Trauma specific reenactment may occur in play
Repetitive play in which themes or aspects of the events are expressed
What are the negative mood symptoms of acute stress DO
Persistent inability to exp. postive emotion
What are the dissociative s/s of acute stress DO
Altered sense of reality
Being in a daze, or time slowing
Inability to remember important aspects of traumatic events
Amnesia (not head injury, alcohol or drugs)
What are the avoidance s/s in acute stress DO
Efforts to avoid memories, thoughts, or feelings of the event
Efforts to avoid external reminders (people place of things) that arose memories, thoughts or feelings about event
What are the arousal s/s of acute stress DO
Sleep disturbance Irritable behaviors/ angry outbursts Verbal or physical aggression Hypervigilance Problems with concentration Exaggerated startle response
What is the essential feature of Acute Stress DO
Essential feature is the developing characteristic symptoms that last 3 days to 1 after being exposed to a traumatic event(s)
What is the Tx for acute stress DO
Trauma focused CBT
Exposure Therapy
SSRI
BZD (generally contraindicated)
Propranolol
Morphine( in acute treatment PX)
What is the DO criteria for PTSD
Exposure to threatend of actual event with s/s persisting past 1 o month
W/ recurrent involuntary intrusive thoughts of the event
Recurrent distressing dreams
Dissociative reactions/ flashbacks
X 1months or more
What is the essential feature of PTSD
The essential feature is development of characteristic symptoms following exposure to a traumatic event
What is the Tx for PTSD
812 session of therapy
Cognitive processing
Prolonged exposure therapy
EMD reprocessing
SSRI! (Sertaline/ paroxetine DOC)
Propranolol for periphery S/s
Clonidine for hyperarousal s/s
Prazosin for nightmares
Carbamazepine for impulse control or anger managment
BXD ‘generally contraindicated”
Trazadone for insomnia S/s
What is the DOC for PTSD with hyper arousal
Clonidine
What is the DOC for PTSD night mares
Prazosine
What is the DOC for PTSD anger managment and impulse control
Carbamazepine
What is the DOC for PTSD with insomnia
Trazadone
What is the DO criteria for Adjustment DO
Emotional or behaviors in responce to an indenifiable stresser w/in 3 months of event
Not normal bereavement
What is the essential feature of Adjustment DO
Essential feature is emotional or behavioral symptoms in response to an identifiable stressor
Suicide risk: increased attempts and completion
What is the Tx for Adjustment DO
Stress reduction techniques
Daily log of stress triggers
Short course of SSRI, BZD, or antihistamines/ sedatives
What DO?:
Traumatic event, 3 days-1 month, PTSD like Sxs
Acute stress DO
What DO?:
Traumatic event, 1 Month or longer, PTSD Sxs
PTSD
What DO?:
Stressful event, presents 3 months from start, resolves w/in 6 months of stop, stressed out Sxs
Adjustment DO
What is the DO criteria for insomnia
Unhappy with sleep quantity or quality and at least one of the following
Can’t get to sleep
Can’t stay asleep
Clinically significant
At least 3 nights a week
Present for at least 3 months
What is episodic insomnia
S/s last at least 1 month but less than 3 months
What is persistent insomnia
S/s last 3 months of longer
What is recurrent insomnia
Two or more episodes in the the space of 1 year
What is the essential feature of insomnia
Essential feature is unsatisfactory sleep quantity/quality associated with getting to or staying asleep
Frequently presents with non-restorative sleep
-poor sleep quality that does not leave the individual rested upon awakening despite adequate duration
Typically involves daytime impairments as well as nighttime sleep difficulties
What is the Tx for insomnia
CBT- sleep hygiene improvement
Diphenhydramine or hydroxyzine
Trazodone
Lorazepam
Zolpidem
Risk for amnesia with use
Zaleplon
Eszopiclone
What is the DO criteria for Hypersomnolence DO
Self reported excessive sleep, despite having slept for 7 hours w/:
Recurrent sleeps or lapses within the same day
Prolonged main sleep of more than 9 hours (non restorative)
Difficulty bing awake afternoon awakening
At least 3 times per weak for at least 3 months
What is the definition of hypersomnoloence
Hypersomnolence is a broad term for excessive sleepiness with deteriorated wakefulness
Many experience automatic behavior
Such as driving for miles without remembering any of it
What is the tx for hypersomnolence
Encourage good sleep hygiene
Evaluate for and treat comorbidities
Refer to sleep medicine specialist PRN
What is the DO criteria for Narcolepsy
Recurrent irrepressible need to sleep; lapsing into sleep; napping within same day
3 times a week for 3 months
One of the following:
- Cataplexy at least a few times per month
- Hypocretin deficiency
- Polysomnography showing decreased sleep latency (specific parameters needed)
How does cataplexy present in adults vs children
Adults: Sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking
Children: within 6 months of onset, spontaneous grimaces or jaw opening episodes with tongue thrusting or a global hypotonia w/out and emotional triggers
What is the essential feature of narcolepsy
Recurrent naps or lapses into sleep
With cataplexy
What is the Tx for narcolepsy
Stimulants such as dextramphetamine
Or modafinil
Less SE, but has HA and anxiety, less abuse risk, may reduce OCP
What is the DO criteria obstructive sleep apnea
At least 5 apnea’s per hour w/ nocutural breathing disturbances or daytime sleepy ness, fatigue, or unrefreshing sleep.
