Psychiatry Department Exam Review Packet Flashcards
1st Mood Stabilizer for Bipolar
Lithium
Which 2 psych drugs are suicide protective?
Lithium
Clozapine
Which tests do you need to order for Lithium
Serum Level (0.6-1.2 approx; >1.4 is toxic)
Thyroid Level (for hypothyroidism)
BUN/Cr (Renally excreted)
ECG (Arrhythmia risk)
What patients should NOT receive Lithium
Pregnant - Ebstein Heart Defect Diuretics NSAIDs Medications impairing renal function Renal Problems Heart Conditions (Arrhythmia risk)
Common SE of Lithium
GI Weight Gain Acne Fine Tremor Thirst (2/2 polyuria) Hair Loss
Rare SE of Lithium
Hypothyroid
Arrhythmia/CHF
Neurotoxicity
Which anticonvulsant is hepatotoxic?
Depakote
Risk of Depakote use
Increase risk of PCOS
Can affect liver and pancreas -> hemorrhagic pancreatitis
Lab tests for Depakatoe
LFT
CBC for platelets
Which anticonvulsant causes agranulocytosis?
Carbamazepine (Tegretol)
Lab tests to order for Carbamazepine
CBC
LFT- hepatic inducer
BMP- risk of hyponatremia
What anticonvulsant can cause arrhythmia in OD
Carbamazepine
What anticonvulsant may cause neural tube defects?
Depakote
Carbamazepine
Neonatal SE of Lithium
Ebstein’s
Neonatal SE of Lamictal
Cleft Lip/Palate
Dangerous condition when patient gets Lamotrigine + Depakote
SJS
Appropriate serum level of Depakote
50-100 is therapeutic
Which anticonvulsant is associated with risk of kidney stones
Topiramate (Topamax)
Which has higher risk of EPS and TD, Haldol or Thorazine?
Haldol (High potency)
SE of Compazine (Thorazine)
Orthostatic Hypotension
Anticholinergic
Sedation
*Less risk of EPS/TD
Which antipsychotic is NOT metabolized hepatically?
Paliperidone- almost all renal excretion
Which antipsychotics need an EKG done and why?
Prolong QTc
Compazine (Thorazine)
Ziprasidone (Geodon)
Clozapine
Antipsychotic with lowest risk of EPS and TD
Seroquel (Quetiapine0
Clozapine
Treatment for EPS
Amantadine
Benedryl
Benztropine
Proven treatment for TD
Only Cloazpine
Which drug is best for treating negative symptoms in psychosis
Clozapine
SE Profile of Clozapine
Agranulocytosis Prolong QTc WORST Weight gain/Metabolic Syndrome Anticholinergic Antimuscarinic Antihistamine High sedation Seizures
Which antipsychotic is most associated with akathesia?
Aripiprazole (Abilify)
Which atypical antipsychotic most increases Prolactin?
Risperidone
What antipsychotic most commonly causes orthostatic hypotension in elderly?
Seroquel
Best atypical to use in Parkinson’s or Lewy Body Dementia
Seroquel
Which antipsychotic has worst weight gain?
Clozapine
Olanzapine(Zyprexa)
Compazine (Thorazine)
Best antipsychotic for liver failure
Paliperidone
Antipsychotic that needs to be taken with meals
Ziprasidone
Name the SNRIs and 2 Mixed Action Antidepressants
Venlafaxine (Effexor)/Desvenlafaxine
Duloxetine (Cymbalta)
Buproprion (Wellbutrin)
Mirtazepine (Remeron)
SE of Venlafaxine (Effexor)
NEW diastolic HTN (do not use in HTN patients)
Sexual dysfunction
SE of Duloxetine (Cymbalta)
Increased LFT
Sexual Dysfunction
What is Cymbalta good for?
