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IPAP 21-2 Soph Semester > Psych > Flashcards

Psych Flashcards

1
Q

What is the abuse work out for all patients

A

Report to CPS,

Direct contact consult with social work, specialist, trauma team

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2
Q

In child abuse, when should you order a head CT

A

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.

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3
Q

In child abuse, what pts should get radiographs

A

All children <2 yrs

Children <5 years w/ neuro impairment or distracting injury or index fractures

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4
Q

In child abuse, which pts require screening for abdominal injury (AST ALT Lipase)

A

Infants < 6mon

Child with trunk bruising or significant injury

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5
Q

In child abuse, which pts should be screened for bleeding DO

A

Any child with bruising or bleeding

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6
Q

In child abuse, who should be screened for Metz D/o

A

And child with intracranial bleeding

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7
Q

in child abuse, what pts should get a optho consult within 72 hours

A

Any child with suspected abusive head trauma, peri orbital bleeding, or eye injury

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8
Q

In child abuse, which pts should be screened for Met Bone Dz

A

Child with concern of abuse for to fracture

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9
Q

What labs are ordered in osteogenesis imperfecta is suspected

A

COL 1a1, COL 1a2, Gene sequencing

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10
Q

What children should be screened for menkes d/o

A

Male infant <6 months with a fracture

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11
Q

When should children with symptomatic neuro injury get an MRI

A

2 days post injury

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12
Q

When should repeat radiographs be ordered in child abuse

A

2 weeks post injury, OMIT skull, lateral spine and pelvis

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13
Q

What are the 4 types of elder abuse

A

Physical
Emotional
Verbal
Nonverbal

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14
Q

How should questions be asked in evaluating domestic abuse

A

Specific, matter of factly, Direct

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15
Q

Who can you report domestic abuse to in the military

A 
FAP, 
Chain of command 
Chaplains 
Local police 
CPS 
Women’s shelters
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16
Q

What is the DO criteria for specific phobia

A

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

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17
Q

What is the key feature of specific phobia

A

A phobic stimulus with active avoidance

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18
Q

What is the Tx for Specific phobia DO

A

CBT!
Desensitization

SSRI/ SNRI (great in long term Tx)

Gabapentin
Propranolol ( performance anxiety)

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19
Q

What is the DO criteria for Social Anxiety/ Social phobia

A

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

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20
Q

How must social anxiety DO present in children

A

In childern the anxiety must occur in peer settings, not just with adults

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21
Q

How is fear and anxiety often presented in children

A

Crying, tantrums, freezing, clinging , shrinking, or failing to speak in social situations

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22
Q

What is the time frame for social anxiety DO

A

At least 6 months

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23
Q

What is the key feature of Social anxiety DO

A

Key feature is fear of a social situation where one may be scrutinized by others

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24
Q

What is the Tx for social anxiety DO

A

CBT
Desensitization

SSRI/ SNRI
Gabapentin
Propranolol ( performance or test anxiety)

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25
Q

What is the DO criteria for Panic DO

A

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

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26
Q

What is the key feature of Panic DO

A

Unexpected attack with 4 associated s/s that are not culturally normal
With concern about more attacks, or active avoidance of triggers

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27
Q

What is the Tx for panic DO

A

CBT

Relaxation training

SSRi, SNRI, TCA

BZD (ACUTE MANAGMENT)

Propranolol for peripheral symptoms

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28
Q

What is the DO criteria for agoraphobia

A

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
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29
Q

Agoraphobia is associated with

A

Considerable disability and living alone

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30
Q

What is the Tx for agoraphobia

A

Peer support groups

SSRI, SNRI, Gabapentin

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31
Q

What is the DO criteria for GAD

A

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
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32
Q

What is the key feature of GAD

A

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

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33
Q

What is the Tx for GAD

A

CBT!

Relaxation coaching
SSRi, SNRI, TCA

BZD (acute tx)

Busprione
Gabapentin
Propranolol

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34
Q

What is the GAD 7

A

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

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35
Q

What is the definition of dissociation

A

Dissociation: mental process of disconnecting from one’s thoughts, feelings, memories or sense of identity

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36
Q

What is depersonalization

A

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

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37
Q

What is derealization

A

Derealization: experiences of unreality of surroundings

world around an individual is experienced as unreal, dreamlike, distant, or distorted

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38
Q

What is the DO criteria for acute stress DO

A

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

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39
Q

What are the intrusive symptoms of acute stress

A

Recurrent or involuntary memories or dreams
Dissociative reactions/ flashbacks
Intense or prolonger psych distress in response to triggers

