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Psychiatry > Psychiatry Department Exam Review Packet > Flashcards

Psychiatry Department Exam Review Packet Flashcards

1
Q

1st Mood Stabilizer for Bipolar

A

Lithium

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2
Q

Which 2 psych drugs are suicide protective?

A

Lithium

Clozapine

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3
Q

Which tests do you need to order for Lithium

A

Serum Level (0.6-1.2 approx; >1.4 is toxic)
Thyroid Level (for hypothyroidism)
BUN/Cr (Renally excreted)
ECG (Arrhythmia risk)

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4
Q

What patients should NOT receive Lithium

A 
Pregnant - Ebstein Heart Defect
Diuretics
NSAIDs
Medications impairing renal function
Renal Problems
Heart Conditions (Arrhythmia risk)
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5
Q

Common SE of Lithium

A 
GI
Weight Gain
Acne
Fine Tremor
Thirst (2/2 polyuria)
Hair Loss
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6
Q

Rare SE of Lithium

A

Hypothyroid
Arrhythmia/CHF
Neurotoxicity

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7
Q

Which anticonvulsant is hepatotoxic?

A

Depakote

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8
Q

Risk of Depakote use

A

Increase risk of PCOS

Can affect liver and pancreas -> hemorrhagic pancreatitis

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9
Q

Lab tests for Depakatoe

A

LFT

CBC for platelets

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10
Q

Which anticonvulsant causes agranulocytosis?

A

Carbamazepine (Tegretol)

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11
Q

Lab tests to order for Carbamazepine

A

CBC
LFT- hepatic inducer
BMP- risk of hyponatremia

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12
Q

What anticonvulsant can cause arrhythmia in OD

A

Carbamazepine

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13
Q

What anticonvulsant may cause neural tube defects?

A

Depakote

Carbamazepine

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14
Q

Neonatal SE of Lithium

A

Ebstein’s

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15
Q

Neonatal SE of Lamictal

A

Cleft Lip/Palate

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16
Q

Dangerous condition when patient gets Lamotrigine + Depakote

A

SJS

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17
Q

Appropriate serum level of Depakote

A

50-100 is therapeutic

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18
Q

Which anticonvulsant is associated with risk of kidney stones

A

Topiramate (Topamax)

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19
Q

Which has higher risk of EPS and TD, Haldol or Thorazine?

A

Haldol (High potency)

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20
Q

SE of Compazine (Thorazine)

A

Orthostatic Hypotension
Anticholinergic
Sedation

*Less risk of EPS/TD

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21
Q

Which antipsychotic is NOT metabolized hepatically?

A

Paliperidone- almost all renal excretion

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22
Q

Which antipsychotics need an EKG done and why?

A

Prolong QTc

Compazine (Thorazine)
Ziprasidone (Geodon)
Clozapine

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23
Q

Antipsychotic with lowest risk of EPS and TD

A

Seroquel (Quetiapine0

Clozapine

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24
Q

Treatment for EPS

A

Amantadine
Benedryl
Benztropine

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25
Q

Proven treatment for TD

A

Only Cloazpine

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26
Q

Which drug is best for treating negative symptoms in psychosis

A

Clozapine

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27
Q

SE Profile of Clozapine

A 
Agranulocytosis 
Prolong QTc
WORST Weight gain/Metabolic Syndrome
Anticholinergic
Antimuscarinic
Antihistamine
High sedation
Seizures
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28
Q

Which antipsychotic is most associated with akathesia?

A

Aripiprazole (Abilify)

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29
Q

Which atypical antipsychotic most increases Prolactin?

A

Risperidone

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30
Q

What antipsychotic most commonly causes orthostatic hypotension in elderly?

A

Seroquel

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31
Q

Best atypical to use in Parkinson’s or Lewy Body Dementia

A

Seroquel

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32
Q

Which antipsychotic has worst weight gain?

A

Clozapine
Olanzapine(Zyprexa)
Compazine (Thorazine)

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33
Q

Best antipsychotic for liver failure

A

Paliperidone

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34
Q

Antipsychotic that needs to be taken with meals

A

Ziprasidone

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35
Q

Name the SNRIs and 2 Mixed Action Antidepressants

A

Venlafaxine (Effexor)/Desvenlafaxine
Duloxetine (Cymbalta)
Buproprion (Wellbutrin)
Mirtazepine (Remeron)

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36
Q

SE of Venlafaxine (Effexor)

A

NEW diastolic HTN (do not use in HTN patients)

Sexual dysfunction

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37
Q

SE of Duloxetine (Cymbalta)

A

Increased LFT

Sexual Dysfunction

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38
Q

What is Cymbalta good for?