Patients with neuropathy
SE of Buproprion (Wellbutrin)
Lower seizure threshold (avoid in ETOH and BN/AN)
May WORSEN anxiety
Benefits of Buproprion
No sexual dysfunciton
May cause weight loss
SE of Mirtazepine (Remeron)
Highly Sedating (take at bedtime) Increase Appetite
Benefits of Mirtazepine (Remeron)
No sexual dysfunction
No worsening of anxiety (in contrast to Wellbutrin)
Increase appetite
TCA Antidepressants
Imipramine/Desipramine
Amitryptaline/Nortryptaline
Clomipramine
Doxepin
Antidepressants without Sexual SE
Mirtazepine
Burproprion
Major SE of Cymbalta (Duloxetine)
Inc LFT
Major SE of Effexor (Venlafaxine)
New Diastolic HTN
Major SE of Buproprion (Wellbutrin)
Decrease seizure threshold
Worsen anxiety
Worst SSRI for discontinuation syndrome
Paroxetine (Paxil)
Fluvoxamine (Luvox)
SSRI with worst weight gain
Paroxetine (Paxil)
Signs and Sx of SSRI Discontinuation Syndrome
Irritability
Unstable Gait
Rebound Anxiety
electric like shocks (Lhermitte)
Which SSRI are best for avoiding discontinuation sydrome
Fluoxetine (Prozac)
Citalopram (Celexa)
Three C’s of TCA overdose
Cardiotoxicity
Convulsions
Coma
Signs of NMS
"FALTER" Fever Autonomic Instability Leukocytosis Tremor Elevated CK Rigidity
What HTN med can be given for nightmares in PTSD
Prazosin (alpha blocker)
SE of Trazodone
Priaprism
MAO-I + Tyramine excess =?
HTN Crisis => Stroke, Aneurysm
Which MAO-i binds reversibly
Meclobemide
Which MAO-i bind irreversibly
Phenylzine
Tranylcypromine
Selegiline
Nonstimulant option for ADHD
Atomoxetine
Slower onset-> less abuse potentional
also used for Narcolepsy
At what age can you give amphetamines for ADHD
After 3 years old
At what age can you give methylphenidate for ADHD
After 6 years old
Why can’t stimulants be given to ADHD Children if they have hx of HTN, psychosis or seizures
Inc NE => Worsen HTN
Inc Dopamine => Worsen Psychosis
Increased activity/excitation => Worsen seizures
Criteria A Signs and Sx of Schizophrenia
Hallucinations (Auditory MC)
Delusions
Disorganized Thinking/Behavior
Negative Sx
What are the negative sx of Schizophrenia
"5As" Anhedonia Affect (poor) Alogia Avolition Attention (poor)
How many A sx are needed to meet criteria for Schizophrenia
2 out of 5 for at least 1 month
*Unless delusions are bizarre or multiple voices or continuous voices
Duration of Symptoms for Schizophrenia Spectrum Disorders
At least 6 months => Schizophrenia
1-6 months => Schizophreniform
<1 month => Brief Psychotic Disorder
Criteria B for Schizophrenia
Social Occupational Dysfunction: work, interpersonal relationships, self care
What developmental disorders can present with psychosis
Asperger’s
Rhett’s Disorder
Autism (10x more common than Schizo in kids)
What personality disorders can have odd behavior
Cluster A: Paranoid, Schizoid, Schizotypal
What medications can cause psychosis
Steroids
Who gets schizophrenia more, M or F?
M=F; But M with more severe illness
Age of onset for schizophrenia
M: 15, 18-25 years
F: 25-40years
Most common time schizophrenics may attempt suicide?
During remission of illness just after a relapse
*Younger M who are DOING WELL with GOOD insight are highest risk
Cognitive Deficits of Schizophrenia
SMART Speed of Thinking Memory Attention Reasoning Tact
General Lifespan for Schizophrenic. Why?
~50 years
Substance Abuse (Smoking, etoh)
Suicide
Increased CV Risk
Brain Tracts and Associations
Nigrostriatal: EPS (Dystonia, Parkinsonism, Akathesia, TD
Tuberoinfudinbular: Prolactin
Mesolimbic: Psychosis (increased with DA inc)
Mesocortical: responsible for negative signs and sx
Treatment Algorithm for Schizophrenia
1: SGA
2: Different SGA or Try FGA
3: Consider Clozapine
4: Clozapine + SGA/FGA
5: Modify SGA/FGA from stage 4
6: 2 FGA/2SGA/1 of each
How long is adequate anti-psychotic trial
4 weeks at therapeutic dose
*Patients should have SOME response within 2 weeks
MC method of suicide for both sexes? 2nd most common Individually?
