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First Aid 2014 > PSYCH 506-509 > Flashcards

PSYCH 506-509 Flashcards

1
Q

What is multiple personality disorder now called?

A

Dissociative identity disorder

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2
Q

Is dissociative identity disorder more common in men or women?

A

Women

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3
Q

What is dissociative identity disorder associated with?

A

History of sexual abuse, PTSD, depression, substance abuse, borderline personality, somatoform conditions

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4
Q

What is depersonalization/derealization disorder?

A

Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions (depersonalization)

Or one’s environment (derealization)

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5
Q

What are mood disorders?

A

Abnormal range of moods or internal emotional states and loss of control over them. The severity of the moods causes distress and impairment in social and occupational functioning.

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6
Q

Name 4 mood disorders.

A

Major depressive disorder, bipolar disorder, dysthymic disorder, cyclothymic disorder

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7
Q

How do you diagnose a manic episode?

A 
Diagnosis requires hospitalization or at least 3 of the following: DIG FAST
Distractibility
Irresponsibility - seeks pleasure without regard to consequences (hedonistic)
Grandiosity - inflated self esteem
Flight of ideas - racing thoughts
Activity/Agitation
Sleep need decreases
Talkativeness or pressured speech
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8
Q

How is a hypomanic episode different from a manic episode?

A

Severity of the mood is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization.

No psychotic features

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9
Q

How long does a hypomanic episode last vs. a manic episode?

A

Hypomanic lasts at least 4 days vs. manic at least 1 week

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10
Q

Define Bipolar I and Bipolar II disorder.

A

Bipolar I - at least 1 manic episode with or without a hypomanic or depressive episode

Bipolar II - presence of a hypomanic and depressive episode

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11
Q

What are bipolar patients at risk of?

A

Suicide

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12
Q

Why might treating a bipolar patient with antidepressant be contraindicated?

A

Lead to increased mania

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13
Q

How do we treat bipolar?

A

Mood stabilizers (e.g. lithium, valproic acid, carbamazepine), atypical antipsychotics

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14
Q

What is cyclothymic disorder?

A

Dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years

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15
Q

How long do major depressive episodes last?

A

6-12 months

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16
Q

How do you diagnose major depressive disorder?

A

Episodes characterized by at least 5 of the following 9 symptoms for 2 or more weeks (symptoms must include patient-reported depressed mood or anhedonia aka the basic history screen for depression)

SIG E CAPS
Sleep disturbance
Interest loss (anhedonia)
Guilt or feelings of worthlessness
Energy loss and fatigue
Concentration problems
Appetite/weight changes
Psychomotor retardation or agitaiton
Suicidal ideations
Depressed mood
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17
Q

What sorts of sleep changes do patients with depression typically have?

A

Decrease: slow-wave sleep, REM latency
Increase: REM early in sleep cycle, total REM, nighttime awakenings, early-morning awakenings

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18
Q

What is seasonal affective disorder?

A

Symptoms usually associated with winter season and improve in response to full-spectrum bright-light exposure

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19
Q

What is dysthymia?

A

Persistent depressive disorder - milder depression lasting at least 2 years

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20
Q

What is the most common subtype of depression and how does it differ from major depressive disorder?

A

Atypical depression differs by:

  1. Characterized by mood reactivity (being able to experience improved mood in response to positive events, albeit briefly)
  2. “reversed” vegetative symptoms (hyperinsomnia and weight gain)
  3. leaden paralysis (heavy feeling in arms and legs)
  4. long-standing interpersonal rejection sensitivity
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21
Q

How do we treat atypical depression?

A

MAO inhibitors, SSRIs

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22
Q

When do postpartum mood disturbances set in?

A

Within 4 weeks of delivery

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23
Q

What are 3 postpartum mood disturbances and what are their time courses and incidences?

A
  1. Maternal (postpartum) “blues” - usually resolves within 10 days; COMMON 50-85%
  2. Postpartum depression - Lasts 2 weeks to a year or more; KIND OF COMMON 10-15%
  3. Postpartum psychosis - Usually lasts days to 4-6 weeks; RARE 0.1-0.2%
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24
Q

Compare and contrast the treatments for postpartum blues vs. depression vs. psychosis.

A

Blues: supportive treatment, follow up to see if it progresses to depression
Depression: antidepressants, psychotherapy
Psychosis: antidepressants, antipsychotics, possible inpatient hospitalization, assessment of child safety

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25
Q

When do postpartum blues usually occur?

A

2-3 days after delivery

26
Q

Compare and contrast the clinical symptoms in postpartum blues vs. depression.

A

Blues: depressed affect, tearfulness, fatigue
Depression: depressed affect, anxiety, poor concentration

27
Q

What are the symptoms of postpartum psychosis?

A

Delusions, hallucinations, confusion, unusual behavior, possible homicidal/suicidal ideations or attempts

28
Q

What is pathologic grief?

