Psych disorders Flashcards

Question

delusional disorder

Answer 1

- persistent, fixed beliefs - similar delusions to schizo - without other positive or negative symptoms - often lead mostly normal lives and may be perceived as normal except when talking about delusions tx: - rx not generally helpful - CBT often does not change the delusions but can help to control negative effects by teaching when it is socially appropriate to talk about them

Answer 2

- mood disorder + schizophrenia * psychotic sx must be present during both mood episode and euthymic episode (at least 1 of each) - may be bipolar type or depressive type - must not be attributable to substance use HATS Half or more of time ill must be spent with mood sx Alone (psychotic –mood) Together (psychotic +mood) Substances absent mood sx in excess of those typically seen in schizo, e.g. anhedonia, flat affect - must have explicitly depressed or manic mood ddx: - mood disorder w/ psychotic fx - substance-induced psychotic disorder - regular schizophrenia - BPD - bipolar w/o psychotic fx - -- grandiosity (bipolar) --> delusion (schizophrenia) - -- flight of ideas --> thought disorganization - -- similar tx for these symptoms + wait and see which becomes more prominent (mood or delusions)

Answer 3

- psychotic symptoms only during mood episode | - may be bipolar type or depressive type

Answer 4

- psychotic ± mood sx due to substance use common culprits: - meth - cannabis - hallucinogens

Answer 5

- extreme mood swings (100%) - paranoia or psychosis (25-50%) - fear of abandonment, unstable relationships - unstable sense of identity - impulsivity - explosive anger - self destructive behavior, self harm - feelings of emptiness vs schizoaffective: - rapid minute-to-minute or hour-to-hour mood swings (BPD) vs months to yrs cycles (schizoaffective) - transient, vague paranoia and psychosis (BPD) vs fixed, persisting beliefs - auditory hallucinations (if present) coming from inside head, vague or unclear what they're saying vs coming from outside head, distinct words, multiple voices, taunting

Answer 6

STUDENTS Fear C's anxiety attack ``` Sweating Trembling Unsteadiness or dizziness Dissociation Elevated hr Nausea Tingling SOB Fear of dying, losing control, or going crazy Chest pain Chills Choking ```

Answer 7

MISERABLE ± somatic complaints + ruminative thoughts ``` Muscle tension Irritability Sleep difficulty Energy decreased Restlessness Attention decreased Believing the worst Lability Eating changes ```

Answer 8

30% overall lifetime risk F>M 2x begin <25 y/o persistent, non-episodic but has periods of waxing and waning tends to become more stable/less clinically significant after age 55

Answer 9

CBT is first line meds more sparingly - less effective (SSRIs, buspirone) benzos for panic attacks, but chronic use worsens long-term outcomes

Answer 10

EGADS! I'm MISERA-ble ``` Excessive Generalized - affects/concerns many domains of life Anxiety Days (most) Six or more months ``` ``` and 3+ of: Muscle tension Irritability Sleep difficulty Energy decreased Restlessness Attention decreased ```

Answer 11

STUDENTS Fear C's | a lot of people will have one or a few in their lifetime, doesn't always rise to the level of panic disorder

Answer 12

SURP-rise Sudden Unexpectid Recurrent Panic attacks rising to the level of excessive and dysfunctional anxiety

Answer 13

fear of leaving house | 25% of those w/ panic attack d/t fear of having panic attack in public

Answer 14

significant extra effort to avoid stimulus tx: exposure therapy (uncomfortable but not overwhelmed) rarely rx

Answer 15

anxiety specific to fear of rejection or humiliation in social situation 10% of people ≠ shyness CBT (± SSRIs)

Answer 16

- obsessions: specific thought process/ruminations - compulsions: specific actions taken to reduce anxiety associated with obsessions - disorder: rises to level of significant impairment/interference with life cyclical reinforcement

Answer 17

I MURDER? Intrusive - sudden, no warning Mind-based - recognized as internal - not hallucination Unwanted Resistant - hard to make them go away Distressing Ego-dystonic - not reflective of true desires *Recurrent

Answer 18

neutralizing behaviors that calm obsessions don't work for long - vicious cycle - minimal satisfaction once error is fixed, action repeated even when unnecessary often reinforce obsession

Answer 19

``` 1% prevalence 3% lifetime F = M typical onset childhood or adolescence, almost all by age 30 range in disability ```

Answer 20

first line: CBD/ERP (exposure response therapy) rx: - 2nd line: SSRIs (high dose) - clomipramine - gold standard but 3rd line d/t strength, sfx

Answer 21

body dysmorphic disorder Fix ME DOC Fixation on *perceived* deformity Medical care - e.g. excessive plastic surgery, weight loss Ego-syntonic - don't recognize thought as a problem (vs dystonic where they know intrusive thought is not what they actually want/actually true) Disabling - time spent correcting or hiding Obsessions - I MURDR (intrusive, mind-based, resistant, distressing, recurrent) Compulsions - body checking, mirror checking, excessive grooming, seeking validation/reassurance, hiding, plastic surgery

Answer 22

1-2% prevalence ~10% in derm clinics ~30% in plastic surgery F (too large) = M (too small) typically starts around puberty

Answer 23

CBT > SSRIs | difficult to engage pts in tx since it is ego-syntonic

Answer 24

UNDER-rexia ``` Underweight* <17.5 Nervous about weight Distorted perceptions Excessive exercise Restricting calories ``` medical sx: - fatigue/cognitive changes - amenorrhea - cardiac abnormalities - electrolyte abnormalities - anemia - nutrient deficiencies - --> damage to essential organ systems often associated with OCD, except ego-syntonic more accurately associated with OCPD (personality disorder), which is ego-syntonic, has higher comorbidity, high conscientiousness, and rigid behaviors

Answer 25

<0.5% F > M 10x usually by 18 years associated with environmental factors such as: - participation in thin-centric activities (ballet, modeling, wrestling) - parental or peer pressure

Answer 26

deadliest mental illness: 20% moderate suicide rates medical comorbidities but highly variable prognosis based on severity

Answer 27