Firearms MC
M: hanging
F: Drug OD
Highest Suicide Rate Country
- Lithuania
2. Japan
Risk factors for Suicide
Male Age >65 or Adolescent Whites Prior Attempt Divorced Family Hx HIstory of Abuse in Childhood Mental Illness Substance Abuse Other co-morbid medical conditions
Protective Factors for Suicide
Social Support
Religion
Parents with children
Which sex completes more suicide?
Male (3x more)
Which sex attempts more suicide?
Women (4x more)
Which anxiety disorder carries highest risk of suicide?
Panic Disorder
Which personality disorder carries highest risk of suicide?
Borderline PD
SAD PERSONS Scale for Suicide Risk
Sex (1 if Male) Age (1 if <19 or >65) Depression (1 if yes) Previous Attempt (1 if yes) EtOH (1 if yes) Rational Thinking (1 if psychotic) Social Support (1 if lacking) Organized Plan (1 for plan) No Spouse (1 if divorced, widowed, separated) Sick (1 if cancer, epilepsy, MS, GI illness)
Over 5 => consider hospitalization
DSM Criteria for Manic Episode
Abnormally & Persistently elevated, expansive, or irritable mood for at least 1 week and including 3 of 7 DIGFAST Symptoms (Or 4 of 7 if irritable mood)
DIG FAST Sx of Mania
Distractability Insomnia Grandiosity Flight of Ideas Activity/Agitation Speech Pressured Thoughtlessnes (risky behavior- sexual, financial ...)
Hypomania vs Mania
Hypomania: no marked impairment in functioning, does NOT require hospitalization, no psychotic features
Same criteria as for mania episodes but with 4 days of sx
Hypomania: Bipolar II
Mania: Bipolar I
Psychotic Features/Need hospitalization: Bipolar I
Medical Causes of Manic Episode
Metabolic: Hypothyroidism Neuro: SEizures Tumor HIV, Syphilis Meds: Steroids, TCA antidepressants Drugs: MEthamphetaines, Cocaine
Do more women or men get bipolar and how old are they?
Women = Men
Onset: childhood to 50 years
Average Age: 19 years
More common in divorced or single people
Most common Presentation of Bipolar Disorder
Depressive Episode
*In Bipolar I men usually present with mania initially
Labs to order for Bipolar Patient
BMP CBC LFT Urine Drugs TSH Vitamin B12 RPR HIV
Criteria for Cyclothymic Disorder
2 years of sx with periods of hypomanic sx and depressive sx with no more than 2 months of symptom free time
Non-Pharm Tx for Bipolar Disorder
ECT
Procedure for ECT
Early morning after 8-12hr fast -> Patient gets atropine/anticholinergic + anesthesia -> stimulus electrodes placed bitemporally -> brief pulse stimuli
SE of ECT
Increased ICP
Bradycardia that advances to tachycardia
Memory Loss, HA, confusion
Contraindications for ECT
Absolute: Increased ICP
RElative: Recent MI, large aneurysms, tumors
Most common dementia
Alzheimer’s
Characteristics of Vascular Dementia
Stepwise history of progression
Hx of CV disease
Characteristics of Lewy Body Dementia
Visual Hallucinations
Respond poorly to levo-dopa
May worsen with antipsychotics
Dementia associated with younger patients (<75) who have major personality change with prominent early behavior changes?
Frontotemporal Dementia
Natural Hx of Alzheimer’s Disease
W >M
Age is most key risk factor
Slow progressive loss of cognitive funciton
Early onset is <65 yrs
Lots of memory problems leading ot loss of ADLs later
Attention okay -> will guess for you
Natural Hx of Vascular Dementia
2nd MC after Alzheimer’s
Onset may be sudden
Patients with difficulty within 3 months of CVA
Risk Factors: HTN, HL, DM
Hx of triggering CV event -> stepwise progression
Early difficulty with gait, may have + neuro deficits, imaging with infarcts/white matter lesions
Natural Hx of Lewy Body Dementia
More Parkinsonian type sx Visual Hallucinations Difficulty with attention - cannot cooperate Neuroleptics may cause mortality High rate of EPS SE
Natural Hx of Frontotemporal Dementia
<65 years (younger)
Behavioral Issues (lying, stealing, poo hygiene)
No localized neurological issue
Memory generally okay early on
DSM Criteria for Major Depressive EPISODE
5 of 9 symptoms (Need depressed mood or anhedonia) for at least a 2 week period
Depressed Mood + SIG E CAPS
Sleep changes Interest loss (anhedonia0 Guilt Energy Loss Concentration problems Appetite change Psychomotor Agitation or Retardation Suicidal thoughts
What medical conditions can cause depression?
