Psych- Exam 1

Question 1

What is the definition of anxiety? What does it affect

Answer 1

Anxiety is state anxiety is a state associated with intesnse feelings of dicomfort accompanied by somatic complaints that indicate a hyperactive autonomic nervous system such as palpitations and sweating
* Affects cognition and perception

Question 2

Definition of anxiety
* Anxiety is a response to what?
* Anxiety is anticipation of what?
* What is fear?
* What overlaps?

Answer 2

• Anxiety is a response to a threat that is unknown, vague or conflictual.
• Anxiety is anticipation of a future threat
• Fear is the emotional response to real (or perceived) imminent threat
• Fear and anxiety overlap

Question 3

Anxiety disorder:
* Sometimes the level of fear or anxiety is decreased by what?
* What is prominent in anxiety disorders? ⭐️

Answer 3

• Sometimes the level of fear or anxiety is decreased by pervasive avoidance behaviors
• Panic attacks are prominent in anxiety disorders- as a particular type of fear response⭐️ Be carefeul because of panic disorder

Question 4

PSYCHODYNAMICS OF ANXIETY DISORDERS

With phobia, what is the defense?

Answer 4

Displacement and Symbolization
* Anxiety detached from idea/situation and displaced on some other symbolic object or situation

Question 5

With panic, what is the defense?

Answer 5

Regression
* Anxiety overwhelms personality and is “discharged” in a panic state

Question 6

With agoraphobia, what is the defense?

Answer 6

Projection and displacement
* Repressed hostility, rage, or sexuality projected on the environment, that is seen as dangerous

Question 7

With anxiety, what is the defense?

Answer 7

Regression
* Break down of repression of forbidden sexual, aggressive, or dependency strivings

Question 8

Separation anxiety disorder:
* What is?
* What is the duration of illness? ⭐️

Answer 8

Developmentally inappropriate excessive fear or anxiety concerning separation from those to whom the individual is attached

Duration of illness
* At least 4 weeks in children and adolescents
* Six months or more in adults

usually under 12 years old

Question 9

It is long but I wanted it together

SEPARATION ANXIETY DISORDER
* You must have 3 of the following?

Answer 9

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death
3. Persistent and excessive worry about experiencing an untoward event (e.g. getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure
4. Persistent reluctance or refusal to go out, away from home, to school, or elsewhere because of fear of separation
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure
7. Repeated nightmares involving the theme of separation
8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated

Question 10

Separation anxiety disorder : ADULTS
* typically overconcerned about what?
* What happens?

Answer 10

Typically overconcerned about offspring and spouses.
* Discomfort when separated from them

Experience significant disruption in work or social experiences (need to continuously check on whereabouts of significant other)

Question 11

Separation anxiety disorder
* What are the comorbid diseases with childrena and adults

Answer 11

• In children, disorder highly comorbid with Generalized Anxiety Disorder and specific phobia
• In adults comorbid with specific phobia, PTSD, panic Disorder, Generalized Anxiety Disorder, Socail Anxiety Disorder, Agoraphobia, OCD, personality Disorders AND depressive and bipolar disorders

Question 12

Selective mutism
* Consistent failure to do what?
* Interferes with what?
* What is the duration? ⭐️

Answer 12

• Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.
• The disturbance interferes with educational or occupational achievement or with social communication
• The duration of the disturbance is at least 1 month

Question 13

Selective mutism
* The failure to speak is not attributable to what?
* The disturbance is not better explained by what?

Answer 13

• The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation
• The disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not exclusively occur during the course of an autism spectrum disorder, schizophrenia, or another psychotic disorder

Question 14

What is an example of selective mutism?

Answer 14

• Lack of speaking may occur in social interactions with children or adults
• Children will speak at home with immediate family members
• Often not in from of close friends

• Relatively rare
• Onset usually before age 5
• Usually “outgrow but longitudinal course not known

Question 15

Selective mutism
* What is the social impairment?
* What is the school setting issues?
* What is a strategy

Answer 15

Social impairment- no reciprocal social interaction
* As mature-Social isolation

School settings- suffer academic impairment. Not communicating- class assignment; cannot ask to go to restroom

In some cases, a compensatory strategy to decrease anxious arousal in social situations (work them into smaller classrooms)

Question 16

Specific phobia
* What is it?
* What are the specify types?

Answer 16

• An anxiety disorder characterized by intense fear of particular objects or situations
• Specify types: Animal type, Natural environmental type, Blood-Injection-Injury type, Situational type,

The most common psychiatric disorder.

Question 17

DSM criteria- specific phobia
* Marked fear or anxiety about what?
* What does it provoke?
* What happens as a defense?

Answer 17

• Marked fear or anxiety about a specific object or situation (e.g. flying, heights, animals, receiving an injection, seeing blood
• The phobic object or situation almost always provokes immediate fear or anxiety
• The phobic object or situation is actively avoided or endured with intense fear or anxiety

Question 18

DSM criteria- specific phobia
* The fear or anxiety is out of _
* What is the timeline? ⭐️

Answer 18

• The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation, and to the sociocultural context
• The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

Question 19

Specific phobia
* Key feature is what?
* What are specifiers?
* What do you need to make dx?

Answer 19

• Key Feature is fear (or anxiety) circumscribed to a particular situation or object (called the phobic stimulus)
• Categories of feared situations or objects are called specifiers
• To make diagnosis, fear/anxiety must differ from the normal

Question 20

Specific phobia
* MC when?
* What is the theory about families?

Answer 20

• Usual onset is in childhood-> Most cases occur before age 12
• Phobic Disorders run in families->Theory: Phobias learned by being paired with traumatic situation

Question 21

Did not say we need so I placed it one card aka long

Treatment of phobia?

Answer 21

• Systemic desensitization
• Flooding (exposure therapy)-> operant conditioning, goal is to demostrate fear is irrational
• Hypnosis to help anxiety with rehearsal of step-wise approach to the situation
• Sometimes anti-anxiety medications used along with these treatments but it is only to calm the patient enough to make him/her receptive to behavioral Rx; not the treatment itself

Question 22

Social Anxiety (=Social Phobia) Disorder: DSM V Criteria
* Marked fear or anxiety about what? What is an example?
* What does the individual fear?

Answer 22

• Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples: social interactions (having conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), performing in front of others (e.g., giving a speech)
• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e. be humiliating or embarrassing; lead to rejection or offend others)

Question 23

Social Anxiety Disorder: DSM V Criteria
* What provokes fear and anxiety?
* What happens with the social situations?
* What is out of proportional?
* What is the duration? ⭐️

Answer 23

• Social situations almost always provoke fear or anxiety
• The social situations are avoided or endured with intense fear or anxiety
• Fear or anxiety is out of proportion to actual threat posed by the social situation and to the sociocultural context
• The fear, anxiety, or avoidance is persistent, typically lasting for 6 mos or more

Question 24

Social Anxiety Disorder: DSM V Criteria
* What is a specifier?

Answer 24

Specify if performance only

Question 25

Social Anxiety Disorder
* What is anticipatory anxiety?

Answer 25

Anticipatory anxiety can appear days or weeks before feared event. This then becomes a “self-fulfilling prophecy, contributing to an actual or perceived poor performance in the feared situation. A never ending cycle of further anticipatory anxiety develops with subsequent perceived or true poor performance

Question 26

Social Anxiety Disorder
* Individuals with a particular fear avoid an activity? (2)

Answer 26

• Fear of trembling hands- avoid drinking, eating, writing, or pointing in public
• Some individuals avoid urinating in public restrooms

Question 27

Social Anxiety Disorder
* This disorder increases the risk of what other psychiatric disorder?
* What disorder is commonly co-morbid? (3)

Answer 27

• Lifetime risk of depression about 2 to 4 times higher in persons with Social Anxiety (especially older adults)
• Alcohol use disorders are commonly co-morbid
• Is frequently co-morbid with bipolar disorder or body dysmorphic disorder

Question 28

said we did not need to know, so one slide

Treatment of Social Anxiety Disorder
* What is the treatment?

Answer 28

If Social Phobia is circumscribed- limited to certain settings- public speaking/ artistic performance
* Use meds on as-needed basis and to est. feelings of reassurance: B- blockers

SSRI, SNRIs, MAOi, others off label: gabapentin, pregabalin, inosital

Exposure, CBT, social skills training (ex. skills with eye contact, starting/cont conversation), Sx management (calming)

Question 29

PANIC DISORDER- DSM-V CRITERIA
* What is it? What are the sxs? (12)

Answer 29

Recurrent unexpected panic attacks

PANIC ATTACK: abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
* Palpitations, pounding heart, or accelerated heart rate
* Sweating
* Trembling or shaking
* Sensations of shortness of breath or smothering
* Feelings of choking
* Chest pain or discomfort
* Nausea or abdominal distress
* Feeling dizzy, unsteady, light-headed or faint
* Chills of heat sensations
* Paresthesias (numbing or tingling sensations
* Derealization (feelings of unreality) or depersonalization(being detached from oneself)
* Fear of losing control or “going crazy.”
* Fear of dying

Question 30

Panic Disorder
* What is the duration and what do they need?

Answer 30

At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
* Persistent concern about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”.
* A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations
* The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition(e.g., hyperthyroidism, cardiopulmonary disorders
* The disturbance is not better explained by another mental disorder

Question 31

PANIC ATTACKS
* How long does a panic attack last?

Answer 31

• Panic Attacks peak around 10 minutes
• Are thought to last maximum of 20 minutes because individual’s nerve endings depleted of norepinephrine by that time.

BE CAREFUL BECAUSE PANIC ATTACK IS NOT THE SAME AS PANIC DISORDER

Question 32

Panic attacks can be associated with what?

Answer 32

Drugs of abuse
* Intoxication (cannabis; stimulant
* Withdrawal (sedative-hypnotic; alcohol; benzos)
* Prescription/over-the-counter drugs: Decongestants; stimulants, dopaminergic agents, asthma meds
* Caffeine/energy drinks/bars

Panic attacks can occur in context of any anxiety disorder

When panic attack identified, should be noted as a specifier (e.g., posttraumatic stress disorder with panic attacks

Question 33

Panic Attack Specifier
* What is it?

Answer 33

An abrupt surge of intense fear or discomfort that reaches a peak within minutes and during which time four (or more) of following symptoms occur:
* Palpitations, pounding heart, or accelerated heart rate
* Sweating
* Trembling or shaking
* Sensations of shortness of breath or smothering
* Feelings of choking
* Chest pain or discomfort
* Nausea or abdominal distress
* Feeling dizzy, unsteady, light-headed, or faint
* Chills or heat sensations
* Paresthesias (numbness or tingling sensations)
* Derealization (feeling of unreality) or depersonalization (being detached from oneself)
* Fear of lsing control or “going crazy”
* Fear of dying

THe same as above

Question 34

Panic Attacks
* What is nocturnal panic attack?

Answer 34

Nocturnal panic attack
* Waking from sleep in a state of panic

Question 35

Panic Disorder
* Many patients with panic disorder report what?
* Often do with with food and medications?
* Anticipate what?

Answer 35

• Many patients with panic disorder report constant or intermittent feelings of anxiety more broadly related to health and mental health concerns.
• Often restrict food intake or avoid specific foods or medications – concerned about physical symptoms that provoke panic attacks.
• Anticipate catastrophic outcomes from mild physical problems or medical issues

Only minority of individuals have full remission without subsequent relapse within a few years

Question 36

What can provoke panic attacks with panic disorders?(6)

Answer 36

• Sodium lactate
• yohimbine
• Caffeine
• CO2
• Isoproterenol
• cholecystokinin

Question 37

What is the treatment of panic disorder?

Answer 37

• CBT with and without SSRIs; SNRIs
• Inositol
• Symptom management skills: relaxation training, calming techniques - specifically for fear of panic attack
• Behavioral Desensitization with/without
• Flooding
• Psychodynamic Psychotherapy
• EMDR: Eye Movement Desensitization and Reprocessing
• Supportive Psychotherapy
• Group Therapy and Support Groups
• Complementary/alternative treatments:Yoga, massage

Question 38

What is agoraphobia?

Answer 38

Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms

Question 39

What is the defense mechanism of agoraphobia?

Answer 39

The situations are avoided or else endured with marked distress or anxiety about having a panic attack or panic-like symptoms. Those affected may require the presence of a companion for reassurance.
* The patient makes an association between the attack and where it first occurred and will avoid that place. The attacks might spread to other places, limiting the patient even more

Question 40

Agoraphobia- DSM-V Criteria
* What is the criteria?(5)

Answer 40

Marked fear or anxiety about two (or more) of the following five situations
1. Using public transportation (e.g. cars, buses, trains, ships, planes)
2. Being in open spaces (e.g., parking lots, marketplaces, bridges)
3. Being in enclosed places (e.g., shops, theater or cinemas)
4. Standing in line or being in a crowd
5. Being outside of the home alone

Question 41

Agoraphobia- DSM-V Criteria
* The individual fears or avoids these situations because why?
* What is the duration? ⭐️

Answer 41

• The individual fears or avoids these situations because of thought that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of incontinence)
• The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

Question 42

Agoraphobia- DSM-V Criteria
* What is the duration? ⭐️

Answer 42

The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

Question 43

GAD
* What is it? What is the duration?⭐️
* What does the person find difficult?

Answer 43

• Excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities
• The person finds it difficult to control the worry

Question 44

GAD
* Anxiety and worry are associated with at least 3 (or more) of the following:

Answer 44

1. Restlessness or feeling keyed up or on edge
2. Difficulty concentrating or mind going blank
3. Irritability
4. Muscle tension
5. Sleep disturbance
6. Being easily fatigued

Question 45

⭐️

GENERALIZED ANXIETY DISORDER (GAD)…
* Associated with what?
* May experience what?
* Sxs of what?
* Frequently accompanied by what?

Answer 45

• Associated with muscle tension, trembling, twitching, feeling shaky, and muscle aches, or soreness
• May experience somatic symptoms (e.g., sweating, nausea, diarrhea, exaggerated startle response
• Symptoms of autonomic hyperarousal less prominent in GAD than other anxiety disorders
• Frequently accompanied by other conditions that may be associated with stress e.g., irritable bowel syndrome, headaches

Question 46

⭐️

What do you need to rule out with GAD?(5)

Answer 46

Rule out Endocrine Issues
* Ex: Thyroid, parathyroid, adrenal dysfunction

Rule out Deficiency States
* Ex: Vitamin B12

Rule out Neurologic issues
* Ex: Epilepsy; migraine; neoplasms

Rule out Hypoglycemia, Carcinoid

Use of substances or a prescription medication, including antibiotics

Question 47

What is the txt of GAD

Answer 47

• MEDICATION: SSRIs, SNRIs,
• CBT
• Symptom Management
• Inositol; L-theanine
• Psychodynamic Psychotherapy
• Supportive Psychotherapy
• Group Therapy and Support Groups
• Self-hypnosis; mindfulness; meditation; exercise

Question 48

GAD
* What do you need to consider with dx?

Answer 48

Specific Phobia if avoidance limited to one or only a few specific situations

Question 49

⭐️⭐️⭐️

ANXIETY DISORDERS DUE TO GENERAL MEDICAL CONDITION
* Physical Diseases where anxiety may be a component of what?(7)

Answer 49

• Pheochromocytoma
• Diabetes mellitus
• Temporal lobe epilepsy
• Hyperthyroidism
• Carcinoid
• Alcohol withdrawal
• Arrhythmias

Question 50

Substance/ Medication –Induced Anxiety
* What is predominant?
* Is evidence of what?
* Dx should be made instead of what?

Answer 50

Panic attacks (PA)or anxiety predominant

• Is evidence from history, P.E. or lab findings of both 1) and 2) PA or anxiety developed during or soon after substance intoxication or withdrawal or after exposure to a medication

This dx should be made instead of diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and are sufficiently severe to warrant clinical attention

Question 51

An essential element in evaluating all patients with Panic Disorder is

Answer 51

SUICIDE RISK!

Identify specific psychiatric symptoms associated with suicide attempts or suicide-
* Aggression
* Violence toward others,
* Impulsiveness
* Hopelessness
* Agitation
* Psychosis
* Mood and substance use disorders

Question 52

WHEN IS PATIENT SAFETY A CONCERN?
* What do you need to evaluate?(4)

Answer 52

• Assessment of past suicidal behavior- include intent and lethality of self-injurious acts
• Family history of suicide and mental illness
• Current stressors
• Potential protective factors: positive reasons for living

Question 53

TYPES OF DEPRESSION
* What is endogenous depression?
* What are examples? (4)

Answer 53

Endogenous depression
May be influenced by external events, but primarily determined by biological factors.

Examples:
* Bipolar depression
* Depression as a medication side effect
* PMS
* Depression secondary to hypothyroidism

medication, with supportive psychotherapy as an adjunct

Question 54

Reactive depression
* What is it?
* What is the treatment of choice?

Answer 54

Reactive depression
* Exogenous (from outside the body)
* Neurotic depression, internalized rage, introjection

Treatment of choice:
* psychotherapy (to expel the introject)
* Antidepressant medication will interfere with the process of expelling the introject (externalizing the rage).

Question 55

Chronic Depression
* When does it originate?
* Loss of what?
* What is the treatment of choice?
* What is the goal?

Answer 55

• Chronic depression originating in childhood
• Loss (including chronic abuse or neglect) and rage happen early enough that depression becomes chronic.
• Treatment of choice: Combination of antidepressant medication and supportive psychotherapy
• The goal is to manage the patient’s condition, not to seek a cure

Question 56

Anniversary Depression
* What is it?
* What is the treatment of choice?
* It is difficult to do what?

Answer 56

• Postponed bereavement or reactivated trauma
• Treatment of choice: Psychotherapy to discover the anniversary
• It is difficult (if not impossible) to discover the anniversary and resolve the depression if the patient is taking antidepressant medication

Question 57

⭐️

Bereavement
* Simple dereavement is not what? What can prolong the process?
* In cases where bereavement is complicated by what?
* Treat how?

Answer 57

• Simple bereavement is not depression. Antidepressant medication inhibits and prolongs the bereavement process.
• In cases where bereavement is complicated by reactive depression, the patient is not able to go through the bereavement process and do the work of mourning.
• Treat reactive depression first using psychotherapy. Then encourage the bereavement process.

Question 58

Bipolar I Disorder
* Meet criteria for what?

Answer 58

Vast majority of individuals whose has sxs that meet criteria for all the symptoms of a manic episode also experience major depressive episodes during their lifetime

Question 59

Bipolar I Disorder
* What is an essential feature? ⭐️
* Requires what?

Answer 59

• Essential feature: Distinct period during which there is an abnormally, persistently elevate, expansive, or irritable mood AND persistently increased activity or energy present for most of the the day, nearly every date for at least 1 week
• Requires at least 3 additional symptoms from Criterion B UNLESS mood is irritable (rather than elevated or expansive) and then must have 4 Criterion B sxs

Question 60

Bipolar I Disorder
* What is manic?
* May be characterized as by?
* Often predom mood is what?
* What is lability?
* Children?

Answer 60

• Manic= euphoric, excessively cheerful, high, or “feeling on top of the world.”
• May be characterized by unlimited and haphazard enthusiasm for interpersonal, sexual, or occupational interactions.
• Often predominant mood is irritable rather than elevated
• Lability= rapid shifts in mood over brief periods of time: alternating among euphoria, dysphoria, and irritability
• In children: happiness, silliness and “goofiness” Must be accompanied by persistently increased activity or energy levels

Question 61

Bipolar I Disorder
* When manic, what can they be doing?

Answer 61

• When manic, individual may engage in multiple overlapping new projects.
• Projects often started with little knowledge of the topic
• Nothing seems undoable.
• May see increased activity levels at unusual hours of the day

Question 62

Bipolar I Disorder
* What is typical?
* Individual may embark on what?

Answer 62

Inflated self-esteem typical: uncritical self-confidence to marked grandiosity. May rise to degree of delusional proportion (what type of delusions)
* Grandiose delusions common. Ex:having a special relationship with a famous person

Despite not having an experience or talent, individual may embark on complex tasks such as writing a novel or seeking financial backing for an impractical project

Question 63

Bipolar I Disorder
* What happens with childrena nd grandiosity?

Answer 63

Children: Grandiosity seen as overestimation of abilities and belief in oneself as the best or smartest must be confirmed as contrasting with evidence to the contrary. Other behavior- attempting dangerous feats. These must demonstrate a distinct change from normal behavior

Question 64

Bipolar I Disorder
* Sleep?

Answer 64

Decrease need for sleep
* Common symptom
* Often heralds the onset of a manic episode

Question 65

Bipolar I Disorder
* What happens with speech?

Answer 65

• Rapid, pressured, loud, difficult to interpret
• May talk continuously and intrusively, without giving others a chance to speak
• Speech sometimes characterized by jokes, puns, amusing irrelevancies, and theatricality
• May exhibit dramatic mannerisms, singing, and excessive gesturing
• If mood irritable (rather than expansive) speech may be marked by complaints, hostile comments or angry tirades

Question 66

Bipolar I Disorder
* What happens with thoughts?

Answer 66

Race at a rate faster than they can be expressed through speech

Flight of ideas= a nearly continuous flow of accelerated speech, abrupt shifts from one topic to another
* If severe, speech may become disorganized and incoherent

Question 67

Bipolar I Disorder
* What happens with attention?

Answer 67

Distractibility
* Inability to censor unimportant external stimuli
* Often prevents individuals from holding rational conversation or pay attention to instructions

Question 68

Bipolar I Disorder
* Increase in what activity?
* When manic usually show increased what?
* Psychomotor agitation or restlessness (i.e., purposeless activity by what?

Answer 68

• Increase in goal-directed activity Excessive planning and participation in multiple activities: sexual, occupational, political, or religious
• When manic usually show increased sociability without regard to the intrusive, domineering, and demanding nature of the interactions
• By pacing or by holding multiple conversations simultaneously, excessive letters, e-mails, text messages, etc to friends, public figures, or media

Question 69

Bipolar I Disorder
* What makes it difficult with children?

Answer 69

Increased activity criterion in children often difficult to ascertain
* Ex= child takes on many tasks simultaneously, starts devising elaborate and unrealistic plans for projects, develops previously absent and developmentally inappropriate sexual preoccupations

Question 70

Bipolar I Disorder
* What activity can happen when it is unusual for the person?

Answer 70

Expansive mood, excessive optimism, grandiosity, and poor judgment often lead to reckless behavior that is unusual for the person
* Spending sprees
* Giving away possessions, reckless driving, foolish business investments, and sexual promiscuity

Question 71

Bipolar I Disorder-
* What is expansive mood

Answer 71

Someone demonstrating an expansive mood adopts a grand or lavish style of behavior, assuming a superior or grandiose attitude, perhaps dressing and behaving flamboyantly.

Question 72

Bipolar I Disorder
* Manic sxs or syndromes due to the following do not count toward diagnosis of Bipolar I Disorder: (3)

Answer 72

• physiological effects of a drug of abuse (e.g., cocaine or amphetamine intox)
• Side effects of medications/treatments (e.g., steroids, antidepressants, stimulants, L-dopa)
• Another medical condition

Question 73

Bipolar I Disorder
* What is evidence for a manic episode dx?

Answer 73

HOWEVER, a fully syndromal manic episode arising during treatment (meds, light therapy, etc) or drug use that persists beyond the physiological effects of the “inducing” agent (after a medication is fully out of a person’s system or effects of therapy-ECT- would be expected to have dissipated completely) is evidence for a manic episode diagnosis

Question 74

Bipolar I Disorder: When manic…
* May become what?
* When delusional may be what?
* What has catastrophic consequenes?
* Depressive sxs may occur when?

Answer 74

• May become hostile and physically threatening to others
• When delusional- may be assaultive or suicidal
• Poor judgment, loss of insight, and hyperactivity usually have catastrophic consequences
• Depressive sxs may occur during manic episode and might last moments, hours, or, more rarely days (with mixed features specifier)

Question 75

Bipolar I Disorder- Associated features
* Person does not perceive what?
* Resists what?
* May change what?
* Some perceive sharper sense of what?
* May do what?

Answer 75

• Person does not perceive is ill or in need of treatment
• Resists treatment
• May change dress, makeup, personal appearance to a more sexually suggestive or flamboyant style
• Some perceive sharper sense of smell, hearing, vision
• May gamble; demonstrate antisocial behavior

Question 76

Bipolar I Disorder- risk and prognostic factors
* What can happen enviromental
* What is the genetic and physiologic risk factors?

Answer 76

Environmental- more common in high-income than low-income countries

Genetic and physiological
* Family history of bipolar disorder one of strongest and most consistent risk factor
* Is 10 fold increased risk among adult relatives of individuals with Bipolar I and II disorders

Question 77

Co-morbidity- Bipolar I Disorder
* highly co-morbid with what?

Answer 77

Highly co-morbid with all anxiety disorders
* See in ¾ of individuals
* ADHD, any disruptive, impulse-control, or conduct disorder and any substance use disorder occur in over 50% individuals with Bipolar I Disorder
* Metabolic syndrome and migraine more common
* More than half have alcohol use disorder (both present greater risk for suicide attempt)

Question 78

Bipolar I Disorder
* When does onset occur?
* Onset of manic sxs in late mid life or late life, evaluate what?

Answer 78

Mean age at onset of the first manic, hypomanic, or major depressive episode is approx 18 years for Bipolar I disorder

Onset occurs throughout the life cycle
* Could first appear in individual in 60’s or 70’s
* Onset of manic symptoms (e.g., sexual or social disinhibition) in late mid-life or late-life , evaluation medical condition (e.g., frontotemporal neurocognitive disorder) and substance ingestion or withdrawal

Question 79

Bipolar II Disorder
* What is it?
* What is the duration? ⭐️

Answer 79

• Must have at least one episode of major depression and at least one hypomanic episode
• The major depressive episodes must last 2 weeks
• Hypomanic episode must last 4 days

Question 80

Bipolar II Disorder
* What do they usually present with?
* What does not cause impairment?

Answer 80

• Individuals usually present for RX of depression. Unlikely to complain initially of hypomania
• Hypomanic episodes do not cause impairment.

Question 81

Bipolar II disorder
* What does impairment result from? (3)

Answer 81

• Major depressive episodes
• Persistent pattern of unpredictable mood changes and fluctuating
• Unreliable interpersonal or occupational functioning (friends bothered by erratic behavior)

Question 82

Bipolar II Disorder
* how is it different than bipolar 1?
* What is true?

Answer 82

Compared to Bipolar I, individuals with II
* Have greater chronicity of illness
* On average spend more time in depressive phase (which can be severe and/or disabling)

Depressive sxs can co-occur during hypomanic episode and the reverse is also true

Question 83

Bipolar II Disorder
* What is a common feature? Can contribute to what?
* Might have heightened what?

Answer 83

Common associated feature is impulsivity
* Can contribute to suicide attempts and substance use disorders

Might have heightened levels of creativity
* Sometimes reluctant to take med for this reason

Question 84

Bipolar II Disorder-development and course
* What is the onset?
* Most often begins with what? True dx is not known until what?
* What can preced dx?

