Psych Diagnosis and Pathology

Question 1

Brain areas thought to be involved in anxiety

Answer 1

amygdala, hippocampus, locus cerulus

Question 2

Medical conditions that can cause anxiety

Answer 2

Cardiac (arrythmias, heart failure, heart attack)
Drugs (caffeine, cannabis, cocaine)
Withdrawal (alcohol, benzos)
Endocrine disorders (hypoglycemia, hyperthyroid, pheochromocytoma)
Heme (anemia)
Medications (bronchodilators, stimulants, stopping SSRI’s, phenteramine (diet pills), dextromethorphan)
Electrolyte abnormalities
seizures, migraines, Cerebrovascular disease
Pulm (asthma)

Question 3

Signs there might be an organic cause of anxiety

Answer 3

35+ for onset, no family or personal history of anxiety, no triggers/life events leading to it’s development, poor response to anxiolytic medications

Question 4

Criteria for substance induced anxiety

Answer 4

• intoxicated or in withdrawal, has to develop within 1 month of intox or withdrawal

Question 5

Who does GAD affect more in terms of gender

Answer 5

Females, 2:1

Question 6

How long do you have to have anxiety symptoms for (GAD)

Answer 6

6 months, symptoms for most of the days

Question 7

Neurotransmitters associated with anxiety

Answer 7

NE, GABA, 5HT

Question 8

PTSD vs Acute stress disorder

Answer 8

PTSD > 1 month

Acute stress disorder <1 month

Question 9

Hallmark symptoms associated with PTSD

Answer 9

• Experienced traumatic event
• Intense fear and helplessness after experiencing event
• Re-experiencing of the event (dreams, dissociative flashbacks, psychologically reactive and distress to certain cues)
• hyperarrousal (difficulty falling asleep/staying asleep, irritability, poor concentration, hypervigalance, exaggerated startle response)

Question 10

Hallmark features of panic disorder

Answer 10

• recurrent, unexpected panic attacks (1st panic attack MUST be uncued)
• Behavioral changes because of panic attacks (avoidance) or fear of panic attacks, or worrying about the consequences of the panic attacks

Question 11

What is agoraphobia

Answer 11

Another type of anxiety that is related to being in places or situations that are difficult to escape from

Question 12

Key features of social anxiety disorder

Answer 12

excessive anxiety related to social situations that impairs functioning

• Fear of being humiliated or scrutinized
• Assess if there is specific performance anxiety

Question 13

Key features of specific phobia

Answer 13

anxiety/fear that is irrational and is specific to a situation or object
- common to avoid the object
- can lead to panic attacks when exposed to it
Examples (animals, heights, fear of choking, planes, etc.)

Question 14

When treating anxiety, higher or lower dose of SSRI compared to txof depression

Answer 14

Tend to need higher dose, but make sure to start low and titrate up because anxious patients tend to be sensitive to somatic symptoms

Question 15

Which medication is not effective for social anxiety

Answer 15

TCA’s

Question 16

When is a beta blocker helpful in anxiety

Answer 16

In performance anxiety and in patients who have panic attacks, helps reduce autonomic arousal

Question 17

What is dissociation

Answer 17

When mental contents (cognitions, emotions, sensations, and behaviors) separate from one another

Common in exposure to traumatic stress and acts as a buffer to an overwhelming experience

Question 18

Depersonalization vs derealization

Answer 18

Depersonalization: feeling detached from oneself/viewing oneself as an outsider

Derealization: feeling detached from the environment, things feel unreal

Question 19

The difference between fear and anxiety

Answer 19

fear is a response to something that is known, definite threat

Anxiety is a emotional response to something that is unknown, internal, vague threat

Question 20

How can anxiety be adaptive?

Answer 20

It can be used to warn you body harm, pain, social frustrations and with this warning, the person can take steps to prevent the threat or lessen consequences

Question 21

Where are most of the noradrenergic neurons located? (NE)

Answer 21

locus ceruleus

Question 22

stimulation of the locus ceruleus results in what type of response in animals

Answer 22

fear

Question 23

How does clonidine reduce anxiety symptoms

Answer 23

it works as an alpha2 agonist and reduces the anxiety symptoms

Question 24

Key feature of panic disorder

Answer 24

Unpredictable episodes of severe anxiety, emphasis on unpredictable

Question 25

Characteristics of true auditory hallucinations that help distinguish it from malingering

