Psychiatry - Pathology (2) Flashcards
1
Q
Specific phobia
- Definition
- Treatment
- Social anxiety disorder
- Definition
- Treatment
- Agoraphobia
A
- Definition
- Fear that is excessive or unreasonable and interferes with normal function.
- Cued by presence or anticipation of a specific object or situation.
- Person recognizes fear is excessive.
- Treatment
- Can treat with systematic desensitization.
-
Social anxiety disorder
- Definition
- Exaggerated fear of embarrassment in social situations (e.g., public speaking, using public restrooms).
- Treatment
- SSRIs.
- Definition
-
Agoraphobia
- Exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone.
2
Q
Generalized anxiety disorder
- Definition
- Treatment
- Adjustment disorder
A
- Definition
- Pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event.
- Associated with sleep disturbance, fatigue, GI disturbance, and difficulty concentrating.
- Treatment
- SSRIs, SNRIs, buspirone, cognitive behavioral therapy.
-
Adjustment disorder
- Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, illness) and lasting < 6 months (> 6 months in presence of chronic stressor).
3
Q
Obsessive-compulsive disorder
- Definition
- Treatment
- Ego dystonic
- Body dysmorphic disorder
A
- Definition
- Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress
- Associated with Tourette disorder.
- Treatment
- Relieved in part by the performance of repetitive actions (compulsions)
- SSRIs, clomipramine.
- Ego dystonic
- Behavior inconsistent with one’s own beliefs and attitudes (vs. obsessive-compulsive personality disorder)
-
Body dysmorphic disorder
- Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning
- Patients often repeatedly seek cosmetic surgery.
4
Q
Post-traumatic stress disorder
- Definition
- Treatment
- Acute stress disorder
A
- Definition
- Persistent reexperiencing of a previous traumatic event (e.g., war, rape, robbery, serious accident, fire).
- May involve nightmares or flashbacks, intense fear, helplessness, or horror.
- Leads to avoidance of stimuli associated with the trauma and persistently increased arousal.
- Disturbance lasts > 1 month, with onset of symptoms beginning anytime after event, and causes significant distress, negative cognitive alterations, and/or impaired functioning.
- Treatment
- Psychotherapy, SSRIs.
-
Acute stress disorder
- Lasts between 3 days and 1 month.
5
Q
Malingering
A
- Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific 2° (external) gain (e.g., avoiding work, obtaining compensation).
- Poor compliance with treatment or follow-up of diagnostic tests.
- Complaints cease after gain (vs. factitious disorder).
6
Q
Factitious disorders
- Definition
- Munchausen syndrome
- Munchausen syndrome by proxy
A
- Definition
- Patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (1° [internal] gain).
- Munchausen syndrome
- Chronic factitious disorder with predominantly physical signs and symptoms.
- Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures.
- Munchausen syndrome by proxy
- When illness in a child or elderly patient is caused by the caregiver.
- Motivation is to assume a sick role by proxy.
- Form of child/elder abuse.
7
Q
Somatic symptom and related disorders
- Definition
- Somatic symptom disorder
- Conversion disorder
- Illness anxiety disorder (hypochondriasis)
A
- Definition
- Category of disorders characterized by physical symptoms with no identifiable physical cause.
- Both illness production and motivation are unconscious drives.
- Symptoms not intentionally produced or feigned.
- More common in women.
- Somatic symptom disorder
- Variety of complaints in one or more organ systems lasting for months to years.
- Associated with excessive, persistent thoughts and anxiety about symptoms.
- May co-occur with medical illness.
- Conversion disorder
- Sudden loss of sensory or motor function (e.g., paralysis, blindness, mutism), often following an acute stressor
- Patient is aware of but sometimes indifferent toward symptoms (“la belle indifférence”)
- More common in females, adolescents, and young adults.
- Illness anxiety disorder (hypochondriasis)
- Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance.
8
Q
Personality
- Personality trait
- Personality disorder
A
- Personality trait
- An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself.
- Personality disorder
- Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/ or impaired functioning
- Person is usually not aware of problem.