Answer 84

Average age at onset mid 20’s
* Slightly later than for Bipolar I disorder
* Earlier than MDD

Most often begins with depressive episode
* True dx not known until hypomania occurs (True of 12% of individuals)
* Anxiety, substance use, or eating disorders may precede dx

Question 85

Bipolar II Disorder
* What tends to be higher than for MDD or B1D
* Individ with Bipolar I actually are more likely to experience
* What decreases with age?
* Although hypomanic episode is feature that defines BP II, what is disabling?

Answer 85

• Number of lifetime episodes (both hypomanic and major depressive episodes) tends to be higher than for MDD or Bipolar I Disorder
• Individ with Bipolar I actually are more likely to experience hypomanic symptoms than are individuals with Bipolar II
• Interval between mood episodes in course of bipolar II tends to decrease as individual ages
• Although hypomanic episode is feature that defines BP II, depressive episodes are more enduring and disabling over time

Question 86

Bipolar II Disorder
* Can have rapid what?

Answer 86

Can have rapid cycling
* Multiple (four or more) mood episodes (hypomanic or major depressive) within previous 12 months

Question 87

Bipolar II Disorder
* What is not present in hypomanic episodes?

Answer 87

no psychotic sx in hypomanic episodes

Question 88

Bipolar II Disorder-Children
* Nonepisodic associated with what?
* Persistently what?

Answer 88

• Nonepisodic (lacks well-demarcated periods of altered mood) associated with elevated risk for anxiety disorders and major depressive disorder but NOT bipolar disorder as adults
• Persistently irritable youths- lower familial rate of bipolar disorder than youths who have Bipolar

Question 89

Bipolar II Disorder- Risk and Prognosis
* What is Prognostic factors for functional recovery?

Answer 89

• more education
• Fewer years of illness
• Less severe depression

Rapid cycling pattern associated with poorer prognosis

Question 90

Bipolar II Disorder- Risk and Prognosis
* What can be a specid trigger for hypomanic episode?

Answer 90

Childbirth may be a specific trigger for hypomanic episode
* Can occur in 10-20% of females and usually in early postpartum period.
* Postpartum hypomania may foreshadow onset of a depression that occurs in about half of females who experience postpartum “highs”

Question 91

CYCLOTHYMIC DISORDER
* Individual has what?
* When hypomanic, person not ?
* Depression?
* Individuals swing ?

Answer 91

• Individual has mild swings between two poles of depression and hypomania
• When hypomanic, person not so high that is socially or professionally incapacitated
• Depression not severe enough to meet criteria for a full major depressive episode
• Individuals swing high to low and may have chronic mild mood instability

Question 92

CYCLOTHYMIC DISORDER
* What is the duration? ⭐️
* Cannot be without what?

Answer 92

• During the two year period, hypomanic and depressive symptoms “have to be present for at least half the time.”
• Cannot be without symptoms for more than 2 months at a time

Question 93

SUBSTANCE/MEDICATION-INDUCED BIPOLAR AND RELATED DISORDER
* What are examples?(5)

Answer 93

• Levadopa
• Corticosteriods
• Antidepressents: MAOIs andTricyclic
• Stimulant medication
• Adderall

Question 94

Disruptive Mood Dysregulation Disorder
* Refers to who?
* What are teh core feature?

Answer 94

Refers to children with persistent irritability and extreme behavioral dyscontrol

Core feature is chronic, severe persistent irritability
* Temper outbursts- verbal/behavioral
* Chronic, persistently irritable or angry mood

Question 95

Disruptive Mood Dysregulation Disorder
* Age?
* These children usually go on to develop what?

Answer 95

• Applies up to the age of 12 years
• These children usually go on to develop unipolar depressive disorders or anxiety disorders

Question 96

Disruptive Mood Dysregulation Disorder
* Commin in who?
* Must develop before what age?
* Cannot apply to child with what?
* Must R/O what?

Answer 96

• Higher in males of school age (non-adolescent)
• Must develop before age 10
• Cannot apply to child with developmental age less than 6 yrs
• Rule out Intermittent Explosive Disorder-> No disruption in mood between outbursts

Question 97

MAJOR DEPRESSIVE DISORDER (MDD)
* What is the duration? ⭐️
* Clear-cut changes in
* Remissions?
* Often winds up being what?

Answer 97

• Discrete episodes of at least 2 weeks duration-> Most last longer
• Clear-cut changes in affect, cognition, and neurovegetative functions
• Inter-episode remissions
• Often winds up being a recurrent illness

Question 98

MDD
* What does not typically induce episode of MDD?
* What happens if MDD and bereavement occur togehter?

Answer 98

Bereavement does not typically induce episode of MDD

If bereavement and MDD occur together
* Depressive symptoms tend to be more severe
* Functional impairment more severe
* Prognosis worse
* Is treated with antidepressants

Question 99

GRIEF vs MDE (Major Depressive Episode)
* What is the predominant feeling of grief and MDE?

Answer 99

• Grief: Emptiness and loss
• MDE: Persistent depressed mood and inability to anticipate happiness or pleasure

Question 100

GRIEF vs MDE (Major Depressive Episode)
* What is the dysphoria of grief and MDE?

Answer 100

• Grief: decreases in intensity over days to weeks; Occurs in waves (pangs of grief)
• More persistent. Not tied to specific thoughts or reminders

Question 101

GRIEF vs MDE (Major Depressive Episode)
* What is the pain of grief and MDE?
* What is hte thought content of grief and MDE?

Answer 101

Pain
* Of grief: may also see positive emotions and humor
* MDE: Positive emotions and humor not characteristic. Usually pervasively unhappy and feel misery

Thought content
* Grief: Focused on thoughts and memories of deceased
* MDE: Self critical and self ruminations

Question 102

GRIEF vs MDE (Major Depressive Episode)
* What is the self esteem with grief and MDE?
* What is the thoughts of dealth and dying with grief and MDE?

Answer 102

Self esteem:
* In grief usually preserved. If any self-derogatory ideation present, focuses on not having done enough
* MDE: Feelings of worthlessness and self-loathing common

Thoughts of death and dying
* Grief: To join loved one
* MDE: End one’s life because feels worthless, undeserving of life or unable to cope with pain of depression

Question 103

PERSISTENT COMPLEX BEREAVEMENT DISORDER
* What is the duration?
* The nature and severity?
* Can be associated with what?

Answer 103

• Diagnosed only if at least 12 months elapsed since death of loved one (6 months in children)-> Time frame distinguishes normal grief from persistent grief
• The nature and severity of grief must be beyond expected norms
• Could be associated with hallucinations of deceased. Also somatic complaints, including sxs the deceased experienced

Question 104

PERSISTENT COMPLEX BEREAVEMENT DISORDER
* When can it occur?
* Sxs can appear when?
* What do they report?

Answer 104

• Can occur at any age- as early as 1 yr of age
• Sxs can appear immediately after the death, but could be delay of months or years
• Individuals frequently report suicidal ideation

Question 105

MDD
* What are some sxs?

Answer 105

• Insomnia or fatigue may be (only) presenting complaint-> Clinician needs to probe deeper
• May just present with somatic complaints
• Fatigue and sleep disturbance seen in large # of cases
• Psychomotor disturbances seen less often but indicate greater severity
• May see delusional or near delusional guilt

Question 106

MDD
* Essential feature is either what?
* Children?
* Adults sometimes present mainly with what?
* If insomnia usually what?

Answer 106

Essential feature is either depressed mood or loss of interest or pleasure in nearly all activities
* Mood often described as sad, hopeless, discouraged, or “down in the dumps”

Children often irritable rather than sad

Adults sometimes present mainly with irritability

If insomnia usually middle insomnia- waking up in middle of night and unable to go back to sleep. Could have initial insomnia

Question 107

MDD
* When treated, what abates? What is pseudodementia?
* In some, especially elderly, MDE may sometimes be what?

Answer 107

When treated successfully, memory problems often full abate
* Pseudodementia- appears as though there is a dementia but cognitive problems totally due to depression and remit with treatment

In some, especially elderly, MDE may sometimes be the initial presentation of an irreverible dementia

Question 108

BRAIN IMAGING IN MOOD DISORDERS
* What do you see?

Answer 108

Some patients with mania or psychotic depression: enlarged cerebral ventricles on CT

Some depressed patients: Decreased blood flow in basal ganglia

MRI: Depressed patients have smaller caudate nuclei and smaller frontal lobes than normals
* Theory: abnormal regulation of membrane phospholipid metabolism

Question 109

What is anhedonia?
What is Neuro-vegetative symptoms?

Answer 109

• ANHEDONIA : Inability to experience feelings of pleasure at all
• Neuro-vegetative symptoms = vegetative symptoms = common somatic manifestations of depression

Question 110

VEGETATIVE SIGNS
* What are they?

Answer 110

Physiologic disturbances associated with mood disturbances. Some include the following:
* Anorexia/hyperphagia
* Insomnia/hypersomnia; early am awakening
* Diurnal variation of sxs (worse in a.m.)
* Diminished libido
* Constipation
* Pica: craving and eating of nonfood substances like clay or paint

Question 111

VEGETATIVE SIGNS
* What happens with menses?
* What can be sign with atypical depression?

Answer 111

• Abnormal menses
• Insatiable hunger and voracious eating: seen in atypical depression

Question 112

I do not think we need to specifiers but idk

SUBTYPES OF MAJOR DEPRESSION
* What is going on with seasonal pattern?

Answer 112

Episodes more common in fall and winter
* Develops with shortened daylight in winter and fall
* Disappears during spring and summer

Hypersomnia, hyperphagia, and psychomotor slowing

Must occur over 2 year period

Treat with exposure to bright artificial light

May see in patients also diagnoised with Bipolar I and II disorders

Question 113

Persistent Depressive Disorder (Dysthymia)
* What is the timeline? (adults and children?
* May be preceded by what?
* May occur with?

Answer 113

Mood disturbance continues for
* At least 2 years- adults
* At least 1 year- children

May be preceded by a major depressive disorder

May occur simultaneously with a major depressive disorder (sometimes referred to as double depression)

Question 114

Persistent Depressive Disorder (Dysthymia)
* Common onset?
* What is early vs late onset?

Answer 114

Has early and insidious onset (i.e., childhood, adolescence, or early adult life)

Early onset- if before age 21 years
* Assoc with higher likelihood of comorbid personality and substance use disorders
* Childhood risk factors- parental loss or separation

Late onset- at age 21 years or older

Question 115

Persistent Depressive Disorder (Dysthymia)
* What is the number of brain regions implicated in persistent Depressive Disorder?(4)

Answer 115

• Prefrontal cortex
• Anterior Cingulate
• Amygdala
• Hippocampus

Question 116

PREMENSTRUAL DYSPHORIC DISORDER (PDD)
* What are the essential features?
* What are the sxs (general)
* Myst have sx free period when?

Answer 116

• Essential features: Mood lability, irritability, dysphoria, anxiety that occur repeatedly during premenstrual phase and peak and then remit around onset of menses
• Are behavioral and physical symptoms
• Must have sx-free period in follicular phase after menstrual period starts

Question 117

PREMENSTRUAL DYSPHORIC DISORDER (PDD)
* What can happen but is rare?
* When can sxs worsen?
* When can sxs stop?

Answer 117

Delusions and hallucinations
* Described in late luteal phase of cycle
* Rare

Affected individuals worsen as approach menopause

Symptoms cease after menopause

Question 118

What is the difference between PDD vs Premenstrual Syndrome

Answer 118

• Does not require 5 sxs
• No stipulation for affective sxs
• Thought to be less severe than PDD

Question 119

SUBSTANCE/MEDICATION INDUCED DEPRESSIVE DISORDER
* Diagnostic features include sxs of what?
* Developed when?
* What happens with depressive sxs?

Answer 119

• Diagnostic features include sxs of a depressive disorder but are associated with ingestion, injection, or inhalation of an substance
• Developed during or within 1 mo after use of substance
• Depressive sxs persist beyond expected length of effects of the substance

Question 120

SUBSTANCE/MEDICATION INDUCED DEPRESSIVE DISORDER-
* What are some of the causes?

Answer 120

• Stimulants
• Steroids
• L-dopa
• Antibiotics
• CNS system drugs
• Dermatological agents
• Chemotherapeutic agents
• Immunologic agents

Question 121

Additional Facts About Depression
* What disease states can have depression sxs?(5)

Answer 121

• Interferon and Neuropsychiatric Sx associated with treatment of Hepatits C
• Huntington’s Disease
• Parkinson’s Disease
• TBI
• Stoke

Question 122

Additional Facts About Depression
* Depression is a risk factor for what diease?

Answer 122

Depression is a risk factor for cardiovascular disease
* 3-4 fold increase in risk of recurrent cardiac events and death in patients with coronary artery disease
* After controlling for multiple variables, psychosocial factor index was a stronger risk factor for acute MI than hypertension, diabetes, or obesity
* Depression predicts mortality and morbidity in patients who have had coronary artery bypass procedures.

Depression in patients with preexisting cardiac disease
* Predictive of future cardiac mortality and morbidity in patients with coronary artery disease
* Patient with MI have SEVEN times greater risk of recurrent MI

Question 123

What is the Proposed Mechanisms of depression and cardiac disease?

Answer 123

• Increased Platelet reactivity causing increased platelet aggregation and thrombus formation
• Inflammatory markers increased in depression linked to CHF, atherosclerosis, MI, stroke

Question 124

What is the current thinking is psychosocial stress responsible for both the depression and mortality:

Answer 124

• Stress is a risk factor for depression
• Depression risk factor of increased cortisol secretion
• Increased cortisol secretion can have potentially adverse cardiovascular effects

Question 125

DEPRESSION AND PREGNANCY- Risks of major affective episodes
* How does bipolor play a part?

Answer 125

Women with Bipolar disorder
* 23% had illness episodes during pregnancy
* 52% ill during postpartum period

Women with Unipolar depression
* 4.6% had illness episodes during pregnancy
* 30% during postpartum period

Depression was the symptom seen most often during pregnancy but sometimes a woman manifested a dysphoria that was due to bipolar disorder

Question 126

What are preipartum episodes? What is the risk?

Answer 126

• 50% of “postpartum major depressive episodes actually begin PRIOR to delivery. These are referred to as peripartum episodes
• Risk of occurrence was higher with bipolar disorder I, next with bipolar II, and then unipolar depression

Question 127

What are the Factors Associated with Unipolar or Bipolar Depression During Pregnancy (Ranked highest to lowest)?

Answer 127

• Having an illness onset after 1992 (no one knows why)
• Never married
• Unemployed and not a homemaker, student, or retiree
• Educated beyond high school
• Having an onset age below median of 33 years
• Having a (prior) diagnosis of bipolar (I or II)
• Relatively few pregnancies- less than four vs more than four

Question 128

DEPRESSION AND PREGNANCY
* how has the research of SSRI use during pregnancy has changed throughout the years?

Answer 128

Question 129

What is the FDA CLASS STATEMENT: PNAS?

Answer 129

• Neonates exposed to SSRIs or SNRIs late in the third trimester have developed complications requiring prolong hospitalization, respiratory, support, and tube feeding. Can arise immediately upon delivery
• Clinical findings reported: respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyper-reflexia, tremor, jitteriness, irritability and constant crying
• Sxs consistant with either direct toxic effect of SSRIs/SNRIs or possibly drug discontinuation sx

Question 130

• What is mild depression after delivery? What are the sxs? What is the duration?

Answer 130

• Mild “BABY BLUES”- different from postpartum depression
• Symptoms: crying, “mild” irritability, “mild” mood swings
• Onset 0-3-10 days after delivery
• Usually resolves on its own in ONE WEEK or TWO

Question 131

Postpartum Depression
* May reflect interactions of what?
* If does not resolve after one or two weeks, then one must consider patient has what?

Answer 131

If does not resolve after one or two weeks, then one must consider patient has a postpartum depression

Question 132

Postpartum Depression
* Meets the full criteria for what?
* Must be watchful for what?

Answer 132

• Meets the full criteria for Major Depressive Disorder (MDD)->Etiologically related to MDD
• Must be watchful for several months after delivery as symptoms may manifest later

Question 133

Postpartum Depression
* An even bigger concern is a depression with what?
* Evidence indicates

Answer 133

• An even bigger concern is a depression with psychotic features that could prompt mother to harm child while influenced by psychosis
• Evidence indicates that a depressed mother affects child’s temperament and cognitive development

Question 134

Postpartum Depression
* What is likely to have bipolar outcome?

Answer 134

• Some researchers believe that depression that begins for the first time in the postpartum period is more likely to have a bipolar outcome
• Postpartum psychosis is frequently a manifestation of bipolar disorder

Question 135

POSTPARTUM PSYCHOSIS
* May present with what?
* Counsel women with a history of what?
* Consider risk/benefits of what?

Answer 135

• May present (in new mother) with rapid onset of hallucinations, delusions, mood swings, confusion, and insomnia.
• Counsel women with a history of bipolar disorder and their significant others to report these sxs immediately if they occur.
• Consider risk/benefits of antipsychotics or mood stabilizers during pregnancy and postpartum

Question 136

POSTPARTUM PSYCHOSIS
* Many individuals with this dx, need what?
* Need to determine what?

Answer 136

• Many individuals with this diagnosis require hospitalization
• Need to determine if have delusions about or thoughts about harming infants

Question 137

POSTPARTUM PSYCHOSIS-
* What are the risk factors

Answer 137

• Sleep deprivation in susceptible women
• Hormonal shifts after birth (Primarily rapid drop in estrogen)
• Bipolar Disorder history
• Schizoaffective Disorder history
• Past hx or family hx of Postpartum Psychosis
• Previous psychiatric hospitalization (esp during prenatal period) for Bipolar or psychotic condition

Question 138

Postpartum Depression (PPD) vs PostPartum Psychosis (PPP)
* What is the difference in reported moods?
* What are other features of PPP?
* What can be in either?

Answer 138

A woman with PPD or PPP may report depressed mood, but in PPP depressed mood is often related to rapid mood changes

Other clinical features that may suggest PPP:
* Unusual hallucinations such as olfactory or tactile
* Hypomanic or mixed mood symptoms
* Confusion

Suicidal or harming the infant can be in both

Question 139

DISRUPTIVE, IMPULSE-CONTROL, AND CONDUCT DISORDERS
* These disorders are marked by
* What do they vary in?
* What type of connection?

Answer 139

• These disorders are marked by a similar presence of impaired self-regulation that results in difficult, disruptive, aggressive, or antisocial behavior.
• They vary: May be defensive, premeditated, or impulsive
• There is a clinical and biological connection along a developmental spectrum for Oppositional Defiant Disorder, Conduct Disorder, and Antisocial Personality Disorder

Question 140

OPPOSITIONAL DEFIANT DISORDER
* Have a pattern of what?
* Does not exhibit what?
* what is the duration?

Answer 140

• Have a pattern of negative, hostile and defiant behavior
• Do not exhibit the serious violation of societal norms or rules (as seen in Conduct Disorder)
• Demonstrate a pattern of defiant, angry, and negative behavior that lasts for at least 6 months

Question 141

OPPOSITIONAL DEFIANT DISORDER
* Children who frequently do what?
* Ages?

Answer 141

• Child who frequently loses his temper, is resentful, easily annoyed, and overtly defies requests and rules right in front of adults (he knows) and with peers
• May observe as early as 3 years of age
• Usually picked up by time 8 years old

Question 142

OPPOSITIONAL DEFIANT DISORDER
* What is seen twice within a 6 month period?
* May be result of what?
* May be what type of behavior?
* Behavior not limited to

Answer 142

• Such children spiteful or vindictive (seen at least twice within 6 month period)
• May be result of unresolved conflicts
• May be a reinforced, learned behavior
• Behavior not limited to relationship with a sibling

Question 143

OPPOSITIONAL DEFIANT DISORDER
* Persistence and frequency of these behaviors should be used to distinguish what?

Answer 143

Persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from one that is symptomatic:
* For children younger than 5 years, behavior should occur on most days for a period of at least 6 months
* For children 5 years and older, behavior should occur at least once per week for at least 6 months

Question 144

OPPOSITIONAL DEFIANT DISORDER- differential diagnosis
* What is developmental stage oppositional behavior?
* What is adjustment disorder?
* What is conduct disorder?

Answer 144

Developmental-stage oppositional behavior
* Durations shorter
* Symptoms not as frequent or intense

Adjustment Disorder
* Behavior observed in reaction to stress

Conduct Disorder
* Basic rights of other individuals violated
* Is possible to have Conduct Disorder and ODD simultaneously

Question 145

OPPOSITIONAL DEFIANT DISORDER- Treatment
* What is the txt?

Answer 145

Psychotherapy- including family therapy
* Parenting skills
* Prognosis determined by health of parents and family over all as well as development of any co-morbid psychopathology in child
* Consider in- home consult with behaviorist

Medication
* Treat co-morbid disorders (e.g. anxiety)
* Of label- guanfacine (Tenex) or its long- acting version: Intuniv

Question 146

INTERMITTENT EXPLOSIVE DISORDER
* What type of outbursts?
* Usually little or no?
* What type of assaults?
* What happens on property?
* What type of physical assault?
* Outbursts most commonly in response to what?

Answer 146

• Aggressive outbursts that are rapid in onset and have short duration
• Usually little or no prodrome
• Verbal assaults
• Destructive and nondestructive assault on property
• Injurious or non-injurious physical assault
• Outbursts most commonly in response to minor provocation

Question 147

INTERMITTENT EXPLOSIVE DISORDER
* This diagnosis can be made in addition to diagnosis of what? (4)
* when recurrent impulsive aggressive outbursts are in excess?

Answer 147

This diagnosis can be made in addition to diagnosis of
* ADHD
* Conduct disorder
* ODD
* Autism Spectrum Disorder

when recurrent impulsive aggressive outbursts are in excess of those usually seen in the above disorders and require independent clinical attention

Question 148

INTERMITTENT EXPLOSIVE DISORDER
* Essence of the disorder us that the outburst is what?
* Applies to what ages?
* behavior is not what?
* Dx not used in who?

Answer 148

• Essence of the disorder us that the outburst is grossly out of proportion to what might occur in most individuals faced with a stressful situation
• Applies to individuals at least 6 years or older to adulthood
• Behavior not premeditated. It is impulsive
• Dx not used in children ages 6-18 who manifest aggressive behavior but have dx of Adjustment Disorder

Question 149

INTERMITTENT EXPLOSIVE DISORDER
* What do the outburst require? (timeline)

Answer 149

• Either high frequency and low intensity (two outbursts per week for 3 months)
• Or low frequency and high intensity (three or more severe outbursts a year)

Question 150

Conduct disorder
* What is essential feature?
* What are examples?

Answer 150

Essential feature = repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate social norms or rules are violated

Examples
* Aggressive conduct that causes or threatens harm to others or animals
* Non-aggressive behavior that causes property damage
* Stealing; Deceitfulness
* Serious violation of rules

Question 151

CONDUCT DISORDERS
* What are the specifiers?

Answer 151

• Childhood-onset: One sx appears prior to 10 years
• Adolescent-onset: No sxs seen prior to age 10 yrs
• With limited prosocial emotions: Included to describe childhood equivalent of the adult with psychopathy

Question 152

CONDUCT DISORDERS: psychopathy
* A distinct syndrome within what?
* Characterized by what?
* Suck traits found in who?

Answer 152

• A distinct syndrome within the antisocial spectrum
• Characterized by lack of empathy and concern for the feelings, wishes, and well being of others
• Such traits found in minority of youth with Conduct Disorder

Question 153

CONDUCT DISORDERS
* When individual is age 18 years or older, diagnosis criteria for what?

Answer 153

Antisocial Personality Disorder

Question 154

CONDUCT DISORDER-
What are Common characteristics ?

Answer 154

• Attention deficit
• Low frustration tolerance
• Impulsivity, recklessness
• Learning disorders, especially reading
• Negative mood
• Sullenness
• Irritability
• Volatile anger outbursts
• Low self-esteem

Question 155

Conduct disorder: Common characterisitcs
* What is the Impaired cognition?
* What do they use?

Answer 155

Impaired cognition:
* Distortion of size and time awareness.
* Lack of and distorted connection between prior events and consequences
* Limited ability to generate, evaluate, and implement alternative problem-solving strategies

Use of less adaptive intra-psychic mechanisms
* Minimization
* Avoidance
* Externalization
* Denial
* Identification with the aggressor

Question 156

What are the emotional characterisitics and impaired interpersonal relations? of conduct disorder?

Answer 156

Emotional deficits
* Minimization of fear and sadness
* Inability to control and modulate anger
* Lack of empathy
* Lack of guilt

Impaired interpersonal relations
* Suspiciousness or paranoia, with cognitive distortions
* Attributional bias: misperceives others’ actions as hostile
* Preference for nonverbal, action-oriented, aggressive solutions to problems

Question 157

What is pyromania?

Answer 157

Pyromania is defined as a pattern of deliberate setting of fires for pleasure or satisfaction derived from the relief of tension experienced before the fire-setting. The name of the disorder comes from two Greek words that mean “fire” and “loss of reason” or “madness.” Classified as a disorder of impulse control, meaning that a person diagnosed with pyromania fails to resist the impulsive desire to set fires—as opposed to the organized planning of an arsonist or terrorist.

Question 158

What is kleptomania?

Answer 158

• Kleptomania is a complex disorder characterized by repeated, failed attempts to stop stealing. It is often seen in patients who are chemically dependent or who have a coexisting mood, anxiety, or eating disorder. Other coexisting mental disorders may include major depression, panic attacks,social phobia,anorexia nervosa,bulimianervosa, substance abuse, andobsessive-compulsive disorder. People with this disorder have an overwhelming urge to steal and get a thrill from doing so. The recurrent act of stealing may be restricted to specific objects and settings, but the affected person may or may not describe these special preferences. People with this disorder usually exhibit guilt after the theft.
• Detection of kleptomania, even by significant others, is difficult and the disorder often proceeds undetected. There may be preferred objects and environments where theft occurs. One theory proposes that the thrill of stealing helps to alleviate symptoms in persons who are clinically depressed.

Question 160

Dissociative disorders
* Sxs may present as what?

Answer 160

• Unwanted intrusions into awareness and behavior
• Inability to access information or control mental functions that usually an individual can control

Question 161

Dissociative identity disorder
* Criterion A acknowledges what?
* Swtich to what?
* What can happen In some cultures?

Answer 161

• Criterion A acknowledges a marked discontinuity in the sense of self and agency
• Switch to (at least) a second personality has to represent a break with an individual’s usual thinking and behavior
• In some cultures the change to a second (or more) personality states is described as an experience of possession

Question 162

What is the sense of agency?

Answer 162

The “sense of agency” (SA) refers to the subjective awareness that one is initiating, executing, and controlling one’s own volitional actions in the world. It is the pre-reflective awareness or implicitsensethat it is I who is executing bodily movement(s) or thinking thoughts.

Question 163

DISSOCIATIVE IDENTITY DISORDER (DID)
* These symptoms are experienced how?
* What is disrupted?
* Individual’s may lose his sense of what?