A

Includes any of the following:

  1. Excessively intense grief (shock, denial, guilt, and somatic symptoms)
  2. Prolonged grief lasting > 6 - 12 months
  3. Grief that is delayed, inhibited, or denied
29
Q

What are psychiatric symptoms that may present with pathologic grief?

A

Depressive symptoms, delusions, hallucinations

30
Q

How do we treat major depressive disorder refractory to other treatment? What other group of patients can also receive this treatment?

A

Electroconvulsive therapy; can also treat:

  1. pregnant women with major depressive disorder
  2. if immediate response is necessary (e.g. acute suicidality)
  3. depression with psychotic features
  4. catatonia
31
Q

What does ECT produce in an anesthetized patient?

A

Relatively painless seizure

32
Q

What are some of the adverse effects of ECT?

A

Disorientation, temporary headache, partial anterograde/retrograde amnesia usually fully resolving in 6 months

33
Q

What are risk factors for suicide completion?

A 
SAD PERSONS:
Sex (male)
Age (teenager or elderly)
Depression
Previous attempt
Ethanol or drug use
Rational thinking loss
Sickness (medical illness, 3 or more prescription medications)
Organized plan
No spouse
Social support is lacking
34
Q

Which gender attempts suicide more often? Which gender succeeds more often?

A

Women make more attempts but men succeed more often

35
Q

What is anxiety disorder?

A

inappropriate experience of fear/worry and its physical manifestations (anxiety) when the source of the fear/worry is either not real or insufficient to account for the severity of the symptoms; the symptoms interfere with daily functioning

36
Q

Name 3 anxiety disorders.

A

Panic disorder, Phobias, Generalized anxiety disorder

37
Q

Are anxiety orders more common in men or women?

A

Lifetime prevalence of 30% in women, 19% in men

38
Q

How do you diagnose panic disorder?

A

Diagnosis requires panic attack followed by 1 month (or more) of 1 (or more) of the following: persistent concern of additional attacks, worrying about consequences of the attack, behavioral change related to attacks

39
Q

What is the treatment for panic disorder?

A

Cognitive behavioral therapy, SSRI’s, venlafaxine (think hyperVENtilating person having a panic attack), benzodiazepines

40
Q

What is a panic attack?

A 
Periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following:
PANICS
Palpitations, paresthesias
Abdominal distress
Nausea
lghtheadedness
Chest pain, chills, choking, disConnectedness
Sweating, shaking, shortness of breath
41
Q

In panic disorder, what emotion are the symptoms a systemic manifestation of?

A

Fear

42
Q

Why should you ask about a family history in panic disorders?

A

Strong genetic component

43
Q

What is a phobia?

A

Fear that is excessive or unreasonable and interferes with normal function, cued by presence or anticipation of a specific object or situation

44
Q

Are patients with phobia self aware?

A

Yes, they recognize that the fear is excessive

45
Q

How do we treat phobias?

A

Systematic desensitization

46
Q

A patient describes being afraid of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone. What is this called?

A

Agoraphobia

47
Q

What is social anxiety disorder and how is it treated?

A

Exaggerated fear or embarrassment in social situations (e.g. public speaking, using public restrooms)

Treatment: SSRIs

48
Q

What is generalized anxiety disorder?

A

Pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event

49
Q

What is GAD associated with?

A

Sleep disturbance, fatigue, GI disturbance, difficulty concentrating

50
Q

How is GAD treated?

A

SSRI’s, SNRI’s, buspirone, cognitive behavioral therapy

51
Q

What is adjustment disorder?

A

Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor and lasting < 6 months

52
Q

A patient describes having recurring intrusive thoughts, feelings, or sensations that cause severe distress. It is relieved in part by the performance of repetitive actions. What is this called?

A

Obsessive compulsive disorder

53
Q

How is OCD different from obsessive-compulsive personality disorder?

A

In OCD, the ego is dystonic meaning behavior is inconsistent with one’s own beliefs and attitudes. This is not true in obsessive-compulsive personality disorder.

54
Q

What other disorder is OCD associated with?

A

Tourette disorder

55
Q

How do we treat OCD?

A

SSRI’s, clomipramine

56
Q

What is body dysmorphic disorder?

A

Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning

57
Q

What is PTSD?

A

Post-traumatic stress disorder - persistent reexperiencing of a previous traumatic event (e.g. war, rape, robbery, serious accident, fire)

58
Q

How long does PTSD disturbance last?

A

> 1 month with onset of symptoms beginning anytime after event

59
Q

What are some symptoms of PTSD?

A

Nightmares, flashbacks, intense fear, helplessness, horror

60
Q

What are treatments for PTSD?

A

Psychotherapy, SSRI’s

61
Q

How is acute stress disorder different from PTSD?

A

Lasts between 3 days and 1 month

First Aid 2014 (24 decks)

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