Psych path 4

Question 1

Postpartum mood disturbances:

Post partum blues

Answer 1

50-85% incidence rate
Depressed affect, tearfulness, fatigue lasting 2-3 days after delivery

Usually resolves in 10-14 days

Treatment: supportive, f/u for post partum depression

Question 2

Postpartum mood disturbances:

Post partum depression

Answer 2

10-15% incidence rate
Depressed affect, anxiety, and poor concentration
within 4 weeks after delivery
Lasts 2 wks to a year or more

Tx: antidepressant, psychotherapy

Question 3

Postpartum mood disturbances:

Post partum psychosis

Answer 3

0.1-0.2% incidence rate
Delusion, hallucination, confusion, usual behavior
Possible homocidal, suicidal ideation or attempt

Ususually lasts 4 to 6 wks

Tx: antipsychotic, antidepressant, possible inpt hospitalization.

Question 4

Electroconvulsive therapy

Answer 4

1) treatment for major depressive disorder refractory to other treatment
2) For pregnant women with major depressive disorder
3) when immediate response is necessary (acute suicidality)
4) depression with psychotic features, for catatonia

Produces painless seizures in anesthesized pts

Major side effects: disorientation, temporary anterograde and retrograde amnesia usually fully resolving in 6 months.

Question 5

Risk factor for suicide completion

Answer 5

Sex (male)
Age (teenage or elderly)
Depression

Previous attempt
Ethanol or drug sue
Rational thinking gone
Sickness (medial illness, >3 medical prescriptions)
Organized plan
No spouse
Social support lacking

Women try more often, men succeed more

SAD PERSONS

Question 6

Anxiety disorder

Answer 6

Inappropriate fear/worry and its physical manifestation when the source of fear is either not real or insufficient to account for the severity of the symptom

Symptoms AFFECT daily funcitoning
Lifetime prevalence of 30% in women and 19% in men

Panic disorder, phobias, OCD, PTSD, and GAD

Question 7

Panic disorder

Answer 7

Presence of recurrent periods of intense fear

PANICS:
Palpitation/Paresthesia
Abdominal stress
Nausea
Intense fear of dying or losing control, lightheadeness
Chest pain, chills, choking, disconnected
Sweating, shaking and SOB

Strong genetic component

Tx: CBT, SSRI, venlafaxine, benzo

Question 8

Specific phobias

Answer 8

Excessive and unreasonable fear and interferes with normal functioning.

Person recognizes that fear is excessive

Can treat with systemic desensitization

Question 9

Social phobias

Answer 9

(social anxiety disorder)

Exaggerated fear of embarrassment in social situation
(public speaking, using public restroom)

Treatment: SSRI
“Social phobia = SSRI”

Question 10

OCD

Answer 10

Intrusive thoughts, feelings, or sensations (obsessions)
Relieved partly by performance of repetitive tasks (compulsion).

Ego dystonic: behavior inconsistent with one’s belief and attitude (vs. obsessive-compulsive personality disorder)

Associated with Tourette’s disorder

Tx: SSRI, clomipramine (TCA)

“oCd=Clomipramine”

Question 11

PTSD

Answer 11

Traumatic events
Involve nightmares and flashbacks, intense fear, helplessness

Disturbance lasts > 1 month

Tx: psychotherapy, SSRI

Question 12

Acute stress disorder

Answer 12

Lasts between 2 days and 1 month
(vs. > 1 month in PTSD)

PTSD~aSD

Question 13

Generalized anxiety disorder

Answer 13

Pattern of uncontrollable anxiety for at least 6 months
Unrelated to specific person, situation or devent
Associated with sleep disturbances, fatigue, GI, concentration

Treatment: SSRI

“GAD=6 months, because G looks like 6”

Question 14

Adjustment disorder

Answer 14

(Compare to GAD~AD)
Emotional symptoms  (anxiety and depression) causing impairment following an identifiable psychosocial stressor (divorce, illness) 

Lasting less than 6 months (vs. >6 months in GAD)
(>6 months in the presence of stressor)

Question 15

Malingering

Answer 15

In order to attain a specific 2nd gain (avoiding work, drugs)
Poor compliance with treatment or f/u of dx tests

Complaints ceases after gain (vs. factitious order)

Question 16

Factitious disorder

Answer 16

Patient consciously created physical or psychological symptoms in order to assume sick role and to get medical attention (primary gain)

Question 17

Factitious disorder: Munchausen’s syndrome

Answer 17

Chronic factitious disorder with predominantly physical signs and symptoms

Multiple hospitalization and willingness to receive invasive procedures

Question 18

Factitious disorder: Munchausen’s by proxy

Answer 18

When illness in a child or elderly is caused by the caregiver.
Motivation is to assume a sick role by proxy

Form of child/elder abuse

Question 19

Somatoform disorder

Answer 19

Physical symptoms with no identifiable physical cause
Both illness production and motivations are unconscious drives

Symptoms NOT intentionally produced or feigned.

More common in women

Question 20

Somatoform disorder:

somatization disorder

Answer 20

Variety of complaints in multiple organ systems
(at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic)
Over a period of years, developing before age 30 years

Question 21

Somatoform disorder:

conversion

Answer 21

Sudden loss of sensory or motor function
(paralysis, blindness, mutism), often following an acute stressor.

Patient always aware but sometimes indifferent toward symptoms (la belle indifference)

More common in females, adolescents, and young adults

Question 22

Somatoform disorder:

hypochondriasis

Answer 22

Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance

Question 23

Somatoform disorder:

Body dysmorphic disorder

Answer 23

Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning.

Patient often repeatedly seek cosmtic surgery.

Question 24

Somatoform disorder:

pain disorder

Answer 24

Prolonged pain with no physical finding.

Pain is the predominant focus of clinical presentation and psychological factors play an important role in severity, exacerbation, or maintenance of the pain