Endocrine: thyroid, cortisol, calcium
Neuro: Parkinson’s, Mono
Cancer: Lymphoma, Pancreatic
SLE
DSM Criteria for MDD
At least 1 major depressive episode
No signs of manic or hypomanic episode
Sleep Problems associated with MDD
Multiple Awakenings
Initial and Terminal Insomnia
Hypersomnia
REM sleep earlier in night
What is seasonal affective disorder?
Subtype of MDD
Eipsodes only occur during winter months.
Patients are:irritable, hypersomnic, and have carbohydrate cravigs
What is dysthymic disorder
Depressed mood for most days for at least 2 years: 2 of the following: Poor appetite Poor sleep Hopelessness/guilt Low self esteem Concentration problems Fatigue/Loss of energy
*Doesn’t list anhedonia or SI; adds low self esteem
Patients must not have been without above sx for >2months at a time
Do not meet criteria for MDD
What is Double Depression
Patients with MDD who have dysthymic disorder in residual periods (Dysthymia in between episodes)
What is cyclothymic disorder
Alternating periods of hypomania nad periods of mild moderate depression
No actual major depressive or manic episodes
associated with Borderline Personality Disorder
M=F
Onset: 15-25 yeras of age
1/3 of patients advance to Bipolar II
Tx: Antimaniac agents
Is MDD more common in women or in men?
Average age?
Risks?
2x more common in women
Any age for onset; Average onset age is 40
Very prevalent in elderly
2-3x greater risk if positive family hx
What % of depressed patients have SI? What % commit suicide?
2/3 have SI
10-15% commit suicide
What is the kindling theory of depression
With each episode of depression, patients are more prone to have further depressive episodes triggered with weaker stimuli/stressors
5 Possible Outcomes during depression
Response Remission Relapse Recovery Recurrence
Risks of recurrent episodes of depression
50% after 1
70% after 2
90% after 3
What is CBT for depression
Focuses on here and now
Very little exploration of person
Focuses on correction of abnormal thought connections based on person’s experience
(used for black and white or catastrophic thinking,etc)
What is Interpersonal Therapy for Depression?
Focuses on here and now
Uses relationship with therapist as a vehicle
Help redefine one’s relationships with others
Used for bulimia nervous patients
What is Behavioral therapy for depression
Focused on learning models, healthy eating, relaxation models, exercise
Very effective for anxiety disorders and stress
What is insight oriented therapy for depression?
Very focused on the person
Based on Freud and childhood developmental traumas
Powerful but hard for patients to go through
*Personality change is part of therapy
How often do patients with MDD have another comorbid psych condition
about 60% of time
25% of time there are 3 or more disorders
Ex: Substance abuse, anxiety disorders, somatoform disorder, OCD, eating disorder,s personality disorders
Which patients with MDD need maintanence phase therapy?
Patients who have had 3 or more episodes OR Pat had 2 episodes + risk factor Family Hx of Bipolar or recurrent MDD Psychosis Closely spaced episodes (<3 years) Onset of 1st episode <21 yr or over 60 yr Very long episodes lasting >2 yrs
What organ system is most strongly affected by depression?
Cardiovascular
What are 4 ways in which anxiety response goes from normal to pathological?
Autonomy: pts with anxiety without obvious reason
Intensity: response out of proportion -> dysfunciton
Duration: stress response lasts longer than expected
Behavior: coping mechs overwhelmed, patient behaves in dysfunctional ways (anger, depression, agitation)
List the anxiety disorders
Panic disorder GAD OCD PTSD Social Phobia Specific Phobia
Most common mental disorders
- Phobia
- Substance Abuse
- MDD
- OCD
Which gender are anxiety disorders more common in ?