Or
15 or more obstructive apnea’s per hour
What is the most common breathing related sleep DO
Obstructive Sleep apnea
What is the tx for Obstructive sleep apnea
Aimed at resolving symptoms but also reducing comorbid conditions
Positive airway pressure or dental devices
Reduces obstruction
Improves oxygenation
What is the DO criteria for Circadian Rhythm DO
Sleep disruption primarily related to altered circadian rhythm
The disruption leads to excessive sleepiness
Clinically significant distress from the disturbance
What are the prominent features of circadian rhythm sleep DO
Sleep-onset insomnia, difficulty waking in the morning, and excessive early day sleepiness are prominent features
What is the Tx for Circadian Sleep DO
Reorganization of circadian rhythm and improved sleep hygiene are key
Melatonin may help if patient responds to it
Zolpidem may be needed
Benzodiazepine may be needed
What is the DO criteria for RLS
Restless leg syndrome
Urge to move legs, typically because of uncomfortable sensation with:
-Urge to move begins or worsens during rest
AND
-Urge to move is relieved my movement
AND
-Urge is worse in evening than day or only in evening
3 times a week for 3 months
Clinically significant
How do pts describe RLS
Desire to move the legs or arms
Associated with uncomfortable sensations typically described as creeping, crawling, tingling, burning, or itching
Significant sleep fragmentation and impairment associated with the symptoms and fatigue
What is the Tx for RLS
Some behavioral therapies may work
Avoidance of aggravating factors
-Iron replacement may help if iron is low
-For Chronic symptoms:
Dopamine agonist is considered first line
Ropinirole
Gabapentin
Low dose benzodiazepines
Clonazepam
What is the 1st line DOC for chronic RLS
Dopamine
What is the DO criteria for Substance induced sleep DO
Sleep disturbance with both of the following
- Started after starting a new medication
- The new medication capable of disturbing sleep
Not better explained
Does not happen exclusively during delirium
What is the screening test for sleep DO
Epworth sleepyness scale
What is the STOP BANG criteria
Snore
Tired
Observed stop breathing
Pressure (HTN)
BMI
Age >50
Neck >16 inches
Gender: male
High risk 5-8 yes
Im risk 3-4 yes
Low risk 02 yes
What is a somatic symptom
Pain Tremors Fatigue Paralysis Shortness of breath
What is somatization
Physical Sxs that mimic a disease that isn’t there
Psychological distress felt in a physical form
What is the DO criteria for Somatic Symptom DO
At least one somatic symptom with disruption of normal life
Excessive thoughts/feelings/behaviors related to the sxs with at least one of these:
- Thoughts OOPT the seriousness
- Persistent high anxiety about the sxs
- Excessive time devoted to the sxs
- State of being symptomatic continuously is present
Can be mild (1 s/s) , moderate (2 or more) or severe (2 or more plus multiple somatic complaints)
What is the Tx approach to somatic symptoms DO
Schedule regular visits
Establish collaborative, therapeutic alliance with the patient (don’t blow them off)
Acknowledge and legitimize symptoms as appropriate
Coordinate care with other providers/specialists so everyone is on same page
Evaluate and treat medical conditions which are present
Limit diagnostic tests and specialist referrals, and focus on education
MUCH reassurance that nothing has been missed
Treat any comorbid psych diagnoses (depression/anxiety/etc.)