``` feeding - often forced feeding tx of medical complications therapy - especially family therapy no rx shown to benefit pts often reluctant to participate ```

Answer 28

BOWL-emia Binge eating Offsetting (purging) - vomiting, laxatives Weekly - 1x/week for 3 mo Linked to self-esteem - not as much BDD or OCD behaviors - still distressed if perceived to be overweight - more sensitivity to interpersonal rejection, poor self-esteem, fear of being alone - closer to BPD medical complications: - teeth erosion - kidney damage (dehydrations) - K+ low - metabolic alkalosis - hormone changes - boerhaave syndrome - esophagus damage from vomiting - often damage to knuckles from self-induced vomiting

Answer 29

``` ~1% adolescence or early adulthood F>M 10x in BPD: >50% often normal weight or potentially overweight ```

Answer 30

highly variable some self-recover, others require extensive tx lower mortality rate and medical complications than anorexia @10 years from dx: - 50% full recovery - 30-40% partial recovery - 10-20% insignificant change

Answer 31

CBT/IPT > SSRIs generally both used do not use bupropion - electrolyte changes --> seizures

Answer 32

similar to bulimia but no purging M=F often significantly overweight better prognosis BPD associated CBT/IPT and SSRIs

Answer 33

highly selective about food intake or calorie restriction not generally linked to BDD/fear of weight gain instead - chronically low appetite - strong food aversions - color, appearance, texture, smell - fear of consequences (not weight) e.g. vomiting, constipation, choking - often d/t history medically can be as significant as anorexia, including extreme weight loss

Answer 34

limited studies ~0.2% 5-6 years at onset

Answer 35

CBT | exposure/reward therapy

Answer 36

TRAUMA Traumatic event - violent, life-threatening - ~50% in intentional trauma, <10% in accidental Re-experience - flashbacks - visual, auditory, sensory Nightmares - usually related directly to trauma Arousal - most of time and most settings (MISER-able) Unable to function Month or more - not necessarily 1st month Avoidance - including emotional avoidance such as numbing Have you experienced trauma? Does it interfere with your life? --> if yes, ask further questions to determine specific dx

Answer 37

``` 3% prevalence 10% lifetime F>M 2x rarely <10 or >55, but highly variable age nature of trauma characteristics of person social support ```

Answer 38

intentional trauma - often does not improve, may get worse unintentional - usually improves with time

Answer 39

CBT exposure therapy rx: - SSRIs (2nd line) - prazosin for nightmares - avoid benzos d/t worse long term outcomes Prazosin Therapy SSRIs

Answer 40

<1 month meets all other PTSD criteria may or may not progress to PTSD

Answer 41

Personality Trauma-related, other Somatoform Dissociative especially chronic trauma

Answer 42

PTSD+ emotion dysregulation negative self-concept interpersonal difficulties avoidance or withdrawal from relationships stable sense of self, but negative generally no suicidality or tendency to self-harm more resistant to tx than regular PTSD CBT/IPT > SSRIs

Answer 43

depressive/anxious sx + recent major life stressor <5/9 sx of clinical depression does not meet criteria for anxiety disorder distressing event, not a life-threatening trauma lesser severity "diagnosis of normalcy" allows pt to access care

Answer 44

detachment from reality - feeling of reality vs psychosis = inability to tell reality from experiences DDREAMS Depersonalization - "indescribable" feeling Derealization- world seems fake or alien, unsteady or uneasy Retrograde amnesia - previous memories lost Errors of commission - false memories of things that haven't happened - rarer than omission Absorption in imagination/own thoughts Motor automaticity Suggestibility - easily believe what others tell them especially common following trauma normal if not intense & often