A

Patients with neuropathy

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39
Q

SE of Buproprion (Wellbutrin)

A

Lower seizure threshold (avoid in ETOH and BN/AN)

May WORSEN anxiety

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40
Q

Benefits of Buproprion

A

No sexual dysfunciton

May cause weight loss

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41
Q

SE of Mirtazepine (Remeron)

A 
Highly Sedating (take at bedtime)
Increase Appetite
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42
Q

Benefits of Mirtazepine (Remeron)

A

No sexual dysfunction
No worsening of anxiety (in contrast to Wellbutrin)
Increase appetite

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43
Q

TCA Antidepressants

A

Imipramine/Desipramine
Amitryptaline/Nortryptaline
Clomipramine
Doxepin

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44
Q

Antidepressants without Sexual SE

A

Mirtazepine

Burproprion

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45
Q

Major SE of Cymbalta (Duloxetine)

A

Inc LFT

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46
Q

Major SE of Effexor (Venlafaxine)

A

New Diastolic HTN

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47
Q

Major SE of Buproprion (Wellbutrin)

A

Decrease seizure threshold

Worsen anxiety

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48
Q

Worst SSRI for discontinuation syndrome

A

Paroxetine (Paxil)

Fluvoxamine (Luvox)

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49
Q

SSRI with worst weight gain

A

Paroxetine (Paxil)

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50
Q

Signs and Sx of SSRI Discontinuation Syndrome

A

Irritability
Unstable Gait
Rebound Anxiety
electric like shocks (Lhermitte)

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51
Q

Which SSRI are best for avoiding discontinuation sydrome

A

Fluoxetine (Prozac)

Citalopram (Celexa)

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52
Q

Three C’s of TCA overdose

A

Cardiotoxicity
Convulsions
Coma

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53
Q

Signs of NMS

A 
"FALTER"
Fever
Autonomic Instability
Leukocytosis
Tremor
Elevated CK
Rigidity
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54
Q

What HTN med can be given for nightmares in PTSD

A

Prazosin (alpha blocker)

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55
Q

SE of Trazodone

A

Priaprism

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56
Q

MAO-I + Tyramine excess =?

A

HTN Crisis => Stroke, Aneurysm

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57
Q

Which MAO-i binds reversibly

A

Meclobemide

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58
Q

Which MAO-i bind irreversibly

A

Phenylzine
Tranylcypromine
Selegiline

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59
Q

Nonstimulant option for ADHD

A

Atomoxetine
Slower onset-> less abuse potentional
also used for Narcolepsy

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60
Q

At what age can you give amphetamines for ADHD

A

After 3 years old

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61
Q

At what age can you give methylphenidate for ADHD

A

After 6 years old

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62
Q

Why can’t stimulants be given to ADHD Children if they have hx of HTN, psychosis or seizures

A

Inc NE => Worsen HTN
Inc Dopamine => Worsen Psychosis
Increased activity/excitation => Worsen seizures

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63
Q

Criteria A Signs and Sx of Schizophrenia

A

Hallucinations (Auditory MC)
Delusions
Disorganized Thinking/Behavior
Negative Sx

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64
Q

What are the negative sx of Schizophrenia

A 
"5As"
Anhedonia
Affect (poor)
Alogia
Avolition
Attention (poor)
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65
Q

How many A sx are needed to meet criteria for Schizophrenia

A

2 out of 5 for at least 1 month

*Unless delusions are bizarre or multiple voices or continuous voices

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66
Q

Duration of Symptoms for Schizophrenia Spectrum Disorders

A

At least 6 months => Schizophrenia
1-6 months => Schizophreniform
<1 month => Brief Psychotic Disorder

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67
Q

Criteria B for Schizophrenia

A

Social Occupational Dysfunction: work, interpersonal relationships, self care

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68
Q

What developmental disorders can present with psychosis

A

Asperger’s
Rhett’s Disorder
Autism (10x more common than Schizo in kids)

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69
Q

What personality disorders can have odd behavior

A

Cluster A: Paranoid, Schizoid, Schizotypal

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70
Q

What medications can cause psychosis

A

Steroids

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71
Q

Who gets schizophrenia more, M or F?