CLEARLY set the treatment goal as functional improvements
Evaluate and treat any underlying substance abuse/self-medication issues
What is the DO criteria for Illness anxiety DO
Worried they MAY have or acquire a serious illness
Somatic sxs absent or minimal
High anxiety about health and over alarmed about health status
Excessive health related behavior or maladaptive behavior
At least 6 months
What is the distinguishing feature between somatic symptom DO and illnesss anxiety
Somatic symptom presents with pain complains
Illness anxiety does not, and illness anxiety is over a 6 month period and illness of anxiety may change
What are the two types of illness anxiety DO
Care seeking vs care avoidant
What is the Tx approach for illness anxiety DO
High quality patient provider relationship can be very helpful
Treat as you would somatic symptom disorder
Schedule regular visits
Establish collaborative, therapeutic alliance with the patient (don’t blow them off)
Acknowledge and legitimize symptoms as appropriate
Coordinate care with other providers/specialists so everyone is on same page
Evaluate and treat medical conditions which are present
Limit diagnostic tests and specialist referrals, and focus on education
MUCH reassurance that nothing has been missed
Treat any comorbid psych diagnoses (depression/anxiety/etc.)
CLEARLY set the treatment goal as functional improvements
Evaluate and treat any underlying substance abuse/self-medication issues
What is the DO criteria for conversion DO
At least one sx of altered voluntary motor or sensory function
Objective evidence of incompatibility between sxs and known neurological disorder
No better explanation
Clinically significant distress
What is Hoover’s sign
Hip flexion test for malingering
What is the Tx approach to conversion DO
hypnosis may help
What is the DO criteria or Factitious DO
Falsified signs or symptoms or induced injury or disease with identified deception
Presents themselves as affected
Deception evident without signs of secondary gain
What is the key finding in factitious DO
A patient purposefully deceives and falsifies signs and symptoms
Can be falsified about ones self or another
What is the Tx approach for Factitious DO
Early psychiatric consultation is indicated
conjoint confrontation
biofeedback and self-hypnosis
may foster recovery
double bind
What are delusions
fixed beliefs that are not amenable to change in light of conflicting evidence
What are hallucinations
perception-like experiences that occur without an external stimulus
What is catatonic behavior
marked decrease in reactivity to the environment
Resistance to instructions; to maintaining a rigid bizarre posture; to a complete lack of verbal/motor responses
Can also include purposeless and excessive motor activity without obvious cause
What is Catatonia
a psychomotor disturbance that may involve decreased motor activity, decreased interaction, or excessive and odd motor activity
What are thee negative s/s of schizophrenia
Inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships
S/s that TAKE AWAY
What are the postive S/s of schizophrenia
Hallucinations
Delusions
Hard to control repetitive movements
S/s that ADD TO
What is the criteria for Bried Psychotic DO
At least 1 :
Delusions
hallucinations
or disorganized speech
Lasts at least one day, but comes back to normal function within one month
What are the 4 levels of brief psychotic DO
With a marked stressor
Without a marked stressor
Or with peripartum onset
W/ or w/o Catatonia
What is the Tx approach to brief psychotic DO
The major considerations are to prevent self-inflicted harm or harm to others
Hospitalization may be necessary
A full medical evaluation and brain imaging should be considered in first episodes of psychosis
Antipsychotics are drugs of choice
Antidepressants may be used in conjunction with antipsychotics if significant depression is present
What is the DO criteria for delusional DO
Presence of at least one delusion for at least a month and unable to meet criteria for schizophrenia
Function not impaired and behavior not odd (outside of delusional effect)
Any bipolar symptoms considered mild compared to delusions
What is the essential feature of Delusional DO
Essential feature is at least one delusion that persists for at least 1 month
What is the Tx approach for Delusional DO
The major considerations are to prevent self-inflicted harm or harm to others
Hospitalization may be necessary
Antipsychotics are drugs of choice
Antidepressants may be used in conjunction with antipsychotics if significant depression is present
What is the DO criteria for schizophrenia
At least 2 of 5 symptoms, present for most of the time, for at least 1 month (at least one is 1, 2, or 3):
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized behavior or catatonia
- Negative SXs
Since onset, level of functioning is significantly decreased in at least one area of life, compared to before symptom onset
Signs persist for at least 6 months, but have at least 1 month of symptoms from criterion A
What are the characteristics S/s of schizophrenia
Characteristic symptoms involve a range of cognitive, behavioral, and emotional dysfunctions
no single symptom is pathognomonic
Impairment in one or more major areas of functioning
Diagnosis requires the presence of delusions or hallucinations in the absence of mood episodes
What is the Tx approach for schizophrenia