Answer 45

1-3% young adulthood pathological: F>M 10% non-pathological: F=M

Answer 46

``` highly disabling often comorbid - personality disorders - substance use - depression - anxiety - physical ```

Answer 47

tx comorbid conditions no real consensus on treating dissociation itself - CBT - DBT - supportive - hypnosis - art - experiential - education *long term often dissociative sx resolve eventually on their own (years) but comorbid conditions persist avoid meds, generally don't help

Answer 48

retrograde amnesia gaps in chronological memory disorder = weeks or months fugue state r/o other causes of memory loss most often localized = trouble recalling traumatic event can be generalized = any of past systematized, continuous

Answer 49

either/or 1/2 persistent, 1/2 episodic some spontaneous, some specific triggers including cannibis, hallucinogens unpleasant, impairing often affects work, home-life

Answer 50

by far most common form of DID alters - sensation of different identities - not literal presence (despite most popular depictions) ``` affective lability memory errors inconsistent sense of self - sudden and dramatic shifts in way they perceive, think and feel - self-aware - know it's weird - certain characteristics of a different person - disorientation - powerless to understand - minutes to hours - repeated episodes ``` ongoing distress and disability comorbidities no good tx underdiagnosed by most, over by some

Answer 51

very rare - covert DID much more common (and is still rare) outright assume > 2 distinct identities ``` talk and act differently completely take over body and mind not always aware forget portions of day -- may escalate to fugue potentially endangering - self-mutilation - suicide 75% ```

Answer 52

genuinely experience medically unexplained sx distressing SOME ATTIC ``` Somatic sx - any body system, most often GI, in women gyn One or more Medically unexplained Excessive Anxiety Thinking about Time and energy spent Impairing Chronic ``` high risk for iatrogenic disorders

Answer 53

aka Munchausen's knowingly fake somatic sx generally for attention possible intentional self-harm also factitious disorder imposed by another - child FRACK-titious - failure of generally effective tx - recurrent presentations - atypical s/sx - clingy/contentious - knowledge of illness

Answer 54

``` knowingly face somatic or psych sx for external reward e.g. - settlement - favorable sentencing - disability pay - work absence - excused from military service - drug-seeking - food and shelter in hospital ``` ``` SHAM Secondary gain Holes/inconsistencies in pt's story Antisocial traits Missing tx not of direct benefit ``` open-ended questions avoid suggestion of which sx are important connect w/ resources better geared toward them if possible

Answer 55

``` hypochondriasis persistent belief that one has a medical disorder ± sx despite contradictory evidence OCD-spectrum ```

Answer 56

``` genuinely experienced sx subset of somatic sx disorder involving neurological sx - weakness - numbness - blindness - seizures similar to dissociative disorders ``` ``` CAN'T - genuinely can't do things they say they can't Clinically unexplained Abnormality Nervous system Trigger/trauma (~50%) ```

Answer 57

most to all people will experience some somatized sx in their life 5% incidence F>M 10x <30 y/o 75% transient, stress-related 25% chronic 80% improve even w/o tx 20% worsening sx, increasing anxiety

Answer 58

I Do CARE ``` Interface - interact w/ all other providers Do no harm CBT Antidepressants < CBT Regular visits Empathy ```

Answer 59

aka hypochondriasis OCD-spectrum obsessed with idea that they have a disease, especially a specific one - obsession not with symptoms, but any symptoms often support their obsession (e.g. all headaches must be a brain tumor) some avoid medical care for fear of results, others seek excessive care significant time researching disease significant time with other self-dx such as checking for lumps etc. never get feeling of knowing despite negative tests iatrogenic harm

Answer 60

0.5% | M = F

Answer 61

generally persistent, not episodic | cyclically reinforcing, like OCD

Answer 62

CBT SSRIs low engagement rate d/t lack of self-awareness

Answer 63

~30% of all neuro patients mostly adolescents and young adults F>M 3-10x

Answer 64

90% resolve w/in days to weeks 70% never have another episode depression, anxiety, other problems even after disorder resolves

Answer 65

education wait to resolve CBT and meds not helpful

Answer 66

comorbid in 30-50% of cases some evidence for linked pathology overlapping demo, response to tx disconnect b/w real and perceived experience suggestibility/hypnotizability frequently early life traumas

Answer 67

0.1% generally, 1% hospital 30s F>M 2x often family member that has or had an illness many work in medicine, most often nursing

Answer 68

poor prognosis d/t comorbidity w/ other psych disorders | high suicide rate

Answer 69

meds and CBT not helpful confrontation generally not helpful keep linked to care but do no harm, try to push toward psych, treat comorbidities

Answer 70

consistent reliable OCEAN Openness to new experiences Conscientiousness - following societal expectations, rules, rigidity Extroversion Agreeableness - likelihood to agree with group, more suggestible Neuroticism - more likely to experience negative emotions over positive

Answer 71

``` TIDE Traits become Inflexible Disabling Extreme ```

Answer 72

"weird": paranoid schizoid schizotypal few shared underlying etiologies/pathologies - only superficial similarities highest chance of misdx of paranoid disorders

Answer 73

``` "wild": borderline antisocial narcissistic histrionic ``` most similar in underlying etiologies/pathologies relative to other 2 clusters - sense of unbalanced emotions - extreme emotional states - does not specifically fit one single mood disorder, but often comorbid - poor self-image

Answer 74

"worried" dependent obsessive-compulsive avoidant few shared underlying etiologies/pathologies - only superficial similarities

Answer 75

10% worldwide ~30% psych reluctant to dx b/f age 18, but early intervention and treatment is associated with best outcomes

Answer 76

often levels off in severity over lifetime | major risk factor for failure of tx of comorbid conditions

Answer 77

CBT/DBT > meds | tx cormorbidities

Answer 78

mistrust of most people unlikely to confide social isolation but often don't mind extreme low agreeableness paranoid disorders: - generally one or a few fixed belief systems paranoid personality disorders: - jump between many paranoid beliefs, objects of paranoia (people)