W >M
Why are SSRIs started at low dose in patients iwth panic disorder?
Patients are more prone to early activation side effects of SSRIs -> feel more jittery or anxious or restless
Panic Disorder pts take this as worsening anxiety
Common Comorbid Conditions with Anxiety Disorders
Substance Abuse
Personality Disorders (Cluster C-Avoidant)
Other Anxiety disorders
What can you use to differentiate between GAD and Panic Disorder?
CO2 Inhalation Test
Panic Disorder: will induce panic attack
GAD: will not
What anxiety condition is known to increase glucose metabolism in the brain and is thought to be caused by autoimmune response to streptococcus in kids?
OCD: increases glucose metabolism
OCD Kids: PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep)
Neurological Conditions that cause 2ndary Anxiety Sx
Temporal Lobe Epilepsy Parkinon's Disease Post-Concussion Syndrome Multiple Sclerosis Meniere's Disease, Migraines
General Medical Conditions that cause anxiety symptoms
Endocrine: hypoglycemia, pheo, carcinoid, insulinoma
CV: angina, arrhythmia, palpitations, chf
Pulm: PE, COPD, asthma
Irritable Bowel Sydrome
Caffein
Drugs
Severe Anemia
Patient Presentation of Panic Disorder
Age: 20s or earlier
Dramatic Onset with panic attack that pt remembers for life
Pt usually goes to PCP first due to physical sx
May try to medicate with drugs, alcohol
DSM Criteria for Panic Disorder
NEED ALL THREE:
Recurrent Unexpected Panic Attacks (Peak within 10 mins)
Phobic Avoidance (avoid situations associated with attacks)
Anticipatory Anxiety about Attacks (Very worried about future attacks, or implications of future attacks)
What risk factors do patients with panic disorder have?
High risk of suicide of all anxiety disorders
Increased risk of CV problems and stroke
DSM Criteria for GAD
Pattern of frequent, persistent worry and anxiety that is out of proportion ot impact of event/circumstance that is focus of worry
Pt must be bothered by degree of worry
More often than not over 6 months
Need 3 out of 6: Restless/On Edge Easily Fatigued Difficulty Concentrating Irritable Muscle Tension Sleep Disturbances
When do patients present with OCD? When is it worse?
Present genreally in early to mid-twenties
Unusual after 50, almost never after 65
Worsens in: Pregnancy, Postpartum period
DSM Definition of OCD
EITHER Obsessions or Compulsions (can be both)
Pts think these behaviors are unreasonable or excessive
Behaviors cause distress and impair functioning
If another disorder involved, obsessions/compulsion are not limited to it (Ex: not only obsessed with food for eating disorder pt)
Common Obsessions
Aggression Contamination, Symmetry, Exactness Somatic, Hoarding/Saving Religious Sexual
What are compulsions and what are common ones?
Repetitive behaviors or mental acts a person feels driven to perform in response to an obsession or to rules which must be applied rigidly
Aimed at preventing/reducing distress or a dreaded event/situation
Common: checking, washing, repeating, ordering/arranging, counting, hoarding
What predicts a poorer response to treatment in OCD
Sexual/Religious Obsessions
Poor insight into illness
Hoarding
Comorbid Depression, Personality disorder, or social anxiety
DSM Criteria for PTSD
Need sx in each of 3 broad categories
Re-Experience of events
Avoidance of stimuli
Increased Arousal (need 2 here): sleep issues, irritable/angry, can’t concentrate, hypervigilant, exaggerated startle response
Timefram of Acute Stress Disorder vs PTSD
Acute Stress Disorder: within 1 month and lasting at least 2 days with remission within 1 month
PTSD: symptoms last for more than 1 month
Acute Stress Disorder
At least 2 days but no greater than 1 month
PTSD Sx in 3 categories PLUS sense of numbing, detachment, depersonalization
Time frames for Acute, Chronic, Delayed PTSD
Acute: onset within 3 months, duration less than 6 months
Chronic: onset within 3 months duration more than 6 months
Delayed: onset at more than 6 months after trauma
Risk Factors for PTSD
Female Assaultive Violence Prolonged or Repeated Exposure Childhood Trauma Separation from parents during childhood
Protective Factors for PTSD
Religious
What is the diagnosis of a patient who presents with psychological symptoms after a stressful but non-life threatening event?