The major considerations are to prevent self-inflicted harm or harm to others
Hospitalization may be necessary
A full medical evaluation and brain imaging should be considered in first episodes of psychosis
Antipsychotics are drugs of choice
Antidepressants may be used in conjunction with antipsychotics if significant depression is present
What is the criteria for Oppositional Defiant DO
Angry/irritable mood, argumentative/defiant behavior, or vindictiveness;
- at least 6 months,
- at least 4 Sxs, and against a non-sibling
- Loses temper
- Touchy/easily annoyed
- Angry/resentful
- Argues with authority figures (adults)
- Defies or refuses to comply with requests from authority figures or with rules
- Deliberately annoys rules
- Blames others for mistakes or misbehavior
- Spiteful or vindictive (twice in last 6 months)
Behavior change is associated with distress in the individual or in immediate social context or impacts negatively on important areas of functioning
What is the essential feature of Oppositional Defiant DO
The essential feature is a frequent and persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness
More prevalent in families in which child care is disrupted by a succession of different caregivers or in families in which harsh, inconsistent, or neglectful child-rearing practices are common
Two most common co-occurring conditions are ADHD and conduct disorder
Can be mild moderate or severe
What are the two most common co-occurring conditions with oppositional defiant DO
ADHD and conduct DO
What are the 7 levels of delusional DO
Eromatic (romantic delusion) Grandious Jealous Persecution Somatic Mixed Unspecified
What is the tx approach for Oppositional defiant DO
Psychotherapy: Family intervention/training to reward good behavior, discourage undesired behavior
Pharmacotherapy: Treat co-morbidities accordingly
What is the criteria for conduct DO
Pattern of behavior which violates the basic rights of others or major societal norms as manifested by 3 of the following Sxs, and at least one in the last 6 months:
Bullies/threatens/intimidates
Initiates physical fights
Used a weapon capable of serious harm
Can be mild moderate of severe
Physically cruel to people
Physically cruel to animals
Stolen while confronting a victim
Forced someone into sexual activity
Fire setting with intent of causing damage
Deliberately destroys other’s property
Broken into someone else’s house/care/etc
Lies to obtain goods/favors or avoid obligations
Stolen items of nontrivial value without confronting
Stays out at night despite prohibitions (before 13 YO)
Runaway from home overnight at least twice while living at home or once for a long time
Truant from school before 13 YO
What is the essential feature of Conduct DO
The essential feature is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated
Often initiate aggressive behavior and react aggressively to others
Oppositional defiant disorder typically less severe than conduct disorder
Oppositional defiant disorder includes problems of emotional dysregulation (i.e., angry and irritable mood) that are not included in the definition of conduct disorder
What is the Tx approach for conduct DO
Psychotherapy: Same as above, occasional placement away from home in some circumstances
Pharmacotherapy:
Antipsychotics:
(haloperidol, risperidone, olanzapine) may help control aggressive/assaultive behaviors
Lithium may help with mood stabilization
Stimulants may help if co-morbid ADHD is present
What is the def. of a personality
CMDT 2019: An individual’s personality structure, or character, is an integral part of self-image. It reflects genetics, interpersonal influences, and recurring patterns of behavior adopted in order to cope with the environment.
DSM-V: Personality traits are enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.
What is the enduring pattern of a personality DO
Inflexible and pervasive across a broad range of personal and social situations
Leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning
Stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood
Not better explained as a manifestation or consequence of another mental disorder.
What does CARPI stand for in personality DO
Enduring pattern of behavior/inner experience deviates from one’s culture and manifested in 2 or more of the following:
Cognition
Affect
Personal relationships
Impulse Control
What are cluster A personality DO
Paranoid – Schizoid – Schizotypal
WIERD
What are cluster B personality DO
Antisocial – Borderline – Histrionic – Narcissistic
DRAMATIC
What are cluster C personality DO
Avoidant – Dependent – Obsessive-Compulsive
WORRIED
What is the DO criteria for Paranoid Personality DO
Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent with at least 4 associated symptoms:
Suspects, without sufficient basis, that others are exploiting/harming/deceiving
Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
Reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
Reads hidden demeaning or threatening meanings into benign remarks or events
Persistently bears grudges
Perceives attacks on character or reputation that are not apparent to others and is quick to react angrily or to counterattack
Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
What is the essential feature of paranoid personality DO
The essential feature is a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.
