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Behavioral Sciences > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Bipolar Disorder subtypes

A
  • Bipolar I: at least 1 manic or mixed episode
  • Bipolar II: at least 1 MDE and hypomanic episode
  • Rapid cycling: 4 or more episodes (MDE, manic, mixed, or hypomanic) in 1 year
  • Cyclothymic
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2
Q 
Neurocognitive Disorder (Dementia)
(Work up)
A
  • A careful history and physical is critical. Serial mini-mental state exams should be performed
  • Rule out treatable causes; obtain CBC, Rapid pasma reagin (RPR),Comprehensive metabolic panel (CMP), Thyroid function tests (TFTs), HIV, B12/folate, ESR, UA, and head CT or MRI
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3
Q 
Neurocognitive Disorder (Dementia) 
(Definition and Presentation)
A
  • Decline in cognitive functioning with global deficit, but level of consciousness is stable
  • Memory impairment (amnesia [partial or total) and 1 or more of the following:
  • Aphasia (language impairment)
  • Apraxia (inability to perform motor activities)
  • Agnosia (inability to recognize previously known objects/places/people)
  • Impaired executive function (problems with planning, organizing, and abstracting) in the presence of clear sensorium
  • Personality, mood, and behavior changes are common (e.g., wandering and aggression)
  • Only 15% is reversible
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4
Q

Postpartum Psychosis

A
  • Within 2-3 weeks after birth
  • Depression, delusions and thoughts of harm
  • May have thoughts of harming baby
  • Rx: anti-psychotics, lithium, and possibly anti-depressants
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5
Q

Korsakoff Syndrome

A
  • Amnesia (anterograde > retrograde)
  • Caused by B1 deficiency and associated with mammillary bodies destruction
  • Seen in alcoholics as a late neuropsychiatric manifestation of Wernicke’s encephalopathy
  • Confabulations are characteristic
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6
Q

Bipolar Disorder facts

A
  • Both sexes affected equally
  • Prevalence is 1% for type I and 4% for type II
  • Average age of onset 20
  • Up to 10-15% commit suicide
  • Most genetic of all psychiatric disorders
  • High SES more likely
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7
Q

Bipolar Disorder treatment

A
  • Acute mania:
  • acute therapy: anti-psychotics
  • Maintenance therapy: mood stabilizers (lithium, carbamazepine, valproic acid, lamotrigine
  • Benzodiazepines for refractory agitation
  • Bipolar depression: mood stabilizers +/- anti-depressants. Start mood stabilizers first to avoid inducing mania. ECT for refractory cases
  • Bipolar II with predominantly depressive features: anti-depressants can be augmented with low dose lithium
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8
Q

Pervasive Developmental Disorders (PDD)

Definition, Findings, Types, Associations

A
  • Abnormal or impaired social interaction and communication together with restricted activities and interests evident before age of 3
  • Patients fail to develop normal social behaviors (e.g., social smile, eye contact) and lack interest in relationships
  • Development of spoken language is delayed or absent
  • Children show stereotyped speech and behavior (hand flapping) and restricted interests (preoccupation with parts of objects
  • It includes Autism, Asperger’s syndrome, Rett disorder and childhood disintegrative disorder
  • Associated congenital conditions are tuberous sclerosis and fragile X syndrome
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9
Q

Major Depressive Disorder subtypes

A
  • Psychotic features: mood-congruent
  • Post-partum: occurs within 1 month post-partum
  • Atypical: weight gain, hypersomnia, and rejection sensitivity
  • Seasonal
  • Double depression: MDE in a patient with dysthymia
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10
Q

Dysthymia

A
  • Presence of depressed mood that lasts most of the day and is present almost continuously for more than 2 years
  • The patient is functional but at suboptimal level
  • Rx: anti-depressants and psychotherapy
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11
Q

Anxiety (Neurotransmitter Changes)

A
  • Increased NE

- Decreased GABA and 5-HT

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12
Q

Cluster C Personality Disorders

Other name, Enumerate, Clinical dilemma, Strategy

A
  • Anxious and Fearful “Worried or Wimpy”
  • Obsessive-Compulsive, Avoidant, Dependent
  • Patients are controlling and may sabotage their treatment. Words may be inconsistent with actions
  • Avoid power struggles. Give clear recommendations, but do not push patients into decisions
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13
Q