Answer 79

``` asociality lack of interest in social relationships indifference to praise coldness/aloofness preference for alone time extreme low extroversion ```

Answer 80

many weird ideas e.g. mystical, magical, or outright delusional unusual perceptions such as hearing name called in empty room, but not outright hallucinations loneliness and isolation d/t fear of (or actual) judgement, not disinterest no direct link to OCEAN traits many genetic links to schizophrenia often pre-schizophrenia

Answer 81

Borderline - Antisocial most impairing Histrionic - Narcissistic least impairing Borderline - Histrionic F>M Antisocial - Narcissistic M>F

Answer 82

chronic instability in most areas I DESPAIR (5+/9) Identity instability - follow the crowd, or narrowly defined by single interest Dysphoria Emotional instability - affective lability - mood swings w/in minutes - esp exacerbated around relationship troubles Self-harm/chronic suicidality - cutting common in bpd, rare in other disorders Psychotic/dissociative - transient, related to severe personal stress - generally related to others judging them etc rather than complex belief systems Anger/hostility Impulsivity Relationships - unstable and short-lived (1) - rejection sensitivity (2)

Answer 83

``` DBT 1-2 yr b/f meaningful outcomes long waiting lists not often covered by insurance specific training required ``` ``` DELAPSE Diagnose Educate Life outside tx; "work before love" Avoid meds - they don't help; do treat sx if needed, e.g. antipsychotics and antidepressants Prioritize - tx of bpd comes before other psych conditions except when immediate threat exists - improvements in others will follow Safety plan Expect change ```

Answer 84

purposeful infringement on rights and safety as others ``` ACID LIAR (adult and 3+/7) Adult >18 Criminality Impulsivity Disregard for own and others' safety Lying/cheating/deceiving w/ or w/o purposeful gain Irresponsibility Aggression - purposeful and targeted Remorselessness - but remorse is sometimes present ``` consistent and repeated independent of circumstances cluster B vs psychopathy - cluster B - externalizing negative emotion, taking them out on others - psychopathy - inability to empathize

Answer 85

difficult | hard to get pts to engage

Answer 86

inflated sense of self demand for admiration fantasies of success or power disregard for others emotions - but not safety per se manipulation prone to irritability esp d/t feedback, not being center of attention relationship difficulties underlying poor sense of insecurity, fear of being unloved M>F

Answer 87

``` excessive/exaggerated center of attention approval seductive/provocative dramatic/over the top emotions flashy dress/make up theatrical speech unstable affect suggestibility/peer pressure belief that relationships are more intimate than they actually are ``` ``` desire to be loved unstable sense of identity poor self-image least impairing of cluster B no clear connection to childhood abuse ```

Answer 88

over reliance on others for most lings extremely defferential in relationships rarely remain on own excessively high agreeableness tx: - maladaptive thought processes - maladaptive relationship behaviors

Answer 89

``` overly conscientious neat, controlled, orderly excessively rigid unable to delegate excessive perfectionism overreliance on checklists - to point of questioning essentialness of overall project inability to spend money on oneself unable to throw things out excessive religiosity in some cases ego-syntonic - reluctant to seek tx ``` tx: - CBT - IPD

Answer 90

``` desire connection but shun companionship avoidance of social activities unwillingness to meet new people fear/avoidance of interpersonal relationships inhibited behavior in social situations poor self-image view selves as inept or unworthy of love reluctant to take risks or do anything potentially embarrassing ``` highly comorbid w/ social anxiety disorders better conceptualized as severe social anxiety disorder than a personality disorder tx: SSRIs CBT

Answer 91

5-10% 30% in psych 50% heritability few symptoms from early in life e.g. impulsivity, emotional instability most first meet full criteria by adolescence or young adulthood can be dx before 18 y/o must be stable for >1 year and above normal personality fluctuation overdx in women dx: 3xW>M actual: W=M

Answer 92

50% remission at 2 years, 85% at 10 years even w/o tx (<5/9 criteria) more extreme sx e.g. cutting, impulsivity, emotional instability tend to diminish with age dysphoria, interpersonal trouble, occupational dysfunction tend to persist throughout life

Answer 93

externalizing negative emotions reactive violence high neuroticism when planned violence: "I need to look after myself b/c no one else will" poor social skills lack of executive functioning lack of understanding of social rules few acquaintances, no close friends

Answer 94

~5% general population ~25% group homes ~50% jails/prisons significant heritability begin in adolescents - generally first evident as conduct disorders: ODD, CD, IED, DMDD M>F 5x

Answer 95

improve generally by 30s-40s peak in adolescence and early adulthood negative mood, addiction, occupational dysfunction, interpersonal dysfunction tend to persist

Answer 96

no good tx - but does improve on its own with time pts often difficult to engage DBT and anticonvulsants may help w/ impulsivity short incarcerations (<1 year) may reduce recidivism but longer will not

Answer 97

lack of emotional range lack of empathy subtype of ASPD ``` BDSM Boldness Disinhibition Shallowness Meanness ``` Boldness - high self confidence - tolerance for danger - calmness in danger or when caught Disinhibition - instrumental violence - impatience and need for immediate gratification - more overtly violent behavior/more severe crimes - criminal versatility - substance use, but controlled Shallowness - lack of emotional range - if any emotion is expressed, generally affective mimicry (not genuine underlying emotion) - may be superficially charming, manipulative - perpetual boredom and apathy - lack of long-term goals --> more likely to engage in criminal behavior vs corporate progression/more conventional schemes Meanness - inability to feel emotions of others - aggressive resource seeking - empowerment through cruelty

Answer 98

0.5% general population 10% ASPD 15% prisons 30% violent prisoners >90% heritable but environment still matters M>F 20x

Answer 99

often starts very early babies: - difficult temperament - lack of social smile - excessive crying - hyperactivity early childhood: - mild physical aggression e.g. - biting - hitting school age: - setting fires - stealing small items - torturing animals adolescence: - bullying - stealing larger objects e.g. cars adult: - major crimes e.g. - robbery - fraud - assault - rape - murder

Answer 100

poor extreme violent acts such as rape and murder tend to decrease after young adulthood core traits persist

Answer 101