Answer 25

Clearly spoken
The number of voices increase as the disease progresses
The majority can identify if it is a female or a male or who the speaker is
Typically accusatory/negative/abusive comments or asking questions
Tend to be mood congruent when they have an affective disorder

Question 26

Good follow-up question for a patient who has command hallucinations

Answer 26

What happens if they do not complete the command and what is the continent of the command, it is typically about suicide or harm to self or others

Question 27

How do patients with auditory hallucinations typically deal with their voices

Answer 27

Activities, changing past year, social interactions, medication, prayer

Question 28

What is the typical visual hallucinations of

Answer 28

Humanoid or not something that has been seen before

They are typically overwhelmed or fearful

Question 29

What is a key factor of delusions that helps to distinguish it from true delusions and malingered delusions

Answer 29

True delusions take weeks to develop in a given Up slowly

Question 30

What are key features in malinger psychosis

Answer 30

They tend to overact And push their symptoms in your face and pay attention to the form of their psychosis ( like derailment, neologism, Word salad)

They also tend to give big or approximate answers

Can do the M fest or MMPI 2

Question 31

Signs of malinger mood disorders

Answer 31

They will have subtle symptoms, won’t see objective evidence, they may have conditionals threats like “if you don’t admit me I’ll xyz”

Question 32

What will the malingering PTSD patients do in terms of their sx description

Answer 32

They will describe variations of their traumatic event in their dreams versus actually dreaming about their traumatic experience

They will also have retrograde amnesia, which is typically temporary in the head injury, it will still remember the event And will also volunteer examples of memory failure

Question 33

What is the criteria for generalize anxiety disorder

Answer 33

Worrying +3 of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances

For about six months

They also said difficulty controlling their worry

Question 34

What is a diagnostic criteria for separation anxiety disorder

Answer 34

A developmentally inappropriate and excessive fear or anxiety related to separation from the person that the individual is attached to that is demonstrated by three out of the eight criteria:

Excessive distress when anticipating or experiencing separation, persistent and excessive worry about the individual, persistent or excessive worry about experiencing separation, refusal to go out, excessive fear about being alone, refusal to sleep away, nightmares about separation, somatic symptoms

Typically experience for six months

Question 35

Key features of social anxiety disorder

Answer 35

Fear and anxiety about social situation that revolves around scrutiny by others like being observed, humiliation, performing in front of others, having conversations

Typically last thing six months

Question 36

With children that have early onset bipolar disorder, what is it typically comorbid with

Answer 36

ADHD, 60 to 90% of these patients will have ADHD as A comorbid diagnosis

This happens because both ADHD and bipolar disorder have common symptoms/diagnostic criteria

Question 37

Although early onset bipolar disorder is rare, what is one of the key characteristics of papyrus order in prepubescent children

Answer 37

Extreme irritability had a severe and persistent and may include aggressive outburst and violent behavior

Question 38

At what age is it considered child on set schizophrenia

Answer 38

When the patient has psychotic symptoms by the age of 12 years old

Question 39

What are the key features of anorexia nervousa

Answer 39

Self induced starvation, a drive for thinness or a fear of fatness, medical signs resulting from starvation

They often view themselves as large even though they are obviously thin

Question 40

At what age is anorexia most likely to present

Answer 40

Midteens, especially girls

10-30 years usually

Question 41

What is the most common comorbid diagnosis with anorexia

Answer 41

Depression, followed by social phobia and ocd

Question 42

What are some medical changes you will see in anorexia

Answer 42

Elevated cortisol
Suppressed thyroid function/hypothyroidism
Amenorrhea

When it is severe you will start to see hypothermia, edema, bradycardia, hypotension, lanugo

Ekg changes including: st segment depression and QR prolongation possibly from potassium loss that can sometimes lead to death

Hypocalcemia especially in the purging type

Question 43

What are the 2 subtypes of anorexia

Answer 43

Restricting type and binge eating/purge type (self induced vomiting, laxative use, diuretics, etc)

Question 44

What will you likely see in someone who has anorexia binge/purge type

Answer 44

They likely have family members who are obese or they have a personal history of being obese/heavier body weight themselves

Question 45

What are patients that have anorexia binge purge type most at risk for

Answer 45

Suicide, higher than those who have the restrictive type

Question 46

Anorexic patients with the restrictive tire are more likely to suffer from what?

Answer 46

OCD, they can be very ritualistic

Question 47

When do parents with anorexia tend to not have an appetite

Answer 47

Late in their disease, they still do have an appetite earlier on but chose not to eat