Psychiatry Flashcards
Infant deprivation effects
S - Social engagement disinhibited - indiscriminately attaches
T - Trust (lack of)
A - Attachment disorder (reactive) - withdrawn/unresponsive
T - Thrive (failure)
S - Socialization skills are poor
Child neglect
Failure to provide a child with: S - shelter S - supervision A - affection F - food E - education
Attention-deficit
hyperactivity
disorder
Onset before age 12, > 6 months of limited attention span and/or poor impulse control.
in multiple settings
Normal intelligence, but commonly coexists with difficulties in school. Often persists into adulthood.
Treatment: stimulants (eg, methylphenidate) +/- cognitive-behavioral therapy (CBT);
alternatives include:
C - clonidine
A - atomoxetine
G - guanfacine
Autism spectrum
disorder
May be accompanied by intellectual disability;
rarely accompanied by unusual abilities (savants).
More common in boys.
Associated with inc head/brain size.
Disruptive mood
dysregulation
disorder
Onset before age 10. Severe, recurrent temper outbursts out of proportion to the situation.
The child is constantly angry and irritable between outbursts.
Treatment: stimulants, antipsychotics.
Intellectual disability
Global cognitive deficits (vs specific learning disorder)
Adaptive functioning is impaired
Treatment: comprehensive, multidisciplinary support to improve global functioning (eg, special education, psychotherapy, speech therapy, occupational therapy).
Selective mutism
Onset before age 5. Anxiety disorder lasting > I month involving refraining from speech in certain
situations despite speaking in other, usually more comfortable situations
Commonly comorbid with a social anxiety disorder. Treatment: behavioral, family, and play therapy; SSRIs.
“5elective, 4 weeks (month)”
Separation anxiety
disorder
An overwhelming fear of separation from home or attachment figure lasting > 4 weeks.
Can be normal behavior up to age 3- 4.
May lead to factitious physical complaints to avoid school.
Treatment: CBT, play therapy, family therapy.
Specific learning
disorder
Onset during school-age years.
Inability to acquire or use information from a specific subject (eg, math, read ing, writing) near age-expected proficiency for > 6 months despite focused intervention.
Treatment: academic support, counseling, extracurricular activities.
Tourette syndrome
Onset before age 18.
Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for> I year. Coprolalia (involuntary obscene speech) found in only 40%. of patients.
Treatment: psychoeducation, behavioral therapy.
T - Typical high-potency antipsychotics (eg, haloperidol, fluphenazine)
A - alfa 2 -agonists (eg, guanfacine, clonidine)
T - tetrabenazine
A - atypical antipsychotics.
Orientation - Order of loss:
Order of loss: time -> place -> person.
Delusions Types:
Erotomanic, Grandiose
J - jealous U - unspecified M - mixed P - persecutory S - somatic
Schizophrenia - Symptom categories include:
Positive-hallucinations, delusions, unusual thought processes, disorganized speech, bizarre behavior.
Negative- Aat or blunted affect, apathy, anhedonia, alogia, social withdrawal
Cognitive- reduced ability to understand or make plans, diminished working memory, inattention
Schizophrenia diagnosis requires:
Diagnosis requires > 2 of the following active symptoms, including > 1 from symptoms #1- 3:
- Delusions
- Hallucinations, often auditory
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
Requires > I month of active symptoms over the past 6 months;
onset > 6 months prior to diagnosis.
Brief psychotic disorder vs Schizophreniform
Brief psychotic disorder: > I positive symptom(s) lasting < I month, usually stress-related.
Schizophreniform disorder: > 2 symptoms lasting 1-6 months.
Schizophrenia - pathology, and pathophysiology
Associated with:
Inc dopaminergic activity
Inc serotonergic activity
Dec dendritic branching.
Ventriculomegaly on brain imaging.
Schizoaffective disorder
Shares symptoms with both schizophrenia and mood disorders (major depressive or bipolar disorder). To differentiate from a mood disorder with psychotic features, the patient must have> 2 weeks of psychotic symptoms without a manic or depressive episode.
Delusional disorder
> 1 delusion(s) lasting > 1 month, but without a mood disorder or other psychotic symptoms.
Daily functioning, including socialization, may be impacted by the pathological, fixed belief but is otherwise
unaffected. It can be shared by individuals in close relationships (folie a Deux).
Manic episode
activity or energy lasting > I week.
Diagnosis requires hospitalization or marked functional impairment with > 3 of the following
(manics DIG FAST):
D - Distractibility
I - impulsivity/Indiscretion
G - Grandiosity
F - Flight of ideas
A - Agitation
S - Sleep (dec need)
T - Talkativeness
Hypomanic episode
Similar to a manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization. No psychotic features. Lasts >4 consecutive days.
0.5 manic
Bipolar disorder - Bipolar I
> I manic episode +/- a hypomanic or depressive episode (may be separated by any length of time).
1-1.5 manic
The patient’s mood and functioning usually normalize between episodes.
The use of antidepressants can destabilize mood.
High suicide risk.
Treatment: mood stabilizers (eg, lithium, valproic acid, carbamazepine, lamotrigine), atypical antipsychotics.
Bipolar disorder - Bipolar II
a hypomanic and a depressive episode (no history of manic episodes).
0.5 + depression
The patient’s mood and functioning usually normalize between episodes. The use of antidepressants can
destabilize mood. High suicide risk. Treatment: mood stabilizers (eg, lithium, valproic acid, carbamazepine, lamotrigine), atypical antipsychotics.
Cyclothymic disorder
a milder form of bipolar disorder fluctuating between mild depressive and hypomanic symptoms. Must last > 2 years with symptoms present at least half of the time, with any remission lasting < 2 months.
0.5 + 0.5 deperssion
