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1
Q

Personality traits are

A

enduring patterns of perception/thinking about environment/social setting.

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2
Q

Personality Disorder is?

A

When personality traits are inflexible, maladaptive, and impairs life/fx.

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3
Q

General personality disorder criteria

A
  • Patterns deviate from culture in >1 areas (Cognition, Affect, Interpersonal Fx, impulse control)
  • Pattern is inflexible/pervasive
  • Distressing/impairs
  • Hx Stable/tracing back to adolescence/early adult
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4
Q

Cognition is…

A

Ways of perceiving/interpreting self, people, events

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5
Q

Affectivity is…

A

Emotional response

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6
Q

Cluster A personality disorders list?

A

Paranoid
Schizoid
Schizotypal

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7
Q

Paranoid Personality D/O def?

A

Pervasive distrust that is interpreted as malevolent.

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8
Q

Paranoid Personality D/O criteria

A

> 3 of

  • suspects exploitation/harmful/deceitfulness
  • preoccupied w/ unjustified doubts of loyalty/trust
  • reluctant to confide in others due to fear of reprise
  • reads demeaning/threatening messages into NL things
  • persistently has grudges and is unable to forgive
  • perceives attacks of character/reputation
  • recurrent suspcisions of fidelity
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9
Q

Schizoid Personality d/o def?

A

Pervasive detachment from social relations and restricted range of expression or emotions in interpersonal settings.

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10
Q

Schizoid Personality d/o criteria

A

> 3 of

  • No desire/enjoyment of close relationships friend/fam
  • Almost always chooses solitary activities
  • No interest in sex
  • Few if any activities that please
  • Lacks close friends/confidents
  • Indifferent to praise or criticism
  • Appears emotionless, detached, or flat
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11
Q

Premorbid schzoid personality disorder indicates?

A

Prior to onset of schizophrenia

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12
Q

Schizotypal Personality d/o def?

A

Pervasive of social deficits w/ discomfort/reduced capacity for close relationships and cognitive/perceptual distortions/eccentric behaviors.

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13
Q

Schizotypal Personality d/o criteria?

A

> 4

  • Ideas of reference
  • Odd beliefs/magical thinking influencing behavior
  • Odd behavior/appearance
  • Unusual perceptual experiences (illusions)
  • Odd thinking/speech
  • Suspicious/paranoid ideation
  • Affect inappropriate or constricted
  • Lack of close friends/confidents
  • Excess social anxiety from paranoid fears
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14
Q

Premorbid Schizotypal Personality d/o indicates?

A

Prior to onset of schizophrenia

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15
Q

Cluster B personality disorders list?

A

Antisocial
Borderline
Histrionic
Narcissistic

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16
Q

Antisocial Personality d/o def?

A

Pervasive disregard/violation of others rights since 15yo

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17
Q

Antisocial Personality d/o criteria?

A

Conduct d/o <15yo but must be >18yo for dx and w/ >2

  • Fail to conform to lawful behaviors
  • Deceitfulness/conning for personal profit/pleasure
  • Impulsivity/fails to plan ahead
  • Aggressiveness (repeated fights)
  • Irresponsibility (fail to sustain work/debts)
  • Lack of remorse
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18
Q

Borderline Personality d/o def?

A

Pervasive relationship instability, self image, and impulsivity.

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19
Q

Borderline Personality d/o criteria?

A

Chronic feelings of emptiness
Inappropriate, intense anger
Transient stress related paranoia/dissociative s/s
—
>4
- Frantic efforts to avoid real/imagines abandoment
- Unstable intense relations + alter ideals/deavualtion
- Identity disturbance (unstable self image)
- Impulsivity w/ >1 ($,sex,drugs,reckless driving, eating)
- Recurrent suicidal behavior, threats, SIB
- Affect instability (alternating w/in hrs)

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20
Q

Histrionic Personality d/o def?

A

Pervasive excessive emotions and attention seeking

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21
Q

Histrionic Personality d/o criteria?

A

> 4

  • Uncomfortable if not the center of attention
  • Inappropriate seductive/provoctive behavior
  • Rapid shifting/shallow expression of emotions
  • Uses physical appearance to draw attention
  • Excess impressionistic speech lacking in detail
  • Self dramatization
  • Easily influenced by others
  • Thinks relations more intimate than really are
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22
Q

Narcissistic Personality d/o def?

A

Pervasive grandiosity, need for admiration, and lacks empathy.

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23
Q

Narcissistic Personality d/o criteria?

A

> 4

  • Grandiose self importance
  • Fantasizes of unlimited success/power/beauty
  • Believes they are special and only associates w/ like
  • Req excess admiration
  • Sense of entitlement
  • Exploits people
  • Lacks empathy
  • Envious of others envious of them
  • Arrogant attitude
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24
Q

Cluster C personality d/o list?