Think: Pathologically jealous and distrustful
What is the criteria for schizoid personality DO
Detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, indicated by at 4 Sxs:
Neither desires nor enjoys close relationships, including being part of a family
Almost always chooses solitary activities
Has little, if any, interest in having sexual experiences with another person
Takes pleasure in few, if any, activities
Lacks close friends or confidants other than first-degree relatives
Appears indifferent to the praise or criticism of others
Shows emotional coldness, detachment, or flattened affectivity
THINK THANOS
What is the essential feature of schizoid personality DO
The essential feature is a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings
Think: Someone who doesn’t fit in, but isn’t bothered by it
What is the criteria for schizotypal personality DO
Social and interpersonal deficits with acute discomfort and reduced capacity for close relationships along with cognitive/perceptual distortions and eccentricities and at least 5 associated Sxs:
Ideas of reference
Odd beliefs or magical thinking that influences behavior (clairvoyance or a “sixth sense”)
Unusual perceptual experiences
Odd thinking and speech (vague, overelaborate, or stereotyped)
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behavior/appearance that is odd or eccentric
Lack of close friends or confidants other than first-degree relatives
Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears
What is the essential feature of schizotypal personality DO
The essential feature is interpersonal deficits marked by acute discomfort with close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior
Think: eccentric person that has acquaintances but not friends
What is the criteria for antisocial personality DO
A disregard for and violation of the rights of others, since age 15 years, at least 3 of the following:
Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
Impulsivity or failure to plan ahead
Irritability and aggressiveness, as indicated by repeated physical fights or assaults
Reckless disregard for safety of self or others
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
At least age 18 years; evidence of conduct disorder before age 15 years
What is the essential feature of antisocial personality DO
The essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood and continues into adulthood
This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder
Think: Psychopath…
What is the criteria for Borderline personality DO
Instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, with at least 5 of the following:
Frantic efforts to avoid real or imagined abandonment
Unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance: markedly and persistently unstable self-image
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving)
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger
Transient, stress-related paranoid ideation or severe dissociative symptoms.
What is the essential feature of borderline personality DO
The essential feature is instability of interpersonal relationships, self-image, and affects, and marked impulsivity and is present in a variety of contexts
Commonly use the defense mechanism of Splitting
View others and themselves as either all good or all bad
Think: pathologically unstable
What is the criteria for histrionic personality DO
Excessive emotionality and attention seeking, in a variety of contexts, at least 5 of the following:
Is uncomfortable in situations in which he or she is not the center of attention
Interaction often characterized by inappropriate sexually seductive or provocative behavior
Rapidly shifting and shallow expression of emotions
Consistently uses physical appearance to draw attention to self
Speech that is excessively impressionistic and lacking in detail
Shows self-dramatization, theatricality, and exaggerated expression of emotion
Is suggestible (i.e., easily influenced by others or circumstances)
Considers relationships to be more intimate than they actually are
What is the essential feature of histrionic personality DO
The essential feature is pervasive and excessive emotionality and attention-seeking behavior
What is the criteria for narcissistic personality DO
Pattern of grandiosity, need for admiration, and lack of empathy, in a variety of contexts, at least 5 of the following:
Has a grandiose sense of self-importance (e.g., exaggerates and talents, expects to be recognized as superior)
Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
Believes that he or she is “special” and unique and can only be understood by/associate with other high-status people
Requires excessive admiration
Has a sense of entitlement
Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends)
Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
Is often envious of others or believes that others are envious of him or her
Shows arrogant, haughty behaviors or attitudes
What is the essential feature of narcissism
The essential feature is a pervasive pattern of grandiosity, need for admiration, and lack of empathy
What is the DO criteria for avoidant PDO
Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, present in a variety of contexts, at least 4 of the following:
Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection
Is unwilling to get involved with people unless certain of being liked
Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
Is preoccupied with being criticized or rejected in social situations
Is inhibited in new interpersonal situations because of feelings of inadequacy
Views self as socially inept, personally unappealing, or inferior to others
Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
What is the essential feature of avoidant PDO
Essential feature is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
What is the criteria for dependent PDO
Excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, and at least 5 of the following:
Difficulty making everyday decisions without an excessive amount of advice and reassurance from others