``` very difficult to treat poor tx compliance no meds anticonvulsants not helpful as this only helps with reactive violence little engagement in therapy punishment doesn't seem to help ``` appearance of therapy success often associated with more recidivism likely b/c deceit

Answer 102

oppositional defiant disorder argumentative vindictive outbursts/temper tantrums rule-breaking persistent anger and irritability (no waning b/w episodes) consistent intentional less severe than conduct disorder: stops short of overt violence, aggression, theft

Answer 103

3% of children 6-8 yr persist into adolescence 70% no sx as adult M>F 2x

Answer 104

individual and family therapy | meds not helpful unless ADHD comorbid

Answer 105

conduct disorder overt violation of rights of others ``` persistent anger, irritability (no waning b/w episodes) consistent intentional more extreme/severe acts e.g.: - threats - violence - fire setting - property damage - robbery - sexual coercion ```

Answer 106

1-2% of children <10 yr ODD --> CD fairly common 40% --> ASPD M>F 3-4x

Answer 107

individual and family tx less beneficial than in ODD meds not helpful except comorbidities

Answer 108

intermittent explosive disorder screaming hitting kicking tantrums discrete episodes <1h reactionary but out of proportion to events anger/irritability, wanes b/w episodes (not persistent) episodic reactive, not intentional lower severity than CD or other premeditation

Answer 109

5% children and adolescents ~13 yr average M>F 2x often lifelong but severity decreases w/ age

Answer 110

individual and family tx | 2nd line: SSRIs

Answer 111

disruptive mood dysregulation disorder similar to IED - tantrums - episodic - reactive - lower severity than CD BUT - persistent negative emotions - anger, irritability, disruptive behaviors during outbursts - irritability, sadness, anger between episodes

Answer 112

individual and family tx | 2nd line: SSRIs

Answer 113

behavioral disorders in children externalization of negative emotion CD - most severe - premeditated overt acts, persistent anger; ~40% --> ASPD ODD - intentional, non-overtly violent acts, persistent anger DMDD - episodic outbursts, reactive, persistent anger IED - episodic outbursts, reactive, negative emotion wanes between episodes

Answer 114

use caution as relying on parental narrative rather than child's in most cases often a response to stressor, complex situations hx of trauma, early life neglect

Answer 115

most common: inattentive type (– hyperactivity) persistent and inflexible sx, esp in inappropriate locations - must be in at least 2 settings dx of exclusion - trauma - hunger - young compared to peers (e.g. youngest child in class) ``` FIDGETY Functionally impairing Impulsivity ± Distractibility Greater than normal Exclude other causes Two or more settings Young at onset (≤12) ```

Answer 116

``` DETAILS OFF Details sloppy Easily distracted Task Avoidance Ignor instructions Lose things Sustained attention difficulty Organization lacking Forgetful Fail to finish tasks ```

Answer 117

``` HE RILED UP Hyperactive Energetic Running around Interrupts Loud Effusive Delay intolerant Unseated Prematurely answers ```

Answer 118

``` 10% children 5% adults 2/3 inattentive 10% hyperactive 20% combined ``` ``` 75% heritable other risk fx e.g.: - in utero drug or alcohol exposure - poverty - cultural factors ``` 3-8 y/o initial sx usually M > F 2x inattentive more common in F 2/3 persistent sx to adulthood Hyperactivity usually improves long-term outcomes related to education attainment, career performance, relationships, self-worth, etc.

Answer 119

therapy - behavior and family training ``` rx: stimulants - methylphenidate - amphetamines non-stimulant - atomoxetine - guanfacine - clonidine - smaller effect size - generally reserved for when stimulants are c/i or add-on is needed ```

Answer 120

``` social communication difficulties restricted interests early development impairing exclude other causes ``` ASD Aloneness Sameness Development ±: - communication difficulties - verbal and nonverbal - sensory hyper/hyposensitivity - motor signs - savantism - intellectual disability

Answer 121

not required for dx but often present delayed speech - often one of initial presenting signs mutism nonverbal communication - body language - facial expressions - overly literal - intonation - context implicit rules of social interaction - greetings - reciprocity - turn-taking - sharing

Answer 122

"insistence upon sameness" e. g. - routines and distress when disrupted - repetitive meals - special interest - single subject, hobby, activity - same movies, same games, etc. - repetitive movements e.g. stimming, flapping - fidget objects - self-injurious behavior (banging head against wall)

Answer 123

common but not required for dx hyper and hyposensitivity e.g. overstimulated by sounds and lights, sensitive to certain textures, smells, tastes less sensitive to heat, pain

Answer 124

common but not required for dx ``` poor coordination weak muscle tone odd gait e.g. walking on tip-toes stimming flapping rocking ```

Answer 125

somewhat common but not required for dx >50% of savants have autism some autistics have savantism - intellectual disability is more common extremely high intelligence especially in one specific domain - memory - calculation

Answer 126

common but not required for dx

Answer 127

0.1 - 2% general population depending on dx criteria spectrum of severity highly heritable 2-3 first sx sx often improve over lifespan - likely d/t compensatory tools M>F 4x dx likely underdx in women due to more subtle sx risk fx: - children of older fathers (?)