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40
Q

How can intrusive symptoms present in children with acute stress DO

A

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

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41
Q

What are the negative mood symptoms of acute stress DO

A

Persistent inability to exp. postive emotion

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42
Q

What are the dissociative s/s of acute stress DO

A

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)

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43
Q

What are the avoidance s/s in acute stress DO

A

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

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44
Q

What are the arousal s/s of acute stress DO

A 
Sleep disturbance 
Irritable behaviors/ angry outbursts 
Verbal or physical aggression 
Hypervigilance 
Problems with concentration 
Exaggerated startle response
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45
Q

What is the essential feature of Acute Stress DO

A

Essential feature is the developing characteristic symptoms that last 3 days to 1 after being exposed to a traumatic event(s)

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46
Q

What is the Tx for acute stress DO

A

Trauma focused CBT
Exposure Therapy

SSRI
BZD (generally contraindicated)
Propranolol
Morphine( in acute treatment PX)

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47
Q

What is the DO criteria for PTSD

A

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

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48
Q

What is the essential feature of PTSD

A

The essential feature is development of characteristic symptoms following exposure to a traumatic event

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49
Q

What is the Tx for PTSD

A

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

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50
Q

What is the DOC for PTSD with hyper arousal

A

Clonidine

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51
Q

What is the DOC for PTSD night mares

A

Prazosine

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52
Q

What is the DOC for PTSD anger managment and impulse control

A

Carbamazepine

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53
Q

What is the DOC for PTSD with insomnia

A

Trazadone

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54
Q

What is the DO criteria for Adjustment DO

A

Emotional or behaviors in responce to an indenifiable stresser w/in 3 months of event

Not normal bereavement

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55
Q

What is the essential feature of Adjustment DO

A

Essential feature is emotional or behavioral symptoms in response to an identifiable stressor

Suicide risk: increased attempts and completion

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56
Q

What is the Tx for Adjustment DO

A

Stress reduction techniques
Daily log of stress triggers

Short course of SSRI, BZD, or antihistamines/ sedatives

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57
Q

What DO?:

Traumatic event, 3 days-1 month, PTSD like Sxs

A

Acute stress DO

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58
Q

What DO?:

Traumatic event, 1 Month or longer, PTSD Sxs

A

PTSD

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59
Q

What DO?:

Stressful event, presents 3 months from start, resolves w/in 6 months of stop, stressed out Sxs

A

Adjustment DO

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60
Q

What is the DO criteria for insomnia

A

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

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61
Q

What is episodic insomnia

A

S/s last at least 1 month but less than 3 months

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62
Q

What is persistent insomnia

A

S/s last 3 months of longer

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63
Q

What is recurrent insomnia

A

Two or more episodes in the the space of 1 year

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64
Q

What is the essential feature of insomnia

A

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

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65
Q

What is the Tx for insomnia

A

CBT- sleep hygiene improvement

Diphenhydramine or hydroxyzine

Trazodone

Lorazepam

Zolpidem
Risk for amnesia with use

Zaleplon

Eszopiclone

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66
Q

What is the DO criteria for Hypersomnolence DO

A

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

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67
Q

What is the definition of hypersomnoloence

A

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

68
Q

What is the tx for hypersomnolence

A

Encourage good sleep hygiene

Evaluate for and treat comorbidities

Refer to sleep medicine specialist PRN

69
Q

What is the DO criteria for Narcolepsy

A

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)
70
Q

How does cataplexy present in adults vs children

A

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

71
Q

What is the essential feature of narcolepsy

A

Recurrent naps or lapses into sleep

With cataplexy

72
Q

What is the Tx for narcolepsy

A

Stimulants such as dextramphetamine

Or modafinil
Less SE, but has HA and anxiety, less abuse risk, may reduce OCP

73
Q

What is the DO criteria obstructive sleep apnea

A

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

74
Q

What is the most common breathing related sleep DO

A

Obstructive Sleep apnea

75
Q

What is the tx for Obstructive sleep apnea

A

Aimed at resolving symptoms but also reducing comorbid conditions

Positive airway pressure or dental devices

Reduces obstruction

Improves oxygenation

76
Q

What is the DO criteria for Circadian Rhythm DO

A

Sleep disruption primarily related to altered circadian rhythm

The disruption leads to excessive sleepiness

Clinically significant distress from the disturbance

77
Q

What are the prominent features of circadian rhythm sleep DO

A

Sleep-onset insomnia, difficulty waking in the morning, and excessive early day sleepiness are prominent features