A

M=F; But M with more severe illness

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72
Q

Age of onset for schizophrenia

A

M: 15, 18-25 years
F: 25-40years

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73
Q

Most common time schizophrenics may attempt suicide?

A

During remission of illness just after a relapse

*Younger M who are DOING WELL with GOOD insight are highest risk

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74
Q

Cognitive Deficits of Schizophrenia

A 
SMART
Speed of Thinking
Memory
Attention
Reasoning
Tact
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75
Q

General Lifespan for Schizophrenic. Why?

A

~50 years
Substance Abuse (Smoking, etoh)
Suicide
Increased CV Risk

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76
Q

Brain Tracts and Associations

A

Nigrostriatal: EPS (Dystonia, Parkinsonism, Akathesia, TD
Tuberoinfudinbular: Prolactin
Mesolimbic: Psychosis (increased with DA inc)
Mesocortical: responsible for negative signs and sx

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77
Q

Treatment Algorithm for Schizophrenia

A

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

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78
Q

How long is adequate anti-psychotic trial

A

4 weeks at therapeutic dose

*Patients should have SOME response within 2 weeks

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79
Q

MC method of suicide for both sexes? 2nd most common Individually?

A

Firearms MC
M: hanging
F: Drug OD

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80
Q

Highest Suicide Rate Country

A
  1. Lithuania

2. Japan

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81
Q

Risk factors for Suicide

A 
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
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82
Q

Protective Factors for Suicide

A

Social Support
Religion
Parents with children

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83
Q

Which sex completes more suicide?

A

Male (3x more)

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84
Q

Which sex attempts more suicide?

A

Women (4x more)

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85
Q

Which anxiety disorder carries highest risk of suicide?

A

Panic Disorder

86
Q

Which personality disorder carries highest risk of suicide?

A

Borderline PD

87
Q

SAD PERSONS Scale for Suicide Risk

A 
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

88
Q

DSM Criteria for Manic Episode

A

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)

89
Q

DIG FAST Sx of Mania

A 
Distractability
Insomnia
Grandiosity
Flight of Ideas
Activity/Agitation
Speech Pressured
Thoughtlessnes (risky behavior- sexual, financial ...)
90
Q

Hypomania vs Mania

A

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

91
Q

Medical Causes of Manic Episode

A 
Metabolic: Hypothyroidism
Neuro: SEizures
Tumor
HIV, Syphilis
Meds: Steroids, TCA antidepressants
Drugs: MEthamphetaines, Cocaine
92
Q

Do more women or men get bipolar and how old are they?

A

Women = Men
Onset: childhood to 50 years
Average Age: 19 years
More common in divorced or single people

93
Q

Most common Presentation of Bipolar Disorder

A

Depressive Episode

*In Bipolar I men usually present with mania initially

94
Q

Labs to order for Bipolar Patient

A 
BMP
CBC
LFT
Urine Drugs
TSH
Vitamin B12
RPR
HIV
95
Q

Criteria for Cyclothymic Disorder

A

2 years of sx with periods of hypomanic sx and depressive sx with no more than 2 months of symptom free time

96
Q

Non-Pharm Tx for Bipolar Disorder

A

ECT

97
Q

Procedure for ECT

A

Early morning after 8-12hr fast -> Patient gets atropine/anticholinergic + anesthesia -> stimulus electrodes placed bitemporally -> brief pulse stimuli

98
Q

SE of ECT

A

Increased ICP
Bradycardia that advances to tachycardia
Memory Loss, HA, confusion

99
Q

Contraindications for ECT

A

Absolute: Increased ICP
RElative: Recent MI, large aneurysms, tumors

100
Q

Most common dementia

A

Alzheimer’s

101
Q

Characteristics of Vascular Dementia

A

Stepwise history of progression

Hx of CV disease

102
Q

Characteristics of Lewy Body Dementia

A

Visual Hallucinations
Respond poorly to levo-dopa
May worsen with antipsychotics

103
Q

Dementia associated with younger patients (<75) who have major personality change with prominent early behavior changes?