Adjustment Disorder (NOT an anxiety disorder)
- maladaptive behavior or emotional sx after stressful life event
- sx canot be from bereavement
- sx begin within 3 months and end before 6 months
DSM Criteria for Social Phobia (Social Anxiety Disorder)
Persistent fear of 1+ social situations where patient is exposed to new people or is under scrutiny
Pt fears they will be humiliated or embarrassed
Pt recognizes fear is unreasonable
Onset: adolescence, sometimes resolves by age 25
When does animal type of phobia develop?
childhood
When does environmental type of phobia develop (ex: water, storms)
childhood
When does blood injury/injection type of phobia develop?
childhood to adolescents
*highly familial with strong vasovagal response
When does situational type of phobia develop
adulthood
DSM Definition of a personality disorder
Enduring pattern of behavior that deviates from patient’s culture
Pattern manifests in 2 or more areas of functioning (CAPRI: cognitive, affectivity, relations, impulse control)
3 Clusters and their subtypes of Personality Disorders
Cluster A(Odd or Eccentric): Paranoid, Schizoid, Schizotypal Cluster B (Dramatic, Erratic, Emotional): Borderline, HIstrionic, Antisocial, Narcissistic Cluster C (Anxious, Fearful): Avoidant, OCPD, Dependent
Characteristics of Paranoid Personality Disorder
Cluster A
Suspicious of others
Assume motives are hostile when benign
Looks for hidden messages
Characteristics of Schizoid Personality Disorder
Cluster A
Loners Do not enjoy social relationships Constricted Affect Prefer solitary tasks Okay alone
Characteristics of Schizotypal Personality Disorder
Cluster A
Loners
Magical beliefs
Eccentric thoughts/behaviors
May be disordered in thinking
Characteristics of Borderline Personality Disorder
Cluster B
Intense relationships
Black and White Thinking
Splitting as defense mech
May have hx of sexual abuse/trauma
Characteristics of Narcissistic Personality Disorder
Cluster B
Gradiose view Wants to be admired Superiority complex Very sensitive to critique Become depressed when they dont get recognition
Characteristics of Antisocial Personality Disorder
Cluster B
Disregard rights of others
Lack empathy or feelings of guilt
Some aspect before age 15 suggestive of conduct disorder
Often with substance abuse hx and legal problems
Characteristics of Histrionic Personality Disorder
Cluster B
Dramatic and attention seeking behavior
Theatrical
Draws attention to self
Superficial and seductive
Characteristics of Avoidant Personality Disorder
Cluster C
Fears rejection or criticism
Hyperaware of cues that may mean they are being mocked or criticized
Characteristics of Dependent Personality Disorder
Cluster C
Rely on others, submissive, clingy behavior
Will agree to avoid abandonment
Characteristics of Obsessive Compulsive Personality Disorder
Cluster C
Perfectionism than true OCD
Inflexible
Bothered bychanges in routine
Needs to be in control of situations and upset when not in control
What is the first problem of treating personality disorders
Comorbid disorders must be treated 1st
Changes in behavior are very small and take a long time
Pts may not recognize their problems or follow treatment
Which personality disorder has an increased correspondence with childhood sexual trauma or abuse
Borderline Personality Disorder
Which cluster of personality disorder has a familial association with psychotic disorders
Cluster A
Schizoid
Schizotypal
Paranoid
Which personality disorder has been shown to be most susccessfully treated with drugs
Borderline PD
Which personality disorder uses regression as a defense mechanism
Histrionic- pts very theatrical, perceive relations as more intimate than they are, inappropriately seductive/provocative
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.
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
Which PD does this patient have?
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
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.
Which PD does this patient have?
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.”
Borderline
- unstable self-image, labile relationships, suicide attempts, inappropriate anger, vulnerable to abandonment.
- “every other dr I met before you was horrible”
How is social phobia different from Avoidant PD?
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
What are some risk factors for OCPD?
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.
In Keye’s study of healthy men who were starved,
What symptoms did they develop? What % never recovered?
Symptoms=moody, loss of humor, preoccupation with food, discussion of recipes, group solidarity, decreased decision making.
20% were permanently psychologically hurt and never recovered.