Asperger’s syndrome

A
  • Boys > Girls
  • Normal IQ and language development
  • Preoccupied with rules
  • Rx: improve relationships with others
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14
Q

Attention and Info processing deficits in schizophrenia

A
  • Smooth pursuit eye movement (SPEM): 80% of patients have impaired capacity of following a slow moving target which showed as saccadic eye movement
  • Prefrontal cortical (PFC) impairment: decreased physiological activity when faced with cognitive tasks, impaired performance on the Wisconsin Card Sort Test (WCST) [sensitive to prefronatl dysfunction]
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15
Q

Schizophrenia Prognosis

A
  • 33% lead normal life
  • 33% experience symptoms but function in society
  • 33% require frequent hospitalization
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16
Q

Major Depressive Disorder treatment

A
  • Cognitive Behavioral Therapy (CBT)
  • Anti-depressants: SSRIs are the first line: effective in 50-70% of patients. Allow 2-6 weeks to take effect and treat for 6 or more months
  • CBT combined with anti-depressants is more effective than either treatment alone
  • Electroconvulsive therapy (ECT):
  • Safe, and highly effective and often lifesaving that reserved for refractory depression or psychotic depression or if rapid improvement in mood is needed
  • May be used for intractable mania and psychosis. Usually requires 6-12 treatments
  • S/E: postictal confusion, arrhythmia, headache and anterograde amnesia
  • C/I: recent MI/stroke, intracranial mass and high anesthetic risk
  • Phototherapy
  • Transcranial magnetic stimulation (TMS): not as effective as ECT
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17
Q

Postpartum Depression

A
  • Within 1-3 months after birth
  • Depressed mood, weight changes, sleep disturbances, and excessive anxiety
  • May have negative feelings toward baby
  • Rx: anti-depressants
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18
Q

Illness Anxiety Disorder (Hypochondriasis)

Diagnosis and Treatment

A
  • Preoccupation with or fear of having serious disease despite medical reassurance
  • Rx: psychotherapy
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19
Q

Major Depressive Disorder differential diagnosis

A
  • Mood disorder due to medical condition (hypothyroidism, Parkinson’s disease, CNS neoplasm, other neoplasms [like pancreatic cancer], stroke [especially ACA stroke], dementia, parathyroid disorders)
  • Substance induced mood disorders (illicit drugs, alcohol, anti-hypertensives, corticosteroids and OCPs)
  • Adjustment disorder with depressed mood
  • Normal bereavement
  • Dysthymia
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20
Q

Autism

A
  • Boys > Girls
  • 80% IQ below 70
  • Language development delay
  • Linked to chromosomes 11 and 15
  • Rx: behavioral techniques (shaping), if aggressive give anti-psychotic medications (risperidone)
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21
Q

Huntington’s Disease (Neurotransmitter Changes)

A
  • Decreased GABA and ACh

- Increased dopamine

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22
Q

Bulemia Nervosa

Facts, Associations, Findings, Diagnosis

A
  • Risk factors: female gender and low self esteem
  • Low baseline serotonin concentrations
  • One-third have alcohol or drug problem
  • Associated with mood disorders and OCD
  • Patients have normal weight or are overweight
  • Dorsal hand calluses from induced vomiting (Russell sign), parotitis, enamel erosion, electolyte disturbances and alkalosis
  • Binge eating with inappropriate compensatory behavior occurring weekly for at least 3 months
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23
Q

Left vs Right cerebral hemispheres

A
  • Left is dominant in 97% of population. 60-70% in left handed persons. Language, logic, math and analytic thought. Stroke is more likely lead to depression
  • Right holistic thought, intuition, creativity, art and music. Stoke is more likely lead to apathy and indifference
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24
Q

Rett disorder

A
  • Girls > Boys
  • Low IQ and delayed language development
  • A genetic neurodegenerative disorder (X-linked dominant) that presents after 5 months of normal development
  • Microcephaly, hand wringing, with progressive encephalopathy and ataxia
  • Rx: symptomatic, behavior therapy for self-injurious behavior, and physiotherapy for muscular dysfunction
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25
Q