A

Frontotemporal Dementia

104
Q

Natural Hx of Alzheimer’s Disease

A

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

105
Q

Natural Hx of Vascular Dementia

A

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

106
Q

Natural Hx of Lewy Body Dementia

A 
More Parkinsonian type sx
Visual Hallucinations
Difficulty with attention - cannot cooperate
Neuroleptics may cause mortality
High rate of EPS SE
107
Q

Natural Hx of Frontotemporal Dementia

A

<65 years (younger)
Behavioral Issues (lying, stealing, poo hygiene)
No localized neurological issue
Memory generally okay early on

108
Q

DSM Criteria for Major Depressive EPISODE

A

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
109
Q

What medical conditions can cause depression?

A

Endocrine: thyroid, cortisol, calcium
Neuro: Parkinson’s, Mono
Cancer: Lymphoma, Pancreatic
SLE

110
Q

DSM Criteria for MDD

A

At least 1 major depressive episode

No signs of manic or hypomanic episode

111
Q

Sleep Problems associated with MDD

A

Multiple Awakenings
Initial and Terminal Insomnia
Hypersomnia
REM sleep earlier in night

112
Q

What is seasonal affective disorder?

A

Subtype of MDD
Eipsodes only occur during winter months.
Patients are:irritable, hypersomnic, and have carbohydrate cravigs

113
Q

What is dysthymic disorder

A 
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

114
Q

What is Double Depression

A

Patients with MDD who have dysthymic disorder in residual periods (Dysthymia in between episodes)

115
Q

What is cyclothymic disorder

A

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

116
Q

Is MDD more common in women or in men?
Average age?
Risks?

A

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

117
Q

What % of depressed patients have SI? What % commit suicide?

A

2/3 have SI

10-15% commit suicide

118
Q

What is the kindling theory of depression

A

With each episode of depression, patients are more prone to have further depressive episodes triggered with weaker stimuli/stressors

119
Q

5 Possible Outcomes during depression

A 
Response
Remission
Relapse
Recovery
Recurrence
120
Q

Risks of recurrent episodes of depression

A

50% after 1
70% after 2
90% after 3

121
Q

What is CBT for depression

A

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)

122
Q

What is Interpersonal Therapy for Depression?

A

Focuses on here and now
Uses relationship with therapist as a vehicle
Help redefine one’s relationships with others
Used for bulimia nervous patients

123
Q

What is Behavioral therapy for depression

A

Focused on learning models, healthy eating, relaxation models, exercise

Very effective for anxiety disorders and stress

124
Q

What is insight oriented therapy for depression?

A

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

125
Q

How often do patients with MDD have another comorbid psych condition

A

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

126
Q

Which patients with MDD need maintanence phase therapy?

A 
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
127
Q

What organ system is most strongly affected by depression?

A

Cardiovascular

128
Q

What are 4 ways in which anxiety response goes from normal to pathological?

A

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)

129
Q

List the anxiety disorders

A 
Panic disorder
GAD
OCD
PTSD
Social Phobia
Specific Phobia
130
Q

Most common mental disorders

A
  1. Phobia
  2. Substance Abuse
  3. MDD
  4. OCD
131
Q

Which gender are anxiety disorders more common in ?

A

W >M

132
Q

Why are SSRIs started at low dose in patients iwth panic disorder?

A

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

133
Q

Common Comorbid Conditions with Anxiety Disorders

A

Substance Abuse
Personality Disorders (Cluster C-Avoidant)
Other Anxiety disorders

134
Q

What can you use to differentiate between GAD and Panic Disorder?

A

CO2 Inhalation Test
Panic Disorder: will induce panic attack
GAD: will not

135
Q

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?

A

OCD: increases glucose metabolism

OCD Kids: PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep)

136
Q

Neurological Conditions that cause 2ndary Anxiety Sx

A 
Temporal Lobe Epilepsy
Parkinon's Disease
Post-Concussion Syndrome
Multiple Sclerosis
Meniere's Disease, Migraines
137
Q

General Medical Conditions that cause anxiety symptoms

A

Endocrine: hypoglycemia, pheo, carcinoid, insulinoma
CV: angina, arrhythmia, palpitations, chf
Pulm: PE, COPD, asthma
Irritable Bowel Sydrome
Caffein
Drugs
Severe Anemia

138
Q

Patient Presentation of Panic Disorder

A

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

139
Q

DSM Criteria for Panic Disorder

A

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)

140
Q

What risk factors do patients with panic disorder have?