Answer 163

• These symptoms are experienced consciously (reflecting an alter’s intrusion into a person’s conscious functioning)
• Individual’s sense of self is disrupted
• Individual’s may lose his sense of directing his or her speech and actions

Question 164

DISSOCIATIVE IDENTITY DISORDER (DID)
* What can intrude into the conscious mind?
* Individual might experience sudden what?
* A person may become what?
* Individual’s body may feel like what?

Answer 164

• Voices might intrude into the conscious mind
• Individual might experience sudden emergence of strong emotions and/or impulses
• A person may become a depersonalized observer of his actions- powerless to stop it
• Individual’s body may feel different (like that of opposite gender or of a small child)-> Accompanied by the recognition that the feelings do not belong to the individual

Question 165

DISSOCIATIVE IDENTITY DISORDER (DID)
* Diagnosis does not apply in situation when?
* What are the dx exclusions

Answer 165

Diagnosis does not apply in situation where the disturbance is a normal part of a broadly accepted cultural or religious practice

Diagnosis excludes
* Physiologic effect of a substance (e.g. blackouts or chaotic behavior during alcohol intoxication, hallucinogens, PCP)
* Another medical condition- e.., complex partial seizures, brain tumors

Question 166

DISSOCIATIVE IDENTITY DISORDER (DID)
* Most individuals with non-possession form do not display what?
* Only a small minority of individuals present how?

Answer 166

• Most individuals with non-possession form do not display their discontinuity of identity for long periods of time
• Only a small minority of individuals present to clinical attention with observable alteration of identities

Question 167

DISSOCIATIVE IDENTITY DISORDER (DID)
* The dissociative amnesia in DID manifests in 3 primary ways?

Answer 167

1. Gaps in remote memory of personal life events (periods of childhood or adolescence) such as death of a grandparent, giving birth, getting married
2. Lapses in dependable memory (what happened today, well-learned skills such as how to do job, use computer, read, drive
3. Discovery of evidence of everyday actions and tasks the person does not remember doing

Question 168

DISSOCIATIVE IDENTITY DISORDER (DID)
* May experience what?
* Amnesia in DID NOT limited to what?

Answer 168

• May experience dissociative fugues (Find themselves in Vermont and no recollection of how got there) or somewhere at home with no recollection of how got there
• Amnesia in DID NOT limited to stressful traumatic events. May have amnesia for everyday events

Question 169

DISSOCIATIVE IDENTITY DISORDER (DID)
* May have dissociative flashbacks during which cause what? (2)

Answer 169

• Have loss of contact with or disorientation to the current reality
• Subsequent amnesia for content of flashback

Question 170

DISSOCIATIVE IDENTITY DISORDER (DID)
* Can manifest at what age?
* Children usually do not present with what?

Answer 170

Can manifest at any age

Children usually do not present with identity changes
* Instead, present with Criteria A sxs of problems with memory, concentration, attachment, and traumatic play

Question 171

DISSOCIATIVE IDENTITY DISORDER (MULTIPLE PERSONALITY DISORDER)
* Recovery is how?
* Individual personalities may have their own what?

Answer 171

• Recovery is generally incomplete
• Individual personalities may have their own separate mental disorders, mood disorders, and personality disorders, with other dissociative disorders being the most common

Question 172

DISSOCIATIVE IDENTITY DISORDER (MULTIPLE PERSONALITY DISORDER)
* What is the txt?

Answer 172

Psychotherapy
* Insight-oriented, often with hypnotherapy or drug-assisted interviewing
* Goal- reconciliation of disparate, split-off affects by helping patient understand original reasons for the dissociation no longer exists and one whole personality can express all the feeling without the self being destroyed.

Pharmacotherapy
* Drug-assisted interviewing to obtain hx and identify unrecognized identities
* Antidepressant and anti-anxiety medications useful adjuvants
* Anticonvulsant meds (eg: Tegretol) helpful in some patients

Question 173

DISSOCIATIVE AMNESIA
* Primarily affects the ability to recall what?
* Criterion specifies what?
* Person may feel he/she is what?
* Dissociative amnesia must be distinguished from what?

Answer 173

• Primarily affects the ability to recall personal information about oneself-> It may be selective for specific events or more global
• Criterion specifies two types of amnesia- localized (selective) and generalized
• Person may feel he/she is “going crazy” or may have concerns about self-identity
• Dissociative amnesia must be distinguished from other mental disorders

Question 174

DISSOCIATIVE AMNESIA
* What is the specifier?

Answer 174

• Dissociative fugue is a specifier
• Used when a person unexpectedly travels away from home or the workplace, or wanders bewilderedly, during an episode of dissociative amnesia

Question 175

DISSOCIATIVE AMNESIA
* Onset?
* History usually shows what?
* Patient is aware of what?

Answer 175

Onset of dissociative amnesia often abrupt

History usually shows a precipitating emotional trauma charged with painful emotions and psychological conflict

Patient aware has lost memory
* Some upset by this
* Others unconcerned or indifferent

Question 176

DISSOCIATIVE AMNESIA
* The forgotten memories usually relate to what?
* Patient does have capacity to do what?
* What is intact?

Answer 176

• The forgotten memories usually relate to day-to-day information that is routine part of conscious awareness (who a person is)
• Patient does have capacity to learn and remember new information
• General cognitive functioning and language capacity usually intact

Question 177

DISSOCIATIVE AMNESIA
* Patients usually alert?
* Some report what?
* What type of gain?

Answer 177

• Patients usually alert before and after period of amnesia
• Some report slight clouding of consciousness during period immediately surrounding onset of amnesia
• Amnesia may provide primary or secondary gain (Example: woman amnestic about birth of dead infant

Question 178

DISSOCIATIVE AMNESIA
* What is localized?

Answer 178

Localized - memory loss for events over short period of time
* May be broader than for one single traumatic event (e.g., child abuse over months or years/intense combat)
* Selective or systematized amnesia -inability to recall some but not all events over a short time

Question 179

DISSOCIATIVE AMNESIA
* What is generalized amenia?

Answer 179

Generalized amnesia - Loss of memory for a whole lifetime of experiences
* May forget personal identity (rare)
* Onset acute
* Seen in individuals experiencing extreme emotional distress or conflict
* Disorientation, perplexity, and purposeless wandering usually brings them to the attention of the authorities

Cannot be due to general medical condition or ingestion of substance

Question 180

DISSOCIATIVE AMNESIA
* What do you need to r/o?

Answer 180

R/o Dementia or delirium
* In this circumstance, amnesia associated with many cognitive sxs

R/O Epilepsy
* Ck for abnormal EEG

Question 181

DISSOCIATIVE AMNESIA
* How do sxs happen?
* Recovery?
* Length?
* Lost memories should be restored when?
* Generally, recover is what?

Answer 181

• Symptoms of dissociative amnesia terminate abruptly
• Recovery complete with few recurrences
• May last long time in some patients (esp if there is secondary gain)
• Lost memories should be restored asap or the repressed memory may form a nucleus in the unconscious mind where future amnestic episodes may develop
• Generally, recover spontaneously->Accelerated with treatment

Question 182

DISSOCIATIVE AMNESIA- treatment
* What is psychotherapy and pharmacotherapy?

Answer 182

Psychotherapy
* to help incorporate the memories into patient’s conscious state
* Hypnosis can be used primarily as means to relax the patient sufficiently to recall forgotten information

Pharmacotherapy
* Drug-assisted interviews with short-acting barbiturates, such as Pentothal (thiopental) and Amytal (sodium amobarbital) iv; and benzos may be used to help patients recover their forgotten memories

Question 183

DEPERSONALIZATION/DEREALIZATION DISORDER- diagnostic criteria
* Presence of what?
* What is intact?

Answer 183

• Presence of persistent or recurrent experiences of depersonalization, derealization, or BOTH
• Intact reality testing

Question 184

What is depersonalization?

Answer 184

DEPERSONALIZATION: Experiences of unreality, detachment, being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing

Question 185

DEPERSONALIZATION/DEREALIZATION DISORDER
* Depersonalization by itself comprised of several factors?

Answer 185

• Anomalous body experiences (i.e., unreality of the self and perceptual alterations
• Emotional or physical numbing
• Temporal distortions with anomalous subjective recall

Question 186

What is DEREALIZATION?

Answer 186

Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)

Question 187

DEPERSONALIZATION/DEREALIZATION DISORDER
* Derealization- a person may:

Answer 187

• Feel in fog or bubble
• There is veil or glass wall between individual and world
• Surroundings seem artificial, colorless, or lifeless
• Commonly see subjective visual distortions: blurriness, heightened acuity, widened or narrowed visual field, two-dimensionality or flatness, exaggerated three-dimensionality, altered distance or size of objects (macropsia or micropsia)
• Auditory distortions: voices or sounds muted or intensified

Question 188

DEPERSONALIZATION/DEREALIZATION DISORDER
* Persistent, recurrent episodes of what?
* Pt reports seems like what?
* Episodes are what?
* Patients recognize what?

Answer 188

• Persistent, recurrent episodes of feeling detached from one’s self or body
• Pt reports seems like watching herself in a movie, feeling mechanical, or as if in a dream (dreaming)”I am no one; I have no self”
• Episodes are ego-dystonic (unwelcomed and uncomfortable)
• Patients recognize the unreality of the symptoms

Question 189

DEPERSONALIZATION/DEREALIZATION DISORDER
* May feel subjectively detached from what?
* May feel what?
* A split self?

Answer 189

May feel subjectively detached from aspects of the self, including feelings (e.g., hypoemotionality: “I know I have feelings but I don’t feel them.” “My thoughts don’t feel like my own,” “my head is filled with cotton.”

May feel robotic

A split self- one part observing and one part participating
* In extreme form known as out-of-body experience

Question 190

DEPERSONALIZATION/DEREALIZATION DISORDER
* Affected individuals think what?
* fear what?
* Altered sense of what?
* Subjective difficulty in what?
* What are the Vague somatic sxs?
* Ruminate/obsess about what?

Answer 190

• Affected individuals think they are crazy or going crazy
• Fear irreversible brain damage
• Altered sense of time (too fast or slow)
• Subjective difficulty in vividly recalling past memories and owning them as personal and emotional
• Vague somatic sxs: head fullness, tingling, lightheadedness
• Ruminate/obsess about whether they really exist

Question 191

DEPERSONALIZATION/DEREALIZATION DISORDER
* Transient depersonalization/derealization sxs lasting what?
* One-half of all adults have experienced what?

Answer 191

• Transient depersonalization/derealization sxs lasting hrs to days common in general population
• One-half of all adults have experienced at least one lifetime episode of depersonalization/derealization.

Meeting full criteria for disorder less common than transient sysmptoms

Question 192

DEPERSONALIZATION/DEREALIZATION DISORDER
* What is the mean age onset?
* Onset can be what?
* Duration?
* Course is often what?

Answer 192

• Mean age onset- 16 yrs. Can start in early or middle childhood
• Onset can be sudden or gradual
• Duration varies from hours or days to weeks, months, years
• Course is often persistent-> 1/3 cases discrete episodes/continuous episodes/initially episodic course becomes continuous

Question 193

DEPERSONALIZATION/DEREALIZATION DISORDER
* Clear association between what?
* What is less common?

Answer 193

Clear association between disorder and childhood interpersonal traumas (but still not as extreme as in DID)
* Sexual abuse much less common that other stressors: physical abuse, growing up with seriously mentally ill parent, unexpected death or suicide of family member or close friend

Question 194

DEPERSONALIZATION/DEREALIZATION DISORDER
* Most common causes?
* Sxs specifically induced by what?
* Marijuana may precipitate what?

Answer 194

• Most common proximal precipitants are severe stress, depression, anxiety, and illicit drug use
• Sxs specifically induced by marijuana, hallucinogens, ketamine, MDMA (such as ecstasy), and salvia
• Marijuana may precipitate new-onset panic attacks and depersonalization/derealization symptoms simultaneously

Question 195

DEPERSONALIZATION/DEREALIZATION DISORDER
* What is major morbidity?
* What is comorbidity?

Answer 195

• Major morbidity- Impairment in both interpersonal and occupational spheres
• Comorbidity- Unipolar depressive disorder and any kind of anxiety disorder and, for many, both

Question 196

DEPERSONALIZATION/DEREALIZATION DISORDER
* What is the treatment/course/prognosis?

Answer 196

• Benzos/SSRI’s may do something. Some recent evidence- Lamictal
• Cognitive behavioral- re-learn feelings and attitudes

Question 197

PERSONALITY CLUSTERS
* What are the 3 clusters?

Answer 197

• Cluster A: Odd/eccentric
• Cluster B: Dramatic/erratic
• Cluster C: Anxious/fearful

Question 198

Cluster A
* What type of cluster?
* Tends to be what?
* What are the examples? (3)
* Involve use of what?
* Associated with what?

Answer 198

• The odd and eccentric cluster
• Tend to be detached and distrustful
• Includes the following: Paranoid Personality, Schizoid Personality, Schizotypal Personality
• Involve use of fantasy and projection
• Associated with tendency toward psychotic thinking and Cognitive disorganization when stressed

Question 199

PERSONALITY DISORDERS
* What is the cognitive and perceptual dysreguation?

Answer 199

• Odd or unusual thought processes and experiences, including depersonalization, derealization, and dissociative experiences
• Mixed sleep-wake state experiences;
• Thought control experiences

Question 200

Cluster B:
* What type of cluster?
* Individuals tend to be what?
* What does it include?

Answer 200

• The dramatic, emotional, and erratic cluster
• Individuals tend to be emotionally unstable, impulsive and intense.
• Includes: Borderline Personality, Antisocial Personality, Narcissistic Personality, Histrionic Personality

Question 201

CLUSTER B
* use what type of mechanisms?
* What is common?

Answer 201

• Use defense mechanisms- dissociation, denial, splitting, and acting out.
• Disorders in this group are common

Question 202

CLUSTER C
* Individuals tend to be what?
* What are the examples?
* Commonly use what?

Answer 202

• Individuals tend to be nervous, fearful, passive or rigid and preoccupied
• Includes: Dependent Personality, Avoidant Personality, Obsessive-compulsive personality
• Commonly used defense mechanisms- isolation, passive aggression, and see illness anxiety issues

Question 203

What is fatal flaws?

Answer 203

If one places the word deficient before any of the traits just listed, one can perceive the problems associated with the various personality disorders

Question 204

TEMPERAMENT
* The definition should include what?
* Includes what?
* Dysfunction in these dimensions leads to what?

Answer 204

• The definition should include emotional, motivational, and adaptive traits.
• Includes harm avoidance, novelty seeking, reward dependence, and persistence
• Dysfunction in these dimensions leads to problems that Cloninger sees as occurring along a continuum

Question 205

What are the four examples of CONTINUUM OF TEMPERAMENT?

Answer 205

Question 206

When does a person has a personality disorder?

Answer 206

If there is impairment in this constellation of patterns so that the pattern of an individual’s inner experience and outward behavior deviates significantly and persistently from the person’s culture and leads to significant distress and relationship problems, then the person

Question 207

People with personality disorders
* Usually are not particularly upset by what?
* They can become distressed by what?

Answer 207

• Usually are not particularly upset by their flawed patterns of thinking and behavior
• They can become distressed by the consequences of the maladaptive behaviors (unlike other mental illnesses)

Question 208

Underlying Causes of Personality Disorders
* Result of what?
* What is an example?

Answer 208

The result of a complex matrix of biological (genetic), psychological, social, and spiritual factors
* Example: Individuals with Borderline and Antisocial Personality Disorders commonly have histories of sexual abuse during childhood

Question 209

What is the general dx criteria for a personality disorder

Answer 209

An enduring pattern of feeling, thinking, and behaving that deviates markedly from the expectations of the person’s culture. This pattern is manifested in at least two of the following areas:
1. Cognition (ways of perceiving and interpreting self, other people and events)
2. Affect (the range, intensity, volatility, and appropriateness of their emotional responses)
3. Interpersonal relationships
4. Impulse control

Question 210

PRINCIPLES RELATED TO DEALING WITH PEOPLE WITH PERSONALITY DISORDERS

• People with disorders of personality and character are excessively what?
• They have difficulty with what?
• Often do not bother to consider what?

Answer 210

• People with disorders of personality and character are excessively self-involved
• They have difficulty understanding and accepting other people’s points of view
• Often do not bother to consider how what they say or do might affect the people who are closest to them-> People with Antisocial Personality Disorder may inflict severe psychological and physical damage on others to meet their own needs and achieve their own ends

Question 211

Paranoid Personality Disorder and Schizotypal Personality Disorder
* Usually what?
* They are often conflicted about what?
* What is the result?

Answer 211

Are so self-absorbed that they distort reality
* They are often conflicted about their own angry and sexual feelings, that they unconsciously project onto others
* Result is they feel threatened and persecuted for no substantiated reason

Question 212

NARCISSITIC PERSONALITY DISORDER
* Takes credit for what?
* Exaggerate what?
* Ignore what?
* Exploit what?

Answer 212

• Take the credit for the accomplishments of others
• Exaggerate their own achievements
• Ignore people whom they believe cannot advance their status
• Exploit others to enhance their self-image and self-esteem

Question 213

Histrionic Personality Disorder
* Disturbances in what?
* As a rule they are highly suggestible and have characteristic styles of thinking what?
* A pattern of excessive what?

Answer 213

• Disturbances in interpersonal relationships among mother, father, and child key factors leading a child to develop histrionic personality disorder as an adult
• As a rule they are highly suggestible and have characteristic styles of thinking that are impressionistic and deficient in logic- mental states that are likely brain based and genetically determined
• A pattern of excessive emotionality and attention seeking

Question 214

Many people with personality disorders will not accept what? May blame what?

Answer 214

Many people with personality disorders will not accept that they have problems, will refuse treatment, and therefore will not change

May blame all their relationship problems on someone else

Question 215

personality disorders

Often they become involved with who? Why?

Answer 215

Often they become involved with the most kind, accommodating, and selfless individuals, perhaps sought out because they are vulnerable to exploitation
* Such vulnerable people will respond to the relentless criticism and devaluation by trying to change and improve themselves to satisfy the individual with personality issues–but to no avail

Question 216

What is the first line therapy for personality disorders? What commonly coexist?

Answer 216

• Insight-oriented and cognitive-behavioral psychotherapies are the first-line treatments for most people with personality disorders
• Anxiety and mood disorders commonly coexist with personality disorders so medication may be a component of treatment

Question 217

Personality disorders:
* Usually occur when?
* What are the biological determinants?

Answer 217

• Usually the first evidence is in late adolescence or early adulthood
• Impulsive traits associated with increased levels of testosterone, 17- estradiol, and estrone. Low levels of platelet monoamine oxidase may be associated with sociability or with schizotypal personality disorder

Question 218

Underlying Causes of Personality Disorders
* What commonly have histories of what?

Answer 218

Overall are the result of a complex matrix of biological (genetic), psychological, social, and spiritual factors
* People with Borderline and Antisocial Personality Disorders commonly have histories of sexual abuse in childhood

Question 219

What are the tests for personality disorders?

Answer 219

Neuropsychological testing

Projective testing
* Minnesota Multiphasic Personality Inventory: MMPI-2
* Draw a Person Test
* Rorschach
* Thematic Apperception Test: TAT

Question 220

Most personality disorders tend to involve what? (4)

Answer 220

• Ego function impairment
• Superego impairment
• Self-image, self-esteem problems
• Enactments of inner psychological conflicts based on past experiences, with impairments in judgment

Question 221

PARANOID PERSONALITY DISORDER
* Pattern of what?

Answer 221

A pattern of distrust and suspiciousness such that others’ motives interpreted as malevolent

Question 222

PARANOID PERSONALITY DISORDER
* Diagnosis requires four or more of the following what?

Answer 222

1. Suspects without sufficient basis, that others are exploiting, harming, or deceiving him/her
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him/her
4. Suspicious about partner’s fidelity
5. Responds by counterattacking
6. Perceives attacks on his or her character and is quick to react angrily
7. Persistently bears grudges
8. Reads hidden demeaning or threatening meanings into benign remarks or events

Question 223

PARANOID PERSONALITY DISORDER
* What is the classic defense?
* Shame?
* What is projected?

Answer 223

• Classic defenses – projection, denial, and rationalization
• Shame a prominent feature
• Superego projected onto authority

Question 224

PARANOID PERSONALITY DISORDER
* The main feature of Paranoid Personality Disorder is what?
* These patients have difficulty maintaining what?

Answer 224

• The main feature of Paranoid Personality Disorder is a pervasive mistrust so that the motives of others are interpreted as being deliberately hurtful.
• These patients have difficulty maintaining friendships because of their continual accusations or thoughts of malevolence, exploitation, deception, and humiliation toward them

Question 225

Paranoid personality treatment:
* What is the txt of choice?
* What is not choice treatment?
* What can be used for agitiation and anxiety?
* Low dose waht?
* Therapy?

Answer 225

• Psychotherapy is the treatment of choice
• Group therapy is NOT choice treatment but can help with social skills and to decrease suspiciousness
• Anti-anxiety meds for agitation and anxiety
• Sometimes low dose antipsychotic medication
• Cognitive-Behavioral therapy

Question 226

Delusional disorder, persecutory type-
* WThe patient has what? What are the two types?

Answer 226

Delusional disorder, persecutory type- the patient has systematized, encapsulated non-bizarre delusions:
* Systematized: a scheme of actions and concerns that appear logical “only IF” the initial premise of persecution is taken as correct
* Encapsulation indicates the activities of the person outside the delusion are not obviously unusual. A patient with Delusional Disorder, Persecutory type evidences circumscribed area of paranoia

Question 227

SCHIZOID PERSONALIT DISORDER
* A pattern of what?

Answer 227

A pattern of detachment from social relationships and restricted range of emotional expression

Question 228

SCHIZOID PERSONALITY DISORDER-DIAGNOSIS
* Need four or more of the following?

Answer 228

1. Neither desires nor enjoys close relationships
2. Almost always chooses solitary activities
3. Has little, if any, desire for a sexual experience with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first-degree relatives
6. Appears indifferent to the praise or criticism of others
7. Shows emotional coldness, detachment, or flattened affect

Question 229

SCHIZOID PERSONALITY DISORDER
* Pervasive what?
* Social needs are what?

Answer 229

• Pervasive social inhibition
• Social needs are repressed to ward off aggression

Question 230

SCHIZOID PERSONALITY DISORDER
* May appear as what?
* May avoid what?

Answer 230

• May appear as constricted, aloof, or inappropriately serious
• May avoid spontaneous speech, use occasional odd metaphors but can abstract/interpret proverbs

Question 231

SCHIZOID PERSONALITY DISORDERS
* What is the treatment?

Answer 231

• Psychotherapy (These individuals may be introspective)
• Low dose anti-psychotics (still, not considered psychotic), low dose antidepressants (With serotonergic meds may become less sensitive to rejection), low dose psychostimulants
• Group Therapy

Question 232

• Paranoid personality disorder:
• Schizotypal personality disorder:
• Avoidant personality disorder:

Answer 232

• Paranoid Personality Disorder- the patient is involved with others
• Schizotypal Personality Disorder- the patient exhibits oddities and eccentricities of manners
• Avoidant Personality Disorder- the patient is isolated but WANTS to be involved with others

Question 233

What are the schizoid themes?

Answer 233

• Prefer to do things alone
• Why bother? Who cares?
• Withdrawn and reclusive
• May work below potential and/or may show considerable creativity
• Lacks interests or hobbies
• Little apparent desire to pursue relationships
• Goes through the motions but is aloof, distant, and cold
• Emotionally constricted

Question 234

SCHIZOTYPAL PERSONALITY DISORDER-
* What is the pattern?

Answer 234

A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior

Question 235

SCHIZOTYPAL PERSONALITY DISORDER-DIAGNOSIS
* Need for 5 or more of the following?

Answer 235

1. Ideas of reference
2. Odd beliefs or magical thinking
3. Unusual perceptual experiences
4. Odd thinking and speech
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behavior or appearance is odd, eccentric or peculiar
8. Lack of close friends or confidantes other than first degree relatives
9. Excessive social anxiety that does not diminish with familiarity

Question 236

SCHIZOTYPAL PERSONALITY DISORDER
* These people are what?
* When test with Rorschach they answer like what?
* What is the eye movement?
* Diminished what?

Answer 236

• These people are overtly odd and eccentric
• When test with Rorschach they answer like a person with a thought disorder
• Abnormal saccadic eye movements with poor eye tracking
• Diminished brain mass, especially in the temporal lobe

Question 237

SCHIZOTYPAL PERSONALITY DISORDER
* Rarely seek treatment for what?
* Usually what happens in order for them to get help?
* In response to stress, these individuals may experience periods of what?
* What is the timeline?

Answer 237

• Rarely seek treatment for their personality eccentricities alone
• Usually an acute stressor or the encouragement of a family member brings them in “for help”
• In response to stress, these individuals may experience periods of psychosis that last from minutes to hours. These episodes are referred to as micropsychotic episodes.
• Last less than 24 hours and therefore do not meet criteria for a Brief Psychotic Disorder

Question 238

Schizotypal personality disorder
* What is the txt?

Answer 238

• Psychotherapy
• Low dose anti-psychotics (to deal with ideas of reference/illusions)
• Antidepressants if depression occurs

Question 239

Schizotypal vs. paranoid personality disorder vs Borderline vs schizophrenia?

Answer 239

Paranoid Personality Disorder- the patient is suspicious and guarded

Schizoid Personality Disorder- the patient has no particular eccentricities

Borderline Personality Disorder- the patient shows emotional instability, int ensity and impulsiveness

Schizophrenia- the patient is out of touch with reality; has true thought disorder

Question 240

ANTISOCIAL PERSONALITY DISORDER
* what is it? What do they need?

Answer 240

A pervasive pattern of disregard for and the violation of others, occurring since age 15 years, as indicated by three or more of the following:
1. Failure to conform to social norms with respect to lawful behaviors
2. Deceitfulness
3. Impulsivity or failure to plan ahead
4. Irritable or aggressive
5. Reckless disregard for safety of self and others
6. Consistently irresponsible
7. Has no remorse for behavior or its consequences

Question 241

ANTISOCIAL PERSONALITY DISORDER
* Age?
* There is evidence what?
* The disorder involves what behavior?

Answer 241

• Must be 18 years of age (If not, use Conduct Disorder
• There is evidence of a conduct disorder with onset before the age of 15 years
• The disorder involves maladaptive behavior in which the patient does not recognize the rights of others-> It is not synonymous with criminality (even though criminals may have this disorder)

Question 242

ANTISOCIAL PERSONALITY DISORDER-DIAGNOSIS
* What are the pschopathic features?

Answer 242

Mask of Sanity
* May appear trustworthy but commonly manipulative, cunning, and calculating

Criminal or dishonest activities are common
* Lying, truancy
* History of violence or have potential for violence

Question 243

ANTISOCIAL PERSONALITY DISORDER-DIAGNOSIS
* Lack of what? (2)
* What is common?
* What is a way of life?
* Disregard for what?

Answer 243

• Lack remorse for actions
• Impulse dyscontrol and failure to plan
• Characteristically show a lack of sensitivity to others
• Irritability and aggression are common
• Deceit and irresponsibility are a way of life
• Disregard for the safety of others and themselves

Question 244

ANTISOCIAL PERSONALITY DISORDER-Etiology
* What is common? Examples
* History of what?

