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Psych Clerkship > Psych Review Notes 5 > Flashcards

Psych Review Notes 5 Flashcards

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1
Q

What are four ways in which the anxiety response goes from normal to pathological?

A

Autonomy- anxiety sxs w/out obvious reasons
Intensity- response out of proportion
Duration- lasts longer than expected
Behavior- coping mechs overwhelmed giving anger, depression, agitation, etc.

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2
Q

List the Anxiety Disorders

A

Panic Disorder, GAD, OCD, PTSD
Social Phobia, Specific Phobia

Note: phobias are the most common mental disorder, followed by Substance Abuse, MDD then OCD.

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3
Q

Are Anxiety disorders more common in women or men?

A

Women (30% lifetime)» Men (19% lifetime)

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4
Q

Why are SSRI’s started at low dose in pts with panic disorder?

A

Pts more prone to the early “activation” s/e of SSRI’s where pts feel a more jittery/anxious/restless

Pts take this as worsening anxiety.

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5
Q

Common comorbid conditions w/anxiety disorders?

A

Substance Abuse
Personality disorders (generally Cluster C-avoidant)
Other anxiety disorders (comorbidity is the rule)

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6
Q

What two conditions can be differentiated based upon CO2 inhalation test?

A

Panic Disorder (will induce panic attack) vs. GAD (will not)

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7
Q

Which condition is known to increase glucose metabolism in the brain?

A

OCD (inc glucose metab)

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8
Q

What are some general medical conditions that cause anxiety symptoms?

A

1-Endocrine, including hypoglycemia and secreting tumors such as pheo/carcinoid/insulinoma
2-Cardiovascular-angina, arrhythmias, palpitations, CHF
3-Pulmonary-PE, COPD, Asthma
4-Irritable Bowel Syndrome
5-Caffeinism
6-Drugs
7-Severe Anemia

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9
Q

Likely patient and presentation of Panic Disorder?

A

20s or earlier, generally a dramatic onset with panic attack pt remembers for rest of life.

Pt usually goes to PCP first because of physical symptoms. May try to medicate with drugs, alcohol.

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10
Q

What is the DSM criteria for panic disorder?

A

Patients need to have all three:

  1. Recurrent unexpected panic attacks (peak w/in 10 min)
  2. Phobic avoidance (avoid situations assoc w/attacks)
  3. Anticipatory anxiety (worried about future attacks or implications of future attacks such as MI, ‘going crazy’, losing control, etc)
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11
Q

What risk factors do patients with Panic Disorder have?

A

Highest risk of suicide of all anxiety disorders
Increased risk of CV problems & stroke
Comorbidity w/other Axis I is the rule (not exception)
No good way to predict agoraphobics

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12
Q

What is the DSM criteria for GAD?

A

Frequent/persistent worry and anxiety that’s out of proportion

  • pts must be bothered by degree of worry.
  • they don’t worry about another anxiety disorder

Need 3 out of 6 for 6+ months (typical time):
1-restless or feeling keyed up or on edge
2-being easily fatigued
3-difficulty concentrating or mind goes blank
4-irritable
5-muscle tension
6-sleep disturbances

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13
Q

When do pts present with OCD? When is it worse?

A

OCD generally presents in early to mid-twenties
Unusual after 50, almost never after 65
Worsen in pregnancy & postpartum period

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14
Q

What is the DSM definition of OCD?

A

Either Obsessions or Compulsions (may be both)
Pts think these behaviors are unreasonable or excessive
Behaviors cause distress & impair functioning
If another d/o is involved, OC are not limited to it
-not only obsessed w/food if pt also has eating d/o

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15
Q

What are some common obsessions?

A

Aggressive (thinking will hurt someone or desires injury to others)
Contamination, Symmetry or Exactness
Somatic, Hoarding/Saving
Religious, Sexual (unsure of orientation, thinking will molest kids, etc)
**Most pts have multiple of the above (>60% are more than 1)

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16
Q

What are compulsions and what are some common ones?