Needs others to assume responsibility for most major areas of his or her life
Difficulty expressing disagreement with others because of fear of loss of support or approval
Difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities)
Goes to excessive lengths to obtain nurturance and support from others, to point of volunteering to do things that are unpleasant
Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself
Urgently seeks another relationship as a source of care and support when a close relationship ends
Is unrealistically preoccupied with fears of being left to take care of himself or herself
What is the essential feature of dependent PDO
The essential feature is a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
What is the criteria for Obsessive Compulsive PDO
Preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, at least 4 of the following:
Preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
Perfectionism that interferes with task completion (e.g., unable to complete a task because personal overly strict standards are not met)
Excessively devoted to work and productivity to the exclusion of leisure activities and friendships
Over-conscientious, scrupulous, and inflexible about matters of morality, ethics, or values
Unable to discard worn-out or worthless objects even when they have no sentimental value
Reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
Shows rigidity and stubbornness
What is the essential feature of OCD PDO
The essential feature is a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
What is the TX approach to personality DO
Peer pressure to modify behaviors
Operant conditioning
Aversive conditioning
Group and individual therapy
What is the pharm approach to Borderline personality DO
Antidepressants have improved anxiety, depression, and sensitivity to rejection in some patients with borderline personality disorder
What is the pharm approach to impulsive aggressive pts
SSRIs also have a role in reducing aggressive behavior in impulsive aggressive patients
What is the pharm approach to targeting hostility, agitation, and as adjuncts to antidepressant therapy
Antipsychotics
What is the pharm approach to decrease the severity of behavioral dyscontrol in some personality disorder patients
Anticonvulsants
What is the pharm approach to schizotypal pts
Antipsychotics
What is the pharm approach to avoidant personality DO
Avoidant personality may benefit from strategies that reduce anxiety, including the use of SSRIs and benzodiazepines
What is the Dx criteria for separation anxiety DO
excessive fear or anxiety concerning separation from
those to whom the individual is attached,
- Recurrent excessive distress when anticipating or experiencing separation from
home or from major attachment figures. - Persistent and excessive worry about losing major attachment figures or about possible
harm to them, such as illness, injury, disasters, or death. - Persistent and excessive worry about experiencing an untoward event (e.g., getting
lost, being kidnapped, having an accident, becoming ill) that causes separation
from a major attachment figure. - Persistent reluctance or refusal to go out, away from home, to school, to work, or
elsewhere because of fear of separation. - Persistent and excessive fear of or reluctance about being alone or without major
attachment figures at home or in other settings. - Persistent reluctance or refusal to sleep away from home or to go to sleep without
being near a major attachment figure. - Repeated nightmares involving the theme of separation.
- Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea,
vomiting) when separation from major attachment figures occurs or is anticipated.
4 weeks in children or 6 months in adults
What is the Dx criteria for central sleep apnea
Evidence by polysomnography of five or more central apneas per hour of sleep.
What is the Dx criteria for sleep related hypo ventilation
Polysomnography demonstrates episodes of decreased respiration associated with elevated
CO2 levels.
(Note: In the absence of objective measurement of CO2, persistent low levels of hemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.)
What is the Dx criteria for NREM Sleep arousal DO
Recurrent episodes of incomplete awakening from sleep, usually occurring during the
first third of the major sleep episode, accompanied by either one of the following:
Sleep walking
Or Sleep terrors (intense fear and signs of autonomic
arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode.)
What is the Dx criteria for REM sleep behavior DO
Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.
Usually after 90 minutes of sleep onset.
Talking in sleep or moving in sleep
What is the major difference in criteria for schizophreniform DO and brief psychotic DO from schizophrenia
These disorders are of shorter duration than schizophrenia as specified in Criterion C, which requires 6 months of symptoms.
In schizophreniform disorder, the disturbance is present less than 6 months, and in brief psychotic disorder, symptoms are present at least 1 day but less than 1 month.
What is the Dx criteria for schizoaffective DO
An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.
Must Include a depressive episode
Delusions of hallucinations for 2 or more weeks
What is the Dx criteria for intermittent explosive DO
Recurrent behavioral outbursts representing a failure to control aggressive impulses
Tantrums
. Three behavioral outbursts involving damage or destruction of property and/or
physical assault involving physical injury against animals or other individuals occurring
within a 12-month period.
At least 6 years or older
For children ages 6–18 years, aggressive behavior that occurs as part
of an adjustment disorder should not be considered for this diagnosis.
What is the Dx criteria for pyromania
Deliberate and purposeful fire setting on more than one occasion.
What is the Dx. Criteria for Kleptomania
Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.
