Psychiatry Flashcards
DSMV criteria for a major depressive episode
2-wk duration of a change in previous functioning in which at least 5/9 symptoms must occur on more days than not, and at least 1 of the symptoms must be either depressed mood or loss of interest or pleasure:
SIGECAPS
Sleep disturbance (insomnia or hypersomnia)
Interest in activities decreased—anhedonia
Guilty feelings or feeling worthless
Energy decreased—fatigue
Concentration decreased or indecisiveness
Appetite change (gain or loss of weight)
Psychomotor agitation or retardation
Suicidal thoughts
mainstay of pharmacologic treatment of MDD
SSRI
criteria for dysthymia for adults?
-low-grade chronic depression occurring most of the day for more days than not and lasting at least 2 years without more than 2 months of symptom remission
-at least 2 of the following: sleep disturbance,
appetite change, low energy, poor concentration or indecisiveness, low self-esteem, and hopelessness
criteria for dysthymia for adolescents or children
same as in adults but mood can be irritable instead of depressed, and the minimum duration is 1 year
What defines a bipolar I disorder?
-manic + depressive episodes
-manic episode defined by >=7 days of euphoric mood or extreme irritability with at least 3 (4 if the mood is only irritable) of the symptoms DIGFAST:
Distractibility
Insomnia
Grandiosity
Flight of ideas
Activities (increased goal-directed activities) or
Agitation
Speech (increased or pressured speech)
Thoughtlessness
What defines a bipolar II disorder?
hypomanic episodes (defined as 4-7 days of DIGFAST) and major depressive episodes
Cyclothymia
sustained cycling of mood in which there are hypomanic episodes, but the depressive episodes do not meet criteria for a major depressive episode
AEDs used for bipolar disorders
valproic acid
carbamazepine
oxcarbazepine,
lamotrigine
The signature feature of panic disorder
recurrent, unexpected panic attacks
Agoraphobia
intense anxiety about being in places or situations from which egress may be difficult or embarrassing, or in which assistance mightbe unavailable
Treatment of panic disorder
Cognitive behavioral therapy (CBT) and exposure therapy +/- anxiolytic
OCD is believed to be a neurobiological illness tied in part to
serotonergic dysregulation
Most effective treatment of OCD
combination of a serotonergic agent and CBT
Acute Stress Disorder vs PostTraumatic Stress Disorder
ASD >= 2 days of symptoms
PTSD >= 1 month
What characterizes Acute Stress Disordedr?
- development of physiologic and psychological responses that occur following exposure to 1 or more situations involving death, serious injury, or a threat to physical integrity
- > =3 dissociative symptoms
3 cardinal features of PTSD
- hyperarousal
- flashbacks of the initial trauma
- psychic numbing , avoidance of reminders of thentrauma
Treatment of PTSD
trauma-focused, exposure-based CBT
Generalized anxiety disorder (GAD) is manifested by
symptoms associated with excessive anxiety and worry occurring more days than not during a time frame of at least 6 months resulting to functional impairment
Treatment of specific phobias
Behavioral or cognitive behavioral therapies
3 components: exposure, systematic desensitization, and participant modeling
4 main treatment approaches for social phobia:
exposure-based strategies, cognitive therapy, social skills training, and applied relaxation
Somatic symptom disorders
Multiple somatic complaints not fully explained by a medical condition or substance use
Conversion disorder
- Voluntary but unconscious motor or sensory function deficits that suggest a general medical or neurologic condition
- Symptoms do not fit known physiologic mechanisms
Hypochondriasis
Preoccupation with having or acquiring a serious illness
Factitious disorders
Physical or psychological symptoms that are purposely feigned to achieve the sick role (the primary gain) with potentialpersonal benefits (the secondary gain)
Malingering
Physical or psychological symptoms purposely feigned and consciously motivated by an external incentive (the primary gain is receiving compensation, avoiding prosecution, or receiving another personal benefit)
The neurotransmitter implicated in schizophrenia pathophysiology
dopamine
Criterion A consists of active-phase symptoms of schizophrenia
2/5 >=1 month Delusions, hallucinations Disorganized speech Disorganized behavior Catatonic signs Negative symptoms (eg, blunted affect, social withdrawal)
Schizophrenia Criterion B
significant social, occupational, self-care, or educational dysfunction as the result of the symptoms and signs
Criterion C
active-phase symptoms >=1 month (or less if being treated), but the total duration of illness, including prodromal and residual symptoms, >= 6 months
Schizophrenia longitudinal course specifiers 4
1 episodic with interepisode residual symptoms
2 episodic with no interepisode residual symptoms
3 continuous
4 single episode
Subtypes of Schizophrenia. Describe each.
Disorganized: Presence of disorganized speech and behavior along with flat or inappropriate affect and absence of catatonic signs
Paranoid: Presence of ≥1 delusions or auditory hallucinations in the absence of significant other active-phase symptoms Catatonic: Presence of ≥1 prominent catatonic signs
Undifferentiated: Presence of active-phase symptoms that do not meet criteria for any of the other 3 types above
Residual: Attenuated psychotic signs or negative symptoms that do not meet criterion A
Schizophreniform disorder
essential clinical features of schizophrenia, which include prodromal, active-phase, and residual symptoms, lasting at least 1 month but no more than 6 months
Schizophreniform good prognostic indicators 4
1
What is a Schizoaffective disorder?
a major depressive or manic episode and also meet criterion A for schizophrenia concomitantly with the mood episode, but who have delusions or hallucinations without mood symptoms for >=2 weeks
Brief psychotic disorder is
a syndrome of psychosis that lasts ≥1 day but ≤1 month and is not caused by a substance or general medical condition
Subtypes of Delusional Disorder
Erotomanic Jealous Grandiose Somatic Persecutory Mixed Uncharaccterized
DSM V definition of personality disorder
an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment
PD Cluster types
Cluster A odd or eccentric character
Cluster B dramatic, emotional, or erratic
Cluster C anxious or fearful
Cluster A Personality Disorders
Paranoid
Schizoid
Schizotypal
Cluster B Personality Disorders
Antisocial
Borderline
Histrionic
Narcissistic
Cluster C Personality Disorders
Avoidant
Dependent
Obsessive-compulsive
Infancy Life stage
Freud:
Erikson:
Piaget:
Freud: Oral
Erikson: basic trust vs mistrust
Piaget: sensorimotor
Toddler life stage
Freud:
Erikson:
Freud: Anal
Erikson: autonomy vs shame and doubt
Preschool life stage
Freud:
Erikson:
Piaget:
Freud: phallic
Erikson: initiative vs guilt
Piaget: concerete operational
School age life stage
Freud:
Erikson:
Freud: latency
Erikson: industy vs inferiority
Early adolescence life stage
Freud:
Erikson:
Freud: genital
Erikson: identity vs role confusion
*eating disorders, schizophrenia, mood disorders, substance use
Late adolescence life stage
Freud:
Erikson:
Freud:
Erikson: initmacy vs isolation
Adulthood life stage
Erikson:
Erikson: generativity vs stagnation
Erikson’s eighth stage
integrity versus despair