A

Avoidant
Dependent
Obsessive-Compulsive

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25
Q

Avoidant personality d/o def?

A

Pervasive social inhibition, inadequacy, and hypersensitivity to negative criticism.

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26
Q

Avoidant personality d/o criteria?

A

> 3

  • Avoids activities w/ significant contact
  • Unwilling to befriend people unless will be liked
  • Restraint w/in intimate relations; fear of shame
  • Preoccupied w/ being criticized/rejected
  • Inhibited w/ people due to inadequacy
  • Views self as socially inept/inferior
  • Reluctant to take personal risks/new activities
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27
Q

Dependent personality d/o def?

A

Pervasive excess need to be taken care leading to submissiveness and fear of separation

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28
Q

Dependent personality d/o criteria?

A

> 4

  • Cant make decisions w/out excess advice
  • Req others to take over major areas of life
  • Difficulty expressing disagreement
  • Lacks self confidence to start new projects
  • Feels helpless when alone
  • Preoccupied w/ fears to have to take care of oneself
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29
Q

Obsessive-compulsive personality d/o def?

A

Pervasive preoccupation w/ orderliness/perfection and control at the expense of flexibility/efficiency

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30
Q

Obsessive-compulsive personality d/o criteria?

A

> 3

  • Preoccupies w/ details that core point of task is lost.
  • Perfection affects task completion
  • Devoted to work/productivity to exclusion of leisure
  • Overconscientious
  • Unable to discard meaningless worn objects
  • Cant delegate tasks
  • Money is something to be hoarded for catastrophes
  • rigid and stubborn
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31
Q

Specifiers of personality change due to medical conditions

A 
Labile
Disinhibited
Aggressive
Apathetic
Paranoid
Other
Combined
Unspecified
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32
Q

Cluster A personality d/o’s are described as?

A

Odd or eccentric

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33
Q

Cluster B personality d/o’s are described as?

A

Dramatic, Emotional, Erratic

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34
Q

Cluster C personality d/o’s are described as?

A

Anxious/fearful

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35
Q

Somatization is?

A

Physical S/S that mimic a disease that is not there

- Pyschological stress expressed physically

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36
Q

Somatization is AKA?

A

Hysteria

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37
Q

Reasons pts have Somatic S/S?

A
  • Cry for help
  • Secondary gains
  • Physical/sexual trauma is for communicating
  • Socially acceptable illness that explains failures
  • Physical illness has less stigma than mental illness
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38
Q

Reasons somatization occurs?

A
  • Learned behavior

- Pt perceives provider ignore non-physical S/S

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39
Q

Somatic Symptom disorder characteristics?

A
  • High levels of worry
  • Think the worst about their health despite evidence
  • Central focus of life
  • High level of medical care but unsatisfied
  • Cant let fear of health GO!
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40
Q

Somatic Symptom disorder criteria?

A

> 6mo (S/S may alternate or change but for >6mo)

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41
Q

Somatic Symptom disorder specifiers?

A
  1. Predominant pain

2. Persistent >6mo

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42
Q

Type of S/S ass/w somatic symptom disorder?

A

Symptoms that cant be measured (Constitutional)

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43
Q

Somatic symptom disorder presents as?

A

Multiple constitutional S/S
Vague history that doesn’t add up
History out of proportion to exam

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44
Q

Best treatment for Somatic symptom disorder?

A

Psychotherapy/pharmacotherapy while legitimizing d/o w/ regular visits of education and reassurance

45
Q

Rx for Somatic Symptom disorder?

A

1L - SSRI
2L - SNRI
St Johns wort

46
Q

Illness anxiety disorder def?

A

High level of anxiety of having serious illness w/ or w/out mild somatic S/S that result in excess health related checks for >6mo (illness may change)

47
Q

Illness anxiety d/o Eval/txt?

A

Same as somatic s/s d/o
CBT/Rx - 1L SSRI - 2L SNRI - St john wort
Multiple visits w/ education/reassurance

48
Q

Conversion d/o is AKA?

A

Fx neurological symptom d/o

49
Q

Conversion d/o often ass/w?

A

Comorbid psych Dx

50
Q

Dx criteria of conversion d/o?

A

1 or more S/S of altered VOLUNTARY motor/sensory fx

that doesnt match medical condition

51
Q

Dx criteria of conversion d/o?

A

1 or more S/S of altered VOLUNTARY motor/sensory fx

that doesnt match medical condition

52
Q

TXT of conversion d/o?

A

Neuro eval +- inpt admit
Education then CBT
(NO RX)

53
Q

Factitious d/o def?

