PSYCH 506-509 Flashcards
What is multiple personality disorder now called?
Dissociative identity disorder
Is dissociative identity disorder more common in men or women?
Women
What is dissociative identity disorder associated with?
History of sexual abuse, PTSD, depression, substance abuse, borderline personality, somatoform conditions
What is depersonalization/derealization disorder?
Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions (depersonalization)
Or one’s environment (derealization)
What are mood disorders?
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.
Name 4 mood disorders.
Major depressive disorder, bipolar disorder, dysthymic disorder, cyclothymic disorder
How do you diagnose a manic episode?
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
How is a hypomanic episode different from a manic episode?
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
How long does a hypomanic episode last vs. a manic episode?
Hypomanic lasts at least 4 days vs. manic at least 1 week
Define Bipolar I and Bipolar II disorder.
Bipolar I - at least 1 manic episode with or without a hypomanic or depressive episode
Bipolar II - presence of a hypomanic and depressive episode
What are bipolar patients at risk of?
Suicide
Why might treating a bipolar patient with antidepressant be contraindicated?
Lead to increased mania
How do we treat bipolar?
Mood stabilizers (e.g. lithium, valproic acid, carbamazepine), atypical antipsychotics
What is cyclothymic disorder?
Dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years
How long do major depressive episodes last?
6-12 months
How do you diagnose major depressive disorder?
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
What sorts of sleep changes do patients with depression typically have?
Decrease: slow-wave sleep, REM latency
Increase: REM early in sleep cycle, total REM, nighttime awakenings, early-morning awakenings
What is seasonal affective disorder?
Symptoms usually associated with winter season and improve in response to full-spectrum bright-light exposure
What is dysthymia?
Persistent depressive disorder - milder depression lasting at least 2 years
What is the most common subtype of depression and how does it differ from major depressive disorder?
Atypical depression differs by:
- Characterized by mood reactivity (being able to experience improved mood in response to positive events, albeit briefly)
- “reversed” vegetative symptoms (hyperinsomnia and weight gain)
- leaden paralysis (heavy feeling in arms and legs)
- long-standing interpersonal rejection sensitivity
How do we treat atypical depression?
MAO inhibitors, SSRIs
When do postpartum mood disturbances set in?
Within 4 weeks of delivery
What are 3 postpartum mood disturbances and what are their time courses and incidences?
- Maternal (postpartum) “blues” - usually resolves within 10 days; COMMON 50-85%
- Postpartum depression - Lasts 2 weeks to a year or more; KIND OF COMMON 10-15%
- Postpartum psychosis - Usually lasts days to 4-6 weeks; RARE 0.1-0.2%
Compare and contrast the treatments for postpartum blues vs. depression vs. psychosis.
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
When do postpartum blues usually occur?
2-3 days after delivery
Compare and contrast the clinical symptoms in postpartum blues vs. depression.
Blues: depressed affect, tearfulness, fatigue
Depression: depressed affect, anxiety, poor concentration
What are the symptoms of postpartum psychosis?
Delusions, hallucinations, confusion, unusual behavior, possible homicidal/suicidal ideations or attempts
What is pathologic grief?
Includes any of the following:
- Excessively intense grief (shock, denial, guilt, and somatic symptoms)
- Prolonged grief lasting > 6 - 12 months
- Grief that is delayed, inhibited, or denied
What are psychiatric symptoms that may present with pathologic grief?
Depressive symptoms, delusions, hallucinations
How do we treat major depressive disorder refractory to other treatment? What other group of patients can also receive this treatment?
Electroconvulsive therapy; can also treat:
- pregnant women with major depressive disorder
- if immediate response is necessary (e.g. acute suicidality)
- depression with psychotic features
- catatonia
What does ECT produce in an anesthetized patient?
Relatively painless seizure
What are some of the adverse effects of ECT?
Disorientation, temporary headache, partial anterograde/retrograde amnesia usually fully resolving in 6 months
What are risk factors for suicide completion?
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
Which gender attempts suicide more often? Which gender succeeds more often?
Women make more attempts but men succeed more often
What is anxiety disorder?
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
Name 3 anxiety disorders.
Panic disorder, Phobias, Generalized anxiety disorder
Are anxiety orders more common in men or women?
Lifetime prevalence of 30% in women, 19% in men
How do you diagnose panic disorder?
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
What is the treatment for panic disorder?
Cognitive behavioral therapy, SSRI’s, venlafaxine (think hyperVENtilating person having a panic attack), benzodiazepines
What is a panic attack?
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
In panic disorder, what emotion are the symptoms a systemic manifestation of?
Fear
Why should you ask about a family history in panic disorders?
Strong genetic component
What is a phobia?
Fear that is excessive or unreasonable and interferes with normal function, cued by presence or anticipation of a specific object or situation
Are patients with phobia self aware?
Yes, they recognize that the fear is excessive
How do we treat phobias?
Systematic desensitization
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?
Agoraphobia
What is social anxiety disorder and how is it treated?
Exaggerated fear or embarrassment in social situations (e.g. public speaking, using public restrooms)
Treatment: SSRIs
What is generalized anxiety disorder?
Pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event
What is GAD associated with?
Sleep disturbance, fatigue, GI disturbance, difficulty concentrating
How is GAD treated?
SSRI’s, SNRI’s, buspirone, cognitive behavioral therapy
What is adjustment disorder?
Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor and lasting < 6 months
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?
Obsessive compulsive disorder
How is OCD different from obsessive-compulsive personality disorder?
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.
What other disorder is OCD associated with?
Tourette disorder
How do we treat OCD?
SSRI’s, clomipramine
What is body dysmorphic disorder?
Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning
What is PTSD?
Post-traumatic stress disorder - persistent reexperiencing of a previous traumatic event (e.g. war, rape, robbery, serious accident, fire)
How long does PTSD disturbance last?
> 1 month with onset of symptoms beginning anytime after event
What are some symptoms of PTSD?
Nightmares, flashbacks, intense fear, helplessness, horror
What are treatments for PTSD?
Psychotherapy, SSRI’s
How is acute stress disorder different from PTSD?
Lasts between 3 days and 1 month