78
Q

What is the Tx for Circadian Sleep DO

A

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

79
Q

What is the DO criteria for RLS

A

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

80
Q

How do pts describe RLS

A

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

81
Q

What is the Tx for RLS

A

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

82
Q

What is the 1st line DOC for chronic RLS

A

Dopamine

83
Q

What is the DO criteria for Substance induced sleep DO

A

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

84
Q

What is the screening test for sleep DO

A

Epworth sleepyness scale

85
Q

What is the STOP BANG criteria

A

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

86
Q

What is a somatic symptom

A 
Pain
Tremors
Fatigue
Paralysis 
Shortness of breath
87
Q

What is somatization

A

Physical Sxs that mimic a disease that isn’t there

Psychological distress felt in a physical form

88
Q

What is the DO criteria for Somatic Symptom DO

A

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)

89
Q

What is the Tx approach to somatic symptoms DO

A

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

90
Q

What is the DO criteria for Illness anxiety DO

A

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

91
Q

What is the distinguishing feature between somatic symptom DO and illnesss anxiety

A

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

92
Q

What are the two types of illness anxiety DO

A

Care seeking vs care avoidant

93
Q

What is the Tx approach for illness anxiety DO

A

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

94
Q

What is the DO criteria for conversion DO

A

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

95
Q

What is Hoover’s sign

A

Hip flexion test for malingering

96
Q

What is the Tx approach to conversion DO

A

hypnosis may help

97
Q

What is the DO criteria or Factitious DO

A

Falsified signs or symptoms or induced injury or disease with identified deception

Presents themselves as affected

Deception evident without signs of secondary gain

98
Q

What is the key finding in factitious DO

A

A patient purposefully deceives and falsifies signs and symptoms

Can be falsified about ones self or another

99
Q

What is the Tx approach for Factitious DO

A

Early psychiatric consultation is indicated

conjoint confrontation

biofeedback and self-hypnosis
may foster recovery

double bind

100
Q

What are delusions

A

fixed beliefs that are not amenable to change in light of conflicting evidence

101
Q

What are hallucinations

A

perception-like experiences that occur without an external stimulus

102
Q

What is catatonic behavior

A

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

103
Q

What is Catatonia

A

a psychomotor disturbance that may involve decreased motor activity, decreased interaction, or excessive and odd motor activity

104
Q

What are thee negative s/s of schizophrenia

A

Inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships

S/s that TAKE AWAY

105
Q

What are the postive S/s of schizophrenia

A

Hallucinations
Delusions
Hard to control repetitive movements

S/s that ADD TO

106
Q

What is the criteria for Bried Psychotic DO

A

At least 1 :
Delusions
hallucinations
or disorganized speech

Lasts at least one day, but comes back to normal function within one month

107
Q

What are the 4 levels of brief psychotic DO

A

With a marked stressor
Without a marked stressor
Or with peripartum onset

W/ or w/o Catatonia

108
Q

What is the Tx approach to brief psychotic DO

A

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

109
Q

What is the DO criteria for delusional DO

A

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

110
Q

What is the essential feature of Delusional DO

A

Essential feature is at least one delusion that persists for at least 1 month

111
Q

What is the Tx approach for Delusional DO

A

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

112
Q

What is the DO criteria for schizophrenia

A

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):

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized behavior or catatonia
  5. 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

113
Q

What are the characteristics S/s of schizophrenia

A

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

114
Q

What is the Tx approach for schizophrenia

A

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

115
Q

What is the criteria for Oppositional Defiant DO

A

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

116
Q

What is the essential feature of Oppositional Defiant DO

A

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

117
Q

What are the two most common co-occurring conditions with oppositional defiant DO

A

ADHD and conduct DO

118
Q

What are the 7 levels of delusional DO

A 
Eromatic (romantic delusion) 
Grandious 
Jealous
Persecution
Somatic 
Mixed 
Unspecified
119
Q

What is the tx approach for Oppositional defiant DO

A

Psychotherapy: Family intervention/training to reward good behavior, discourage undesired behavior

Pharmacotherapy: Treat co-morbidities accordingly

120
Q

What is the criteria for conduct DO

A

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

121
Q

What is the essential feature of Conduct DO

A

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

122
Q

What is the Tx approach for conduct DO

A

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

123
Q

What is the def. of a personality

A

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.

124
Q

What is the enduring pattern of a personality DO

A

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.