Obsessive Compulsive Disorder

Diagnosis and Treatment

A
  • Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by performance of repetitive actions (compulsions)
  • Ego-dystonic vs OCPD (ego-syntonic)
  • Associated with Tourette syndrome
  • Increased frontal lobe metabolism and activity in caudate nucleus
  • Rx: SSRIs are first line, CBT using exposure and desensitizing relaxation techniques, patient education and clomipramine
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26
Q

Body Dysmorphic Disorder

Diagnosis and Treatment

A
  • Preoccupation with an imagined physical defect or abnormality. patients often present to dermatologists and plastic surgeons
  • Rx: SSRIs
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27
Q

Avoidant Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Socially inhibited; rejection sensitive. Fear being disliked or ridiculed
  • Common
  • Possible deforming illness
  • None
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28
Q

Somatic Symptom Disorder (Somatization)

Diagnosis and Treatment

A
  • Multiple, chronic somatic symptoms from different organ systems with significant functional impairment
  • Onset below age of 30
  • Men to women 1:20
  • Rx: psychotherapy
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29
Q

Dissociative Amnesia

A
  • Inability to recall important personal info, usually subsequent to severe trauma or stress
  • May be accompanied by dissociative fugue
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30
Q

Medical complications of eating disorders

A
  • Constitutional: cachexia, hypothermia, fatigue, electrolyte disturbances (hypokalemia, pH abnormalities)
  • Cardiac: arrhythmias, sudden death, hypotension, bradycardia, and prolonged QT interval
  • GI: dental erosions and decay, abdominal pain, and delayed gastric emptying
  • GU: amenorrhea, and nephrolithiasis
  • Others: Lanugo hair, leukopenia, seizures, osteoporosis, stress fractures (metatarsal due to loss of pulsatile GnRH secretion)
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31
Q

Anterograde Amnesia

A

Inability to recall things that occurred after a CNS insult (decreased acquisition of new memory)

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32
Q

Generalized Anxiety Disorder

Diagnosis and Treatment

A
  • Uncontrollable, excessive anxiety or worry about multiple activities or events that leads to significant impairment or distress
  • Should be for 6 months or more and associated with 3 or more somatic symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, disturbed sleep)
  • Rx:
  • Short term: benzodiazepines for immediate relief. Taper them and do not stop “cold turkey” (potentially lethal withdrawal symptoms)
  • Long-term: Lifestyle changes, psychotherapy, medications (SSRIs are first line, venlafaxine and buspirone). Patient education is essential
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33
Q

Attention Deficit Hyperactivity Disorder (ADHD)

Facts, Associations, Diagnosis, Treatment

A
  • More in boys. Between ages 3-13 years and up to 50% continue into adulthood
  • Associated with lower dopamine and NE levels. Strongly associated with Williams syndrome
  • Diagnosis is done by presence of Inattention, hyperactivity, and impulsivity for 6 or more months and affects at least 2 areas (schoolwork, home)
  • Rx:
  • Psychostimulants (Methylphenidate [Ritalin], dextroamphetamine (S/E: insomnia, decreased appetite and headache
  • Atomoxetine (Strattera): NE reuptake inhibitor (the preferred answer option
  • Anti-depressants (e.g., SSRIs, nortriptyline, bupropion) and alpha-2 agonists (e.g., clonidine)
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34
Q

Alzheimer’s Disease (Neurotransmitter Changes)

A
  • Decreased ACh

- Increased glutamate

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35
Q 
Neurocognitive Disorder (Dementia)
(Causes or types)
A
  • Alzheimer’s disease (most common)
  • Vascular dementia (second most common) [Lateralizing signs present vs Alzheimer’s]
  • Degenerative diseases (Parkinson’s, Huntington’s, and Pick’s disease [frontal lobe dementia])
  • Endocrine (thyroid, parathyroid, pituitary, adrenal)
  • Metabolic (alcohol, electrolytes, vitamin B12 deficiency, glucose, hepatic, renal, Wilson’s disease)
  • Exogenous (heavy metals, carbon monoxide, drugs)
  • Neoplasia
  • Trauma (subdural hematoma)
  • Infection (meningitis, encephalitis, endocarditis, syphilis, HIV, prion disease, Lyme disease)
  • Affective disorders (pseudodementia)
  • Stroke/Structure (vascular, ischemia, vasculitis, normal pressure hydrocephalus)
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36
Q