A

Purposefully producing, simulating or exaggerating physical illness (esp during sick call)

54
Q

DIfferences between malingering and factitious d/o?

A

Malingering - intentional reporting s/s for gain

Factitous d/o - req absence of obvious reward

55
Q

Factitious d/o criteria?

A

Deception of physical/pyschological S/S by presenting oneself to others as impaired/ill but w/out external rewards

56
Q

Factitious d/o eval and TXT?

A

Thoroughly analyze Hx for gains and document everything

57
Q

Somatic d/o w/ highest potential for litigation?

A

Factitous d/o

58
Q

General eval of sleep related disorders components?

A

Sleep log w/ Rx/diet
Hx, PE (airway, thyroid)
Screening exams
CBC, TFT, Polysomnography, asthma/copd, GERD

59
Q

Name of scale used to screen for sleep disorders?

A

Epworth sleepiness scale

60
Q

Sleep study is AKA?

A

Polysomnography

61
Q

A sleep study is often used to Dx what?

A

OSA - obstructive sleep apnea

62
Q

What is the name of the test following a sleep study?

A

Multiple sleep latency test is performed the day after a sleep study

63
Q

How is a Multiple sleep latency test performed?

A

Pt attempts to take a nap times for 20min inbetween 2hrs of activity on 5 different occasions.

64
Q

What parameters are recorded during a Multiple sleep latency test

A

Electro-encephalography
Electro-oculography
Electro-myography (mental/submental)
Electro-cardiography

65
Q

What is the goal of Multiple sleep latency test and what is it trying to Dx?

A

Time it takes to from wake to REM (latency) and how many sleep onset REMs occur during that time - for narcolepsy

66
Q

Insomnia d/o def?

A

Dissatisfaction w/ sleep quality or quanity due to dificulty falling/staying asleep w/ impairment

67
Q

What are Insomnia d/o subclassifications?

A
  1. Initial/sleep-onset - (Cant fall)
  2. Middle/Sleep maintenance - (frequent wakings)
  3. Late/terminal - Early wake w/out return; >30m before alarm and <6hrs total.
68
Q

Diagnostic criteria of Insomnia d/o?

A

Sleep difficulty at least 3x/wk for >3mo

69
Q

Insomnia d/o TXT?

A

No 1L - (CBT(sleep hygiene), Rx, Combo)

70
Q

What is stimulus control therapy?

A

TXT for Insomnia d/o - Alternating between 20m of trying to sleep in bed and relaxing activity out of bedroom until sleepy
- Same alarm time Q/Day per week w/out any day naps

71
Q

What is sleep restriction therapy?

A

TXT for Insomnia d/o - Limit time spent in bed to at least 5hrs and when 85% efficiency is reached increase time by 15-30m and repeat to 85%.

72
Q

2 specific therapy TXTs for Insomnia d/o?

A

Stimulus control therapy and sleep restriction therapy

73
Q

Rx TXT for ‘sleep onset’ Insomnia d/o?

A 
Short acting/lower dose used first
Zaleplon (Sonata)
Zolpidem (Ambien)
Benzo's - (triazolam/lorazepam)
Ramelteon (Rozerem)
74
Q

Difference between
-Zaleplon (Sonata)
VS
-Zolpidem (Ambien)

A

Zaleplon (Sonata)
- Onset 5-15m AND t1/2 1-1.5hrs (Falling asleep)
Zolpidem (Ambien)
- Onset 15-30m AND t1/2 3-4hrs (Staying asleep)

75
Q

What Rx are non-benzodiazepine hypnotics?

A

Zaleplon (Sonata)

Zolpidem (Ambien)

76
Q

2 important points about Zaleplon (Sonata)?

A
  1. Tobacco/caffeine reduce effectivness

2. CI w/ ETOH (respiratory depression) or Cimetidine

77
Q

2 important points about Zolpidem (Ambien)?

A
  1. SE: Night eating syndrome or ataxia

2. Reversed w/ FLUMAZENIL if OD

78
Q

2 Simiarities of Zolpidem (Ambien) and Zaleplon (Sonata)?

A

Less morning grogginess
Anterograde amnesia
Withdrawal (DOA)

79
Q

Ramelteon MOA?

A

Melatonin Receptor agonist (mimics melatonin)

80
Q

Ramelteon is better for what sleep d/o?

A

Circadian rhythm sleep d/o

81
Q

Ramelteon is CI if pt is taking what Rx?

A

Amiodarone (Antiarrythmic)
Ciprofloxacin
Fluvoxamine (Luvox)
Ticlopidine (Anti-PLT)

82
Q

Rx TXT for ‘sleep maintenance’ Insomnia d/o?