Answer 128

behavioral tx - specific adaptive skills e.g. speaking, responding appropriately to others, recognizing emotions family tx - improve skills - educate caregivers tx: - none for core features - tx comorbidities

Answer 129

``` primitive reflexes - rooting - gripping - toe curling (babinsky) - moro or startle (loud sounds) - galant (stroking lower back) hearing smelling seeing 20:600 - faces and objects w/ sharp contrast ```

Answer 130

gross and fine motor dev 6 wk - head control - reaches for objects 4 mo - rolling front to back - grasping objects 6 mo * sitting unattended - rolling back to front * transferring objects across midline 9 mo - pull to stand * refined pincer grasp (feeding) 12 mo * starting to walk unattended - pointing to objects

Answer 131

2-4 mo - cooing - orienting to voice 6 mo - babbling 9 mo - responds to name 9-10 mo - mama and dada 12 mo - following simple commands - ≥1 word

Answer 132

2-3 mo - responsive smile 6 mo - sense of self - attachment w/ caregiver <9 mo - stranger anxiety 9-10 mo - separation anxiety 12 mo - early empathy

Answer 133

0-4 mo - modify/regulate reflexes 4-8 mo - meaningfully manipulate objects ~7mo - attention span ~5 min 9 mo * object permanence 9-12 mo - goal-directed behaviors

Answer 134

15 mo - crawl upstairs - walk bckwards 18 mo - walk stair w/ help - run - scribbling 24 mo - kick ball - tip toes - clothing 30 mo - jump * tower of ~8 blocks - proper estimate is age in yr x3 (2.5 *3 = 8) 36 - alternate feet on stairs - bridge of blocks

Answer 135

18 mo - 50-75 spontaneous words 24 - 50-200 words - 2+ word phrases 36 - 300+ words - 3+ word phrases

Answer 136

18 mo - peak of separation anxiety, persists to ~3-4 yr 24 mo - rapprochement - moves away from and returns to parent

Answer 137

12-18 mo - cause and effect 18-24 mo * symbolic representation - conceptualize body parts 24 mo - start of simple concepts e.g. size, color, number 24+ mo - focus 5-10 min on activity, w/ parental encouragement 24-36 mo * parallel play (w/ other children)

Answer 138

3 - broad jump - gallop - utensils * hand preference - if hand preference is sooner explore pathology e.g. one-sided weakness 4 * hop on foot - skip 5 - balance 10 sec on one foot - print letters

Answer 139

3 yr - 3 word phrases - follow multi-step commands - 75% intelligible - use 300+ words - understand 1000+ words 4 yr - 4 word sentences - follow multi-step commands - ~100% intelligibility <5 yr - conversation - recalling events - using language to learn - express feelings - talk about past - understand and use grammar - improved intelligibility

Answer 140

3 yr - know own age * know gender * imaginative play - imaginary friends - turn taking - sharing - toilet training 4 yr - interactive small-group play - pretend social scenarios - role playing 4-5 yr - simple board games - rule following

Answer 141

4 yr - colors 4-5 yr - complex body parts 5-6 yr * abstract symbols e.g. letters and numbers - -> reading (variable)

Answer 142

- refinement of coordination - coordination for structured athletics - coordination for fine arts - cursive writing - typing

Answer 143

- inferences - jokes - sarcasm - story telling - complex narratives - conversation - reading

Answer 144

- identity and self-esteem * accomplishment - want to be "good" * understand social rules, sportsmanship, morality - increased importance of peer relationships - best friend - play segregated by gender

Answer 145

- "frontal lobe growth spurt" * conservation of volume - perceive and understand multiple concepts at once - reasoning - classification - mental rules - time - organization and sequential skills, e.g. homework - active working memory - attention span 0.5-1 hour - emotional regulation

Answer 146

pregnancy thru 4 week post-birth

Answer 147

solidifying identity as a mother normal state involves a certain amount of discomfort and questioning identity important to understand this baseline level of discomfort to distinguish from pathology e.g. postpartum depression

Answer 148

not pathology (yet) - no fx impairments ~80% of women peaks 4-5 days post delivery spontaneous remission w/in 2 weeks d/t hormonal shift sx: - mood lability - tearfulness - anxiety - irritability - not necessarily sadness

Answer 149

postpartum depression 15-20% frequency during pro or w/in 4 wk after ``` SIGECAPS * anhedonia * low mood anxiety related to infant egodystonic intrusive thoughts e.g. hurting infant obsessions ```

Answer 150

d/t: - high sensitivity to hormonal changes risk fx: - depressive sx in preg - lack of partner support - recent stressful life events - personal hx of mood disorders - personal hx of postpartum depression - family hx of mood disorders - COVID? maybe "just" isolation, health anxiety, shorter hospitalization around delivery

Answer 151

- r/o medical: - - postpartum thyroiditis - - anemia - education, reassurance, and support - CBT/IPT - SSRIs - crisis: hospitalization

Answer 152

0.1% emergency 4% rate of infanticide most often 48-72 h post-delivery to 2 wk postpartum r/o hx bipolar ``` sx: - dramatic presentation - restlessness - irritability - insomnia ± delusions ± auditory hallucination ```

Answer 153

hospitalize educate and reassure family ``` mood stabilizer - lithium - valproate - carbamazepine - lamotrigine antipsychotic ``` ECT in refractory cases

Answer 154

quality of interaction b/w infant and caregiver implications for relationships and dev thru lifespan caregiver role: - secure base: child supported to explore - safe haven: child feel safe to return home after exploring

Answer 155

foundation of self esteem separation distress, but consolable on return caregiver sensitive and consistent response child comfortable expressing range of emotions child consolable child learns to self-soothe

Answer 156

psych manifestation of another (usually somatic) illness slower illness recovery higher death rate *impairment of memory and attention ``` Where THE F AM I? Where (disorientation) Thought disorganization Hallucinations - visual Energy changes - high or low Fluctuating - waxing and waning - vs dementia which is more stable Acute / transient Medical causes Intoxicants ```

Answer 157