What are the subtypes of anorexia nervosa?
Restricting
Binge-Purge Types
What are some risks for AN?
Females, Genetics, Obstetrical complications, Dieting, Athletes (disordered eating, amenorrhea and osteoporosis)
What is the DSM definition of bulimia nervosa?
Binge eating (large amounts or a sense of lack of control), with recurrent compensatory behavior (purging, laxatives, over-exercising, pills, restricting), both occur 2x week for over 3 months.
Are genetics more a risk factor in AN or BN?
Anorexia has more of a link to genetics
What cathartic can cause heart enlargement & cardiac toxicity?
Syrup of Ipecac
What are the four main causes of death in eating disorders?
Starvation
Cardiac Arrythmia
Suicide
Gastric Dilitation/Rupture
- eating disorders have the highest death rate
- about 10% of ED pts will die from d/o directly (above)
What is the most common Axis I co-morbidity in both AN & BN?
MDD or Dysthymia (50-60% of patients)
Which disorder dose better on psych meds, AN or BN?
Bulimia
Treatment for Bulimia
CBT is FIRST LINE Tx
-SSRI show ability to reduce binging behaviors and 50% reduction in sx
Treatment in Anorexia
Best Tx is Family therapy
Best if patient is <21 years old
What is the diagnosis if patients have recurrent binges, 2x/week
Over period of 6 months with marked distress over the binging?
Binge-Eating Disorder.
- No purging behaviors
- pts eat alone 2/2 embarrassment, eat when not hungry
- Men=Women, onset in middle adult years
Even after AN patients return to a normal weight, are they still
At risk for fertility and pregnancy complications?
Yes-reproductive rates are diminished-higher rate of pregnancy complications even if at normal weight!
What sort of gain is sought in factitious disorder?
PRIMARY gain=patient wants to be in sick role & cared for, intentionally produce complaints. Pts are not looking for housing or malingering.
- pts often will have undergone multiple medical procedures
- pts often work in medical field or family does
What sort of gain is sought in malingering?
SECONDARY gain
What are two strong predictors of violence?
EtOH intoxication and an overt stressor (breakup, loss)
- Males ages 15-24 most likely to be violent
- Low socioeconomic status, poor social support
What sort of disorder is it when a patient expresses feelings unintentionally
And unconsciously through a metaphorical body dysfunction?
Conversion disorder
- dramatic sudden development of neurologic symptoms not associated with usual signs and test results expected
- Similar to conversion d/o, somatization is also unconscious and unintentional
Compare “circumstantial” vs. “perseverating” thought process?
Circumstantial=pt brings in lots of irrelevant details and comments, but will get back to the point. (Dates, etc)
Perseveration=pt repeats phrases over & over again
Treatment of Alcoholism
Antabuse
Acamprosate
Criterion of Schizophrenia
2 out of 5 Criteria A symptoms x 1 month
Total period of symptoms=6 months
If pts have bizarre delusions or constant voices or voices conversing that meets Criteria A by itself
Criterion of Mania
3/7 for 1 week of DIGFAST
Criterion of Hypomania
3/7 for 4 days of Criterion of
But not significantly impaired and not psychotic
Criterion of Depressive Episode
5/9 SIGECAPS for 2 weeks
Criterion of Major Depression Disorder
Depressive Episode + No mania or hypomania
Criterion of Dysthymic Disorder
2 yrs of depression without meeting episode criteria
No more than 2 months without sx
Never has psychotic features
Criterion of Panic Disorder
All three:
Panic Attacks
Avoidance of situations that trigger panic
Anticipatory Anxiety about future attacks
Criterion of OCD
Obsession OR compulsions
Pt distressed by behavior
Obsessions and Compulsions not limited to other disorders
Criterion of PTSD
All three:
Reexperiencing event
Avoidance of reminders of event
Increased arousal (need 2 sx)
Criterion of Acute Stress Disorder
Occurs within 1 month, lasts for 2 days or more,
resolves in 1 month
Criterion of GAD
Pts have generalized, persistent worry about things that they recognize is excessive for 6 months
3/6 of symptoms: keyed up/onedge Sleep disturbed Irritable Easily fatigued Muscle Tension Can't Concentrate