125
Q

What does CARPI stand for in personality DO

A

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

126
Q

What are cluster A personality DO

A

Paranoid – Schizoid – Schizotypal

WIERD

127
Q

What are cluster B personality DO

A

Antisocial – Borderline – Histrionic – Narcissistic

DRAMATIC

128
Q

What are cluster C personality DO

A

Avoidant – Dependent – Obsessive-Compulsive

WORRIED

129
Q

What is the DO criteria for Paranoid Personality DO

A

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

130
Q

What is the essential feature of paranoid personality DO

A

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

131
Q

What is the criteria for schizoid personality DO

A

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

132
Q

What is the essential feature of schizoid personality DO

A

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

133
Q

What is the criteria for schizotypal personality DO

A

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

134
Q

What is the essential feature of schizotypal personality DO

A

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

135
Q

What is the criteria for antisocial personality DO

A

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

136
Q

What is the essential feature of antisocial personality DO

A

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…

137
Q

What is the criteria for Borderline personality DO

A

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.

138
Q

What is the essential feature of borderline personality DO

A

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

139
Q

What is the criteria for histrionic personality DO

A

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

140
Q

What is the essential feature of histrionic personality DO

A

The essential feature is pervasive and excessive emotionality and attention-seeking behavior

141
Q

What is the criteria for narcissistic personality DO

A

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

142
Q

What is the essential feature of narcissism

A

The essential feature is a pervasive pattern of grandiosity, need for admiration, and lack of empathy

143
Q

What is the DO criteria for avoidant PDO

A

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

144
Q

What is the essential feature of avoidant PDO

A

Essential feature is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

145
Q

What is the criteria for dependent PDO

A

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

146
Q

What is the essential feature of dependent PDO

A

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

147
Q

What is the criteria for Obsessive Compulsive PDO

A

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

148
Q

What is the essential feature of OCD PDO

A

The essential feature is a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

149
Q

What is the TX approach to personality DO

A

Peer pressure to modify behaviors

Operant conditioning

Aversive conditioning

Group and individual therapy

150
Q

What is the pharm approach to Borderline personality DO

A

Antidepressants have improved anxiety, depression, and sensitivity to rejection in some patients with borderline personality disorder

151
Q

What is the pharm approach to impulsive aggressive pts

A

SSRIs also have a role in reducing aggressive behavior in impulsive aggressive patients

152
Q

What is the pharm approach to targeting hostility, agitation, and as adjuncts to antidepressant therapy

A

Antipsychotics

153
Q

What is the pharm approach to decrease the severity of behavioral dyscontrol in some personality disorder patients

A

Anticonvulsants

154
Q

What is the pharm approach to schizotypal pts

A

Antipsychotics

155
Q

What is the pharm approach to avoidant personality DO

A

Avoidant personality may benefit from strategies that reduce anxiety, including the use of SSRIs and benzodiazepines

156
Q

What is the Dx criteria for separation anxiety DO

A

excessive fear or anxiety concerning separation from
those to whom the individual is attached,

  1. Recurrent excessive distress when anticipating or experiencing separation from
    home or from major attachment figures.
  2. Persistent and excessive worry about losing major attachment figures or about possible
    harm to them, such as illness, injury, disasters, or death.
  3. 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.
  4. Persistent reluctance or refusal to go out, away from home, to school, to work, or
    elsewhere because of fear of separation.
  5. Persistent and excessive fear of or reluctance about being alone or without major
    attachment figures at home or in other settings.
  6. Persistent reluctance or refusal to sleep away from home or to go to sleep without
    being near a major attachment figure.
  7. Repeated nightmares involving the theme of separation.
  8. 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

157
Q

What is the Dx criteria for central sleep apnea

A

Evidence by polysomnography of five or more central apneas per hour of sleep.

158
Q

What is the Dx criteria for sleep related hypo ventilation

A

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.)

159
Q

What is the Dx criteria for NREM Sleep arousal DO

A

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.)

160
Q

What is the Dx criteria for REM sleep behavior DO

A

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

161
Q

What is the major difference in criteria for schizophreniform DO and brief psychotic DO from schizophrenia

A

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.

162
Q

What is the Dx criteria for schizoaffective DO

A

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

163
Q

What is the Dx criteria for intermittent explosive DO

A

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.

164
Q

What is the Dx criteria for pyromania

A

Deliberate and purposeful fire setting on more than one occasion.

165
Q

What is the Dx. Criteria for Kleptomania

A

Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

IPAP 21-2 Soph Semester (20 decks)

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