Schizotypal Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Odd behavior, perceptions, and appearance. Magical thinking, ideas of reference
  • Men > women
  • None
  • None
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37
Q

Schizoid Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Isolated, detached “loners”. Restricted emotional expression
  • Men > women
  • Increased incidence in families with schizophrenia
  • None
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38
Q

Depression (Neurotransmitter Changes)

A

Decreased NE, 5-HT and dopamine

39
Q

Schizophrenia treatment and long-term course

A
  • First line is atypical anti-psychotics like risperidone
  • Positive symptoms associated with dopamine receptors, while negative symptoms with muscarinic receptors
  • Typical anti-psychotics treat positive symptoms while atypicals treat both
  • Negative symptoms are more difficult to treat
  • Relapse rates: 40% in 2 years if on medications. 80% in 2 years if off medications
40
Q

Bulemia Nervosa treatment

A
  • Psychotherapy
  • Nutritional rehabilitation
  • Anti-depressants
  • Bupropion should be avoided in treatment of eating disorders as it is associated with a decreased seizure threshold
41
Q

Disruptive Behavioral Disorder (enumerate)

A
  • Oppositional defiant disorder

- Conduct disorder

42
Q

Factitious Disorder

Diagnosis and Treatment

A
  • Intentional illness production with unconscious motivation
  • Both primary and secondary gain
  • Munchausen syndrome (health care worker) and Munchausen by proxy
  • Rx: foster relationship and look for motive, psychotherapy
43
Q

Paranoid Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Distrustful, suspicious, interpret others’ motives as malevolent
  • Men > women
  • Increased incidence in families with schizophrenia
  • Projection
44
Q

Antisocial Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Violate rights of others, social norms, and laws. Impulsive; lack remorse. Begin in childhood as conduct disorder
  • Men > women
  • None
  • Superego lacunae
45
Q

Phobias

Diagnosis and Treatment

A
  • Social and Specific
  • Patients recognize that their fear is excessive
  • Rx:
  • Specific: CBT involving desensitization through incremental exposure along with relaxation techniques. Supportive, family and insight-oriented psychotherapy
  • Social: CBT, SSRIs, low-dose benzos
  • Beta-blockers (atenolol or propanolol) are only used for performance anxiety (stage fright) and are given 30 to 60 minutes before the performance
46
Q

Major Depressive Disorder diagnosis

A

Requires depressed mood or anhedonia (loss of interest/pleasure) and 5 or more signs/symptoms from the SIG E CAPS for a 2 weeks period

  • Sleep (hypersomnia or insomnia)
  • Interest (loss of interest or pleasure in activities)
  • Guilt (feeling of worthlessness or inappropriate guilt)
  • Energy decreased or fatigue
  • Concentration decreased
  • Appetite (increase or decrease) or weight (increase or decrease)
  • Psychomotor agitation or retardation
  • Suicidal ideation
47
Q

Cyclothymia

A
  • Presence of hypomanic episodes and mild depression for more than 2 years
  • Rx: lithium, valproic acid, carbamazepine and psychotherapy
48
Q

Delirium

Treatment

A
  • Treat underlying causes (delirium is often reversible)
  • Normalize fluids and electrolytes
  • Optimize the sensory environment, and provide necessary visual and hearing aids
  • Use low-dose antipsychotics (haloperidol) for agitation and psychotic symptoms
  • Conservative use of physical restrains may be necessary to prevent harm to the patient and others
49
Q

Oppositional Defiant Disorder

Facts, Diagnosis, Treatment

A
  • Noted by age of 8 years, more in boys until puberty then equal incidence
  • Argue with others, lose temper, easily annoyed by others, and blame others for their mistakes.
  • Tend to have problems with authority figures and justify their behavior as a response to other’s actions
  • Symptoms should be more than 6 months
  • Rx: behavioral therapy such as CBT
50
Q