A

High risk of suicide of all anxiety disorders

Increased risk of CV problems and stroke

141
Q

DSM Criteria for GAD

A

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
142
Q

When do patients present with OCD? When is it worse?

A

Present genreally in early to mid-twenties
Unusual after 50, almost never after 65

Worsens in: Pregnancy, Postpartum period

143
Q

DSM Definition of OCD

A

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)

144
Q

Common Obsessions

A 
Aggression
Contamination, Symmetry, Exactness
Somatic, Hoarding/Saving
Religious
Sexual
145
Q

What are compulsions and what are common ones?

A

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

146
Q

What predicts a poorer response to treatment in OCD

A

Sexual/Religious Obsessions
Poor insight into illness
Hoarding
Comorbid Depression, Personality disorder, or social anxiety

147
Q

DSM Criteria for PTSD

A

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

148
Q

Timefram of Acute Stress Disorder vs PTSD

A

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

149
Q

Acute Stress Disorder

A

At least 2 days but no greater than 1 month

PTSD Sx in 3 categories PLUS sense of numbing, detachment, depersonalization

150
Q

Time frames for Acute, Chronic, Delayed PTSD

A

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

151
Q

Risk Factors for PTSD

A 
Female
Assaultive Violence
Prolonged or Repeated Exposure
Childhood Trauma
Separation from parents during childhood
152
Q

Protective Factors for PTSD

A

Religious

153
Q

What is the diagnosis of a patient who presents with psychological symptoms after a stressful but non-life threatening event?

A

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
154
Q

DSM Criteria for Social Phobia (Social Anxiety Disorder)

A

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

155
Q

When does animal type of phobia develop?

A

childhood

156
Q

When does environmental type of phobia develop (ex: water, storms)

A

childhood

157
Q

When does blood injury/injection type of phobia develop?

A

childhood to adolescents

*highly familial with strong vasovagal response

158
Q

When does situational type of phobia develop

A

adulthood

159
Q

DSM Definition of a personality disorder

A

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)

160
Q

3 Clusters and their subtypes of Personality Disorders

A 
Cluster A(Odd or Eccentric): Paranoid, Schizoid, Schizotypal
Cluster B (Dramatic, Erratic, Emotional): Borderline, HIstrionic, Antisocial, Narcissistic
Cluster C (Anxious, Fearful): Avoidant, OCPD, Dependent
161
Q

Characteristics of Paranoid Personality Disorder

A

Cluster A

Suspicious of others
Assume motives are hostile when benign
Looks for hidden messages

162
Q

Characteristics of Schizoid Personality Disorder

A

Cluster A

Loners
Do not enjoy social relationships
Constricted Affect
Prefer solitary tasks
Okay alone
163
Q

Characteristics of Schizotypal Personality Disorder

A

Cluster A

Loners
Magical beliefs
Eccentric thoughts/behaviors
May be disordered in thinking

164
Q

Characteristics of Borderline Personality Disorder

A

Cluster B

Intense relationships
Black and White Thinking
Splitting as defense mech
May have hx of sexual abuse/trauma

165
Q

Characteristics of Narcissistic Personality Disorder

A

Cluster B

Gradiose view
Wants to be admired
Superiority complex
Very sensitive to critique
Become depressed when they dont get recognition
166
Q

Characteristics of Antisocial Personality Disorder

A

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

167
Q

Characteristics of Histrionic Personality Disorder

A

Cluster B

Dramatic and attention seeking behavior
Theatrical
Draws attention to self
Superficial and seductive

168
Q

Characteristics of Avoidant Personality Disorder

A

Cluster C

Fears rejection or criticism
Hyperaware of cues that may mean they are being mocked or criticized

169
Q

Characteristics of Dependent Personality Disorder

A

Cluster C

Rely on others, submissive, clingy behavior
Will agree to avoid abandonment

170
Q

Characteristics of Obsessive Compulsive Personality Disorder

A

Cluster C

Perfectionism than true OCD
Inflexible
Bothered bychanges in routine
Needs to be in control of situations and upset when not in control

171
Q

What is the first problem of treating personality disorders

A

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

172
Q

Which personality disorder has an increased correspondence with childhood sexual trauma or abuse

A

Borderline Personality Disorder

173
Q

Which cluster of personality disorder has a familial association with psychotic disorders

A

Cluster A
Schizoid
Schizotypal
Paranoid

174
Q

Which personality disorder has been shown to be most susccessfully treated with drugs

A

Borderline PD

175
Q

Which personality disorder uses regression as a defense mechanism

A

Histrionic- pts very theatrical, perceive relations as more intimate than they are, inappropriately seductive/provocative

176
Q

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.

