PSYCH 510-512 Flashcards
What 3 disorders are on a differential of a patient with unexplained symptoms of complaints?
- Somatoform disorder
- Factitious disorder
- Malingering
What distinguishes somatoform disorder from factitious disorder and malingering?
In somatoform disorder, there is no conscious attempt to deceive
What is the difference between factitious disorder vs. malingering?
Factitious disorder - chief goal is psychological (primary) gain
Malingering - chief goal is external (secondary) gain; complaints cease after receiving gain
Explain psychological vs. external gain.
Psychological - to assume sick role and get medical attention
External - EX. avoiding work, obtaining compensation
What characterizes Munchausen syndrome?
Chronic factitious disorder with:
- Predominantly physical signs and symptoms
- Multiple hospital admissions
- Willingness to receive invasive procedures
How is Munchausen syndrome by proxy distinct from Munchausen syndrome?
Motivation is to assume a sick role by proxy - when illness in a child or elderly patient is caused by the caregiver; form of child/elder abuse
What characterizes somatoform disorders?
Physical symptoms with no identifiable physical cause and the symptoms are not intentionally produced or feigned (unconsciously driven)
Are somatoform disorders more common in men or women?
Women
What are three types of somatoform disorders?
- Somatic symptom disorder
- Conversion disorder
- Illness anxiety disorder (hypochondriasis)
What is hypochondriasis?
Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance
Give 3 characteristics of somatic symptom disorder.
- Complaints in one or more organ systems
- Lasts for months to years
- Excessive, persistent thoughts and anxiety about symptoms
What is conversion disorder?
Sudden loss of sensory or motor function often following an acute stressor
What is la bell indifference and what disorder is it associated with?
Conversion disorder - patient is aware of but sometimes indifferent toward symptoms
What age/gender is conversion disorder often associated with?
Adolescents and young adults
Women
What is a personality trait?
An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself
What are the three clusters of personality disorder and how would you generally categorize their symptoms?
A, B, C - think Weird (accusatory, aloof, awkward), Wild (bad to the bone), Worried (cowardly, compulsive, clingy)
How is a personality disorder distinct from a personality trait?
Causes subjective distress and/or impaired functioning
What are the 3 types of Cluster A personality disorders?
Paranoid, schizoid, schizotypal
Cluster A has a genetic association to what disorder?
Schizophrenia
What are some of the general characteristics of Cluster A personality?
- Odd or eccentric
- Inability to develop meaningful social relationships
- No psychosis
Describe paranoid personality disorder.
Pervasive distrust and suspiciousness
What is the major defense mechanism of patients with paranoid personality disorder?
Projection
Describe schizoid personality disorder.
Voluntary social withdrawal, limited emotional expression, content with social isolation
Describe schizotypal personality disorder.
Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
What are some general characteristics of Cluster B personality?
Dramatic, emotional, or erratic
Cluster B has a genetic association to what disorder?
Mood disorders and substance abuse
What are the 4 types of Cluster B personality disorder?
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Describe antisocial personality disorder.
Disregard for and violation of rights of others, criminality, impulsivitiy
To be diagnosed with antisocial personality disorder, what age must the patient be?
> 18 and must have history of conduct disorder before age 15
If patient is < 18, then conduct disorder
Is antisocial personality disorder more common in men or women?
Men
Describe borderline personality disorder.
Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, boredom, sense of emptiness
Is borderline disorder more common in men or women?
Women
What is the major defense mechanism in borderline disorder?
Splitting
Describe histrionic personality disorder.
Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance
Describe narcissistic personality disorder.
Grandiosity, sense of entitlement, lacks empathy, requires excessive admiration, often demands the best, reacts to criticism with rage
What is the predominant emotion in Cluster C personality disorders?
Anxiety or fear
What are the three Cluster C personality disorders?
Avoidant, obsessive-compulsive, dependent
Cluster C personality disorders are genetically associated with what class of disorders?
Anxiety disorders
Describe avoidant personality disorder.
Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others
How can you distinguish avoidant personality disorder from schizoid?
Patients with avoidant personality disorder desire relationships with others
Describe obsessive-compulsive disorder.
Preoccupation with order, perfectionism, and control
Describe dependent personality disorder.
Submissive, clinging, excessive need to be taken care of, low self-confidence
How is obsessive-compulsive disorder different from OCD?
Obsessive-compulsive personality disorder is ego-syntonic (behavior is consistent with one’s own beliefs and attitudes (vs. OCD).
Distinguish the three disorders in the schizophrenia spectrum by time course.
< 1 month: brief psychotic disorder (usually stress related)
1 - 6 months: schizophreniform disorder
> 6 months: schizophrenia
What are the 2 types of eating disorders?
- Anorexia nervosa
2. Bulimia nervosa
Describe anorexia nervosa.
Mnemonic: ANOREXIA
Amenorrhea Not eating Osteopenia/osteoporosis Really fine body hair (lanugo) Electrolyte disturbance Xercise Image (body) distortion Anemia
Describe bulimia nervosa.
Mnemonic: BULIMIA
Binge eating Uncovered teeth (enamel erosion) Laxatives, diuretics, emetics Induced vomiting Morphed skin (dorsal hand calluses) Inflammed parotid (parotitis) Alkalosis
What is gender dysphoria?
Strong persistent cross-gender identification that is characterized by persistent discomfort, distress, and impaired functioning
How is transvestism different from transsexualism?
Transvestism is a type of paraphilia (intense sexual arousal to atypical objects, situations, or individuals) and just involves wearing clothes of the opposite sex
Transsexualism is marked by a desire to live as the opposite sex
What are the 4 types of sexual dysfunction disorders?
- Sexual desire disorders
- Sexual arousal disorders
- Orgasmic disorders
- Sexual pain disorders
What is on your DDX along with sexual dysfunction disorders?
Drugs (antihypertensives, neuroleptics, SSRIs, ethanol), diseases (depression, diabetes, STDs), psychological (performance anxiety)
Give 2 examples of sexual desire disorders.
- Hypoactive sexual desire
2. Sexual aversion
What type of disorder is erectile dysfunction?
Sexual arousal disorder
Give 2 examples of orgasmic disorders.
- Anorgasmia
2. Premature ejaculation
Give 2 examples of sexual pain disorders.
- Dyspareunia
2. Vaginismus
What is sleep terror disorder?
Periods of terror with screaming in the middle of the night
Sleep terror disorder is more common in children or adults?
Children
During what phase of sleep does sleep terror occur?
Slow-wave, non-REM
What causes a sleep terror?
Unknown - triggers may include emotional stress, fever, or lack of sleep
How is a sleep terror distinguished from a nightmare?
Sleep terrors occur during non-REM sleep (no memory of arousal) vs. nightmares that occur during REM sleep (memory of a scary dream)