A

Longer acting perferred

  • Zolpidem ER (Ambien CR)
  • Eszopiclone (Lunesta)
  • Temazepam/Estazolam
  • low dose Doxepin
83
Q

Rx TXT for ‘Late terminal’ Insomnia d/o?

A

Req at least 4hrs in bed after admin

  • Zaleplon (Sonata)
  • Zolpidem sublingual (Edular)
84
Q

Hypersomnolence d/o def? And Criteria

A

SELF REPORTED excess sleepiness w/ a main sleep period lasting >7hrs… >2x/wk at least 3mo PLUS 1 or more S/S of…

  • Recurrent sleep/lapses during day
  • Non-restorative sleep despite >9hrs
  • After abrupt waking (Cant stay awake)
85
Q

Hypersomnolence d/o MC population?

A

Adolescent or young adult

86
Q

Hypersomnolence d/o eval?

A

Hx, sleep log 1-2w, PE, PSG + Multiple sleep latency test

87
Q

Hypersomnolence d/o TXT?

A

Consult to sleep - Rx only (No CBT)
DOC - Modafinil (provigil)
- Armodafinil (Nuvigil)
- Methylphenidate (Ritalin, Concerta)

88
Q

Narcolepsy def?

A

Uncontrollable daytime sleepiness w/ cataplexy, hypnagogic hallucinations, or sleep paralysis.

89
Q

Narcolepsy

A

> 2x/wk at least 3months of irrepressible need to sleep + Cataplexy
OR
+ Hypocretin deficiency (CSF test)
OR
PSG w/ REM <15m or MSL test <8m mean >1 REM

90
Q

Cataplexy def?

A

1-2m Sudden muscle weakness triggered by strong emotion followed by sleep and patient is aware

91
Q

Hypnagogic hallucinations are? Types?

A

Brief Hallucinations occuring from

  • wake > GO to sleep (HypnaGOgic)
  • sleep > wake (Hypnopomic)
92
Q

Sleep paralysis def?

A

Experience of being aware during sleep but unable to speak, move, or react

93
Q

Hypocretin is?

A

Neuropeptide that regulates arousal, wakefulness, appetite.

94
Q

Narcolepsy eval?

A

Hx (cataplexic events)
PE
Studies - PSG/MSL, CBC, TFT, Hypocretin

95
Q

Narcolepsy TXT? Goal?

A

To improve alertness
- Driving a car mod
- Rx -
Daytime sleepy (Modafinil or Methylphenidate)
Cataplexy (Venlafaxine or Fluoxetine) REM suppressing

96
Q

OSA def?

A

Recurrent collapse of AW structures causing reduced airflow/oxygen that leads to hypoxemia/hypercapnia and unfulfilling sleep.

97
Q

OSA criteria?

A

PSG evidence >4 hypopneas/hr + either
- breathing disturbances (Snoring, Gasping, pauses)
or
- Daytime sleepiness

VS

PSG evidence of 15 episodes of hyponea/hr w/out S/S

98
Q

Causes of OSA?

A

PE -
Large body habitus (esp neck)
Narrow post-pharyngeal
Enlarged tonsils

99
Q

OSA eval?

A

HX, PE, Studies (PSG w/ 2nd night (CPAP) if positive 1st night) CBC TFT.
Refer - sleep/ENT

100
Q

OSA TXT?

A

Wgt loss
CPAP
UPPP (uvulopalatopharyngyoplasty)
Tonsillectomy/adenoidectomy

101
Q

UPPP is?

A

surgical removal of uvula and distal 1/3 of upper palate to open posterior pharyngeal

102
Q

OSA treatment prognosis?

A

Excellent w/ treatment and compliance

103
Q

Restless leg syndrome def?

A

Pts moves legs to relieve overwhelming unplesant sensation that is worse at rest and is ass/w periodic leg movements (jerks) of sleep (PLMS)

104
Q

Restless leg syndrome criteria?

A

3x/wk for 3mo

105
Q

Restless leg syndrome eval?

A

Hx (diagnosed typically through Subj complaints)
Sleep log
PE - neuro
Studies - Iron panel, CBC, thyroid, PSG

106
Q

Restless leg syndrome TXT?

A

Iron replacement
Rx
Avoidance

107
Q

Restless leg syndrome Rx TXT?

A

Pramipexole, Gabapentin, Benzo’s intermittent

108
Q

Restless leg syndrome pts should avoid?

A

Sleep deprivation
Antidepressants
Metoclopramide
Sedating AH

109
Q

Which antidepressant is good w/ Restless leg syndrome?

A

Buproprion

Phase 2 - Psych (7 decks)

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