A

Repetitive behaviors OR mental acts a person feels DRIVEN to perform in response to an obsession or to rules which must be applied rigidly
-compulsions are aimed at preventing/reducing distress or a dreaded event or situation
Checking, Washing, Repeating, Ordering/Arranging, Counting, Hoarding.

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17
Q

What things predict a poorer treatment response in OCD?

A

Sexual/religious obsessions, poor insight into illness, hoarding, comorbid depression/PD or social anxiety

18
Q

What is the DSM criteria for PTSD?

A

Pts need to have symptoms in each of three broad categories
-Re-experiencing of events
-Avoidance of Stimuli
-Increased arousal (need 2 in this category)
sleep issues, irritable/angry, can’t concentrate, hypervigilance, exaggerated startle response.

19
Q

How is Acute Stress Disorder timeframe different than PTSD?

A

ASD=occurs w/in 1 month and lasts at least two days with remission within 1 month. Pts have PTSD symptoms in 3 categories PLUS sense of numbing, detachment, depersonalization.

PTSD symptoms last for more than 1 month.

20
Q

What are the time-frames for Acute, Chronic and Delayed PTSD?

A

Acute- onset w/in 3 months, Duration less than 6 mo
Chronic- onset w/in 3 months, Duration more than 6 mo
Delayed onset- occurs more than 6 mo after trauma

21
Q

What are some risk factors for PTSD? Protective factors?

A

Female, Assaultive Violence (rape, physical assault), Prolonged or repeated exposure, Childhood trauma or separation from parents during childhood.

Protective: high religiosity

22
Q

The presence of psychological symptoms after a stressful but
Non-life threatening event suggests what disorder?

A

Adjustment Disorder (not an anxiety disorder)

  • maladaptive behavior or emotional sx after stressful life event such as divorce, death of loved one, loss of a job.
  • symptoms cannot be from bereavement
  • symptoms begin w/in 3 mo and end w/in 6 mo
23
Q

What is the DSM definition of social phobia

-social anxiety disorder?

A

Persistent fear of 1+ social situations where pt is exposed to new people or is under scrutiny

  • pt fears that they will be humiliated or embarrassed
  • pt recognizes fear is unreasonable (unless it’s a kid)
  • onset generally in adolescence, sometimes resolves by age 25.
24
Q

What is the order in life in which specific phobias develop?

A 
Animal Type (animals or insects)—childhood		
Environmental Type (water, storms)---childhood
Blood-Injury-Injection Type-childhood to adolescents
	*highly familial, strong vasovagal response
Situational Type (tunnels, airplanes, bridges)-adulthood
25
Q

How does DSM define a PD?

A 
Enduring pattern (“pt always been this way”) of behavior that deviates from the patient’s CULTURE. 
-Pattern manifests in 2 or more areas of functioning such as cognitive, affectivity, interpersonal functioning or impulse control.
1st Aid: CAPRI (cognitive, affect, personal relations, impulse)
26
Q

What are the three clusters and the subtypes within?

A

Cluster A: Odd or Eccentric
-paranoid, schizoid, schizotypal
Cluster B: Dramatic, Erratic or Emotional
-borderline, histrionic, antisocial, narcissistic
Cluster C: Anxious or Fearful
-Avoidant, OCPD, Dependent

27
Q

Differentiate between the type A (odd/eccentric) cluster diagnoses.

A

A-Paranoid: suspicious of other people. Assume motives are hostile when benign. Look for hidden messages.

A-Schizoid: “loners” do not enjoy social relationships. Constricted affect. Prefer solitary tasks. Okay alone.

A-Schizotypal: “loners” w/magical beliefs, have eccentric thoughts and behaviors, may be disordered in thinking

In Kids: think more of Autism or Asperger’s

28
Q

Give assoc for each of the Cluster B (dramatic/erratic) diagnoses.

A

B-Borderline: intense relationships, black & white thinking, “splitting” as defense mech, may have hx of sexual abuse/trauma.

B-Narcissistic: grandiose view, want to be admired, superiority complex, VERY sensitive to critique.
-Become depressed when don’t get recognition they deserve.