``` PINCH ME Pain, poorly controlled Infections Nutrition Constipation Hydration Medications/rec drugs - benzos - opioids - diphenhydramine - steroids - alcohol intoxication AND withdrawal Endocrine ```

Answer 158

10-30% hospital 50-75% ICU risk: - older age - M>F 2x

Answer 159

delirium itself usually resolves w/in 1 week but poor px indicator overall - longer hospital stay - higher M&M rate

Answer 160

``` U R SAFE Underlying cause Reorientation - remind them where they are Sleep Antipsychotics Family and friends Environment - calm, quiet, consistent ```

Answer 161

cognitive ability to provide own consent for each tx not overall CURBSIDE need ALL criteria ``` Communicate in any way Understand: Risks, Benefits, Situation & Impact of tx Decide - clearly and consistently relay same choice Explain why they made that choice ```

Answer 162

``` LIMP MEN Lethargic Immobility Mutism Positioning e.g. - catalepsy - loss of sensation or consciousness + rigidity - odd posturing, potentially for hours - waxy flexibility - hold position someone else puts them in ``` ``` Motor abnormalities e.g. - grimacing - mannerisms e.g. wagging finger - stereotypy - repeated actions e.g. walking into a wall repeatedly) - agitation Echolalia & echopraxia - repeating specific words and phrases - repeating actions - specific but not sensitive observation Negativism - e.g. stay still even when ball is being thrown at face ```

Answer 163

usually psych >50% bipolar 30% depression 15% psychosis 2% of all severely ill psych patients M = F any age

Answer 164

<50% recover w/o tx impairment to fx of life most end up hospitalized medical complications e.g. DVT

Answer 165

``` BED Benzos - usually high dose - 80% effective w/in minutes - sometimes used to confirm suspected cases ECT 85-100% D/c antipsychotics ```

Answer 166

catatonia + autonomic instability >50% die w/o tx 10% overall mortality

Answer 167

collection of major neurocognitive disorders (DSM term) ``` DIRE Decline in cognition - language - cognition - executive fx ``` Impairment - IADLS - ADLs in severe cases R/o delirium - temporary - wax and wane - medical cause Exclude mental disorders

Answer 168

instrumental activities of daily living ``` SHAFT Shopping Housekeeping Accounting Food preparation Transportation ```

Answer 169

activities of daily living ``` DEATH Dressing Eating Ambulating Toileting Hygiene ```

Answer 170

``` Alzheimer's vascular dementia dementia w/ Lewy bodies frontotemporal dementia mixed dementia (2+) ```

Answer 171

GRANDPA U OK? Gradual, insidious - months to years Relentless - unremitting and steady progression Amnesia - anterograde > retrograde > implicit memory Neurocognitive Deficits Psych sx - mood, insomnia > psychosis, delusional misidentification Activity - less purposeful behavior, more purposeful - sundowning 30% - wandering, agitation Unable to fx Objective biomarkers Knowledge of illness - lack n

Answer 172

- Aphasia expressive > receptive - Apraxia complex > simple - Agnosia - understanding symbols/meaning of objects, eventually basic signals - visual-spatial - e.g. clock from memory - executive fx