Cluster B Personality Disorders

Other name, Enumerate, Clinical dilemma, Strategy

A
  • Dramatic and Emotional “Wild”
  • Borderline, Histrionic, Narcissistic, Antisocial
  • Patients change rules and demand attention. They are manipulative and demanding and will split staff members
  • Be clear and consistent about boundaries and expectations
51
Q

Borderline Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Unstable mood, relationships, and self-image; feelings of emptiness. Impulsive. History of suicidal ideation or self-harm
  • Women > men
  • Increased incidence in families with mood disorders
  • Splitting
52
Q

Parkinson’s Disease (Neurotransmitter Changes)

A
  • Decreased dopamine

- Increased ACh

53
Q

Binge Eating Disorder treatment

A
  • Psychotherapy such as CBT is first line

- SSRIs

54
Q

Lewy Body Neurocognitive Disorder

A
  • Dementia (confusion, disorientation and memory problems)
  • Associated with visual hallucination
  • Get worse when given anti-psychotics
55
Q

Psychotic Disorders diagnosis

A
  • At least 2 of the following and at least 1 of them from the first 3 (First 4 are positive symptoms):
    1- Delusions
    2- Hallucinations (75% auditory)
    3- Disorganized speech
    4- Disorganized or catatonic behavior
    5- Negative symptoms (affective flatting, poor grooming, anhedonia, and social withdrawal)
  • If duration is > 6 months or unspecified schizophrenia, If 1-6 months schizophreniform disorder, If < 1 month brief psychotic disorder
  • If associated with mood disorder and at least > 2 weeks of hallucinations or delusions without major mood episode (major depression or mania) it is schizoaffective disorder
56
Q

Personality Disorders

Characteristics, Clusters, Treatment

A
  • MEDIC (Maladaptive, Enduring, Deviate from cultural norms, Inflexible, Cause social or occupational functional impairment). Ego-syntonic
  • Cluster A: Odd or Eccentric “Weired”. Cluster B: Dramatic and Emotional “Wild”. Cluster C: Anxious and Fearful “Worried or Wimpy”
  • Rx: Individual psychotherapy. Medications are reserved for cases with comorbid mood, anxiety, or psychotic signs/symptoms
57
Q

Malingering

Diagnosis and Treatment

A
  • Intentional illness production with conscious motivation
  • Purely for secondary gain e.g., to avoid court date, military induction and school
  • No treatment just confront the patient with the diagnosis
58
Q

Retrograde Amnesia

A

Inability to recall things that occurred before a CNS insult

59
Q 
Dissociative Disorders 
(Definition and types)
A
  • Use the defense mechanism of dissociation where you split off a group of activities or thoughts from the main part of consciousness typically due to traumatic events
  • Types:
  • Amnesia
  • Dissociative identity disorder (multiple personality): have lapses in memory. more common in women and associated with history of sexual abuse, PTSD, depression, substance abuse, borderline personality, and somatoform conditions
  • Depersonalization: detachment from one’s own body, thoughts, perceptions and actions
  • Derealization: detachment from one’s environment (Deja vu and Jamais vu)
60
Q

Adjustment Disorder

Diagnosis and Treatment

A
  • 3 criteria:
  • Mild symptoms that must occur within 3 months of an identifiable stressor
  • Must not last more than 6 months
  • Cannot meet criteria for other disorder (also cannot be grief)
  • Rx: psychotherapy (CBT)
61
Q

Cluster A Personality Disorders

Other name, Enumerate, Clinical dilemma, Strategy

A
  • Odd or Eccentric “Weired”
  • Paranoid, Schizoid, Schizotypal
  • Patients are suspicious and distrustful of psychiatrists, making it difficult to form therapeutic relationships
  • Be clear, honest, noncontrolling, and nondefensive
62
Q

Bipolar Disorder hormone and sleep changes

A
  • Increased NE and serotonin

- Multiple awakenings and markedly decreased sleep time

63
Q

Histrionic Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Excessively emotional and attention seeking. Sexually provocative; theatrical
  • Women > men
  • None
  • None
64
Q