A

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

177
Q

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

A

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.
178
Q

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.”

A

Borderline

  • unstable self-image, labile relationships, suicide attempts, inappropriate anger, vulnerable to abandonment.
  • “every other dr I met before you was horrible”
179
Q

How is social phobia different from Avoidant PD?

A

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

180
Q

What are some risk factors for OCPD?

A

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.

181
Q

In Keye’s study of healthy men who were starved,

What symptoms did they develop? What % never recovered?

A

Symptoms=moody, loss of humor, preoccupation with food, discussion of recipes, group solidarity, decreased decision making.

20% were permanently psychologically hurt and never recovered.

182
Q

What are the subtypes of anorexia nervosa?

A

Restricting

Binge-Purge Types

183
Q

What are some risks for AN?

A

Females, Genetics, Obstetrical complications, Dieting, Athletes (disordered eating, amenorrhea and osteoporosis)

184
Q

What is the DSM definition of bulimia nervosa?

A

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.

185
Q

Are genetics more a risk factor in AN or BN?

A

Anorexia has more of a link to genetics

186
Q

What cathartic can cause heart enlargement & cardiac toxicity?

A

Syrup of Ipecac

187
Q

What are the four main causes of death in eating disorders?

A

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)
188
Q

What is the most common Axis I co-morbidity in both AN & BN?

A

MDD or Dysthymia (50-60% of patients)

189
Q

Which disorder dose better on psych meds, AN or BN?

A

Bulimia

190
Q

Treatment for Bulimia

A

CBT is FIRST LINE Tx

-SSRI show ability to reduce binging behaviors and 50% reduction in sx

191
Q

Treatment in Anorexia

A

Best Tx is Family therapy

Best if patient is <21 years old

192
Q

What is the diagnosis if patients have recurrent binges, 2x/week
Over period of 6 months with marked distress over the binging?

A

Binge-Eating Disorder.

  • No purging behaviors
  • pts eat alone 2/2 embarrassment, eat when not hungry
  • Men=Women, onset in middle adult years
193
Q

Even after AN patients return to a normal weight, are they still
At risk for fertility and pregnancy complications?

A

Yes-reproductive rates are diminished-higher rate of pregnancy complications even if at normal weight!

194
Q

What sort of gain is sought in factitious disorder?

A

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
195
Q

What sort of gain is sought in malingering?

A

SECONDARY gain

196
Q

What are two strong predictors of violence?

A

EtOH intoxication and an overt stressor (breakup, loss)

  • Males ages 15-24 most likely to be violent
  • Low socioeconomic status, poor social support
197
Q

What sort of disorder is it when a patient expresses feelings unintentionally
And unconsciously through a metaphorical body dysfunction?

A

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
198
Q

Compare “circumstantial” vs. “perseverating” thought process?

A

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

199
Q

Treatment of Alcoholism

A

Antabuse

Acamprosate

200
Q

Criterion of Schizophrenia

A

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

201
Q

Criterion of Mania

A

3/7 for 1 week of DIGFAST

202
Q

Criterion of Hypomania

A

3/7 for 4 days of Criterion of

But not significantly impaired and not psychotic

203
Q

Criterion of Depressive Episode

A

5/9 SIGECAPS for 2 weeks

204
Q

Criterion of Major Depression Disorder

A

Depressive Episode + No mania or hypomania

205
Q

Criterion of Dysthymic Disorder

A

2 yrs of depression without meeting episode criteria
No more than 2 months without sx
Never has psychotic features

206
Q

Criterion of Panic Disorder

A

All three:
Panic Attacks
Avoidance of situations that trigger panic
Anticipatory Anxiety about future attacks

207
Q

Criterion of OCD

A

Obsession OR compulsions
Pt distressed by behavior
Obsessions and Compulsions not limited to other disorders

208
Q

Criterion of PTSD

A

All three:
Reexperiencing event
Avoidance of reminders of event
Increased arousal (need 2 sx)

209
Q

Criterion of Acute Stress Disorder

A

Occurs within 1 month, lasts for 2 days or more,

resolves in 1 month

210
Q

Criterion of GAD

A

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

Psychiatry (7 decks)

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