Answer 173

``` cortical atrophy loss of cholinergic neurons esp in hippocampus senile plaques / amyloid beta NFTs / tau - tau and amyloid proteins seen in CSF - plaques and tangles seen on biopsy - not routine tests currently APOE4 mutations common ```

Answer 174

<1% total 3% 65 - doubles every 5 years 20% at 80 50% at 90 F>M, may be b/c longer lifespan avg life expectancy 5 yr almost always die w/in 10 usually d/t medical complications

Answer 175

sx reduction no restoration of fx or slowing progression cholinesterase inhibitors - increase ACh memantine - increase NMDA antidepressants & antipsychotics have risks and tend to be less effective behavioral interventions psychotherapy not helpful

Answer 176

2nd most common dementia series of repeated strokes stepwise decreases in cognition multiple areas of ischemic damage no specific pattern of cognition loss as it's based on where strokes occur

Answer 177

reduce stroke risk e.g. blood thinners

Answer 178

3rd most common alpha syn aggregates + visual hallucinations C'N STUFF Cognitive deficits - memory not necessarily first or more prominent domain - distractibility, confusion, incoherence Neuroleptic sensitivity - sensitivity to antipsychotics - EPS - catatonia - neuroleptic malignant syx Sleep behavior - acting out dreams - flailing, thrashing, yelling while sleeping - specific sign Timing - earlier onset >50 - more rapid cog decline - months rather than years Unstable - fluctuations in cognition w/in hours - easier to mistake for delirium Parkinsonism 80% - tremor - rigidity - slow movement - postural instability Hallucinations - even at early stages - people or animals - generally not bothersome - have insight

Answer 179

0.5% >65 | M=F

Answer 180

worse than other dementias | life expectancy ~4 years

Answer 181

palliative no specific tx - less effective than for other conditions, more side fx - cholinesterase inhibitors - antiparkinsonian drugs

Answer 182

frontotemporal dementia OH DEAR Obliviousness to emotions of others Hyperorality - put anything into mouth, but preference for sweet foods Disinhibition - hypersexual common Executive dysfunction - memory and visual-spatial generally well preserved Apathy Repetitive behavior - simple or complex

Answer 183

<10% all dementias 45-65 y/o onset M=F

Answer 184

2-10 yr mortality

Answer 185

SSRIs antipsychotics? cholinesterase inhibitors generally not effective

Answer 186

``` Beta waves Alpha waves Theta waves Sleep spindles & K complexes Delta sleep - deep sleep - most restorative REM - resembles awake on EEG - remember your dreams - remain still ```

Answer 187

suprachiasmatic nucleus part of hypothalamus controls circadian rhythm pineal gland releases melatonin controls SCN

Answer 188

30% 5% when r/o lifestyle fx older age F > M risk: - depression - anxiety

Answer 189

tends to be persistent may be episodic impacts all domains of life <4 h/night associated w/ 15% increase in mortality d/t related fx like accidents, poor physical health, use of stimulants

Answer 190

``` CBTi - specific CBT for insomnia hypnotics - antihistamines - benzos - Z drugs - tolerance common after only a few days ```

Answer 191

obstructive sleep apnea hypoxic episodes transient awakenings headache chronic fatigue ``` STOP BANG Snoring Tired all the time Observed apnea Pressure (BP high) BMI high Age high Neck circumference high Gender M>F ``` risk of heart attack and stroke

Answer 192

restless leg syndrome ``` URGE Urge to move Rest worsens Gets better w/ activity Evening is worse ``` mostly idiopathic iron deficiency genetics

Answer 193

Lifestyle Anticonvolsants Iron supplementation Dopamin antagonists

Answer 194

e.g. jet lag ``` lifestyle changes daytime: - bright light exposure - modafinil nighttime: - melatonin ```

Answer 195

sleepwalking mostly idiopathic iatrogenic - Z drugs

Answer 196

usually hx of trauma stress reduction tx prazosin

Answer 197

non-rem nightmares usually don't remember distress on awakening physical signs similar to panic attack mostly do not persist to adulthood

Answer 198

gains consciousness remains unable to move may hallucinate, esp figures in room/being watched relaxation techniques CBT SSRIs

Answer 199

lack of paralysis during REM | >90% progress to neuro disorder e.g. Parkinson's, Lewy body

Answer 200

CHAP Cataplexy, often triggered by strong emotional states Hypnagogic and hypnopompic hallucinations - when going to sleep and waking up (sleep) Attacks - seconds to minutes - not always present (sleep) Paralysis

Answer 201

onset early adulthood/adolescence <0.1% population M=F tends to be persistent and cause disabiilty

Answer 202

GHB - sodium oxybate - direct impact on narcolepsy modafinil - helps promote wakefulness/sx tx

Answer 203

potentially fatal alcohol withdrawal usually 48-72 h ``` DTS are HELL Delirium Tremor Seizures Hallucinations ESR increase Leukocytosis LFTs ``` tx: - benzos (for any severe alcohol w/d)

Answer 204

chronic alcohol use --> vitamin B1 deficiency ``` COAT RACK Confusion Opthalmoplegia - eye muscle weakness Ataxia Thiamine deficiency Retrograde amnesia Confabulation - (mainly unintentionally) filling in gaps in spotty memory w/ untrue details Knowledge of illness impaired ```

Answer 205

detox - often inpatient rehab some meds: - disulfiram - nausea when +alcohol - naltrexone - acamprosate - GABA AGonist

Answer 206

like a "cleaner" form of EtOH *weaning as slow taper each year on benzo --> month to quit

Answer 207

flumazenil GABA antagonist little good evidence for use in OD but used anyways

Answer 208

opposite of intoxication fx ``` hyperalgesia (pain) tachycardia, htn mydriasis (dilated pupil) dysphoria restlessness, anxiety, irritability diarrhea, abd cramping ```