Psychiatry Flashcards
What is the most likely diagnosis?
Attention deficit/hyperactivity disorder (ADHD). ADHD is estimated to affect up to 8% of U.S. school-age children. Males are more affected than females, and children in North America are diagnosed with ADHD more often than children in other countries.
What are the typical manifestations of ADHD?
ADHD is characterized by hyperactivity, impulsivity, and inattention that lead to significant impairment. Hyperactivity manifests as fidgetiness and an inability to remain seated or play quietly. Impulsivity is displayed as the inability to wait for one’s turn, talking when inappropriate, and constantly interrupting. Inattention is characterized by forgetfulness, poor concentration, an inability to finish tasks, and a lack of attention to detail. To meet the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for ADHD, symptoms must be present before the age of 7 years, persist for at least 6 months, and be present in more than one setting (eg, at home and at school).
What are the known risk factors for ADHD?
Pregnant women who smoke or use drugs are at increased risk for having children with ADHD. Genetics also plays an important role, as one in four children with ADHD has at least one relative with the condition.
What is the appropriate treatment for ADHD?
Treatment includes behavioral interventions, pharmacological therapy, or both. Although it may seem counterintuitive, stimulants have shown great effect in treating patients with ADHD. Stimulants such as methylphenidate and dextroamphetamine act by increasing catecholamine release.
What is the natural course of ADHD?
Many patients with ADHD find that they “outgrow” it during adolescence. For a subset of patients, however, the disorder continues into adulthood; these patients benefit from pharmacotherapy.
What is the most likely diagnosis?
Autism
What is the classic triad of findings in Autism?
What is the epidemiology of Autism?
Autism is relatively rare, with a prevalence of approximately 2 per 1000 children. More common in boys (male-to-female ratio is approximately 4:1), autism presents in early childhood but is a lifelong condition. In addition, up to 70% of autistic children also meet the diagnostic criteria for mental retardation.
What is the etiology of Autism?
Autism is a heterogeneous disorder with a significant, although as yet uncharacterized, genetic component. There is no scientific evidence that vaccination causes autism.
What 3 other conditions should be considered in the differential diagnosis to Autism?
What is the appropriate treatment for Autism?
Behavior therapy and educational interventions can help many autistic individuals reduce maladaptive behaviors and gain greater functional independence.
This patient displays symptoms of what category of psychiatric disorders?
This patient’s symptoms are within the spectrum of mood disorders; specifically, she manifests symptoms of a manic episode of bipolar disorder. Other disorders in this class include major depressive disorder, dysthymic disorder, and bereavement.
What signs and symptoms are commonly associated with Bipolar Disorder?
How is Bipolar Disorder classified?
What are the appropriate treatments for Bipolar Disorder?
First-line drugs include mood stabilizers (lithium, valproate, or carbamazepine) and antipsychotic agents (olanzapine, haloperidol, or risperidone). Hospitalization may be necessary to ensure patient safety.
What is the most likely diagnosis?
Major depressive disorder.
What symptoms are commonly associated with Major depressive disorder?
The diagnosis of major depressive disorder requires two or more episodes of five of the following symptoms, present for at least 2 weeks: Sleep disturbances, decreased Interest, Guilt, decreased Energy, decreased Concentration, change in Appetite (usually decreased), Psychomotor retardation, and Suicidal ideations (mnemonic: SIG E CAPS) in addition to depressed mood. This patient cannot be diagnosed until additional symptoms are determined.
What other conditions can present with similar symptoms to Major depressive disorder?
Bereavement can present with depressive symptoms within 1 year of the loss of a loved one, but symptoms are related to that loss. Grief is characterized by shock, denial, guilt, and somatic symptoms. Depressive symptoms can also suggest dysthymia, a milder form of depression with less intense symptoms that lasts at least 2 years. **Adjustment disorder with depressed mood **also presents as a milder form of depression, but symptoms are usually in response to a significant psychological stressor (eg, marital or financial problems) and usually last less than 6 months.
What is the epidemiology of major depressive disorder?
Women are diagnosed with major depression at approximately twice the rate of men. Studies show that living in urban areas, being of lower socioeconomic status, and being married (for women only) are independent risk factors for major depression.
What neurotransmitter disturbances are common in ajor depressive disorder?
Patients with major depressive disorder commonly have decreased levels of serotonin and norepinephrine. Dopamine may also be decreased in major depression.
What are the appropriate treatments for major depressive disorder?
Psychotherapy, antidepressants (including selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and tricyclic antidepressants), or both may be appropriate. Electroconvulsive therapy can be used for major depressive disorder that is refractory to other treatments.
