Psych/Behavioral Health #3 Flashcards
What is dissociative identity disorder?
2 or more distinct identities or states of personalities
Dissociative identity disorder is MC in ______, those with a history of ______, _____, or ______.
Women
-PTSD, substance abuse, sexual abuse
What is depersonalization?
Persistent feelings of detachment or estrangement from oneself (out of body feeling)
What is derealization?
-Persistent feelings of detachment or estrangement from surrounding environment
What is dissociative amnesia?
Inability to recall personal/autobiographical information (often due to sexual abuse, stress, or trauma)
Abrupt change in geographic location with loss of identity or inability to recall the past
Dissociative fugue
Treatment for dissociative disorders
Psychotherapy
Obesity is defined as a BMI > _____ or body weight _____% or more over the ideal weight
BMI > 30
body weight 20% or greater over ideal weight
At what age should a patient be screened for obesity?
All adults and children age 6 years or older
Orlistat is an anti-obesity medication that works how?
Decreases GI fast digestion
Another anti-obesity medication, Lorcaserin, works…
as a serotonin agonist
Unlike bulimia nervosa, binge-eating episodes are NOT associated with
compensatory behaviors (purging or restrictive behaviors) and they are not as fixated on their body shape or weight
Treatment for binge-eating disorders
- Psychotherapy
- Strict diet and exercise plan
- Topiramate (anti epileptic associated with weight loss)
- Stimulants: appetite suppression (Amphetamine)
What exactly is binge-eating disorder?
Recurrent episodes of binge eating: eating within a 2 hour period more than people would in a similar period with lack of an overeating episode (occurs at least weekly for 3 months)
How does Bulimia Nervosa differ from Anorexia Nervosa?
Patients with bulimia usually maintain a normal weight (or may be overweight) and their compensatory behaviors are ego-dystonic (troublesome to the patient)
Physical exam findings of a patient with bulimia nervosa
- Teeth pitting or enamel erosion (from vomiting)
- Russell’s Sign: calluses on the dorsal of the hand
- Parotid gland hypertrophy
Lab findings of a patient with bulimia nervosa
- Hypokalemia
- Hypomagnesemia
- Increased amylase
-Metabolic alkalosis from vomiting
Diagnostic criteria for bulimia
- Recurrent episodes of binge eating (at least weekly for 3 months)
- Compensatory behaviors: purging and non-purging
Treatment for bulimia
- Psychotherapy
- Pharmacotherapy: Fluoxetine
Anorexia nervosa is _______
Failure to maintain normal weight, fear and preoccupation with body weight, body image, and being thin
True or False: Anorexia nervosa has the highest mortality of all psychiatric conditions?
True
With anorexia nervosa, their behaviors are _____, which means
Ego-syntonic, their behaviors are acceptable to them and are in harmony with their self-image goals
Name and describe the two types of Anorexia Nervosa
Restrictive type: strict, reduced calorie intake, dieting, fasting, excessive exercise, and diet pills
Binge eating/Purging: primarily engages in self-induced vomiting and diuretic, laxative, and enema use
Symptoms of anorexia nervosa
- Amenorrhea
- Lanugo
- Bradycardia
- Dry skin
- Salivary gland hypertrophy
- Osteopenia
- Russell’s Sign
What is the BMI and body weight of a patient with anorexia nervosa?
BMI: 17.5 or less
Weight: < 85% of ideal weight
What labs are present in a patient with anorexia nervosa?
- Hypokalemia
- Metabolic alkalosis
- Increased BUN (dehydration)
- Hypothyroidism
Treatment for anorexia: When should a patient be hospitalized?
< 75% expected body weight or those with medical complications (dehydration)
Most common complication of management of anorexia nervosa?
Refeeding syndrome: increased insulin leads to hypophosphatemia and cardiac complications
What is the recommended pharmacotherapy for anorexia nervosa?
SSRI’s (may help with weight gain)
True or False: Obsessive compulsive disorder: the obsessions are usually ego-dystonic and inconsistent with one’s own personal beliefs?
True
What is the theorized pathophysiology of OCD?
Abnormal communication between the basal ganglia
What is the primary neurotransmitter involved in OCD?
Serotonin
What are the four major patterns of OCD?
1) Contamination: cleaning or hand washing
2) Pathologic doubt: forgetting to unplug iron to avoid danger
3) Symmetry/Precision: ordering or counting
4) Intrusive thoughts
What is the first-line therapy for OCD?
Cognitive behavioral therapy: exposure and response prevention
Pharmacotherapy for OCD
- SSRI in higher doses than with depressive disorders
- TCA: Clomipramine used because it is most serotonin specific
What is body dysmorphic disorder?
Excessive preoccupation with at least 1 perceived flaw or defect in physical appearance not observable by others
What actions will the patient commit with body dysmorphic disorder and what is the average age of onset?
- Repetitive acts related to preoccupation: mirror checking, skin picking, seeing reassurance
- Average age of onset: 15 years old
Treatment for body dysmorphic disorder
-SSRI’s and/or CBT
What is trichotillomania?
Hair-pulling disorder
Risk factors for trichotillomania
- Female gender
- Increased incidence with OCD, excoriation, and depressive disorders
Treatment for trichotillomania
CBT and habit reversal therapy
-SSRI can be used as well
Hoarding disorder is most prevalent in ______ and 20% have ______
Older population
OCD
What is the treatment for hoarding disorder?
CBT specific for hoarding, but very difficult to treat
-SSRI’s can be used as well
67% of patients with ADHD also have _____ and _____
Conduct and oppositional defiant disorders
Diagnostic criteria for ADHD must have three things. Name them.
- Symptom onset before age 12
- Present for at least 6 months
- Must occur in at least 2 settings
What are the three symptoms that are present with ADHD?
- problems paying attention
- Impulsivity
- Hyperactivity
Name some symptoms of ADHD
- Easily distracted; misses details, easily distracted
- Forgets things or loses things easily
- Difficulty in completing assignments
- Fidgets and squirms in seat
- Impatience
- Talks nonstop or excessively
- Restlessness
- Interrupts conversation
The treatment for ADHD is a multimodal approach; explain this
- Behavior modification
- Stimulants (Methylphenidate, Amphetamine/Dextroamphetamine)
- Nonstimulants (Atomoxetine)
Adverse effects of stimulants (Amphetamine, Methylphenidate, Dextroamphetamine)
- Abdominal pain
- Insomnia
- Weight loss
- Hypertension
- Tachycardia
- Growth delays
- Addiction
Mechanism of action of stimulants
Blocks reuptake and increases the release of norepinephrine and dopamine in extraneuronal space
Symptoms of autism are usually recognized between what ages?
12-24 months
Symptoms of autism spectrum disorder
- Social interaction difficulties
- Impaired communication
- Restricted, repetitive stereotyped behaviors
- Savantism (unusual talents)
- Unusual attachments to ordinary objects