Answer 244

History of brain damage somewhat common (may see abnormal EEG and/or soft neurologic signs
* Perinatal brain injury
* Head trauma
* Encephalitis (Affecting the frontal lobe)

History of parental abandonment or abuse very common

Question 245

BORDERLINE PERSONALITY DISORDER-DIAGNOSIS
* need to have one or more of what?

Answer 245

1. Frantic efforts to avoid real or imagined abandonment
2. Unstable and intense interpersonal relationships (alternating between idealization and devaluation).
3. Identity disturbance
4. Impulsivity in at least 2 areas that are potentially self-damaging
5. Recurrent suicidal behavior, gestures, threats or self-mutilating behavior
6. Affect instability (Unstable mood)
7. Chronic feelings of emptiness
8. Inappropriate intense anger or difficulty controlling anger
9. Transient, stress related paranoia or dissociation

Question 246

ANTISOCIAL PERSONALITY DISORDER-PSYCHODYNAMICS
* Patients are impulse-ridden with what?
* What is primitive or poorly developed?
* Object what?
* What is often prominent?
* May see what?

Answer 246

• Patients are impulse-ridden with associated ego deficits in planning and judgment-> Superego deficits or lacunae
• Conscience is primitive or poorly developed
• Object relational difficulties are significant-> Failure with love, empathy(lack it), basic trust
• Aggressive features often prominent
• May see sadomasochism, narcissism, and depression

Question 247

BORDERLINE PERSONALITY DISORDER-DIAGNOSIS
* Overall defined by what? (4)

Answer 247

• Separation-individuation problems
• Affective control problems
• Intense, personal attachments
• Self-image problems

Question 248

BORDERLINE PERSONALITY DISORDER-
What are the SIGNS AND SYMPTOMS?

Answer 248

• Many episodes of having a crisis
• Mini-psychotic episodes are possible, often with paranoia or transient dissociative symptoms
• Self-destructive, self-mutilating acts
• Suicidal threats ,gestures, or acts
• Relationships are tumultuous
• Intolerant of being alone and driven by object hunger
• Engage in efforts to avoid real or imagined abandonment

Question 249

What are some more sxs of borderline?

Answer 249

• May be easily enraged
• Often manipulative, sometimes transparently so
• Self-image and identity are unstable
• Impulsive with regard to money and sex
• Engage in substance abuse, reckless driving, or binge eating
• Mood reactivity. Affect storms
• Pan-anxiety
• Chaotic sexually

Question 250

BORDERLINE PERSONALITY DISORDER-
* What is splitting?
* What type of idealization?

Answer 250

Splitting: Patient manifests rage without a consciousness of ambivalent or positive emotions toward someone. It is usually transient. An associated feature is the ability to divide persons into those who like and those who hate the patient, and into those who are all “good” or all “bad”.

Primitive idealization

Question 251

BORDERLINE PERSONALITY DISORDER-PSYCHODYNAMICS
* What is projective identification?

Answer 251

• Patient attributes idealized positive or negative features to another person, then seeks to engage the other in various interactions that confirm the patient’s belief
• Patient tries, unconsciously, to induce the therapist to play the projected role

Question 252

BORDERLINE PERSONALITY DISORDER-PSYCHODYNAMICS
* Marked fear of what?
* What is impaired? What does that cause?

Answer 252

Marked fear of abandonment

Object constancy is impaired
* Results in a failure of internal structuring and control
* Self-hate and loathing
* Generalized ego dysfunction resulting in identity disturbances

Question 253

BORDERLINE PERSONALITY DISORDER-“Unique Treatment
* What is the txt?

Answer 253

Psychotherapy

DIALECTICAL BEHAVIORAL THERAPY (DBT)
* A cognitive behavioral model
* Core mindfulness
* Interpersonal Effectiveness
* Emotion Regulation
* Distress Tolerance
* Develop strategies to self-soothe

Question 254

HISTRIONIC PERSONALITY DISORDER
* What type of pattern?

Answer 254

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts

Question 255

HISTRIONIC PERSONALITY DISORDER-DIAGNOSIS
* Need five or more of the following:

Answer 255

1. Patient is uncomfortable when he or she is not the center of attention
2. Sexually seductive or provocative
3. Rapidly shifting and shallow expression of emotions.
4. Self dramatization, theatricality, exaggerated expression of emotion
5. Speech is excessively impressionistic and lacking in detail
6. Consistently uses physical appearance to draw attention to oneself
7. Suggestible
8. Considers relationships to be more intimate than they actually are

Question 256

HISTRIONIC PERSONALITY DISORDER- TREATMENT
* What is the txt?

Answer 256

Psychotherapy
* Assistance in clarifying individual’s feelings important because these patients are frequently unaware of their true feelings

Pharmacotherapy
* Antidepressants for depression and somatic complaints. Antianxiety meds for anxiety.
* Antipsychotics for derealization and illusions

Question 257

NARCISSITIC PERSONALITY DISORDER
* Pattern of what?

Answer 257

Pattern of grandiosity, heightened sense of self importance, preoccupation with fantasies of ultimate success and self image, and disturbance in interpersonal relationships

Question 258

NARCISSISTIC PERSONALITY DISORDER-DIAGNOSIS
* Need 5 or more of what?

Answer 258

1. Grandiose sense of self importance
2. Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
3. Believes that he or she is special and can only be understood by other high ranking or special people
4. Requires excessive admiration
5. Sense of entitlement
6. Interpersonally exploitative
7. Lacks empathy
8. Often envious of others or believes that others are envious of him/her
9. Shows arrogant, haughty behavior or attitudes

Question 259

NARCISSISTIC PERSONALITY DISORDER-DIAGNOSIS
* Common cited factor is what?
* What are the psychodynamics?

Answer 259

• Common cited factor is failure in maternal empathy with early rejection or loss
• Psychodynamics: Grandiosity and empathic failure defend against primitive aggression. Grandiosity compensates for sense of inferiority

Question 260

NARCISSISTIC PERSONALITY DISORDER-DIAGNOSIS
* Patient have what?
* Great need for what?
* Lack what?
* Chronic and intense?
* Handle what poorly?
* Fragile what?

Answer 260

• Patients have grandiose sense of self-importance (in fantasy or in behavior)
• Great need for admiration
• Lack empathy
• Chronic, intense envy
• Handle criticism or defeat poorly- become enraged or depressed
• Fragile self-esteem and interpersonal relationships

Question 261

OCPD
* Characterized by what?

Answer 261

Characterized by perfectionism, orderliness, inflexibility, stubbornness, emotional constriction, and indecisiveness

Question 262

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER-DIAGNOSIS
* Need four or more of the following:

Answer 262

1. Preoccupied with details, rules, lists, order, organization, etc
2. Perfectionism that interferes with task completion
3. Excessively devoted to work with the exclusion of leisure activities and friendships
4. Over-conscientious, scrupulous and inflexible about matters of morality, ethics, or values
5. Unable to discard worn-out or worthless objects even when they have no sentimental value
6. Reluctant to delegate tasks to others unless they submit to doing things exactly his or her way
7. Hoards money (miserly spending)
8. Rigid and stubborn

Question 263

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
* Backgrounds of what?
* What are the psychodynamics?

Answer 263

Backgrounds of harsh discipline

Psychodynamics
* Isolation, reaction formation, undoing, intellectualization, and rationalization
* Distrust of emotions
* Issues of defiance and submission psychologically important
* Fixation in anal period

Question 264

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER-
* What type of demeanor
* Lacks what?
* Preoccupied with what?
* Lack of what skills?
* Lack sense of what?
* Eager to what?

Answer 264

• Have stiff, formal and rigid demeanor
• Lack spontaneity and have serious mood
• Preoccupied with rules, regulations, orderliness, neatness, and details
• Lack interpersonal skills
• Lack sense of humor, alienate people and difficulty compromising
• Eager to please powerful figures and carry out their wishes in authoritarian way

Question 265

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER VS. OCD?

Answer 265

• Patient who has obsessive-compulsive disorder has true obsessions or compulsions.
• Patient with personality disorder does not actually have true obsessions or compulsions

Question 266

AVOIDANT PERSONALITY DISORDER
* What type of personality?
* Intesse what?
* Not what?
* But strong need for?
* Often described as having what type of complex?

Answer 266

• Timid (shy) personality
• Intense sensitivity to rejection
• NOT asocial and show great desire for companionship
• But strong need for reassurance and guarantee will be accepted and not criticized
• Often described as having inferiority complex

Question 267

AVOIDANT PERSONALITY DISORDER- DIAGNOSIS
* Four or more of the following?

Answer 267

1. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval or rejection
2. Unwilling to become involved with others unless certain of being liked
3. Shows restraint with intimate relationships because of fear of shame or ridicule
4. Preoccupied with being criticized or rejected in social situations
5. Inhibited in new interpersonal situation because of feelings of inadequacy
6. Views self as socially inept, personally unappealing, inferior to others
7. Reluctant to take personal risks or to engage in any new activity for fear of embarrassment

Question 268

DEPENDENT PERSONALITY DISORDER
* Patients are what?
* Lack of what?
* Get others to assume what?

Answer 268

• Patients are dependent and submissive.
• Lack self confidence
• Get others to assume responsibility for major areas of life

Question 269

DEPENDENT PERSONALITY DISORDER- DIAGNOSIS
* Need five or more of the following?

Answer 269

1. Difficulty making everyday decisions without an excessive amount of advice or reassurance from others
2. Needs others to assume responsibility for major areas of his or her life
3. Difficulty expressing disagreement because of fear of loss of support or approval
4. Difficulty initiating new projects
5. Goes to excessive lengths to obtain nurturance or support (volunteers to do things that are unpleasant)
6. Feels uncomfortable when alone
7. Urgently seeks another relationship when one relationship ends
8. Unrealistically preoccupied with fears of being left alone

Question 270

DEPENDENT PERSONALITY DISORDER
* What are the psychodynamics?
* Intesnse need of what?
* Fear of what?
* Interpersonal what?

Answer 270

Psychodynamics
* Unresolved separation anxiety
* Dependent stance is defense against regression

Intense need to be taken care of Clinging behavior

Fear of separation

Interpersonal dependency

Question 271

What is PNES?

Answer 271

Psychogenic Nonepileptic Seizure (PNES, Pseudoseizure) Seizure-Like Symptoms without abnormal electrical activity

Question 272

What are the risk factors for PNES? What are some causes?(3)

Answer 272

Risk factors:
* Traumatic Brain Injury
* Sexual Trauma

Causes:
* Anxiety Disorder: Panic Attacks and Post-Traumatic Stress Disorder
* Conversion Disorder
* Acute stress response

Question 273

Precautions
* Pseudoseizures are what?
* Patients having Psychogenic Seizures typically do not know what?
* PNES diagnosis does not exclude what?

Answer 273

Pseudoseizures (or Psychogenic Seizures, PNES) are not Malingering

Patients having Psychogenic Seizures typically do not know this is happening

PNES diagnosis does not exclude neurologic Seizures
* PNES can coexist with Epilepsy and neurologic Seizures

Question 274

What are the signs of PNES?

Answer 274

Question 275

What are the atypical seizure timing?(4)

Answer 275

• Gradual onset and last 2-3 minutes (contrast with 1 minute for typical Seizure)
• Waxing and waing course (contrast with rhythmic periodicity of Seizure)
• Recur frequently
• Typically lacks the postictal period of Seizure Disorder

Question 276

Signs of PNES:
* Resistance to what?
* What type of triggers?
* Crying?
* May remember what?

Answer 276

• Resistance to multiple antiepileptic agents
• Emotional or situational triggers
• Postictal crying
• May remember episode (contrast with Seizure where there is no memory of the episode)

Question 277

What are the DDX of PNES?

Answer 277

Question 278

Diagnosis: End-Tidal CO2
* What happens with prolonged seizures and psychogenic seizure?

Answer 278

Prolonged Seizure
* Oxygen Saturation falls
* End-Tidal CO2 rises

Prolonged Psychogenic Seizure
* Oxygen Saturation remains normal
* End-Tidal CO2 remains normal

Question 279

Diagnosis: Inpatient Video EEG
* Typical seizure as confirmed?
* No corresponding what?
* What is poor?

Answer 279

• Typical Seizure as confirmed by witnesses of Seizure
• No corresponding EEG abnormalities
• Interrater reliability of EEG monitoring is poor

Question 280

Diagnosis:
* What are the Clinical findings that do not identify Seizure Disorder? (4)

Answer 280

• Postictal Serum Prolactin
• Tongue-biting, self-injury or Incontinence
• Psychological Testing
• Outpatient Electroencephalogram

Question 281

Management
* What is acute seizure management?
* What is the interdisciplinary approach?
* What happens with mental health?

Answer 281

Acute Seizure management
* Start with Benzodiazepines (as with Status Epilepticus)

Interdisciplinary approach
* Psychogenic Seizure cannot be fully differentiated from epileptic Seizure without EEG

Mental Health
* Cognitive Behavioral Therapy may reduce PNES events in the short term

Question 282

OCD
* Characterized by what? Define them

Answer 282

• Characterized by the presence of obsessions and/or compulsions
• Obsessions: Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted
• Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be rigidly applied.

Question 283

OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
* These disorders differ from what?

Answer 283

These disorders differ from developmentally normative preoccupations and rituals
* Are excessive
* Persist beyond developmentally appropriate periods

Question 284

OCD
* Sxs dimension in OCD similar to what? Give examples (3)

Answer 284

Symptom dimensions (or themes) in OCD common to many individuals with disorder
* Cleaning (contamination obsessions and cleaning compulsions)
* Symmetry (Symmetry obsessions and repeating, ordering, and counting compulsions)
* Forbidden or taboo thoughts (e.g., aggressive, sexual, and religious obsessions and related compulsions)

Question 285

OCD:
* Some people have what?
* What type of specifier?

Answer 285

Some individuals with OCD have tics.
* Up to 30% have lifetime tic disorder
* Most common in males with onset of OCD in childhood

The tic related specifier is used when an individual has a current or past history of a tic disorder.

Is a difference with those with OCD and tics and those with OCD and no tics

Question 286

OCD- Diagnostic Criteria
* Presence of what?

Answer 286

Presence of obsessions, compulsions, or both

Question 287

Obsession is defined as what?

Answer 287

• Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
• The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion)

Question 288

Comilsions are defined as what?

Answer 288

• Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
• The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation. However, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

Question 289

OCD- Diagnostic Criteria
* The obsessions or compulsions are time-consuming. Takes up how much time?

Answer 289

The obsessions or compulsions are time-consuming (take more than 1 hr/day) or cause clinically significant distress or impairment in social, occupational, or other imp areas of functioning

Question 290

OCD- Diagnostic Criteria
* What do you need to specify?

Answer 290

• With good or fair insight: Individual recognizes that OCD beliefs are definitely or probably not true or that they may or may not be true.
• With poor insight: The individual thinks OCD beliefs are probably true.
• With absent insight/delusional beliefs: The individual is completely convinced that OCD beliefs are true

Question 291

Many individuals with OCD have dysfunctional beliefs. These can include what?

Answer 291

• An inflated sense of responsibility
• Tendency to overestimate threat
• Perfectionism
• Intolerance for uncertainty
• Over-importance of thoughts (e.g., believing that having a forbidden thought is as bad as acting on it)
• The need to control thoughts

Question 292

OCD
* Individuals with OCD experience wide range of what? Give examples

Answer 292

Individuals with OCD experience wide range of affective responses when confronted with situations that trigger obsessions and compulsions:
* Marked anxiety and even panic attacks
* Strong feelings of disgust
* Distressed sense of “incompleteness” or uneasiness until things look, feel, or sound “just right”

Question 293

OCD
* May avoid what? What are examples?

Answer 293

May avoid people, places, or things that trigger obsessions or compulsions:
* Ex: individuals with contamination concerns might avoid public situations (e.g., public restrooms, restaurants)

Question 294

OCD≠Obsessive-compulsive personality
* What makes it different?

Answer 294

• Ob-comp personality involves enduring and pervasive maladaptive pattern of excessive perfectionism and rigid control
• The ob-comp personality does not have intrusive thoughts, images, or urges or repetitive behavior performed in response to an intrusive thought

Question 295

OCD Treatment
* What is the mainstay?
* What are some other options?

Answer 295

• Cognitive Behavioral Therapy-Mainstay
• Exposure and Desensitization over 13-20 week period
• Increasingly expose patient to avoided stimulus
• Response prevention
• Prevented from performing associated rituals
• Thought stopping

Question 296

BODY DYSMORPHIC DISORDER-Diagnostic Criteria
* Preoccupation with what?
* At some point during the course of the disorder, the individual has performed what?

Answer 296

• Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
• At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking ) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns

Question 297

BODY DYSMORPHIC DISORDER-Diagnostic Criteria
* The appearance preoccupation is not better explained by concerns with what?

Answer 297

The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder

Question 298

BODY DYSMORPHIC DISORDER
* Individuals preoccupied with one or more what?
* Give examples
* Can focus on what?

Answer 298

Individuals preoccupied with one or more perceived flaws in physical appearance-
* Think are ugly, abnormal, or deformed
* Can be extreme: Think look hideous or like a monster

Focus on one or many body areas
* Skin most common
* Hair- thinning/excessive body or facial hair
* Nose

Question 299

BODY DYSMORPHIC DISORDER
* Time?
* Feel driven to do what?
* May do what?

Answer 299

• Preoccupations intrusive, unwanted, time consuming (on average 3-8 hours/day)
• Feel driven to repetitive behavior that are not pleasurable and may increase anxiety and dysphoria
• May camouflage with makeup, clothing
• Compulsive skin picking to improve perceived skin defects

Question 300

BODY DYSMORPHIC DISORDER
* What is common in males?
* What happens?
* What will they do?

Answer 300

• Muscle dysmorphia
• Occurs almost exclusively in males
• Preoccupied with idea one’s body to small or insufficiently lean or muscular
• Actually have normal-looking body/may be muscular
• May be preoccupied with other body areas- skin or hair
• Will diet, exercise, and/or lift weights excessively (sometimes cause damage)
• May use dangerous anabolic steroids/other substances to make body bigger and more muscular
• Generally poor insight

Question 301

BODY DYSMORPHIC DISORDER-associated features
* Have ideas or delusion of what?
* Many have high levels of what?
* Often seek what?

Answer 301

Many individuals have ideas or delusions of reference:
* Other people take special notice of them or mock them because of how they look

Many have high levels of anxiety, social anxiety, social avoidance, depressed mood, low self esteem

Often seek dermatologic Rx and surgery

Question 302

BODY DYSMORPHIC DISORDER
* associated with what?

Answer 302

Associated with executive dysfunction and visual processing abnormalities
* Have bias for analyzing and encoding details rather than holistic aspect of visual stimuli

Question 303

BODY DYSMORPHIC DISORDER-Suicide Risk
* major drepression?

Answer 303

Major Depression is most common comorbid disorder- onset usually AFTER that of body dysmorphic Disorder

Question 304

BDD Treatment
* What is the txt?

Answer 304

Treating the physical “defect” does not resolve Body Dysmorphic Disorder

Pharmacotherapy is similar to Obsessive Compulsive Disorder
* Selective Serotonin Reuptake Inhibitors (SSRIs)-> requires high end of dosing range
* Clomipramine (Anafranil)

Question 305

HOARDING DISORDER- DIAGNOSTIC CRITERIA
* peristent difficult of what?
* What is it due to?
* The difficulty discarding possessions results in what?

Answer 305

• Persistent difficulty discarding or parting with possessions, regardless of their actual value
• This difficulty is due to a perceived need to save the items and to distress associated with discarding them
• The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use

Question 306

HOARDING DISORDER- DIAGNOSTIC CRITERIA
* What is specify with excessive acqusition?

Answer 306

Specify if with excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed for which there is no available space
* Individuals acquire through excessive collecting, buying, or stealing

Question 307

HOARDING DISORDER- COMMON FEATURES
* What are common sxs?
* What is animal hoarding?

Answer 307

• Indecisiveness, perfectionism, avoidance, procrastination, difficulty planning and organizing tasks, and distractibility
• Animal hoarding- accumulation of large number of animals and a failure to provide minimal standards of nutrition, sanitation, and veterinary care and to act on deteriorating condition of animals

Question 308

TRICHOTILLOMANIA (Hair Pulling Disorder)-Diagnostic Criteria
* Recurrent what?
* Repeated attempts to decrease/stop what?

Answer 308

• Recurrent pulling out of one’s hair, resulting in hair loss
• Repeated attempts to decrease or stop hair pulling

Question 309

Trichotillomania- Diagnostic Features
* What is the essential feature?
* From where? More or less common sites?

Answer 309

Essential feature is the recurrent pulling out of one’s own hair
* From any region of body
* Most common sites-scalp, eyebrows, eyelids
* Less common sites-axillary, facial, pubic. And peri-rectal regions

Question 310

Trichotillomania-associated features supporting diagnosis
* Hair pulling may be accompanied by why?
* May search for what?
* May tried to pull out hair how?
* May do what?

Answer 310

• Hair pulling may be accompanied by a range of behaviors or rituals involving hair
• May search for a particular kind of hair to pull (certain texture or color)
• May tried to pull out hair in specific way: e.g., root intact
• May visually or tactiley examine or orally manipulate the hair-including biting it or swallowing

Question 311

Trichotillomania-associated features supporting diagnosis
* May be preceded or accompanied by what?
* Maybe triggered by what?
* May be preceded by what?
* May lead to what?

Answer 311

• May be preceded or accompanied by various emotional states
• Maybe triggered by feelings of anxiety or boredom
• May be preceded by an increasing sense of tension
• May lead to gratification, pleasure, or a sense of relief when the hair is pulled out

Question 312

Trichotillomania
* Some focus their attention on what?
* Some other display what?
* What do some experience?

Answer 312

• Some focus their attention on the hair pulling (with preceding tension and subsequent relief)
• Some display more autonomic behavior(occurs without full awareness)
• Some report a mix of both behavioral styles
• Some experience an itch-like or tingling sensation in the scalp alleviated by act of pulling

Question 313

Trichotillomania
* What is tonsure trichotillomania?
* What can be completely absent?

Answer 313

• Tonsure trichotillomania-pattern of nearly complete baldness except for a narrow perimeter on the outer margins of the scalp, particularly at the nape of the neck
• Eyebrows and eyelashes may be completely absent

Question 314

Trichotillomania
* Some pts have the urge to do what?
* Majority of individuals also have one or more what?

Answer 314

• Some individuals have urge to pull hair from others
• Some may pull hair from pets, dolls, and other fibrous material(e.g., carpets, sweaters)
• Majority of individuals also have one or more other body-focused repetitive behaviors- skin picking, nail biting, and lip chewing

Question 315

Trichotillomania-development and course
* Infants?
* Onset when?
* Course is what?

Answer 315

• Hair pulling may be seen in infants->Typically resolves during early development
• Onset most commonly coincides her follows the onset of puberty
• Course is chronic.-> Minority remitted without subsequent relapse within a few years of onset

Question 316

Trichotillomania-diagnosis
* What testing?

Answer 316

Skin biopsy and dermoscopy (noninvasive method that allows the in vivo evaluation of the epidermis can differentiate disorder from other causes of alopecia

Question 317

Trichotillomania-functional consequences
* What are some issues do to hair pulling?

Answer 317

• Damage to hair growth and hair quality may be irreversible
• Infrequent medical consequences include-digit purpura, musculoskeletal injury (e.g.carpal tunnel syndrome; back, shoulder, and neck pain).
• Hair swallowing (trichophagia) may lead to trichobezoars,with subsequent anemia, abdominal pain, hematemesis, nausea and vomiting, bowel obstruction, and even perforation

Question 318

EXCORIATION (SKIN PICKING) DISORDER-DIAGNOSTIC CRITERIA
* Recurrent what?
* Repeated attempts to do what?
* What is essential feature?
* Most commpnly picked sites?
* Use what?

Answer 318

• recurrent skin picking resulting in skin lesions
• Repeated attempts to decrease or stop skin picking
• Essential feature is recurrent picking at one’s own skin
• Most commonly picked sites of the face, arms, and hands. Many pick from multiple body sites
• Most use fingernails; mainly used tweezers pins or other objects

Make pick at healthy skin, at minor skin irregularities, at lesions such as pimples or calluses, or at scabs from previous picking

Question 319

EXCORIATION (SKIN PICKING) DISORDER-DIAGNOSTIC FEATURES
* May so be what?
* Significant what?
* Often attempt to what?
* May cause a feeling of what?

Answer 319

• May also be skin rubbing, squeezing, lancing, and biting
• Significant amounts of time spent on picking behavior, sometimes several hours per day. May go on for months and years
• Often attempt to conceal or camouflage lesions
• May cause a feeling a loss of control, embarrassment, and shame

Question 320

EXCORIATION (SKIN PICKING) DISORDER-associated features
* May be accompanied by what?
* May do what with the skin?
* May be preceded or accompanied by what?

Answer 320

• May be accompanied by a range of behaviors or rituals involving skin or scabs
• Make examine, play with, or mouth or swallow the skin after it has been pulled
• May be preceded or accompanied by various emotional states: Triggered by feelings of anxiety or boredom, may be preceded by increasing sense of tension, and lead to gratification, pressure or a sense of relief when skin or scab picked

Question 321

EXCORIATION (SKIN PICKING) DISORDER-prevalence,development,course
* Onset when?
* Course is what?

Answer 321

• Onset most often during adolescence, coinciding with the onset of puberty. Usually begins with a dermatological condition such as acne. Sites of skin picking may vary over time
• Course is chronic with waxing and waning if untreated
• May, and go for weeks, months, or years of the time

Question 322

EXCORIATION-functional consequences
* Time?
* Medical complications include what?
* Rarely?
* Frequently requires what?

Answer 322

• Majority of individuals spend at least one hour per day picking, thinking about picking, and resisting urges to pick
• Medical complications include tissue damage, scarring, and infection and can be life threatening
• Rarely, synovitis of the wrists can occur
• Frequently requires antibiotic treatment for infection On occasion may require surgery

Question 323

Substance/Medication-induced Obsessive-Compulsive and Related Disorder-diagnostic criteria
* What is it?

Answer 323

Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of the obsessive-compulsive and related disorders predominate in the clinical picture

Question 324

Substance/Medication-induced Obsessive-Compulsive and Related Disorder-diagnostic criteria
* There is evidence of what?

Answer 324

There is evidence from history, physical examination, or laboratory findings of both (1) and (2)
1. The symptoms in criterion A developed during or soon after substance intoxication or withdrawal or after exposure to medication
2. The involved substance/medication is capable of producing the symptoms in criteria A

Question 325

Substance/Medication-induced Obsessive-Compulsive and Related Disorder-diagnostic criteria
* The disturbance is not better explained by what?
* The disturbance does not occur exclusively during what?

Answer 325

• The disturbance is not better explained by an obsessive-compulsive and related disorder that is not substance/medication induced
• The disturbance does not occur exclusively during the course of a delirium

Question 326

Substance/Medication-induced Obsessive-Compulsive and Related Disorder-diagnostic criteria
* Specify if what?