What is the most likely diagnosis?
Generalized anxiety disorder (GAD).
What signs and symptoms are commonly associated with Generalized anxiety disorder (GAD)?
What other conditions should be considered in the differential diagnosis to Generalized anxiety disorder (GAD)?
“Normal” worry and adjustment disorder should also be considered. Unlike individuals with normal anxiety, patients with GAD have evidence of social dysfunction secondary to the disorder. Adjustment disorder is characterized by emotional symptoms following an identifiable stressor (eg, divorce or loss of a job) and lasts < 6 months. By contrast, symptoms in GAD persist for > 6 months.
What are the appropriate treatments for Generalized anxiety disorder (GAD)?
- Antidepressants (selective serotonin reuptake inhibitors).
- Buspirone (a serotonin receptor partial agonist).
- Benzodiazepines (fast-acting sedatives).
- Cognitive-behavioral therapy.
What is the danger of using benzodiazepines to treat Generalised Anxiety Disorder (GAD)?
While benzodiazepines show beneficial effects in the short term, they are not recommended for long-term use, as they are associated with the development of tolerance, physical dependence, withdrawal, and addiction.
What is the most likely diagnosis?
What is the epidemiology of OCD?
OCD occurs in approximately 3% of the general population. Males are much more frequently affected than females. The disorder often runs in families and may be associated with tic disorders (eg, Tourette syndrome).
What are the appropriate treatments for OCD?
Selective serotonin reuptake inhibitors and clomipramine are common pharmacologic treatments. Cognitive-behavioral therapy is also used with and without pharmacologic therapy.
What is cognitive-behavioral therapy?
Cognitive-behavioral therapy is a manualized, time-limited type of psychotherapy that seeks to modify a patient’s emotions by identifying and adjusting maladaptive thought patterns and beliefs. In this patient, for example, turning 30 may represent the beginning of adulthood and the end to the impulsiveness of youth. The maladaptive thought may be, “If I count to 30, I am in control and an adult.” The cognitive component of therapy will challenge this irrational thought. The behavioral component will allow him to combat the need to count or check.
What comorbidities are associated with OCD?
The prevalence of major depressive disorder among individuals with OCD is as high as 30%. Panic disorders and social phobia also commonly coexist with OCD.
What is the most likely diagnosis?
This patient exhibits traits consistent with obsessive-compulsive personality disorder (OCPD). Personality traits are patterns of relating to or thinking about the world that are exhibited in various social and personal contexts. A personality trait becomes a personality disorder when the traits are extreme and/or exclude other traits, causing personal distress, problems functioning, and an adverse impact on the social environment. A person is often not aware of maladaptive personality traits.
How are personality disorders classified?
What is the most likely diagnosis?
Panic disorder.
How are panic attacks related to panic disorder?
What syndrome can develop when SSRIs are used with MAO inhibitors?
What is the most likely diagnosis?
Posttraumatic stress disorder (PTSD). PTSD is a complex and heterogeneous disorder characterized by reliving an extremely traumatic event with symptoms of increased arousal and avoidance. The disturbance must last more than 1 month and cause significant social and occupational distress.
What is the most likely diagnosis?
Rett disorder is a neurodevelopmental disorder characterized by initial normal development during the first 6–18 months of life followed by a loss of speech and loss of purposeful hand movements.
What is the progression of Rett disorder over time? (4 stages)
What is the most likely diagnosis?
The constellation of symptoms suggests schizophreniform disorder, which is the presence of psychotic symptoms for > 2 weeks but < 6 months. This contrasts a diagnosis of schizophrenia, which requires the presence of symptoms for at least 6 months. The majority of patients with schizophreniform disorder ultimately develop schizophrenia.
What is the most likely diagnosis?
Somatization disorder.
How are other conditions in the category of Somatization disorders differentiated?
What other conditions must be distinguished from Somatization disorder?
What is the most likely diagnosis?
Steroid-induced mania.
These symptoms could also be seen in which other psychiatric disorders?
These symptoms could also be evidence of delirium or a manic phase of bipolar disorder.
What is the most likely diagnosis?
Tardive dyskinesia. Extrapyramidal symptoms, such as stereotypic oral, buccal, or lingual movements and choreiform or athetoid movements, can occur after several months or years of therapy with antipsychotic agents. These symptoms are often irreversible.
What is the most likely diagnosis?
This patient displays criteria for Tourette disorder, which is characterized by multiple motor and vocal tics present since childhood. A tic is a sudden, stereotypical, repetitive movement or vocalization. The tics in Tourette disorder occur many times a day for at least 1 year.
What is the epidemiology of Tourette disorder?