Schizophrenia (Neurotransmitter Changes)

A

Increased dopamine

65
Q

Atypical depression

A
  • Reverse vegetative changes such as increased sleep, weight and appetite
  • Complaints of extremities feeling “heavy”
  • Rx: SSRIs or MAOIs. SSRIs have a better side-effects profile
66
Q 
Neurocognitive Disorder (Dementia)
(Treatment)
A
  • Provide environmental cues and a rigid structure for the patient’s daily life
  • Cholinesterase inhibitors are used to treat. Low dose antipsychotics may be used for psychotic symptoms and sometimes for agitation, but with the added risk of cardiovascular events in elderly patients. Avoid benzos, which may exacerbate disinhibition and confusion
  • Family, caregiver and patient education and support are imperative
67
Q

Panic Disorder differential diagnosis

A
  • Medical conditions: Angina, MI, arrhythmias, hyperthyroidism and pheochromocytoma
  • Psychiatric conditions: substance induced anxiety, generalized anxiety disorder and PTSD
68
Q

Bereavement (Grief)

A
  • Begins after death of a loved one
  • Feelings of sadness, worrying about the deceased, irritability, sleep disturbances, poor concentration and tearfulness
  • It lasts less than 6 months but up to 1 year is normal
  • Rx: supportive psychotherapy. Medical therapy is a wrong answer
69
Q

Predictors of good prognosis in schizophrenia

A
  • Late onset (females)
  • Quick onset
  • Positive symptoms
  • No family history of schizophrenia
  • Family history of mood disorder
  • Absence of structural brain abnormalities
70
Q

Brain structural and anatomic abnormalities in schizophrenia

A
  • Cortical abnormalities (sensitive but not specific):
  • Larger ventricle size and ventricular brain ratios (VBRs)
  • Cortical atrophy
  • Smaller frontal lobes
  • Atrophy of temporal lobes
  • Subtle abnormalities in limbic system (site of primary pathology in schizophrenia): changes in hippocampus, parahippocampal gyrus, entorhinal cortex, amygdala, and cingulate gyrus
71
Q

Childhood Disintegrative disorder

A
  • Boys > Girls
  • Normal development for 2 years, then marked regression in functioning. This includes loss of language, social interaction, motor function, and bladder function
  • Also have repetitive and stereotyped behaviors
  • Rx: behavioral techniques (shaping), if aggressive give anti-psychotic medications (risperidone)
72
Q

Intellectual disability (Intellectual development disorder) grades

A
  • Mild (IQ 70-50): 85% of cases, reaches sixth grade level of education, can work and live independently, needs help in difficult or stressful situations
  • Moderate (IQ 49-35): Reaches second grade level of education, may work with supervision and support, needs help in mildly stressful situations, and may benefit from vocational training
  • Severe (IQ 34-20): can learn to communicate, basic self-care habits
  • Profound (IQ below 20): needs continuous care, supervision, and highly structured environment
73
Q

Bipolar Disorder diagnosis

A

One week or more of persistently elevated, expansive, or irritable mood plus 3 DIG FAST symptoms
- Distractibility
- Insomnia (decreased need for sleep
- Grandiosity and Goal directed activities (increased)
- Flight of ideas
- Activities/psychomotor Agitation
- Sexual indiscretion/other pleasurable activities
- Talkativeness/pressured speech
Anti-depressants use may trigger manic episodes

74
Q

Postpartum blues or “baby blues”

A
  • Immediately after birth up to 2 weeks
  • Sadness, mood liability and tearfulness
  • No negative feelings toward baby
  • Rx: supportive. Usually self-limited
75
Q

Panic Disorder

Diagnosis and Treatment

A
  • 1 or more months of concern about having additional panic attacks or significant behavior changes
  • Panic attacks presented as tachypnea, chest pain, palpitations, diaphoresis, nausea, trembling, dizziness, fear of dying or going crazy, depersonalization or hot flashes
  • Perioral and/or acral paresthesias fairly specific
  • Agoraphobia present in 30-50%
  • Rx:
  • Short term: benzodiazepines (alprazolam)
  • Long term: CBT and SSRIs (first line-therapy), venlafaxine
  • CO2 for hyperventilation
  • Rx should be for 6-12 months due to risk of relapse
76
Q

Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD)
(Diagnosis, Sleep changes, Hormonal changes, Treatment)

A
  • Follows life-threatening life event (for men rape and combat, for women childhood abuse and rape)
  • Re-experiencing of the event (nightmares and flashbacks), avoidance of stimuli associated with trauma, numbed responsiveness (detachment, anhedonia), increased arousal (hypervigilance and exaggerated startle)
  • Less than 1 month ASD, more than 1 month PTSD
  • Increased REM latency with decrease in amount of REM and stage 4 sleep
  • Increased, sustained activity in amygdala. Increased levels of NE and E with decreased cortisol levels
  • Rx:
  • Short term: beta-blockers and alpha-2 agonists (clonidine)
  • Long term: SSRIs (first line), venlafaxine, buspirone, TCAs, MAOIs, and benzos. Psychotherapy and support groups
  • For ASD just CBT
77
Q

Delirium

Work up

A
  • Check vitals, pulse oximetry, and glucose; perform physical and neurological examination
  • Note recent medications (narcotics, anticholinergics, steroids, or benzos), substance abuse, prior episodes, medical problems, signs of organ failure (kidney, liver) and infection (occult UTI common in elderly; check UA)
  • Order lab and radiologic studies to identify a possible underlying cause
78
Q

Anorexia Nervosa

Facts, Associations, Diagnosis

A
  • Risk factors: female gender, low-self esteem
  • Associated with OCD, MDD, anxiety, and career/hobbies such as modeling, gymnastics, ballet and running
  • Body weight is 15-20% less than expected body weight (Females: 5’=100 lb + 5 lb for every 1’’, Males: 5’=106 lb + 6 lb for every 1’’) or BMI <18.5 kg/m2
  • Refusal to maintain normal body weight, intense fear of weight gain, body image disturbance
  • Family dynamics linked to relationship with the father; harsh mother. Mother with history, 50% of susceptibility inherited
  • Restricts calorie intake or binge and purge
  • Mortality from suicide or medical complications is > 10%
79
Q

Conduct Disorder

Facts, Diagnosis, Treatment

A
  • More frequently in boys and in children whose parents have antisocial personality disorder and alcohol dependence
  • A repetitive, persistent pattern of violating the basic rights of others or age-appropriate social norms or rules for 1 year or more
  • Behaviors may be aggressive (e.g., rape, robbery, animal cruelty) or non-aggressive (e.g., stealing, lying, deliberately annoying people).
  • May progress to anti-social personality disorder in adulthood
  • Rx: Behavioral intervention using rewards for prosocial and non-aggressive behavior. If aggressive, anti-psychotics should be used
80
Q

Obsessive-Compulsive Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Preoccupied with perfectionism, order, and control at the expense of efficiency. Inflexible morals and values
  • Men > women
  • Genetics
  • Undoing and reaction formation
81
Q

Aphasias Diagnosis

A

Three questions Fluent? Comprehends? Repeats?

  • If Fluent
  • Comprehends and Repeats: Anomic aphasia
  • Comprehends but cannot Repeat: Conduction aphasia
  • Cannot Comprehend but Repeats: Transcortical sensory aphasia
  • Cannot Comprehend nor Repeats: Wernicke’s aphasia
  • If not Fluent:
  • Comprehends and Repeats: Transcortical motor aphasia
  • Comprehends but cannot Repeats: Broca’s aphasia
  • Cannot Comprehend but Repeats: Mixed Transcortical aphasia
  • Cannot Comprehend nor Repeats: Global aphasia
82
Q

Major Depressive Disorder changes in hormones and sleep

A
  • Decreases in most hormones (NE, dopamine, and serotonin)
  • Decrease in REM latency and slow-wave sleep. Increase in REM early in sleep cycle and total REM sleep. Repeated nighttime awakenings and early morning waking (terminal insomnia)
83
Q