Answer 326

With onset during intoxication

With onset during withdrawal

With onset after medication use
* Must have its onset while the individual is receiving the medication
* Once treatment is discontinued, symptoms usually improve or remit within days to several weeks to one month
* If symptoms persist longer than one month from the time of severe intoxication or withdrawal

Question 327

Substance/Medication-induced Obsessive-Compulsive and Related Disorder-associated features
* Obsessions, compulsions, hair pulling, skin picking, or other body-focused repetitive behaviors can occur in association with intoxication with what?
* What is helpful?

Answer 327

Use with:
* Stimulants(including cocaine)
* Heavy metals and toxins

Urine toxicology useful to measure substance intoxication as part of assessment

Question 328

Obsessive-Compulsive and Related Disorder due to another medical condition-diagnostic criteria
* What is in the clinical picture?
* What is there evidence of?
* Not better explained by what?

Answer 328

• Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, or other body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and related disorder predominate in the clinical picture
• There is evidence from history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical
• Not better explained by another mental disorder

Question 329

Obsessive-Compulsive and Related Disorder due to another medical condition-diagnostic criteria
* Specify if what?

Answer 329

• With obsessive-compulsive disorder-like symptoms
• With the parent’s preoccupations
• With hoarding symptoms
• With hair-pulling symptoms
• With skin- picking symptoms

Question 330

Obsessive-Compulsive and Related Disorder due to another medical condition-diagnostic criteria
* What is sydenham’s chorea?

Answer 330

• Neurological manifestation of rheumatic fever
• Due to group A streptococcus infection
• Motor and non-motor features
• May present with obsessive-compulsive disorder-like symptoms

Question 331

Obsessive-Compulsive and Related Disorder due to another medical condition-diagnostic criteria
* What is PANDAS?

Answer 331

Postinfectious autoimmune disorder characterized by the sudden onset of obsessions compulsions and/or tics accompanied by a variety of acute neuropsychiatric symptoms Because of controversial diagnosis, renamed “pediatric acute-onset neuropsychiatric syndrome” (PANS)

Question 332

PANDAS- Basic identification guidelines
* What type of behaviors?
* What is the onset (age)
* May observe what?
* What is the txt?

Answer 332

• Tic disorder and/or OCD behaviors-> Often begins with acute anxiety and increases over time
• Pediatric onset from 3 years to puberty
• Onset temporally related to strep infection or presence of undetected strep infection
• May observe neurological abnormalities and/or choreaform/random body or facial movements
• Treatment: antibiotics, sometimes long term

Question 333

PANDAS
* What is mild presentation?
* what is acute presentation?

Answer 333

Mild presentation
* abrupt onset with hyperactivity, agitation, tics, anxiety issues that are OCD-like.
* Symptoms rapidly diminish with antibiotics

Acute presentation
* Appears suddenly
* Looks like acute encephalitic-like illness:
psychotic thoughts, terror, intense anxiety, suicidal comments

Question 334

ADHD:
* Classic triad of what?
* Some individuals only have what?

Answer 334

• Can present as a classic triad of inattention, hyperactivity and impulsivity
• Some individuals only inattentive; some primarily hyperactive

Question 335

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
* Actually ADHD is a disorder of what?
* Affected individuals have what?

Answer 335

Actually ADHD is a disorder of INCONSISTENT attention
* Sometimes there is hyper attention
* Other times there is inability to sustain attention

Affected individuals have poor impulse control, speak before they think, and are easily distracted. Many are disorganized and find it difficult to focus, especially in areas that are not of particular interest or in environments where there is a lot of noise or things going on

Question 336

KNOW

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
* Sxs of inattention must be present for how long?
* What do you need to satisfy criteria for dx?

Answer 336

Symptoms of inattention must be present for 6 months

To satisfy criteria for dx:
* Children require 6 of 9 possible sxs under inattention
* Adults require 5 of 9 possible sxs under inattention

Question 337

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

• What is needed for hyperactivity and impulsivity?
• Age?

Answer 337

Hyperactivity and impulsivity
* 6 (or more) sxs for at least 6 months
* 5 (or more) sxs for anyone 17 years and older

Several inattentive or hyperactive-impulsive sxs must have been present prior to age 12 years

Question 338

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) -some rule-outs
* Must distinguish it from what?
* Disruptive mood dysregulation disorder?
* ADHD not characterized by what?

Answer 338

• Must distinguish it from worry, rumination, internal stimuli due to anxiety and /or depression
• Disruptive mood dysregulation disorder- do not see impulsivity and disorganized behavior as in ADHD
• ADHD not characterized by fears of abandonment , self injury, extreme ambivalence as might see in personality disorder

Question 339

MEDICAL CONTRIBUTION TO ADHD
* Prenatal? birth complications? Perinatal? Infancy? Toxic?

Answer 339

Question 340

MEDICAL CONTRIBUTION TO ADHD
* Genetic disorder?
* Brain injury?

Answer 340

Genetic disorders
* Fragile X syndrome
* Glucose-6-phosphate dehydrogenase deficiency
* Phenylketonuria

Brain Injury
* Trauma
* Infection

Question 341

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
* Not just what?
* there are issues with what?

Answer 341

ADHD is a life concern not (just) a school problem
There are issues about safe driving (they are reckless), likelihood of abusing drugs, self medicating, being accident prone, and having difficult interpersonal relationships. (Some individuals with ADHD manifest irritability)

Question 342

What is the first line txt for ADHD?
* What is the medication?

Answer 342

Behavioral and Family Therapy is first line treatment for ADHD

Psychostimulants
* Methylphenidate (Ritalin)
* Long-acting methylphenidate preparations (Concerta, Metadate CD, Ritalin LA)
* Dextroamphetamine (Dexedrine): Adderall- a long acting dextroamphetamine compound, Adderall XR- a longer acting dextroamphetamine and Vyvanse- only active when it is in gut
* Cylert (magnesium pemoline)- not used very much because of liver toxicity

Question 343

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
* What is Strattera ( atomoxetine)?
* What are the antihypertensive medications?
* What is off label for adults?

Answer 343

Question 344

Autism Spectrum disorder: criterion A
* Essential feature is what?
* Many demonstrate what?
* What is impaired?

Answer 344

Essential feature is persistent impairment in reciprocal social communication and social interaction across multiple contexts
* This impairment is pervasive and constant

Many demonstrate absent speech or delay in onset of speech

Communication may be impaired even when formal skills, (vocabulary and grammar) intact

Question 345

AUTISM SPECTRUM DISORDER- Criterion A
* Obvious deficits in what?
* What is an early finding?

Answer 345

Obvious deficits in social-emotional reciprocity
* Young children my show little or no initiation of social interaction and no sharing of emotions

Early finding- poor or absent eye contact

Question 346

AUTISM SPECTRUM DISORDER- Criterion B
* Child demonstates what?
* May exhibit what?

Answer 346

• Child demonstrates restricted, repetitive patterns of behavior, interests, or activities (e.g., prefers rigid routines and fixed ways of doing things)
• May exhibit stereotyped or repetitive behaviors (e.g., hand flapping; finger flicking)

Question 347

AUTISM SPECTRUM DISORDER- Criterion B
* Excessive adherence to what? Resistance to what? Ritualized what?
* Interest?

Answer 347

Excessive adherence to routines and restricted patterns of behavior =
* Resistance to change
* Ritualized patterns of verbal or nonverbal behavior (e.g., repetitive questions)

Abnormal, restricted, intensive and fixated interests (preoccupation with lawn mower)

Question 348

AUTISM SPECTRUM DISORDER- Criterion B
* Unusual high or low levels of what?

Answer 348

Unusual high or low levels of reactivity : extreme responses to specific sounds or textures, excessive smelling or touching objects, fascination with lights or spinning objects, (sometimes) indifferent to heat, cold, pain

Question 349

AUTISM SPECTRUM DISORDER
* Sxs when?
* Core diagnostic features evident when?
* Must be differentiated from what?

Answer 349

• Symptoms manifest early in life.
• Core diagnostic features evident in developmental period
• Must be differentiated from intellectual disability and global developmental delay because they can be associated with communication difficulties

Question 350

AUTISM SPECTRUM DISORDER
* Sometimes parents not absence of what?
* What ist he FIRST abnormal sign?
* May appear what?
* May engage in what?

Answer 350

Question 351

AUTISM SPECTRUM DISORDER
* Insistence on what?
* Rigidity and difficulty with what?

Answer 351

• Insistence on routines and aversion to change and sensory sensitivities affect eating, sleeping, dental appointments, haircuts, etc. a challenge
• Rigidity and difficulty with new situations may limit independence in even very intelligent individuals with this disorder

Question 352

What are the Disorders subsumed under Autism Spectrum Disorder?

Answer 352

• Rett’s Disorder
• Childhood Disintegrative Disorder
• Asperger’s Disorder
• Pervasive Developmental Disorder

Question 353

Rett’s Disorder (Eliminated in DSM V)
* Now incorporated under what?
* Normal what?
* Normal when?
* First sign is what?

Answer 353

• Now incorporated under Autism Spectrum Disorder
• Normal pregnancy and delivery
• Grow and behave normally for the first six months
• First sign is smaller than normal head. Later delayed growth in other parts of body.

Question 354

Rett’s Disorder (Eliminated in DSM V)
* Brain growth?
* Significant loss of what? What is the first sign?

Answer 354

Brain growth slows after birth

Significant loss of movement (motor) skills between 12 and 18 months
* 1st sign include decrease in hand control and ability to crawl or walk normally

Question 355

Rett Syndrome
* Develop abnormal what?
* Unusuall what?
* What are some breathing issues?
* Increasing what?

Answer 355

• Develop abnormal hand movements- hand wringing, squeezing, clapping, tapping
• Unusual eye movements: blinking, staring intensely
• Breathing issues (while awake): breath-holding, hyperventilation, forceful exhalation of air or saliva
• Increasing agitation and irritability. Long periods of crying and screaming

Question 356

Rett Syndrome
* Sudden what?
* Long bouts of what?
* Gender?
* Commonly develop what?
* What can happen between 8-10 years?
* Heart?

Answer 356

• Sudden, odd facial expressions
• Long bouts of laughter
• Thought to occur primarily in girls. Boys who have the same genetic mutations usually do not survive beyond infancy
• Commonly develop seizures: spasms- epilepsy
• Scoliosis (begins between age 8- 10 years
• Irregular heart rhythm

Life long help

Question 357

• What is the two type of eye movements during sleep?
• When do we have dreaming?

Answer 357

• Named the sleep phase associated with slow rolling rhythmic eye movements non-rapid eye movements (NREM) sleep
• Sleep phase associated with the fast erratic eye movements (REM)
• Dement and Kleitman (1955) discovered that REM sleep was associated with dreaming

Question 358

What is an EEG?

Answer 358

Electroencephalogram (EEG) – a recording of the electrical activity of cortical neurons via scalp electrodes that are placed at standardized positions

Question 359

Polysomnography
* What is it?
* Involves what?

Answer 359

• Polysomnograpy is the method used to objectively evaluate sleep.
• Involves simultaneous recording of multiple physiological variables in a standardized fashion known as a polysomnogram

Question 360

Polysomnography:
* The parameters recorded by the PSG include but are not limited to:

Answer 360

• Electroencephalogram (EEG) – a recording of the electrical activity of cortical neurons via scalp electrodes that are placed at standardized positions
• Electrooculogram (EOG) – a recording of eye movements
• Electrocardiogram (ECT) – a recording of heart rhythm
• Electromyelogram (EMG) – a recording of the activity of the left and right tibialis anterior muscles and the submental chin muscles
• Respiratory effort – a recording of nasal and oral airflow
• Pulse oximetry – a recording of oxygen saturation
• Snore monitor – a recording of snoring

Question 361

Sleep Cycle and Architecture
* In normal health individuals, this cycle of NREM/REM occurs how?
* The pattern repeats how?

Answer 361

• In normal health individuals, this cycle begins with NREM 1 and progresses to NREM 2, 3, 4, 3, 2 and then REM
• The pattern repeats itself at 90 and 120 minute intervals

Question 362

Answer 362

Question 363

Sleep Cycle and Architecture
* What is prominent in the first half of night?
* What is less prominent in the first hald of the night and increases as the night goes on?
* Sleep latency is what? What is normal?

Answer 363

• NREM 3 and 4 are most prominent in the first half of the night
• REM sleep is less prominent in the first half of the night and increases as the night progresses
• Sleep latency is the time from lights out to the first NREM 2. Normal sleep latency is 10-20 minutes

Question 364

Sleep Cycle and Architecture
* What is REM latency? What is normal?
* What is sleep architectures?

Answer 364

• REM latency is the time from sleep onset until the first REM. Normal REM latency is 90-100 minutes
• Sleep architectures is the pattern and distribution of sleep stages across an average night

Question 365

Answer 365

Question 366

Sleep Cycle and Architecture

Answer 366

Question 367

Circadian rhythm
* What is it?
* What is the normal?

Answer 367

• The “biological clock” is an endogenous rhythm of bodily functions that is influenced by environmental cues.
• This cycle is unique to each person, averages 25 hours but can be as long as 50 hours for some

Question 368

Sleep Across the Lifespan
* Infants? Adults?
* Elderly?

Answer 368

• Infants spend more than 2/3 of the day sleeping whereas adults spend less than 1/3
• The elderly experience a reduction in the intensity, depth, and continuity of sleep

Question 369

Answer 369

Question 370

What are the elderly changes in sleep?

Answer 370

• Increased sleep latency
• Reduced NREM 3 and 4
• Reduced REM latency
• Reduced total REM amount
• Frequent awakenings
• Decreased sleep awakenings.

Question 371

Answer 371

Question 372

Primary Sleep Disorders: Dyssomnias

What is dyssomnias?

Answer 372

primary sleep disorders that results in complaints of either sleeping too little (insomnia) or too much (hypersomnia)

Question 373

Primary Sleep Disorders: Dyssomnias

What is primary insomnia?

Answer 373

Primary insomnia – insomnia is the subjective complaint of deficient, inadequate, or unrefreshing sleep. To qualify as a primary insomnia, there must be objective daytime sleepiness and/or subjective feelings of not being rested.

Question 374

Primary Sleep Disorders: Dyssomnias

Primary insomnia:
* What is sleep-state misperception?
* What is idiopathic insomnia?

Answer 374

• Sleep-state misperception – also known as subjective insomnia or non-restorative sleep. Sufferers complain of inadequate and/or poor sleep, but objective findings on the polysomnogram are lacking
• Idiopathic insomnia – chronic insomnia present from childhood

Question 375

Primary Sleep Disorders: Dyssomnias

What is primary and recurrent hypersomnias?

Answer 375

Primary Hypersomnias – The hallmark of all primary hypersomnias is the complaint of somnolence and excessive daytime sleep
* Recurrent hypersomnia – also known as Kleine-Levin syndrome is a rare, often self-limiting condition that primarily affects adolescent males. Symptoms include hypersomnia, hyperphagia, and hypersexuality

Question 376

KNOW

Primary Sleep Disorders: Dyssomnias
* What is narcolespy?

Answer 376

defined by the following: Sleep paralysis that occurs upon falling asleep or waking up, sleep attacks with sleep-onset REM periods (SOREMPs) which are usually brief, cataplexy (a condition of sudden and transient bilateral weakness or paralysis) triggered by strong emotions, hypnagogic hallucinations

Question 377

Primary Sleep Disorders: Dyssomnias

What is circadian rhythm disorders?

Answer 377

Circadian Rhythm Disorders – emerge which societal expectations conflict with an individual’s preferred circadian rhythm. I.e. jet lag syndrome, shift-work sleep phase disorder (“night owls”), advanced sleep phase disorder (“larks”), and non-24 hour day

Question 378

Primary Sleep Disorders: Dyssomnias

What is periodic limb mvt disorder? What helps?

Answer 378

Periodic limb movement disorder – common dyssomnia affecting 40% of people over the age of 65 years, and 11% of people complaining of insomnia
* Brief (0.5-5sec) stereotypic contractions of the lower limbs at intervals of 20-60 sec
* Dopamine agonists (L-dopa, pergolide, bromocriptine) and benzodiazepines (clonazepam) provide some relief

Question 379

Primary Sleep Disorders: Dyssomnias

• What is restless leg syndrome? (KNOW)
• What is post traumatic hypersomnia?
• What is idiopathic hypersomnia?

Answer 379

• Restless leg syndrome (RLS) – is a movement disorder characterized by deep sensations of creeping or aching inside the calves when lying or sitting that produce an overwhelming urge to move them
• Post-traumatic hypersomnia – hypersomnia that occurs within one year of a head trauma
• Idiopathic hypersomnia – hypersomnia of unknown origin

Question 380

What is parasomnias?

Answer 380

Parasomnias are sleep disorders in which undesired activities are performed during sleep; they arise during specific sleep stages or at the transition between wakefulness and sleep

Question 381

What is sleep start and thythmic movement disorder?

Answer 381

Wake-sleep transition disorders
* Sleep Starts - Hypnogogic jerks involve involuntary contractions of the legs and/or arms at the moment in which the individual enters sleep
* Rhythmic Movement Disorder (jactatio capitus nocturna) – involves head-banging at sleep onset

Question 382

Primary Sleep Disorders: Parasomnias
* What is sleep talking and bruxism?
* When do these occur?

Answer 382

Light sleep stage disorders – arises during NREM 1 and 2 and includes Sleep talking and bruxism
* Sleep-talking (somniloquism) – vocalization ranging from simple words and phrases to complete conversations.
* Bruxism – repeated tooth-grinding during sleep

Question 383

NREM sleep disorders:
* When do they most commonly occur?
* What are two examples?

Answer 383

NREM sleep disorders – occurs mainly during NREM 3 and 4 (slow wave) sleep. The most commonly encountered NREM sleep disorders include sleepwalking and night terrors.

Question 384

Sleep walking
* Occurs when?
* What can people do?
* What can happen? (serious)
* Sufferers are frequently unresponsive to what?
* Sleep walking begins when?

Answer 384

Sleep walking (somnambulism) – occurs predominantly during the first third of the night and upon partial emergence from delta sleep
* Individuals may walk for some distance and carry out semi-purposeful activities such as running and eating
* While most patients are quite adept at avoiding obstacles, serious accidents, such as tripping or falling out of open windows, have been reported
* Sufferers are frequently unresponsive to efforts to wake them, and once awakened, are amnestic to the event
* Sleep walking begins in childhood and often resolves by adolescence

Question 385

Night terrors (pavor nocturnus)
* Occurs when?
* Patients generally do what?
* How long are episodes?
* Patients are what to the episode?
* In children is not associated with what? Adults?

Answer 385

Night terrors (pavor nocturnus) – like sleep walking occur during partial arousal from delta sleep but can begin in NREM 2
* Patients generally scream, flail about, sit up in bed, and experience autonomic activity, including tachypnea, tachycardia, and mydriasis
* Episodes last 1-10 minutes, tape place early in the night, when NREM duration is at the longest
* Patients are often amnestic to the episode
* In children is not associated with psychiatric illness; in adults it can be associated with PTSD, Generalized anxiety disorder, and borderline personality disorder

Question 386

Primary Sleep Disorders: Parasomnias

REM Sleep Disorders
* Arrises when? examples?

Answer 386

arises exclusively during REM sleep and includes nightmare disorder and REM behavior disorder

Question 387

Primary Sleep Disorders: Parasomnias
* What is nightmare disorder? What does it lack?

Answer 387

Nightmare disorder – terrifying dreams whose content is often remembered by the patient.
* Unlike sleep terror, nightmare disorder lacks autonomic arousal, frequently occurs late in the night as REM intervals increase, and demonstrates muscle atonia

Question 388

Primary Sleep Disorders: Parasomnias

Rem behavior disorder
* Patients appear how?
* When does it occur?
* Patients often recall what?
* What are the common causes?
* More common in who?

Answer 388

REM behavior disorder – patients appear to be acting-out dream content through simple to quite complex movements that result from the loss of muscle atonia during REM sleep
* In contrast to sleep walking which occurs during the night during delta sleep, REM behavior disorder occurs during the second half of the night during REM sleep
* Patients often recall their dreams in vivid detail
* 60% of cases idiopathic; up to 1/3 are due to brainstem pathology and alcoholism
* More commonly in the elderly, and affects males nine times more frequenlty than females

Question 389

Primary Sleep Disorders: Parasomnias

Diffuse sleep disorders
* Occur when?
* What is nocturnal enuresis?
* What is sleep related seizures?

Answer 389

Diffuse Sleep Disorders – May occur in any or all sleep stages
* Nocturnal enuresis – A condition of involuntary micturition occurs without conscious arousal.-> Affects children more than adults and usually self-limited
* Sleep-related seizures – rare entity involving seizures that mainly occur during light NREM sleep and usually the first 2 hours of sleep.

Question 390

Secondary Sleep Disorders

• What is psychotic disorders? What is decreased and disrupted?

Answer 390

Psychotic disorders – difficulty with sleep initiation and maintenance, which are most common with sleep initiation and maintenance
* Total sleep time and sleep efficiency are often decreased
* REM is disrupted early in the episode

Question 391

Secondary Sleep Disorders

• What happens with mood disorders?
• What happens with anxiety disorders?

Answer 391

Mood disorders
* Classic findings attributed to depression include early morning awakening, decreased delta sleep, decreased REM latency, a long first REM period, increased REM density, and nocturnal restlessness. With atypical depression, there is often hypersomnia as well as an increase in appetite.

Anxiety Disorders – most common psychiatric cause of insomnia.
* Increased pre-sleep worry with difficulty initiating sleep, decreased sleep efficiency, and poor sleep maintenance.

Question 392

Secondary Sleep Disorders

Substance-induced sleep disorders
* Substances whether what?
* Generally, if the substance is a CNS depressant, intoxication causes what?
* Alcohol is widely used and abused – in acute intoxication, alcohol decreases what?

Answer 392

Substance-induced sleep disorders – substances whether prescription medications or recreational drugs, can cause a wide range of sleep abnormalities
* Generally, if the substance is a CNS depressant, intoxication causes sedation and withdrawal causes insomnia. Likewise, if the substance is a CNS stimulant, intoxication results in insomnia and withdrawal results in sedation
* Alcohol is widely used and abused – in acute intoxication, alcohol decreases REM sleep and withdrawal produces insomnia, increases REM sleep, and decreases stages 3 and 4 sleep. Paradoxically, chronic use frequently results in insomnia

Question 393

What is sleep hygiene?

Answer 393

Sleep hygiene refers to the practices and habits that are conducive to sleeping well on a regular basis. Physician assistants can play a crucial role in educating patients about effective sleep hygiene to improve their sleep quality and overall health.
* Prescribe Hypnotics ONLY as last resort.
* Benzo are not sleep aids, they inhibit REM

Question 394

Sleep Hygiene
* Avoid screens when?
* Excerise when?
* Nap for how long?

Answer 394

• Screen: One hour before
• Excerise: 3 hours before
• Nap: 20-30 mins

Question 395

NEUROLEPTIC MALIGNANT SYNDROME- NMS
* What is it?
* What are the prinicpal manifestations?

Answer 395

• An acute, potentially fatal, idiosyncratic reaction to a neuroleptic medication (which for most part are the antipsychotic medications)
• The principal manifestations are due to problems with thermoregulation and skeletal muscle metabolism mediated via central mechanisms

Question 396

DIAGNOSTIC CRITERIA of NMS
* Exposure to what?
* Temp?
* Extreme what?
* Mental?
* Elevation of what?

Answer 396

• Exposure to a dopamine antagonists, or withdrawal from dopamine-agonist, within past 72 hours of onset of symptoms
• Hyperthermia- Fever ›100.4° F or 38.0º C on at least two occasions
• (Extreme) generalized rigidity
• Altered mental status
• Elevation of creatinine kinase (at least 4 times upper limit of normal)

Question 397

NMS-diagnostic criteria
* HR?
* BP?
* BP fluctuation?

Answer 397

• Tachycardia (25% above baseline) plus tachypnea (≥50% above baseline)
• Blood Pressure Elevation: ≥25% above baseline
• Blood Pressure Fluctuation: ≥20 mmHg (diastolic) or ≥ 25 mm Hg (systolic) change within 24 hours

Question 398

NMS-FINDINGS
* Mental status? Pt may become what? May progress to what?
* Muscular rigidity described as what?
* Can also observe what?

Answer 398

Mental status is ALWAYS altered, typically in form of delirium. Pt may become agitated/combative. May progress to stupor, obtundation, and coma

Extreme muscular rigidity described as “lead pipe rigidity”

May also observe:
* Diaphoresis
* Sialorrhea
* Dysphagia

Question 399

NMS
* Labs?
* UA?
* CSF?
* EEG?

Answer 399

Common lab abnormalities
* Elevation of CPK (muscle fraction usually massively elevated)
* Leukocytosis
* Electrolyte disturbances may occur secondarily as well as hypocalcemia, hypomagnesemia,and hypophosphatemia

Urinalysis often shows proteinuria and myoglobinuria from rhabdomyolysis

CSF normal

EEG might show diffuse slowing without focal abnormalities (encephalopathy pattern)

Question 400

NMS- CAUSE
* What medication? Involves an interplay between what?
* All of the antipsychotic medications reported to cause what?
* Also some antiemetic medications that are also neuroleptics:

Answer 400

• Anti-dopaminergic activity of antipsychotic medications, particularly D2 receptor antagonism
  * Involves an interplay between multiple central and systemic pathways and neurotransmitters
• All of the antipsychotic medications reported to cause NMS in individuals. No way to know which med/what patient/when
• Also some antiemetic medications that are also neuroleptics: prochlorperazine maleate (Compazine) and metoclopramide (Reglan)

Question 401

NMS- RISK FACTORS
* What are all the risk factors?

Answer 401

• Dehydration; agitation; exhaustion; low serum iron levels
• Primary diagnosis of affective disorder (especially Bipolar Disorder and Psychotic Depression)
• Concurrent presence of organic brain syndromes- dementia
• Higher doses and parenteral administration of neuroleptics,
• Rapid titration of dose
• Prior history of NMS
• Any medical or neurologic illness: Catatonia
• Recent history of substance abuse or dependence
• Dopamine receptor dysfunction
• Basal ganglia dysfunction

Question 402

What are the complications of neuroleptic malignant syndrome?

Answer 402

• Dehydration from poor oral intake
• Acute renal failure from rhadomyolysis
• Deep vein thrombosis and pulmonary embolism from rigidity and immobilization
• If have to take patient off antipsychotic medication, return of symptoms: psychosis, etc.
• Cardiac Arrest
• Infection
• Aspiration
• Respiratory failure
• Seizure
• Pulmonary embolism
• Hepatic failure
• Death

10-20% mortality rate-> Higher in individuals who develop severe muscle necrosis and then have rhabdomyolysis

Question 403

NMS- TREATMENT
* Supportive measures to what?
* Correct what?
* Monitor what?