B-Antisocial: disregard rights of others, lack empathy or feelings of guilt. Generally some aspect before age 15. Often w/substance abuse history & legal problems.
-hx of behavior like this in a child may suggest conduct disorder

B-Histrionic: dramatic & attention-seeking behavior. Theatrical. Draws attention to self. Superficial & seductive.

29
Q

Give assoc for each of the Cluster C (anxious, fearful) diagnoses.

A

C-Avoidant: fears rejection or criticism. Hyperaware of cues that may mean they are being mocked or criticized.

C-Dependent: rely on others, submissive, clingy behavior. Will agree to avoid abandonment.

C-OCPD: more “perfectionism” than true OCD. Pts are inflexible, bothered by routine changes, need to be in control of situations, are upset when not in control.

30
Q

What is the first problem of treating Personality Disorders?

A

The comorbid disorder (Axis I) must be treated 1st

  • changes in behavior are very small and take a long time
  • patients may not recognize their problems or follow treatment
31
Q

Which PD has an increased correspondence with childhood

Sexual trauma or abuse?

A

Borderline PD

-pt’s goal in ‘splitting’ is to minimize internal distress, meet personal needs, a survival mechanism

32
Q

Which cluster of PD has a familial association with psychotic disorders?

A

Cluster A (schizoid, schizotypal, paranoid)

33
Q

Which PD has been shown to be most successfully treated with drugs?

A

Borderline PD

34
Q

Which PD uses the defense mechanism of regression?

A

Histrionic PD

-pts very theatrical, perceive relations as more intimate than they are, inappropriately seductive or provocative

35
Q

Which PD does this patient have?
Patient states wife cheating on him because he doesn’t have a good enough
Job to care for her needs and is certain that he cannot trust his wife.

A

Paranoid
-note unlike schizophrenia, PDD pts do not have fixed delusions and are not frankly psychotic. Pts tend to have lifelong marital and job problems.

36
Q

Patient dresses in a space suit to work 2x a week and has computers set up
In his basement to detect time of alien invasions. Pt denies AH or VH.

A

Schizotypal

  • pts can have ideas of reference (TV speaks to them, etc but these may not be delusional), magical thinking (superstitious, fantasies, telepathy or clairvoyance)
  • note that schizoid PD pts don’t have eccentric behavior.
37
Q

Patient slit her wrists because things didn’t work out with a guy she dated for
3 weeks. She states that all guys are jerks and dating is “not worth my time.”

A

Schizotypal

  • pts can have ideas of reference (TV speaks to them, etc but these may not be delusional), magical thinking (superstitious, fantasies, telepathy or clairvoyance)
  • note that schizoid PD pts don’t have eccentric behavior.
38
Q

Patient slit her wrists because things didn’t work out with a guy she dated for
3 weeks. She states that all guys are jerks and dating is “not worth my time.”

A

Borderline

  • unstable self-image, labile relationships, suicide attempts, inappropriate anger, vulnerable to abandonment.
  • “every other dr I met before you was horrible”
39
Q

How is social phobia different from Avoidant PD?

A

Social phobia-fear of embarrassment in particular setting like public speaking, using public restroom, eating in public
Avoidant PD-fear of rejection with sense of inadequacy

40
Q

What are some risk factors for OCPD?

A

Men»Women; First-born child
-remember OCPD is ego-syntonic, pts are motivated by work and feel that they are more devoted to work than others. They are not efficient and will not delegate tasks.

41
Q

Which condition thought to be caused by autoimmune response to streptococcus in kids?

A

OCD kids=PANDAS (peds autoimmune neuropsych d/o assoc w/Strep)

42
Q

What are some neurologic conditions that cause secondary anxiety symptoms?

A

1-Temporal Lobe Epilepsy (mult daily panic attacks, brief episodes of altered awareness or memory gaps)
2-Parkinson’s Disease (after 60), mimics GAD
3-Post-Concussion Syndrome (dizziness w/o syncope, cognitive defects), mimics GAD, Panic disorder
4-Multiple Sclerosis (incidence peaks in young adults and in pts over 40), vague and fluctuating presentation with cerebellar signs, optic neuritis and weakness. Mimics GAD.
5-Meniere’s disease, migraines (mimic Panic Disorder)

Psych Clerkship (6 decks)

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