Pseudocyesis

Diagnosis and Treatment

A
  • False, non-delusional belief of being pregnant. May have sings and symptoms of pregnancy but is not pregnant
  • Rx: psychotherapy
84
Q

Anorexia Nervosa

Work-up and Treatment

A
  • Measure height and weight; check BMI, CBC, electrolytes, endocrine levels and ECG. Also perform psychiatric evaluation to screen for comorbid conditions
  • Rx:
  • Initially, monitor caloric intake to restore nutritional status and to stabilize weight; then focus on weight gain
  • Hospitalize if necessary to restore nutritional status, rehydrate and correct electrolyte imbalance
  • Once medically stable, initiate individual, family and group psychotherapy. treat comorbid depression and anxiety
  • Behavioral therapy
  • SSRIs to promote weight gain
  • Refeeding syndrome (Increase insulin leads to hypophosphatemia and cardiac complications) can occur in severely malnourished patients
85
Q

Schizophrenia facts

A
  • Prevalence 1%
  • Peak onset in males (18-25y), in females (25-35y)
  • Increased incidence in those born in winter or early spring and those with schizophrenia in first degree relatives
  • 50% have suicidal ideation and 10% commit suicide
  • Frequent cannabis use is associated with psychosis/schizophrenia in teens
86
Q

Binge Eating Disorder facts

A
  • Regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors once weekly for at least 3 months
  • Increased risk of diabetes
87
Q

Conversion Disorder

Diagnosis and Treatment

A
  • Symptoms or deficits of voluntary motor or sensor function incompatible with medical process
  • Rx: psychotherapy
88
Q

Delirium

Definition and Presentation

A
  • Acute disturbance of consciousness with altered cognition that develops over a short period of time (hours to days)
  • Presents with acute onset of waxing and waning consciousness with lucid intervals and perceptual disturbances (hallucination [usually visual], illusions, delusions). May be combative, anxious, paranoid or stuporous. Decreased attention span and short term memory, a reversed sleep-wake cycle, and symptoms increase at night (sundowning)
  • It is common for delirium to be superimposed on dementia
89
Q

Narcissistic Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Grandiose; need admiration; have sense of entitlement. Lack empathy and overconcerned with issues of self-esteem
  • Common
  • None
  • None
90
Q

Delirium

Causes

A

I WATCH DEATH

  • Infection
  • Withdrawal
  • Acute metabolic/substance Abuse
  • Trauma
  • CNS pathology
  • Hypoxia
  • Deficiencies
  • Endocrine
  • Acute vascular/MI
  • Toxins/drugs
  • Heavy metals
91
Q

Tourette’s Syndrome

Facts, Associations, Diagnosis, Treatment

A
  • More in males and begins below the age of 18 year. Mean age of onset 7
  • Associated with ADHD, learning disorders and OCD. Also increased levels of dopamine
  • Dx: Sudden onset of multiple motor tics first such as head shaking and blinking, then vocal tics such as grunting, coughing, throat clearing and coprolalia (10-20%) occurring many times per day, recurrently, for more than 1 year with social or occupational impairment
  • Rx:
  • Psycho-education and behavioral therapy to learn coping and adjustment
  • For intractable and distressing tics, high potency anti-psychotics (e.g., haloperidol, fluphenazine, pimozide), tetrabenazine, guanfacine, and clonidine may be used
92
Q

Dependent Personality Disorder

Characteristics, Epidemiology, Risk Factors, Associated Defenses

A
  • Submissive, clingy; have a need to be taken care of. Have difficulty making decisions. Feel helpless
  • Women > men
  • None
  • None
93
Q

Delusional Disorder

A
  • Fixed, persistent, false belief lasting more than 1 month and functioning otherwise not impaired
  • Can be shared by individuals in close relationships (folie a deux)
  • Rx: atypical anti-psychotics
94
Q

Major Depressive Disorder facts

A
  • A mood disorder with 1 or more major depressive episodes (MDEs)
  • Females more than males
  • Lifetime prevalence is 15-25%
  • Onset usually in mid 20s and incidence increases with age
  • 60% have suicidal ideation and 15% (2-9% in step 2) commit suicide

Behavioral Sciences (6 decks)

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