Answer 403

• Clustering of risk factors, dysphagia, and severe diaphoresis early in treatment with neuroleptic medication- consider NMS
• Supportive measures to lower temp and ensure good fluid intake are essential
• Correct electrolyte abnormality
• Monitor for signs of impending respiratory failure secondary to severe muscle rigidity and inability to handle oral secretions

Question 404

KNOW

NMS- TREATMENT
* What medications can you give for sereve cases?

Answer 404

• Dopamine agonists (bromocriptine and amantadine) and/or direct muscle relaxants (dantrolene)
• Dopamine agonists in high doses can cause psychosis and/or vomiting
• Benzo’s to relax if agitated or catatonic

Question 405

87% individuals who had NMS will be able to tolerate what? What is the prefferred choice?

Answer 405

• 87% individuals who had NMS will be able to tolerate another antipsychotic medication in the future. Recommendation is to switch to different class of antipsychotic when restarting.
• Often SGA is preferred choice because it is thought that incidence with newer antipsychotics lower

Question 406

How is malignant hyperthermia different than NMS?

Answer 406

• intraoperatively and reflects a pharmacogenetic disorder of calcium regulation in skeletal muscle.
• Rigidity in malignant hyperthermia does not respond to peripheral-acting muscle relaxants

Question 407

SEROTONIN SYNDROME
* Caused by what?
* NMS involves what?

Answer 407

• Serotonin Syndrome is caused by drug toxicity where there is too much serotonin.
• In comparison, Neuroleptic Malignant Syndrome is an idiosyncratic drug reaction involving dopamine

Question 408

SEROTONIN SYNDROME
* What is it?
* Characterized by what?

Answer 408

It is a pharmacologic situation characterized by abrupt increases of serotonin in the body and in the central nervous system
* Characterized by mental status changes, neuromuscular dysfunction, and autonomic instability

Question 409

SEROTONIN SYNDROME
* May occur when?
* Timing?
* Mild forms may go away when?

Answer 409

May occur when add a new medication or increase the dose of a medication (causing increase in serotonin)
* Most usually occurs within several hours
* Mild forms may go away within 24- 36 hours of stopping medication that caused symptoms or stopping a pre-existing medication

Question 410

SEROTONIN SYNDROME
* What are the sxs?

Answer 410

• Headache
• Diarrhea
• Rapid heart rate
• Elevated blood pressure
• Confusion
• Dilated pupils
• Lose of muscle coordination or muscle twitching
• Sweating
• Shivering
• Goose bumps
• Severe: Hyperthermia, seizures, arrhythmias and unconsciousness

Question 411

SEROTONIN SYNDROME-clinical causes
* Serotonin synthesized from what?
* Once synthezied what happens?

Answer 411

Serotonin synthesized from amino acid L-tryptophan. (Serotonin cannot cross blood-brain barrier so need L-tryptophan to take into the CNS)

Once synthesized
* Serotonin stored in neuronal vesicles or
* Metabolized by monoamine oxidase (MAO A or B) to 5-hydroxyindoleacetic acid
* (MAO-B has preferential affinity to dopamine)

Question 412

SEROTONIN SYNDROME-clinical causes
* What has preferential affinity to serotonin?
* What has a greater risk of causing serotonin syndrome?
* Serotonin binds where?
* Hyper-stimulation of the 5-HT receptors in the brain and/or spinal cord is thought to cause what?

Answer 412

• MAO-A has preferential affinity to metabolize serotonin
• Drugs that inhibit MAO-A have greater risk of causing serotonin syndrome
• Serotonin binds 1 of 7 postsynaptic 5- hydroxytryptophan (5-HT) receptors.
• Hyper-stimulation of the 5-HT receptors in the brain and/or spinal cord is thought to cause serotonin syndrome.

Question 414

What are the greater risks of serotonin syndrome?

Answer 414

• If take more than one medication that increases serotonin levels
• You take herbal supplements that increase serotonin levels
• Use illicit drugs that increase serotonin levels
• Individuals whose cytochrome P450 enzyme system does not metabolize or slowly metabolizes a medication that is involved with that enzyme system

Question 415

SEROTONIN SYNDROME-clinical causes
* What are the clinical auses?

Answer 415

Prescription medications

Dietary supplements

Over-the counter/herbal/complementary/alternative substances. Illicit drugs

Question 416

SEROTONIN SYNDROME-clinical causes
* What are some medications?

Answer 416

• SSRI’s- Prevent the reuptake of serotonin released into the synapse. Same for St John’s Wort
• SNRI’s :Effexor (venlafaxine); Cymbalta (duloxetine)
• Bupropion (Wellbutrin/Zyban)
• Tricyclic antidepressants
• Buspar (buspirone)- Direct stimulation of serotonin receptors
• MAOI’s (monoamine oxidase inhibitors)- Prevent metabolism of stored serotonin. Examples included antidepressants such as phenelzine (Nardil), tranylcypromine (Parnate), selegiline transdermal (Ensam).
• Anti-migraine medications: Triptans
• Pain Medications (by increasing release of stored serotonin): Flexeril (cyclobenzaprine), Duragesic (fentanyl), Demerol (merperidine), and Ultram (tramadol) Lithium

Question 417

SS
* What are some street drugs?
* Herbal supplements?
* Cough and cold meds?

Answer 417

• LSD by direct stimulation of serotonin receptors
• Ecstasy, cocaine, amphetamines- by increasing the release of stored serotonin
• Herbal supplements: St John’s Wort; ginseng. L-tryptophan containing substances: increase production of serotonin by providing increased amount of precursors
• Cough and cold medications that contain dextromethorphan- Mucinex DM; Robitussin DM

Question 418

SEROTONIN SYNDROME-clinical causes
* What anti nasea meds?
* What antibiotic?
* What about HIV/AIDS?

Answer 418

Anti-nausea medications: Zofran (ondansetron); Reglan (metoclopramide)

Antibiotic linezolid (Zyvox)

Anti-retroviral medication used to treat HIV/AIDS – Ritonavir (Novir)

Question 419

SS treatment:
* What do you need to do?

Answer 419

• Discontinue offending medications
• Cyproheptadine (a serotonin antagonist- blocks serotonin production). Most patients respond to one or two doses
• Muscle relaxants for agitation, muscle stiffness, seizures
• O2 and IV fluids as needed
• Medication for cardiac issues and blood pressure

Question 420

REACTIVE ATTACHMENT DISORDER
* A consistent pattern of what? What is seen?

Answer 420

A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
* The child rarely or minimally seeks comfort when distressed
* The child rarely or minimally responds to comfort when distressed

Question 421

REACTIVE ATTACHMENT DISORDER
* A persistent social and emotional disturbance characterized by at least two of the following

Answer 421

• Minimal social and emotional responsiveness to others
• Limited positive affect
• Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers

Question 422

REACTIVE ATTACHMENT DISORDER
* The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:

Answer 422

• Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults
• Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g. frequent changes in foster care)
• Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g. institutions with high child-to-caregiver rations

Question 423

REACTIVE ATTACHMENT DISORDER
* Before age what?
* Child has developmental age of what?

Answer 423

• Disturbance is evident before age 5 years
• Child has a developmental age of at least 9 months

Question 424

REACTIVE ATTACHMENT DISORDER
* Rarely do what?
* What is essential feature?
* have a ptential to form what?
* They do not do what?
* Exhibit what?

Answer 424

• These children rarely or minimally turn preferentially to an attachment figure for comfort, support, protection, or nurturance
• Essential feature: absent or grossly underdeveloped attachment between child and (putative) caregiving adults
• These children have potential to form selective attachments
• They do not expect and respond only minimally to comfort from caregivers
• Exhibit compromised emotional regulation-> Display episodes of negative emotions of fear, sadness, or irritability that are not readily explained

Question 425

REACTIVE ATTACHMENT DISORDER
* Co-morb with what?

Answer 425

Neglect, malnutrition, cognitive delays, language delays, stereotypies

Question 426

DISINHIBITED SOCIAL ENGAGEMENT DISORDER
* What is it?

Answer 426

A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:
* Reduced or absent reticence in approaching and interacting with unfamiliar adults
* Behavior (that is not consistent with culturally sanctioned and age-appropriate social boundaries)
* Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings
* Willingness to go off with an unfamiliar adult with minimal or no hesitation

Question 427

DISINHIBITED SOCIAL ENGAGEMENT DISORDER
* the child has experience what? What are examples?

Answer 427

The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following
* Social neglect or deprivation in form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults
* Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g. frequent changes in foster care)
* Rearing in unusual settings that severely limit opportunities to form selective attachments

The child has a developmental age of at least 9 months

Question 428

DISINHIBITED SOCIAL ENGAGEMENT DISORDER
* Essential feature is pattern of behavior that involves what?
* The overly familiar behavior violates what?
* Not uncommon to present with what?

Answer 428

• Essential feature is pattern of behavior that involves culturally inappropriate, overly familiar behavior with relative strangers.
• The overly familiar behavior violates the social boundaries of the culture
• Not uncommon to present with no current signs of neglect (shared etiological association with social neglect) because signs of the disorder often persist even after signs of neglect no longer present

Question 429

DISINHIBITED SOCIAL ENGAGEMENT DISORDER
* Social neglect often present when?
* No evidence of what?
* Indiscriminate social behavior and lack of reticence with unfamiliar adults in toddlerhood accompanied by what?

Answer 429

• Social neglect often present in first months of life (before dx made)
• No evidence that neglect beginning after age 2 years is associated with manifestations of the disorder
• Indiscriminate social behavior and lack of reticence with unfamiliar adults in toddlerhood accompanied by attention-seeking behaviors in preschoolers.

Question 430

DISINHIBITED SOCIAL ENGAGEMENT DISORDER
* When disorder persists into middle childhood, clinical features =
* Peer relationships most affected when?

Answer 430

When disorder persists into middle childhood, clinical features = verbal and physical overfamiliarity as well as inauthentic expression of emotions (especially apparent when child interacts with adults)

Peer relationships most affected in adolescence
* Indiscriminate behavior
* Conflicts

Question 431

POSTTRAUMATIC STRESS DISORDER (PTSD)…
* exposure to what?
* Presence of what?
* Persistent avoidance of what?
* negative what?
* Marked alterations in what?
* How long? (KNOW)

Answer 431

Question 432

PTSD
* Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways?

Answer 432

Question 433

PTSD
* Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s) beginning after the traumatic event(s) occurred:

Answer 433

• Recurrent, involuntary and intrusive distressing memories of the traumatic event.
• Children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed
• Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic events *Children may have frightening dreams without recognizable content
• Dissociative reactions (e.g. flashbacks) in which individual feels or acts as if traumatic event(s) were recurring (Could occur on continuum with most extreme expression being complete loss of awareness of present surroundings)
• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
• Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

Question 434

POSTTRAUMATIC STRESS DISORDER
* Persistent avoidance of stimuli associated with the traumatic event(s) beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

Answer 434

• Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
• Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

Question 435

PTSD
* Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

Answer 435

• Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)
• Persistent and exaggerated negative beliefs or expectations about oneself, other or the world (e.g., “I am bad, “No one can be trusted,” “ The world is completely dangerous,”,” My whole nervous system is permanently ruined”.)
• Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others
• Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)
• Markedly diminished interest or participation in significant activities
• Feelings of detachment or estrangement from others
• Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings)

Question 436

POSTTRAUMATIC STRESS DISORDER
* Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

Answer 436

• Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep

Question 437

PTSD
* Duration? (KNOW)
*

Answer 437

Duration of disturbance (Criteria B,C,D,and E) is more than 1 month

Question 438

PTSD in 6 years and younger
* Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

Answer 438

• Directly experiencing the traumatic event(s)
• Witnessing in person, the event(s) as it occurred to others, especially primary caregivers (Does not include events witnessed only in electronic media, tv, movies, or pictures
• Learning that the traumatic event(s) occurred to a parent or caregiving figure

Question 439

PTSD in 6 years and younger
* Presence of one (or more) of the following intrusion:

Answer 439

• Recurrent, involuntary and intrusive distressing memories of the traumatic event (May not appear distressing and may be expressed as play reenactment)
• Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic events
• Dissociative reactions (e.g.flashbacks) in which child feels or acts as if traumatic event(s) were recurring (Could occur on continuum with most extreme expression being a complete loss of awareness of present surroundings) Such trauma-specific reenactment may occur in play
• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
• Marked physiological reactions to reminders of the traumatic event(s)
  *

Question 440

PTSD in under 6 year olds
* One(or more) of the following symptoms, representing what?

Answer 440

One(or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s) must be present, beginning or worsening after the event(s)

Question 441

PTSD in under 6 year olds
* What is persistent avoidance of stimuli?

Answer 441

• Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of traumatic event(s)
• Avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the traumatic event

Question 442

PTSD in under 6 year olds
* What are the negative alterations in cognition?

Answer 442

• Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion).
• Marked diminished interest or participation in significant activities, including constriction of play
• Socially withdrawn behavior
• Persistent reduction in expression of positive emotions

Question 443

PTSD in under 6 year olds
* Alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

Answer 443

• Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects(exclude extreme temper tantrums
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep

Question 444

PTSD under 6
* Duration?
* May have what? (2)
* May regress and losea bility to what?

Answer 444

• The duration of the disturbance is more than 1 month
• May have depersonalization
• May have derealization
• May regress and lose ability to use language

Question 445

PTSD
* Occur when?
* Sxs usually begin what? But, it can occur when?
* What is delayed expresion

Answer 445

Can occur at any age after the first year of life

Symptoms usually begin within first 3 months after trauma
* Could be delay of months, even years before criteria for dx met
* “Delayed expression”: new label for “delayed onset”

Question 446

PTSD
* How does recovery vary?

Answer 446

• Some 3 months (50% of adults)
• Some symptomatic longer than 12 months and sometimes for more than 50 years
• Symptom recurrence and intensification may occur with reminders of original trauma, ongoing life stressors, or newly experienced traumatic events

Question 447

• The following may exacerbate PTSD sxs in older individual?
• Children may exhibit primarily mood changes because of what?

Answer 447

The following may exacerbate PTSD sxs in older individual:
* Declining health
* Worsening cognitive functioning
* Social isolation

Children may exhibit primarily mood changes because of limitations expressing thoughts, labeling emotions

Question 448

PTSD
* What about the brain?

Answer 448

Question 449

PTSD treatment?

Answer 449

• SSRIs; SNRIs; (Recently, considering atypical antipsychotic meds)
• CBT
• EMDR
• Group Therapy
• Individual and supportive psychotherapy
• “Exposure” Therapy

Question 450

ACUTE STRESS DISORDER
* What is the all the components?
* What is the duration? (KNOW)

Answer 450

• Exposure
• Symptoms of intrusion
• Negative Mood
• Dissociative Symptoms
• Avoidance Symptoms
• Arousal Symptoms
• Duration of 3 days to 1 month after trauma exposure

Question 451

ACUTE STRESS DISORDER
* Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:

Answer 451

• Directly experiencing the traumatic event(s)
• Witnessing, in person, the event(s) as it occurred to others
• Learning that the event(s) occurred to a close family member of close friend (Event has to have been violent or accidental

Question 452

ACUTE STRESS DISORDER
* Experiencing what?

Answer 452

Experiencing repeated or extreme exposure to aversive details of the traumatic even (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse).

Question 453

Acute stress disorder:
* Presence of NINE (or more) of following symptoms from any of the five categories of what?

Answer 453

• intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred

Question 454

ACUTE STRESS DISORDER
* Recurrent, involuntary what?
* Recurrent distressing dreams in which what?
* Dissociative reactions (e.g. flashbacks) in which what?
* Intense or prolonged what?

Answer 454

• Recurrent, involuntary, and intrusive distressing memories of the traumatic even In children repetitive play may occur in which themes or aspects of traumatic event(s) are expressed
• Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s) In children, may be frightening dreams without recognizable content

Question 455

ACUTE STRESS DISORDER
* Dissociative reactions (e.g. flashbacks) in which what?
* Intense or prolonged what?

Answer 455

• Dissociative reactions (e.g. flashbacks) in which individual feels or acts as if traumatic event(s) were occurring (Such reactions may occur on a continuum with the most extreme expression being a complete loss of awareness of present surroundings In children reenactment may occur in play
• Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

Question 456

ACUTE STRESS DISORDER
* What is apart of negative mood?
* What is dissociative symptoms?

Answer 456

Negative
* Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings

DISS0CIATIVE SYMPTOMS
* An altered sense of the reality of one’s surroundings or oneself (e.g. seeing oneself from another’s perspective, being in a daze, time slowing.)
* Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs

Question 457

ACUTE STRESS DISORDER
* What are the avoidance symptoms?

Answer 457

• An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing).
• Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)
• Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
• Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event

Question 458

ACUTE STRESS DISORDER
* What are the arousal symptoms?

Answer 458

• Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
• Irritable behavior and angry outbursts (with little or no provocation, typically expressed as verbal or physical aggression toward people or objects
• Hypervigilance
• Problems with concentration
• Exaggerated startle response

Question 459

ACUTE STRESS DISORDER
* What can happen in some?

Answer 459

• In some, a dissociative or detached presentation but typically also display strong emotional or physiological reactivity in response to trauma reminders
• Others, strong anger response: might be irritable or aggressive

Question 460

ACUTE STRESS DISORDER
* What can be a trigger?
* Might see what?
* What type of difficulty?
* May engage in what?
* May experience what?

Answer 460

• Triggering cue could be physical sensation (e.g., a sense of heat for a burn victim, dizziness for survivors of head trauma
• Might see depersonalization or derealization
• Concentration difficulties (remembering daily events. Phone #s)
• May engage in catastrophic thinking about their role in traumatic event
• May experience panic attacks

Question 461

ADJUSTMENT DISORDERS
* What is it?

Answer 461

The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 (THREE) months of the onset of the stressor

Question 462

ADJUSTMENT DISORDERS
* Symptoms or behaviors are clinically significant, as evidenced by one or both of the following:

Answer 462

• Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptoms severity and presentation
• Significant impairment in social, occupational, or other important areas of functions
• The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
• Symptoms ≠normal bereavement

Question 463

Adjustment disorder:
* Once stressor or its consequences have terminate, the symptoms do not persist for more than what?

Answer 463

than an additional 6 (SIX) months

Question 464

ADJUSTMENT DISORDERS
* Essential feature is what?
* Stressor could be what?
* Adjustment Disorders may be diagnosed following what?
*

Answer 464

• Essential feature is presence of emotional or behavioral symptoms in response to an identifiable stressor
• Stressor could be single event (ending romantic relationship). Stressors could be multiple and/or stressors may be recurrent
• Adjustment Disorders may be diagnosed following death of a loved one when the intensity, quality, or persistence of grief reactions exceeds what normally might be expected

Question 465

SOMATIC SYMPTOM AND RELATED DISORDERS
* All of disorders share common feature: prominence of what?
*

Answer 465

• All of disorders share common feature: prominence of somatic symptoms associated with significant distress and impairment
• Patients with somatic sxs commonly encountered in primary care and other medical settings rather than psychiatric settings

Question 466

SOMATIC SYMPTOM AND RELATED DISORDERS
* Dx based on what?

Answer 466

• Positive signs and symptoms (distressful somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these sxs)
• Not based on absence of a better medical explanation for somatic sxs

Question 467

SOMATIC SYMPTOM AND RELATED DISORDERS
* What are the distinctive characterisitcs?
* Can be also accompany by what?

Answer 467

Distinctive characteristics
* Not the somatic symptoms per se
* Is the way patients present and INTERPRET them

Somatic Symptom Disorders can also accompany diagnosed medical disorders

Question 468

SOMATIC SYMPTOM AND RELATED DISORDERS
* What do we need to remember?

Answer 468

Remember- certain mental disorders my manifest primarily with somatic sxs (e.g., major depressive disorder, panic disorder)
* These dxs may account for the somatic sxs OR may occur alongside one of the Somatic Symptom and Related Disorders

Question 469

What are the factors that may contribute to somatic symptom and related disorder?

Answer 469

• Genetic (e.g., increased sensitivity to pain)
• Early traumatic experiences (e.g., violence, abuse, deprivation)
• Learning (e.g., attention obtained from illness, lack of reinforcement of non-somatic expressions of distress)
• Cultural/social norms that devalue and stigmatize psychological suffering

Question 470

SOMATIC SYMPTOM AND RELATED DISORDERS
* Why do variations occur?

Answer 470

Variations in sx presentation due to interaction of multiple factors within cultures. Affect how individuals
* Identify and classify bodily sensations
* Perceive illness
* Seek medical attention for themselves

Question 471

SOMATIC SYMPTOM AND RELATED DISORDERS
* There is no category of what?

Answer 471

There is no category “hypochondriasis”
* Individuals are best characterized by dx-Somatic Symptom Disorder
* There are 25% of individuals who have “high health anxiety” that do not fit into Somatic Symptom Disorder. For them, use Illness Anxiety Disorder

Question 472

SOMATIC SYMPTOM DISORDER
* Typically have what?
* Sometimes presents with only what?
* Sxs can be what?

Answer 472

• Individuals typically have multiple, current, somatic sxs
• Sometimes presents with only one severe sx- commonly its pain
• Sxs can be specific (e.g., localized pain) OR relatively nonspecific (e.g.,fatigue)

Question 473

SOMATIC SYMPTOM DISORDER
* Have to have what?
* Sxs sometimes represent what?

Answer 473

• Have to have some evidence of a medical explanation of sxs to have this dx. But sxs may or may not be associated with another medical condition
• Sxs sometimes represent normal bodily sensations or discomfort that does not signify serious disease.

Question 474

SOMATIC SYMPTOM DISORDER
* Individuals with this disorder tend to have very high levels of what?

Answer 474

worry about illness
* Bodily sxs unduly threatening, harmful, or troublesome
* Think the worst about their health
* Health-related quality of life often impaired: physically and mentally
* In severe cases, disorder could lead to person becoming an invalid

Question 475

SOMATIC SYMPTOM DISORDER
* High level of ultization of what? Why?
* Unresponsive to what?
* What can exacerbate presenting sxs?
* Some individuals unusually sensitive to what?

Answer 475

High level of utilization of medical care
* Alleviates concerns
* May seek care from multiple doctor’s for same sxs to be reassured over and over

Unresponsive to medical interventions

New interventions may only exacerbate presenting sxs

Some individuals unusually sensitive to side effects of medications

Question 476

SOMATIC SYMPTOM DISORDER
* Some will take view of what?
* May fear what?
* Repeatedly checks what?
* Cannot stop talking about what?
* Reassurance does what?

Answer 476

• Some will take view that their medical assessment and Rx inadequate
• May fear physical activity might damage the body
• Repeatedly check body for abnormalities
• Cannot get off subject of their medical concerns
• Reassurance helps temporarily or is experienced as though the treater is not taking sxs seriously

Question 477

SOMATIC SYMPTON DISORDER: Children
* Most common sxs?
* What is more common?
* Young children may have what?

Answer 477

Most common sxs = recurrent abdominal pain, headache, fatigue nausea

A single prominent sx more common

Young children may have somatic complaints but rarely worry about “illness” per see prior to adolescence
* Parents’ response affects level of associated distress

Question 478

SOMATIC SYMPTON DISORDER- Risk and Prognostic Factors
* What are risk factors?

Answer 478

Question 479

ILLNESS ANXIETY DISORDER
* What is it?
* What is not present?
* Individuals distress does not what?

Answer 479

• A preoccupation with having or acquiring a serious UNDIAGNOSED MEDICAL ILLNESS
• Somatic sx are NOT present, or if present, are VERY mild
• Individuals distress does not emanate from a physical complaint. Instead is anxiety about the meaning, significance, or cause of the complaint (suspected medical diagnosis)

Question 480

ILLNESS ANXIETY DISORDER
* If there is something physical at all, it is often what?

Answer 480

• A normal physiological sensation (e.g., orthostatic dizziness)
• Benign self-limited dysfunction (e.g., transient tinnitus)
• Bodily discomfort not generally considered indicative of disease e.g., belching)

Question 481

ILLNESS ANXIETY DISORDER
* How do they become alarmed about illness?
* Concerns about what?
* Duration? (KNOW)

Answer 481

Question 482

ILLNESS ANXIETY DISORDER
* Central feature?
* Frequent topic during what?
* What is hallmark?
* Illness concerns what?
* What do they do repeatedly?
* Research what?
* Repeatedly seeks what?

Answer 482

Question 483

ILLNESS ANXIETY DISORDER- Associated Features
* Believe they are what?
* Unsatisfactory what?
* Some are too anxious to do what?
* Medical attention can lead to what?

Answer 483

• Believe they are medically ill
• Have extensive yet unsatisfactory medical care
• Some are too anxious to seek medical care
• Medical attention can lead to paradoxical exacerbation of anxiety

Question 484

ILLNESS ANXIETY DISORDER- Risk and prognosis
* may precipitated by what? Children?
* Approximately 1/3 to ½ of individuals have what form? What is it associated with?

Answer 484

Question 485

CONVERSION DISORDER
* Essential feature is what? What are examples?

Answer 485

Essential feature is presence of symptoms or subjective deficits affecting motor or sensory functioning, or apparent impairment in level of consciousness
* Some examples of motor symptoms: weakness, paralysis of body part; abnormal body movements-tremor, jerky movements-, and other hyper-or hypokinetic movement abnormalities; gait abnormalities; and abnormal limb posturing

Question 486

Conversion Disorder
* sxs are not?

Answer 486

Symptoms are not intentionally produced or feigned

Question 487

Conversion disroder
* Sensory symptoms such as what?
* Person may do what?
* Eyes?
* Arm?

Answer 487

• Sensory symptoms such as altered, reduced, or absent skin sensation, vision, or hearing. Episodes of abnormal generalized limb shaking with apparent impaired/loss of consciousness resembling epileptic seizures (pseudoseizures)
• Person may collapse and be motionless and unresponsive in an episode resembling syncope or coma.
• Optokinetic nystagmus occurs in blind person
• Paralyzed arm does not fall on patient’s face during evaluation

Question 488

CONVERSION DISORDER
* What are some biarre symptom presentations?

Answer 488

• Motor deficits do not follow neuronal pathways. Reflexes intact and EMG normal.
• “Blindness” is not associated with lack of pupillary response and patient uncannily does not run into objects or walls
• Seizures: pupillary and gag reflexes are retained and there is no increase in prolactin concentration
• Astasia-abasia
• Deafness: loud noise awakens patient
• Sensory deficits do not follow dermatome distribution

Question 489

Coversion disorder
* What is astasia, abasia, astasia-abasia

Answer 489

• Astasia = motor incoordination with inability to stand
• Abasia = inability to stand or to walk although the legs are otherwise under control
• Astasia abasia- an unsteady gait that does not cause patient with conversion disorder to fall or sustain injury
  *

Question 490

CONVERSION DISORDER
* What is la belle indifference?

Answer 490

lack of concern about illness or obvious impairment
* Has been associated with Conversion Disorder but is not specific for Conversion Disorder and should not be used to make the diagnosis

Question 491

CONVERSION DISORDER
* What are some other symptoms?
* Must be evidence of what?
* What needs to be ruled out?
* Research shows that some individuals diagnosed with Conv Dis. later found to have what what?

Answer 491

• Other symptoms: reduced or absent speech volume, sensation of lump in throat, and diplopia
• Must be evidence of functional neurological symptoms
• True neurological disease must be ruled out
• Research shows that some individuals diagnosed with Conv Dis. later found to have medical or neurological illnesses- so keep an open mind

Question 492

CONVERSION DISORDER
* What is common?
* Associated with what?
* Hx of what?
* What is a risk factors?

Answer 492

• Transient conversion symptoms are common
• Dissociative sxs common. Could see both Conversion Disorder and Dissociative Disorder
• Associated with maladaptive personality traits
• May be hx of childhood abuse and neglect. Often see stressful life events
• Risk factor- presence of neurological disease that causes similar sxs

Question 493

What does it mean when psychological factors affect other medical conditions?

Answer 493

Essential feature is presence of one or more clinically significant psychological or behavioral factors that adversely affects a medical condition by increasing the risk for suffering, death, or disability

Question 494

PSYCHOLOGICAL FACTORS AFFECTING OTHER MEDICAL CONDITIONS
* Psychological or behavioral factors =

Answer 494

• Psychological distress
• Patterns of interpersonal interaction
• Coping styles
• Maladaptive health behaviors (e.g., denial of sxs or poor adherence to medical recommendations)

Question 495

What are EXAMPLES of Psychological Factors Affecting Other Medical Conditions?

Answer 495

• Anxiety-exacerbating asthma
• Denial of need for rx of acute chest pain
• Manipulation of insulin by person with diabetes wishing to lose weight
• Takotsubo cardiomyopathy
• Chronic occupational stress increasing hypertension
• Functional syndromes- migraine, IBS, fibromyalgia

Question 496

Do not think we need to know

Takotsubo Cardiomyopathy
* What is the cause?
* Who is more vulnerable?

Answer 496

Thought that adrenaline and/or cortisol “stun” the heart and cause either heart muscle cell changes or coronary blood vessel changes or both. Results - left ventricle does not contract effectively.

It is thought that the reduced estrogen level in postmenopausal women makes them more vulnerable

Question 497

Do not think we need to know

Takotsubo Cardiomyopathy
* EKG vs cath vs biomarkers?

Answer 497

• Symptoms cannot be distinguished from those of MI. EKG may be abnormal, consistent with findings of MI (elevated ST-segments)
• Must do catheterization to determine no evidence of blockages (especially to rule out microvessel disease as it is more common cause of MI sxs in older women)
• A rapid but small rise in cardiac biomarkers (In MI they rise more slowly)

Question 498

Factitious Disorder
* What is it?
* Motivation is to assume what?
* What is absent?

Answer 498

• INTENTIONAL production or feigning of physical or psychological symptoms
• Motivation is to assume the sick role and be a patient
• Other external secondary stimuli are absent

Question 499

Factitious Disorder
* What is the first cardinal feature?

Answer 499

1. Intentional production of physical or psychological signs or symptoms that are under voluntary control, originate voluntarily and are not explained by any other underlying physical or mental disorder

Question 500

Factitious Disorder-cardinal features
* What is the second cardinal feature?

Answer 500

A strong desire to assume the sick role
* Examples: Feigned depression, hallucinations, dissociation, bizarre behavior, pseudologia fantastica (extensive and colorful fantasies associated with the presentation of the patient’s story). The listener’s interest in the story pleases patient and reinforces behavior.
* May claim death of child or parent
* Impostership may involve assuming the identity of a prestigious person

Question 501

Factitious Disorder- cardinal features
* What is the third one?

Answer 501

3. A lack of incentives that reinforce behaviors such as economic gain and avoidance of legal responsibility

Question 502

FACTITIOUS DISORDER
* Those with the disorder are at risk for experiencing what?
* Characterized by what?

Answer 502

• Those with the disorder are at risk for experiencing significant psychological distress or functional impairment by causing harm to themselves (by proxy- to others)
• Characterized by the persistence of the behavior and how intentionally the person tries to conceal the disordered behavior through deception

Question 503

• Brief Somatic Symptom Disorder?
• Brief Illness Anxiety Disorder?

Answer 503

• Brief Somatic Symptom Disorder: duration of sxs less than 6 months
• Brief Illness Anxiety Disorder: Duration of sxs less than 6 months

Question 504

What is pseudocyesis?

Answer 504

False belief of being pregnant that IS associated with objective signs and reported symptoms of pregnancy

Question 505

Malingering
* What is it?

Answer 505

The INTENTIONAL PRODUCTION of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.

Question 506

MALINGERING
* Motivated to do what?

Answer 506

To avoid “pain” (difficult situations or punishment)

To seek pleasure (obtain medication or financial compensation)
* Example: Institutional setting- malinger mental illness to do “easier time” or obtain drugs

Question 507

What is the difference between factitous and malingering?

Answer 507

Question 508

MALINGERING-
* How to approach do you approach?

Answer 508

Question 509

MALINGERING- How to approach
* What are some clues? (4)

Answer 509

• If subject gives clear and articulate explanation of being confused
• Subject gives conflicting versions of his history
• Alleges having hallucinations yet shows no evidence of being distracted
• Reports seeing visual hallucinations in black and white. Genuine visual hallucinations seen in color

Question 510

MALINGERED PSYCHOTIC SYMPTOMS: Command Hallucinations
* What happens with genuine hallucinations?
* BE SUSPICIOUS when?

Answer 510

People with genuine hallucinations
* Do not always obey the voices, especially if creates danger
* Usually present with NON-command hallucinations (85%) and delusions (75%) as well

If a person alleges an isolated command hallucination without other psychiatric symptoms, BE SUSPICIOUS

Command hallucinations easily fabricated

Question 511

Malingering vs Psychotic Symptoms
* Genuine schizophrenic hallucinations tend to diminish when?
* To deal with their hallucinations, persons with schizophrenia do what?

Answer 511

Genuine schizophrenic hallucinations tend to diminish when patients are involved in activities.

To deal with their hallucinations, persons with schizophrenia
* Engage in activities
* Change posture (Lie down, walk)
* Seek interpersonal contact
* Take medications

Question 512

Malingering vs Psychotic Symptoms
* If suspect person of malingered auditory hallucinations, ask what what?
* Malingerers may report what?

Answer 512

If suspect person of malingered auditory hallucinations, ask what he does to make voice/s go away or diminish

Malingerers may report auditory hallucinations of stilted or implausible language
* Ex: Person charged with attempted rape alleges voices said, “Go commit a sex offense.”

Question 513

Malingering vs Psychotic Symptoms
* What happens with true visual hallucination?
* Genuine hallucinations of small people (Lilliputian hallucination) may be associated with what?
* Psychotic people see what?
* Drug-induced- more readily seen when?

Answer 513

• In a true hallucination people are of normal size and in color
• Genuine hallucinations of small people (Lilliputian hallucination) may be associated with alcohol use, organic disease, or toxic psychosis (such as anti-cholinergic toxicity)
• Psychotic people see the same if eyes open or closed
• Drug-induced- more readily seen with eyes closed or in the dark

Question 514

Malingering vs Psychotic Symptoms
* What are typically associated with neurologic disease and substance use.?

Answer 514

Unformed hallucinations such as flashes of light, shadows, or moving objects-

Question 515

CLINICAL FACTORS THAT SUGGEST MALINGERING
* Absence of what?
* Marked what?
* Patient endores what?

Answer 515

Absence of active or subtle signs of psychosis

Marked inconsistencies and contradictions

Patient endorses improbable symptoms
* Depression concomitant with euphoria
* Overly dramatic
* Extremely unusual comments

Question 516

CLINICAL FACTORS THAT SUGGEST MALINGERING
* how is the patient acting?

Answer 516

Patient evasive or uncooperative
* Excessively guarded or hesitant
* Frequently repeats questions
* Frequently replies, “I don’t know” to simple questions
* Hostile, intimidating
* Seeks to control interview or refuses to participate

Question 517

CLINICAL FACTORS THAT SUGGEST MALINGERING
* Malingerers are quick to what?
* What do they think will make them more believable?

Answer 517

Malingerers are quick to “thrust forward” their illness. Patients with genuine schizophrenia are often reluctant to discuss symptoms

Malingerers often believe that faking intellectual deficits, in addition to psychotic symptoms, will make them more believable
* Ex: College educated man said he did not know the colors of the American flag

Question 518

MALINGERING
* What are the psychometric tests?

Answer 518

Minnesota Multiphasic Personality Inventory Revised (MMPI-2)
* F-scale and F-K Index

Structured Interview of Reported Symptoms (SIRS)

Miller Forensic Assessment of Symptoms Test (M-FAST)
* A Brief reliable screen. Takes 10-15 min

Question 519

BURNING MOUTH SYNDROME
* What is it not?
* What are the sxs?

Answer 519

Question 520

BURNING MOUTH SYNDROME
* Sxs how long?
* What is the primary cause?

Answer 520

Symptoms may stay for years, come and go, become less frequent, etc

PRIMARY- cause unknown
* Thought due to abnormalities of taste and sensory nerves either peripherally or centrally

Question 521

BURNING MOUTH SYNDROME
* What are the secondary underlying causes?

Answer 521

• Meds
• Oral yeast infection; geographic tongue
• Anxiety, depression, excessive health concerns
• Dentures
• Damage to nerves that control taste and pain receptors in tongue
• Allergies, food flavorings/additives, fragrance

Question 522

VULVODYNIA
* not what?
* What is the sxs?

Answer 522

• NOT a Somatoform Disorder
• Pain/burning/irritation in areas around the vaginal orifice
• Other possible sxs are soreness, itching, stinging, rawness, painful intercourse, throbbing

Question 523

VULVODYNIA
* Thought to be what?
* Possible injury or irration of what?
* Previous what?
* Allergies or what?
* Can make what painful?

Answer 523

• Thought to be due abnormality of nerves in muscles of pelvic floor
• Possible injury or irritation of nerves in vulvar region
• Previous vaginal infections
• Allergies or localized skin hypersensitivity
• Can make sitting painful as well as sexual intercourse

Question 524

VULVODYNIA-treatment
* What is the treatment?

Answer 524

• Tricyclic antidepressants; Anticonvulsants such as Tegretol or Neurontin.
• Antihistamines to address itching
• Biofeedback to control specific body responses to help eliminate pain

Question 525

WHat is psychosis? What do they sxs fall into? (4)

Answer 525

Psychosis is a gross impairment of reality testing which can result from a variety of psychiatric AND/OR MEDICAL problems

Symptoms fall into FOUR categories
* Disorders of perception
* Disorders of Thought Content
* Disorders of Thought Processes
* Disorder of Form of thought

Question 526

Disorders of perception
* What is hallucinations?
* What is hypogogic?
* What is Hypnopompic?

Answer 526

Hallucinations
* Sensory Perceptions in the absence of external stimuli(An example: Hearing voiceswhen alone in the room)

Hypnogogic (while Going to sleep) are normal and do not count

Hypnopompic (while awakening) considered to be in range of normal experience

Question 527

Disorder of thought content
* What is the idea of reference? What is an example?

Answer 527

• False belief of being referred to by others
• Example: The thought that one is being discussed by someone on the TV or radio

Question 528

Disorders of thought content
* What are delusions? What are different types?
* Idea of what?

Answer 528

Delusions: Firmly held false beliefs
* Of persecution (Feeling of being followed by the FBI)
* Of Somatic nature
* Of Grandeur
* Of jealousy
* Feeling that someone has been replaced by an impostor (CAPGRAS’ SYNDROME)

Idea of reference

Question 529

Disorder of Thought Processes
* Impaited ability to do what? Therefore what is the patient?

Answer 529

Impaired ability to abstract-> Therefore the patient is concrete
* Example: When asked what brought her to the emergency room, the patient answers, “An ambulance.“
* Another situation where see concrete thinking: Person cannot explain proverbs

Question 530

Disorder of Thought Processes
* What is neologism? What is an example?

Answer 530

Inventing new words
* Example: The patient refers to his doctor as the medocrat

Question 531

Disorders of the Form of thought
* Loosening of what?
* What is it? Shifts of ideas from what? Patient begins to answer a question how?

Answer 531

Loosening of Associations-
* Characteristic schizophrenic thinking or speech disturbance involving a disorder in the logical progression of thoughts, manifested as a failure to communicate (verbally) adequately
* Shift of ideas from one subject to another in an unrelated way
* The patient begins to answer a question about her health and then shifts to a statement about baseball

Question 532

Disorder of the Form of thought
* What is tangentiality?

Answer 532

• Getting further away from the point as speaking continues (On the “outskirts of the topic”)
• Oblique, digressive or even irrelevant manner of speech in which the central idea is not/not well communicated
• Example: A patient is asked where he is from. He answers “from Connecticut” but then continues on that he is not sure if his ancestors came from Ireland or England

Question 533

KNOW

Pscyhotic disorders
* What are some other sxs found in patients with though disorders?(5)

Answer 533

• Incoherence
• Over-inclusiveness
• Thought blocking
• Echolalia
• Poverty of Speech

Question 534

Psychotic disorders
* What is thought insertion, withdrawal and broadcasting?

Answer 534

• THOUGHT INSERTION: A person thinks THOUGHTS PUT IN ONE’S HEAD BY EXTERNAL FORCES
• THOUGHT WITHDRAWAL: A person thinks THOUGHTS TAKEN FROM ONE’S HEAD BY EXTERNAL FORCES
• THOUGHT BROADCASTING: A PERSON THINKS HIS INNER THOUGHTS ARE BEING BROADCAST TO OTHERS OUTSIDE OF HIM

Question 535

What is not necessarily an indication of psychosis?

Answer 535

Inability to abstract by itself without other symptoms is not necessarily an indication of psychosis.
* For example, it may be an indication of a person’s educational level.

Question 536

Psychotic disorders
* The preceding list begins with the diagnosis of what?
* Schizotypal Personality Disorder is included because why?

Answer 536

• The preceding list begins with the diagnosis of least severity of illness and continues in increasing order of severity (of illness) because that is how DSM 5 is configured
• Schizotypal Personality Disorder is included because of its presence within the schizophrenia spectrum. It will be covered in the section: Personality Disorders

Question 537

delusional disorder
* A dx applying to individuals who what? (3)

Answer 537

• Have persistent delusions but relatively normal psychosocial functioning apart from the ramifications of the delusions
• Exhibit behavior that may not be obviously odd or bizarre
• One or more delusions have to have duration of at least one month

Question 538

Delusional disorder
* What are delusions?
* Content of delusions may include what?
* Delusions usually about what?

Answer 538

Delusions are fixed beliefs that are not amenable to change even if there is conflicting evidence

Content of delusions may include a variety of themes (i.e., that one will be harmed, harassed by a person or group)

Delusions usually about situations that could be possible in real life
* Being followed
* Being infected
* Loved at a distance

Question 539

Delusional disorder: subtypes
* What is erotomanic type? Grandiose type?

Answer 539

• Erotomanic type- Patient believes that someone- usually of higher (e.g.,socioeconomic) status- is in love with him or her. More common in women. See stalking behavior
• Grandiose type- Inflated sense of worth, power, or knowledge. Conviction of having some great talent or insight. Person may think he has special relationship to someone who is prominent

Question 540

Delusional disorder: subtypes
* What is jealous type?

Answer 540

Jealous type- delusions of infidelity. Belief not based on any observed behavior or information but is based on incorrect inferences supported by “evidence” that is unfounded such as disarrayed clothing
* Delusional person confronts spouse or lover and attempts to intervene in the imagined infidelity

Question 541

Delusional disorder: subtypes
* What is persecutory type?

Answer 541

Persecutory type-Belief that is being conspired against, cheated, spied on, followed, poisoned, maliciously maligned, harassed, or obstructed in pursuit of long-term goals. Small slights exaggerated. Delusional individual may engage in repeated attempts to obtain satisfaction by legal or legislative action. Often are resentful and angry. May resort to violence against those thought to be hurting the delusional person
* Most common type

Question 542

Delusional disorder: subtypes
* What is somatic type?

Answer 542

Central theme involves body functions or sensations. Can occur in several forms.
* Most common belief is that individual emits a foul odor
* There is an infestation of insects on or in skin
* Parasites internally
* Parts of the body are not functioning

Question 543

Delusional disorder
* A proportion of ppl will develop what?
* What is a common characteristic?
* Usually do not require what?
* What is the treatment?

Answer 543

• A proportion of individuals with Delusional Disorder go on to develop schizophrenia
• Common characteristic is their seemingly normal behavior and appearance when delusional ideas are not being discussed or acted on.
• Usually do not require hospitalization and may be treated as outpatient
• Treatment: Oral antipsychotic medications (increase dose slowly)

Question 544

Treatment delusions
* May need hospitalization when?
* When are SSRIs helpful?
* Therapy?
* Success of treatment measured more by what?

Answer 544

May require hospitalization if
* Unable to control suicidal or homicidal impulses
* Impairment extreme. Ex: Will not eat because thinks food is poisoned

SSRI’s may be helpful with somatic delusions

Psychotherapy: Individual more effective than group

Success of treatment measured more by satisfactory social adjustment than decrease in delusions

Question 545

Delsional disorders unique to derm
* Delusions of what? What is it?

Answer 545

Delusions of parasitosis: A delusion of infestation by parasitic organisms
* Sensations of crawling, burrowing, and biting from parasites
* May describe elaborate, detailed descriptions of the parasites

Previously known as monosymptomatic hypochondriasis

Question 546

Delusions of parasitosis
* May engage in what?
* What sign is present?

Answer 546

May engage in obsessive/ritualistic behaviors
* Picking at skin
* Apply disinfectants and pesticides

Present their collection of lint, dried blood, hairs, and other skin fragments (believed to be the parasites) in a small box or container (matchbox sign)

Question 547

Delusion of parasitosis
* different from what?
* What can cause formication?

Answer 547

Different from formication- patients experience crawling, biting or stinging sensations but pt not convinced it is due to parasites

Illicit drugs such as amphetamines can cause formication and can result in delusional state
* Indistinguishable from delusions of parasitosis

Cocaine abuse can be associated with visual hallucinations and feeling of bugs crawling beneath skin (cocaine bugs)

Question 548

Somatic delusion: morgellon disease
* What is it?
* What does the patient do?
* May also exhibit what sign?

Answer 548

• Patient has unshakeable belief that fibers or some other material is imbedded or emerging from his skin
• Pick and dig at skin to extract offending material. If pick and dig using instruments such as nail clippers or tweezers, this portends a more malignant psychological profile (So ask what they are doing)
• May also exhibit matchbox sign- bring in fibers etc as evidence

Question 549

Olfactory reference syndrome- somatic delusional disorder
* Also known as what?
* WHat is it?
* What does the patient do?

Answer 549

Also known as delusion of bromhidrosis:
* Bromhidrosis is excessive body odor that emanates from skin (order usually unpleasant)
* Pt has delusion that an unpleasant odor is emanating from his/her skin. Also known as Olfactory Reference Syndrome (ORS).
* Primarily an olfactory delusion
* Pts wash excessively, change clothes more often, restrict social and domestic activities

Question 550

Olfactory reference syndrome
* Must condier the possibility of what?
* What is the txt?

Answer 550

• Must consider the possibility of temporal lobe epilepsy.
• Because of close relationship with social anxiety spectrum disorders, treatment based on SSRI’s or TCA’s and CBT

Question 551

Brief psychotic disorder
* Dx used for what? Duration?
* Occurs in individuals who either what?

Answer 551

Diagnosis used for relatively brief episodes of psychosis lasting at least ONE day but less than ONE month

Occurs in individuals who either
* Otherwise have not experienced a decline in their day-to-day functioning
* Or display signs that later on suggest prodrome of schizophrenia

Question 552

Brief psychotic disorder
* Sxs like what? What is the exception?
* What happens if it occurs within 4 weeks of postpartum?

Answer 552

Symptoms like those for schizophrenia EXCEPT for the negative symptoms (not included)

If occurs within 4 weeks postpartum, use specifier “with postpartum onset”
* Typically women with postpartum onset generally develop symptoms within 1-2 weeks of delivery.
* Often referred to as postpartum psychosis

Question 553

Postpartum psychosis
* Occurs when?
* Thoughts of what?
* Patients are what?

Answer 553

• Occurs after childbirth and characterized by severe depression and delusions.
• Thoughts of wanting to harm baby or self
• Patients are confused, irrational, delusional, and are obsessively concerned about the baby

Question 554

Postpartum psychosis
* What are the ddxs?

Answer 554

Question 555

Schizophreniform disorder
* What is the duration?
* What happens when it occurs longer?
* What can they develop?

Answer 555

• Diagnosis is used for symptoms of schizophrenia that last AT LEAST 1 month but LESS THAN 6 months.
• When symptoms last 6 months or longer, diagnosis changes to schizophrenia, even if only residual symptoms remain (e.g., blunted affect)
• Some individuals with this diagnosis develop schizophrenia but others develop a mood disorder or schizoaffective disorder

Question 556

SCHIZOPHRENIFORM DISORDER
* To qualify for this diagnosis, must have two or more of the following for a significant portion of time during a 1 month period and at least one of them has to be 10, 20, or 3)

Answer 556

1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (diminished emotional expression or avolition)

Question 557

Schizophrenia
* In DSM V schizophrenia is defined by a group of symptoms such as what?
* Deterioration in what?
* What is the duration?

Answer 557

• In DSM V schizophrenia is defined by a group of symptoms such as Delusions, hallucinations, and negative symptoms (i.e., diminished emotional expression or avolition = a lack of motivation or initiative)
• Deterioration in social, occupational, or interpersonal functioning
• Continuous signs of the disturbance for at least 6 months

Question 558

Schizophrenia
* What are positive and negative sxs?

Answer 558

• Positive: At least one of the two required symptoms must be delusions, hallucinations, or disorganized speech
• Negative symptom has been described as “diminished emotional expression or avolition. This is meant to emphasize the restricted affect one might observe in an affected individual. You may still see/hear descriptions of someone demonstrating a flat affect, another way to describe the diminished emotional expression

Question 559

Schizophrenia
* Prodromal sxs?
* What may follow?
* Negative sxs when?

Answer 559

• Prodromal symptoms may precede the active phase of the illness.
• Residual symptoms may follow
• Negative symptoms are common in the prodromal and residual phases and can be severe

Question 560

SCHIZOPHRENIA- prodromal and residual symptoms
* Some prodromal and residual symptoms are what?
* May express what? Give examples

Answer 560

Some prodromal and residual symptoms are mild and may be seen as just starting such as hallucinations or delusions

May express unusual or odd beliefs that do not reach the level of an actual delusion:
* Ideas of reference
* Magical thinking (remember, this by itself is not psychotic thinking)
* Person may describe unusual perceptual experiences (sensing a presence of someone but not actually seeing him)

Question 561

SCHIZOPHRENIA- prodromal and residual symptoms
* What are some more prodromal sxs?

Answer 561

• Speech may be comprehendible but vague and somewhat off topic
• Individual may mutter to himself in public

Question 562

Schizophrenia
* When are mood problems an issue?
* BUT to have a diagnosis of Schizophrenia, the individual must have what?

Answer 562

• Mood problems are common and may occur during the active phase of the illness with the typical psychotic symptoms that characterize this disorder
• BUT to have a diagnosis of Schizophrenia, the individual must have delusions or hallucinations in the absence of mood episodes, OR the total duration of the mood episodes must be present for only a small part of the total duration of the active (period)and residual periods of the disease. (Otherwise, the diagnosis would be Schizoaffective Disorder)

Question 563

SCHIZOPHRENIA- to summarize
* The essential psychopathology includes whats?

Answer 563

• Positive sxs (delusions; hallucinations)
• Disorganization (pf speech or grossly abnormal behavior
• Negative sxs (decreased emotional expression and/or motivation)

Question 564

SCHIZOPHRENIA- Positive Symptoms
* Can be seen in many forms?
* Positive sxs give rise to what?

Answer 564

Can be seen in many forms
* Hallucinations
* Hyperactivity and hypervigilance
* Grandiosity
* Suspiciousness
* Hostility

Positive symptoms give rise to
* Problems in cognitive processing
* Altered perceptions
* Misattribution of environmental cues
* Bias toward threatening information

Question 565

What are negative sxs?

Answer 565

• Blunted affect
• Emotional withdrawal
• Poor rapport with others
• Difficulty with abstract thinking; loss of spontaneous conversation
• Rigid, repetitious or barren thought content
• Severe negative sxs associated with worse premorbid function (fewer vocational skills, fewer avocational interests, lower mean IQ,

Question 566

• What is the issue with violenece and schizophrenia?
• What are the predictors of violence?

Answer 566

Most individuals with schizophrenia are not violent but the illness, especially if psychosis not treated is a risk factor for violence

Predictors of violence
* Childhood conduct problems
* Substance misuse
* History of victimization
* Economic deprivation
* Living with others (not living alone)

Question 567

SCHIZOPHRENIA- violence
* What increases rates of violence?
* Negative sxs were what?
* Prison systems have what?

Answer 567

• Increased positive sxs associated with increased rates of violent behaviors
• Negative symptoms were protective against violence
• Prison systems have many mentally ill individuals who have been violent due to their illness

Question 568

Schizophrenia
* What is the average lifespan? Why is this?

Answer 568

Average lifespan is up to 25 years shorter
* Large share of early death is cardiovascular disease associated with smoking, obesity, diabetes, dyslipidemia, lack of exercise, and cardiac side effects of antipsychotic drugs

Question 569

Schizophrenia
* Higher rates of osteoporosis due to what?
* What is a common complication?

Answer 569

Question 570

What medication can reduce sucide risk in schizophrenia?

Answer 570

Clozapine is thought to reduce suicide risk

Question 571

Schizophreneia-substance abuse
* What is most commonly used? Why?

Answer 571

Nicotine most commonly used substance

Higher rate of smoking than general population
* Some thought that the nicotinic system involved in pathophysiology of the illness
* Smoking increases metabolism of many antipsychotic drugs

Question 572

SCHIZOPHRENIA- Substance abuse
* Clozapine has been associated with what? (4)

Answer 572

• Decreased cocaine craving
• Decreased smoking rates
• Decreased substance use
• Increased abstinence

Question 573

Epidemiology of schizophrenia
* Males manifest when? Females?
* What is the overall peak ages?

Answer 573

ales manifest illness earlier than females
* Early –to-mid 20’s in males
* Late 20’s in females

Overall peak ages of onset between 15 and 35 years of age (50% before 25 years)

Onset is earlier in males but equally prevalent in men and women

Question 574

Schizophrenia
* Onset when is uncommon?
* What is a second smaller peak?

Answer 574

• Onset before age 10 or after age 45 (called late-onset) is uncommon but not impossible
• Is a second smaller peak in women near menopause at ages 40-45 years
• Symptoms in diagnosed females may worsen after menopause

Question 575

Schizophrenia
* What appears to be a significant factor?

Answer 575

Stress

Question 576

Schizophrenia
* What is the sopamine hypothesis?

Answer 576

• Symptoms thought to result from increased limbic dopamine activity (positive symptoms) and decreased frontal dopamine activity (negative symptoms)
• Pathology may be result of abnormal receptor number or issues with receptor sensitivity.
• Dopamine receptors that have been identified (for all individuals) D1-D5
• Theory is based on psychotogenic effects of drugs that increase dopamine levels (like cocaine, amphetamines etc) and the antipsychotic effects of dopamine receptor antagonists such as haloperidol (Haldol)

Question 577

What is the limitations of dopamine hypothesis?

Answer 577

Limitation of the theory: all types of psychosis may be responsive to dopamine-blocking agents
* Would suggest that are multiple causes of dopaminergic abnormalities. Other complex factors probably play a role such as serotonin-dopamine interaction, effects of amino acid neurotransmitters

Question 578

Schizophrenia
* What is the NE and GABA hypothesis?

Answer 578

• Increased norepinephrine levels lead to increased sensitization to sensory input
• Another hypothesis: Decreased GABA activity results in increased dopamine activity

Question 579

Schizophrenia
* What is the serotonin hypothesis?

Answer 579

Serotonin metabolism is abnormal in some individuals with chronic schizophrenia
* Both hyperserotoninemia and hyposerotoninemia reported
* Antagonism at serotonin 5-HT2 receptor emphasized as important in reducing psychotic symptoms (also development of movement disorders related to D2 antagonism

Question 580

Schizophrenia
* What is the glutamate hypothesis?

Answer 580

• Hypofunction of the glutamate N-methyl-D-aspartate (NMDA)-type receptor might cause positive and negative symptoms based on what is seen with phencyclidine and ketamine (Ketalar).
• Other support comes from the therapeutic effects of glycine and D-cycloserine (NMDA antagonists) in research situations

Question 581

Schizophrenia
* What is the neurodevelopmental therory?

Answer 581

Abnormal neuronal migration during second trimester of fetal development may cause abnormal neuronal function and could lead to symptoms- particularly in adolescence.

Question 582

Schizophrenia
* What has a reduced volume, decreased blood flow where and altered activation of what?

Answer 582

• Reduced volume of the prefrontal cortex, thalamus, hippocampus and superior temporal gyri
• Decreased blood flow and metabolism of frontal lobes seen on brain imaging
• Altered activation in prefrontal cortex and other areas (hippocampus, amygdala, and thalamus) during cognitive tasks during brain imaging studies

Question 583

Schizophrenia
* Changes in what?
* Degeneration in what?
* Abnormal functioning in what?

Answer 583

• Changes include decreased number of neurons, increased gliosis, and disorganization of neuronal architecture.
• Degeneration in limbic system
• Abnormal functioning in basal ganglia and cerebellum may explain movement disorders sometimes seen

Question 584

Schizophrenia
* Ventricle?
* EEG?
* What is seen on CT scans?

Answer 584

• Lateral and third ventricle enlargement
• Most have normal EEG’s
• Cortical atrophy seen on CT scans

Question 585

Schizophrenia- findings
* Some patients have shown decreased what?
* Dysfunction of the frontal lobe seen in what?

Answer 585

• Some patients show decreased frontal and parietal lobe metabolism
• Dysfunction of frontal lobe seen in examination of PET scans and CBF (cerebral blood flow) studies.

Question 586

Schizophrenia- findings
* Increased what?
* What type of movements?
* Abnormal what?
* Impairment of what?

Answer 586

• Increased primitive reflexes (grasp)
• Paroxysmal saccadic movements (inability to follow objects through space with smooth eye movements
• Abnormal sterognosis and two-pt discrimination
• Dysdiadochokinesia (Impairment in ability to perform rapidly alternating movements)

Question 587

Neuropsychological Testing Findings In Schizophrenia
* What happens with the Thematic Apperception Test and Rorschach ?
* Parents of schizophrenic patients show what?
* Halstead-Reitan battery?

Answer 587

• Thematic Apperception Test and Rorschach -> Bizarre responses
• Parents of schizophrenic patients show more deviation from normal values in such projective tests
• 20 % of patients have impaired attention and intelligence, decreased retention time, and disturbed problem-solving ability on Halstead-Reitan battery

Question 588

What is the DDX of schizophrenia?

Answer 588

Schizophreniform Disorder
* Sx identical
* Lasts less than SIX months
* Deterioration less
* Prognosis better

Brief Psychotic Disorder

Question 589

What is the treatment of schizophrenia

Answer 589

• Antipsychotic medications effective in the treatment of acute psychosis and preventing relapse
• COGNITIVE-BEHAVIORAL THERAPY: Focuses on rationally exploring subjective nature of the psychotic symptoms, challenging the evidence for them, and subjecting beliefs and experiences to reality testing
• INDIVIDUAL PSYCHOTHERAPY: Assists with management of life stressors, enhances medication compliance, and improving self esteem
• Group: Provides supportive social network and good setting for teaching coping and interpersonal skills
• ASSERTIVE COMMUNITY TREATMENT (ACT): Comprehensive integrated community services-> Patients assigned to one multidisciplinary team (case manager, nurse, and M.D.)
• Family therapy: Can be helpful to prevent psychotic relapse and re-hospitalization
• SOCIAL SKILLS TRAINING: Uses learning theory principles to improve social functioning

Question 590

SCHIZOAFFECTIVE DISORDER
* Dx based on what?

Answer 590

Diagnosis based in an uninterrupted period of illness during which there is a major mood episode- major depression or manic episode CONCURRENT with symptoms listed in Criterion A of schizophrenia
* The major depressive episode must include Criterion A1: Depressed mood
* During this period of uninterrupted illness, the patient continues to display active or residual symptoms of psychosis. (Diagnosis usually made during the period of psychosis)

Question 591

SCHIZOAFFECTIVE DISORDER
* What needs to be met?
* Schizoaffective illness is diagnosed when ?
* What needs to be present majority of the duration of the illness?

Answer 591

• Criteria A for schizophrenia must be met.
• Schizoaffective illness is diagnosed when the core symptom criteria for schizophrenia co-occur with a manic or major depressive episode but are preceded or followed by at least 2 weeks of delusions or hallucinations without a major mood episode
• The major mood episodes must be present for the majority of the duration of the illness

Question 592

SCHIZOAFFECTIVE DISORDER- Associated features
* Frequently see impaired what?
* May observe what?

Answer 592

• Frequently see impaired occupational functioning but not a defining criterion as seen with schizophrenia
• May observe restricted social contact and difficulties with self-care but negative symptoms may be less severe and less persistent (compared to with schizophrenia)

Question 593

How do you distinguish schizoaffective disorder from schizophrenia and from depressive and bipolar disorders with psychotic features?

Answer 593

Criterion C is designed to separate schizoaffective disorder from schizophrenia (Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness)

Question 594

Criterion B is designed to distinguish schizoaffective disorder from what? How?

Answer 594

• Criterion B is designed to distinguish schizoaffective disorder from major depression or bipolar disorder with psychotic features (Criterion B: Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode- depressive or manic-during the lifetime duration of the illness)
• In depressive or bipolar disorder with psychotic features, the psychotic features generally occur when there is a problem with mood

Question 595

Schizoaffective
* Specify what?

Answer 595

• BIPOLAR TYPE- If disturbance includes manic or mixed episode
• Depressive type: If Disturbance only includes major depressive episodes

Question 596

What is the treatment of schizoaffective disorder?

Answer 596

Question 597

Substance/medication induced psychotic disorder
* What is it?
* Diagnosis used when sxs in excess of what one would see with what?

Answer 597

• Delusions or hallucinations (Criteria A) are causally related to the effects of a substance or med because they developed during or soon after the substance intoxication or withdrawal or after exposure to a medication (Criterion B)
• Diagnosis used when sxs in excess of what one would see with an intoxication or withdrawal syndrome. Example: Hallucinations seen during alcohol withdrawal delirium and an additional diagnosis of a substance-induced psychotic disorder would not be appropriate

Question 598

Substance/medication induced psychotic disorder: PCP
* At high doses?
* May cause effects that mimic what?
* What is often sparse and garbled?
* Long time users ahve what?
* Sxs can last how long?

Answer 598

• At high doses may see delusions and hallucinations
• May cause effects that mimic full range of symptoms of schizophrenia- delusions, paranoia, disordered thinking, sensation of distance from one’s environment, catatonia
• Speech often sparse and garbled
• Long-time users have memory loss, difficulties with speech and thinking, depression and weight loss
• Symptoms can persist up t one year after cessation of PCP use

Question 599

Substance/medication induced psychotic disorder: Ketamine
* What type?
* What type of drug?
* What is common?

Answer 599

• A dissociative anesthetic
• A non-competitive antagonist of the NMDA receptor
• Psychosis, perceptual alterations, thought disorder, and mood changes

Question 600

Substance/medication induced psychotic disorder: LSD
* Effects depend on what?
* may hear what?

Substance/medication induced psychotic disorder: MDMA
* Occur when?

What is another drug?

Answer 600

LSD
* Effects depend on the amount taken, patient’s personality and expectations, and the surroundings when taken
* May hear colors and see sounds

MDMA:
* Psychological effects can occur either during or weeks after use

Steriods

Question 601

What are the endocrine disorders that can cause psychotic disorders

Answer 601

• Addison’s disease
• Cushing’s syndrome-> Dexamethasone suppression test
• Hypo/hyperthyroidism

Question 602

What are medicaions that can induce psychotic disorders

Answer 602

• Digitalis
• Steroids
• Others, even antibiotics

Question 603

Catatonia:
* Marked what? What is the range?
* Motoric immobility may be what?

Answer 603

• Marked psychomotor disturbance that may involve decreased motor activity, decreased engagement when being interviewed or examined physically.
• Psychomotor disturbance could range from marked unresponsiveness to marked agitation
• Motoric immobility may be severe (mutism) or moderate (catalepsy and waxy flexibility).

Question 604

Catatonia
* Decreased what? (KNOW)
* Excessive and peculiar what?
* In extreme cases, same individual may what?

Answer 604

• Decreased engagement may be may be severe (mutism) or moderate (negativism)
• Excessive and peculiar motor behaviors can be complex (stereotypy) or simple (agitation). May include echolalia and echopraxia
• In extreme cases, same individual may wax and wane between decreased and excessive motor activity

Question 605

Catatonia
* May also manifest what?
* What is echolalia, echopraxia? (KNOW)

Answer 605

• May also manifest unusual facial contortions
• Echolalia (almost parrot-like repeating of what someone says)
• Echopraxia (mimics a person’s movements)

Question 606

Catatonia
* Occurs in who?
* Majority of cases in who?

Answer 606

• Occurs in up to 35% of individuals with schizophrenia
• Majority of catatonia cases involve individuals with depressive or bipolar disorders

Question 607

Biologic factors
* What might contribute to denial of hunger with patients with AN?
* Increased what?
* Decreased what?

Answer 607

• Endogenous opioids might contribute to denial of hunger in patients with AN
• Increased endorphin levels described inpatients with BN after purging and may induce feelings of well being
• Decreased norepinephrine turnover and activity suggested by reduced levels of 3-methoxy-4-hydroxyphenylglycol in the urine and CSF of some patients with AN.

Question 608

Biologic factors
* Starvation causes what many biologic changes?

Answer 608

• Hypercortisolemia
• Nonsuppression of dexamethasone
• Thyroid function suppression
• Amenorrhea
• Several CT brain studies revealed enlarged sulci and ventricles in starvation-> Reversed with weight gain
• Is excess of ghrelin in BN

Question 609

Biologic factors
* What has some research shown?

Answer 609

Some research revealed overlap between uncontrolled compulsive eating and compulsive drug seeking in drug addiction.
* See reduced ventral striatal dopamine in both groups
* The lower the frequency of dopamine D2 receptors, the higher the body mass index

Question 610

What is family life with children of eating disorders?

Answer 610

In families of children with eating disorders, see
* High levels of hostility, chaos, and isolation
* Low levels of nurturance and empathy

One view: anorexia is a reaction of adolescents as they try to become more independent or a response to societal pressures to be slender

Question 611

• AN patients are usually what?
• AN: seld starvation may be an effort to gain what?
• What is often seen in patients with BN?

Answer 611

• AN patients usually high achievers. 2/3 live at home with parents. Many consider their bodies to be under parents’ control
• AN: Self starvation may be an effort to gain validation as unique person
• Difficulties with impulse regulation often seen in patients with BN

Question 612

Pica
* What is it?
* What can common things?

Answer 612

Essential feature-eating one or more non-nutrititive, nonfood substance on a persistent basis over a period of at least ONE month
* Typical ingested substances: paper, sap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal/coal, clay, starch, or ice

Question 613

Pica
* Age?
* what increases risk?

Answer 613

• Minimum age if 2 years suggested for dx to exclude developmentally normal mouthing of objects by infants they may ingest
• In children, neglect, lack of supervision and developmental delay can increase risk for dx

Question 614

Rumination disorders
* What is it?
* What does infants display?

Answer 614

• Repeated regurgitation of food after feeding or eating over a period of at least one month
• Previously swallowed food (partially digested) brought up into the mouth without apparent nausea, involuntary retching, or disgust
• Infants display characteristic position of straining and arching their back, making sucking movements with their tongue.

Question 615

RUMINATION DISORDER
* What are common features in infants?
* May see what?
* In infants (also older individuals) with intellectual disability, behavior has what?

Answer 615

• Weight loss and failure to meet expected weight gain common features in infants
• May see malnutrition, especially if regurgitated food is expelled. Also occurs in older children and adults when regurgitation is accompanied by restriction of intake
• behavior has self soothing quality/function similar to repetitive motor behaviors like head banging

Question 616

ANOREXIA NERVOSA
* Persistent what?
* Intense fear of what?
* Distorted what? (2)
* Cognitive distortions of what?
* Often engage in what?

Answer 616

• Persistent energy intake restriction
• Intense fear of gaining weight
• Distorted body self-perception
• Distorted self-image
• Cognitive distortions regarding food and eating
• Often engage in repeated weighing, measuring, and assessing their body in the mirror

Question 617

ANOREXIA NERVOSA
* What is key clinical features?
* What happens with children and teens?
* Associated with what?

Answer 617

• Key clinical feature – refusal to maintain body weight at or above a minimally normal level for age, sex, developmental trajectory, and physical health
• In children and adolescents- may be failure to make expected weight gain or to maintain a normal developmental trajectory instead of weight loss
• Associated with cardiac arrhythmias, growth retardation, osteoporosis) and mortality

Question 619

ANOREXIA NERVOSA- Diagnostic criteria
* Restriction of what?
* Intense fear of what?
* Persistent behavior that interferes with what?
* Disturbance in way a person experiences what?
* Undude influence of what?
* Persistent what?

Answer 619

• Restriction of energy intake relative to requirements leading to a significantly low body weight
• Intense fear of gaining weight or of becoming fat
• Persistent behavior that interferes with weight gain even though an individuals weight significantly low
• Disturbance in way a person experiences one’s body weight or shape
• Undue influence of body weight or shape
• Persistent lack of recognition of seriousness of current low body weight

Question 620

ANOREXIA NERVOSA- specifiers
* What is the restricting type and binge eating/purging type?

Answer 620

• RESTRICTING TYPE: during last 3 months, individual has not engaged in recurrent episodes of binge eating or purging behavior (self induced vomiting or misuse of laxatives, diuretics or enemas) Weight loss accomplished primarily through dieting, fasting, and/ or excessive exercise
• BINGE-EATING/PURGING TYPE: During last 3 months, individual has engaged in recurrent episodes of binge eating or purging behavior (self induced vomiting or the misuse of laxatives, diuretics, or enemas.

Question 621

Anorexia nervous:
* Often see what disorder when dealing with food?
* Suicide rate higher when?
* Binge eating/purging subtype demonstrated higher than expected rates of what?
* Individuals tend to appear what?
* Seem uninterested in what?

Answer 621

• Often see obsessive compulsive behavior- when dealing with food intake as well as general way person carries out affairs of daily life
• Suicide rate is higher in the restricting type
• Binge eating/purging subtype demonstrated higher than expected rates of substance use disorders
• Individuals tend to appear waif-like, child like
• Seem uninterested in usual adolescent preoccupations: sex; attraction to the opposite sex

Question 622

What are the sxs of anorexia nervosa?

Answer 622

Question 623

What are the medical complications of AN?

Answer 623

Question 624

Medical Complications of AN
* May hav electrolyte disrurbances if what?
* If vomiting-
* May see what?

Answer 624

• May have electrolyte disturbance if bulimic and purging : hypokalemic alkalosis. A metabolic alkalosis (elevated serum bicarbonate) caused by loss of stomach acid due to vomiting
• If vomiting- may have elevated serum amylase
• May see ST-segment and T-wave changes on EKG (usually associated with electrolyte changes)

Question 625

Pharm strategies for treating AN
* Pharm useful when?
* What med is first line?

Answer 625

Pharmacologic strategies may be useful as an adjunct to psychotherapy
* Anti-anxiety agents taken before meals May help an anorectic carry out a behavioral plan that includes a certain caloric intake->This is a time-limited strategy

Question 626

Pharmacologic strategies for treating Anorexia Nervosa
* Antidepressants can be useful with what?
* What can be used?

Answer 626

Antidepressants can be useful with depression, prominent neurovegetative signs, severe anxiety, or OCD- SSRIs
* Desired effects are decreased anxiety and depression, decreased obsessional thoughts about weight gain, increased interest in eating
* Anti-psychotics may be used. Zyprexa (Olanzapine) could be used for anxiety and depression. It causes weight gain in most cases

Question 627

What are non pharm treatments of AN?

Answer 627

Cognitive- Behavioral Therapy (CBT)

Dynamic Psychotherapy

Family Therapy
* Emphasis on this form of therapy as one of the major components of treatment has received more support recently (as it once was in the past)
* For adolescents there is growing literature suggesting they are gest treated using family approach (Maudsley Approach)

Question 628

What is the maudsley approach?

Answer 628

• Highly structured, manual based
• Requires a therapeutic staff highly skilled in managing such patients
• Parents encouraged to take control of individual’s eating behavior and other behaviors
• As patient gains weight and assumes responsibility, focus shifts to more traditional family and personal problems and typical adolescent issues

Question 629

When does a patient need to be hospitalized for AN?

Answer 629

• Weight significantly less than estimated healthy weight
• Rapid, persistent decline in oral intake or weight despite maximally intensive outpatient interventions
• Previous episode of physical instability at a certain weight
• Serious physical issues: Electrolyte or metabolic abnormalities
• Hematemesis
• H.R. less than 40 or greater than 110 bpm
• Inability to sustain body core temperature
• Comorbid psychiatric illness: suicidal, depressed, unable to care for self

Question 630

COURSE AND PROGNOSIS: AN
* What are good and bad prognostic factors?

Answer 630

Good prognostic factors
* Admission of hunger
* Lessening of denial
* Improved self esteem

Poor prognostic factors
* Initial lower weight
* Presence of vomiting or lax abuse
* Failure to respond to previous treatment
* Disturbed family relationships
* Conflicts with parents

Question 631

Bulimia nervosa
* What is it?
* A sense of what?

Answer 631

• Eating, in a discrete period of time (e.g., within any 2 hour period) an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
• A sense of lack of control over eating during the episode

Question 632

Bulimia nervous
* Recurrent what?
* What is the timeline?

Answer 632

• Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications, fasting; or excessive exercise
• Binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 weeks

Question 633

Bulimia nervosa may present ith what?

Answer 633

Question 634

Bulimia Nervosa
* Excessive what?
* What happens with DM patients?
* Some patients do what?
* Rarely-

Answer 634

Excessive exercise used by a subgroup of patients

Insulin-dependent patients with diabetes mellitus may restrict their insulin use as a way of inducing glucosuria and causing weight loss
* Dangerous- can result in neuropathy and retinopathy

Some patient regurgitate and re-swallow food (rumination)
Rarely- use of saunas to sweat off weight

Question 635

Bulimia Nervosa
* Sxs?

Answer 635

• Patients typically ashamed of eating problems
• Binge eating in secrecy
• Individuals are often within normal weight range and restrict total caloric consumption between binges
• Russell’s sign seen in those who self-induce vomiting (also seen in Anorexia)
• Hair loss
• Osteopenia
• fluid and electrolyte abnormalities from vomiting-> Dehydration, hypochloremia, hypokalemia, and metabolic alkalosis, as well as tachycardia and hypotension

Question 636

Bulimia nervosa
* Some may develop what? (KNOW)
* Irreg what?
* What is elevated if patient is vomiting?
* Enlargement of what?
* Erosion?
* What is uncommon but dangerous?

Answer 636

• Some evidence that many patients develop hypercortisolemia
• Irregular menses common
• Serum salivary amylase may be elevated if patient vomiting
• Enlargement of parotid gland
• Dental enamel erosion (from vomiting)
• Gastric dilatation and esophageal rupture uncommon but dangerous

Question 637

What is the txt for bulimia nervosa?

Answer 637

• Antidepressants, especially SSRIs (higher doses)
• The only medication approved by FDA for treatment of bulimia is fluoxetine
• Less effective than psychotherapy but still effective
• Recent trials with Topamax- Topiramate- for binge eating in bulimia and binge eating Disorder-> Not FDA approved and issues with cognition
• CBT best established therapy
• Interpersonal therapy has been effective
• Dynamic psychotherapy
• Is a growing literature indicating DBT (dielectical behavioral therapy) may be effective with some
• There are some other CBT-like therapies that are receiving attention

Question 638

Bulimia nervosa txt
* The components of the various cognitive behavioral treatment approaches include the following:

Answer 638

• Self monitoring
• Meal planning
• Cues and consequences
• Cognitive restructuring (particularly related to weight and shape issues and attitudes toward food

Question 639

BINGE EATING DISORDER
* Comparing individuals with bulimia nervosa and binge-eating disorder:

Answer 639

Individuals with binge eating disorder are generally older, more likely to be male, and have a later age at onset of the disorder

Question 640

BINGE EATING DISORDER
* What is not required for dx?
* An individual eats how much?
* Person feels like what?

Answer 640

• Weight and shape are not required for the diagnosis
• An individual eats an amount of food that is larger than what most people would eat in a discrete period of time
• The person feels she cannot stop eating or control what she is eating

Question 641

BINGE EATING DISORDER- criteria
* Associated with 3 or more of following:

Answer 641

• Eating much more rapidly than normal (Common among men)
• Eating until uncomfortably full
• Eating large amounts of food when not physically hungry
• Eating alone due to embarrassment about how much one is eating
• Feeling disgusted with oneself, depressed, or very guilty afterward (Most common among women)

Question 642

BINGE EATING DISORDER- criteria
* What is the duration? KNOW
* Tend to have family members who are what?

Answer 642

• Binge eating occurs, on average, at least once/week for 3 months
• They tend to have family members who are obese and they themselves have a history of heavier body weight before developing the disorder

Question 643

BINGE-EATING DISORDER
* Binge eating is what?
* No use of what?
* Individuals often try to restrict what?

Answer 643

• Binge eating is distressful
• No use of (inappropriate) compensatory behavior such as using cathartics, etc.
• Individuals often try to restrict their caloric intake early in the day and then binge-eat later in the day

Question 644

BINGE-EATING DISORDER- Epidemiology and Course
* BMI?
* Evidence suggests the disorder confers risk for what?
* Substance?
* May be associated with what?

Answer 644

• Evidence suggests these individuals meet criteria for obesity and also display an increased rate of severe obesity
• Evidence suggests the disorder confers risk for negative medical outcomes beyond effects of obesity
• Substance use disorder- most commonly alcohol abuse: 20-25%
• May be associated with impulse-control disorder and ADHD

Question 645

Binge eating:
* What are the medical complications?
* A significant fraction of individuals with binge-eating disorder display what? Presence of this feature seams to predict what?

Answer 645

• Metabolic, orthopedic, and sleep related disorders
• A significant fraction of individuals with binge-eating disorder display marked overvaluation of shape and weight
• Presence of this feature seams to predict a particularly severe form of the disorder that is resistant to typical treatment

Question 646

binge eating disorder
* Binge after what?
* They may have deficits in what?
* Some individuals report episodes are no longer characterized by what?

Answer 646

• Binge after periods of significant negative emotion
• They may have deficits in decision making resulting in a disinhibited behavioral style that might increase the risk of binge eating
• Some individuals report episodes are no longer characterized by an acute feeling of loss of control but a more generalized pattern of uncontrolled eating.

Question 647

What is the txt for binge eating?

Answer 647

Psychotherapy or behavior therapy (thought to be most efficacious)
* CBT (focuses on enhancing normal meal consumption and reducing inaccurate or unproductive cognitions about food, shape, or weight-related themes
* IPT (focuses almost exclusively on relationship problems and interpersonal patterns of behavior that precipitate binging episodes
* Guided self help (Uses CBT principals in a self-help meeting with a professional facilitating treatment)

Question 648

binge eating
* What is the pharm therapy and weight loss interventions?

Answer 648

Pharmacological interventions
* Imipramine, sertraline, citalopram/escitalopram, and topiramate

Weight-loss interventions
* Very low calorie diets promote weight loss and significantly reduce binge-eating frequency

Question 649

• What is purging disorder?
• What is night eating syndrome?

Answer 649

Purging: Recurrent purging behavior to influence weight or shape (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other meds) in absence of binge eating

NIGHT EATING SYNDROME: Recurrent episodes of night eating
* Awakening from sleep or by excessive food consumption after the evening meal
* Individual is aware and can recall the eating

Question 650

EVALUATION AND TREATMENT for any/all eating disorders
* Assess patients with bulimia nervosa or binge-eating/purging anorexia for: KNOW

Answer 650

• Parotid gland enlargement
• Submandibular adenopathy
• Dental caries
• Hand abrasions (Russell’s sign)
• Decreased or increased bowel sounds
• Rectal prolapse

Question 651

Labs:
* What is needed for purging behavior? Why?
* In AN, what is common?

Answer 651

Initial and periodic assessment of serum electrolytes for anyone with purging behavior
* Hypomagnesemia and hypokalemia common with those who purge

In anorexia nervosa
* Hypoglycemia common
* Leukopenia, neutropenia, anemia, thrombocytopenia

Question 652

EVALUATION AND TREATMENT for any/all eating disorders
* Treatment?

Answer 652

• Medical
• Weight restoration
• Correct electrolyte imbalances
• Vitamin supplementation
• Dental care
• Nutritional counseling
• COGNITIVE-BEHAVIORAL THERAPY is the best treatment for bulimia nervosa and for Binge Eating Disorder-BED. (CBT more effective than medication for both). In anorexia nervosa, CBT more effective when it includes a nutritional component

Question 653

EVALUATION AND TREATMENT for any/all eating disorders
* What is equally has effective as CBT for BED?
* Other therapies?

Answer 653

• Equally effective as CBT for bulimia but takes longer. Effective for BED
• Other therapies: Psychodynamic psychotherapy, dialectical behavioral therapy, motivational enhancement therapy, guided imagery, and guided self-change have shown to be effective in bulimia nervosa

Question 654

EVALUATION AND TREATMENT for any/all eating disorders
* Family?
* Group?
* What is effective for BED?

Answer 654

• FAMILY THERAPY effective for early-onset, non-chronic anorexia nervosa and is useful adjunctive modality for other eating disorders. More recently thought to be a more valuable treatment modality.
• Group psychotherapy is useful adjunctive therapy for anorexia and bulimia nervosa.
• Group CBT or IPT effective for BED