- Usually presents by early adulthood.
- Three clusters, A, B, and C
- Remember as Weird, Wild, and Worried based on symptoms.
9
Q
Cluster A personality disorders
- Definition
- Disorders
A
- Definition
- Odd or eccentric
- Inability to develop meaningful social relationships.
- No psychosis
- Genetic association with schizophrenia.
- “Weird” (Accusatory, Aloof, Awkward).
- Disorders
- Paranoid
- Schizoid
- Schizotypal
10
Q
Cluster A personality disorders
- Paranoid
- Schizoid
- Schizotypal
A
- Paranoid
- Pervasive distrust and suspiciousness
- Projection is the major defense mechanism.
- Schizoid
- Voluntary social withdrawal, limited emotional expression, content with social isolation (vs. avoidant).
- Schizoid** = distant.**
- Schizotypal
- Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness.
- Schizotypal = magical thinking.
11
Q
Cluster B personality disorders
- Definition
- Disorders
A
- Definition
- Dramatic, emotional, or erratic
- Genetic association with mood disorders and substance abuse.
- “Wild” (Bad to the Bone).
- Disorders
- Antisocial
- Borderline
- Histrionic
- Narcissistic
12
Q
Cluster B personality disorders
- Antisocial
- Borderline
- Histrionic
- Narcissistic
A
- Antisocial
- Disregard for and violation of rights of others, criminality, impulsivity
- Males > females
- Must be > 18 years old and have history of conduct disorder before age 15.
- Conduct disorder if < 18 years old.
- Antisocial = sociopath.
- Borderline
- Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, boredom, sense of emptiness
- Females > males
- Splitting is a major defense mechanism.
- Histrionic
- Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance.
- Narcissistic
- Grandiosity, sense of entitlement
- Lacks empathy and requires excessive admiration
- Often demands the “best” and reacts to criticism with rage.
13
Q
Cluster C personality disorders
- Definition
- Disorders
A
- Definition
- Anxious or fearful
- Genetic association with anxiety disorders.
- “Worried” (Cowardly, Compulsive, Clingy).
- Disorders
- Avoidant
- Obsessive-compulsive
- Dependent
14
Q
Cluster C personality disorders
- Avoidant
- Obsessive-compulsive
- Dependent
A
- Avoidant
- Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid).
- Obsessive-compulsive
- Preoccupation with order, perfectionism, and control
- Ego-syntonic: behavior consistent with one’s own beliefs and attitudes (vs. OCD).
- Dependent
- Submissive and clinging, excessive need to be taken care of, low self-confidence.
15
Q
Schizo-
- -id vs. -typal vs. -phrenic vs. -affective
- Schizophrenia time course
A
- Schizoid < Schizotypal < Schizophrenic < Schizoaffective
- Schizotypal = schizoid + odd thinking
- Schizophrenic = greater odd thinking than schizotypal
- Schizoaffective = schizophrenic psychotic symptoms + bipolar or depressive mood disorder
- Schizophrenia time course
- < 1 mo—brief psychotic disorder, usually stress related
- 1–6 mo—schizophreniform disorder
- > 6 mo—schizophrenia
16
Q
Eating disorders
- Anorexia nervosa
- Definition
- Findings
- Bulimia nervosa
- Definition
- Findings
A
- Anorexia nervosa
- Definition
- Excessive dieting +/− purging
- Intense fear of gaining weight, body image distortion, and increased exercise, leading to a body weight well below ideal (≈ BMI < 17 kg/m2).
- Seen primarily in adolescent girls
- Findings
- Associated with decreased bone density.
- Severe weight loss, metatarsal stress fractures, amenorrhea, lanugo (fine body hair), anemia, and electrolyte disturbances.
- Osteoporosis caused in part by decreased estrogen over time.
- Commonly coexists with depression.
- Definition
- Bulimia nervosa
- Definition
- Binge eating +/− purging
- Often followed by self-induced vomiting or use of laxatives, diuretics, or emetics.
- Body weight often maintained within normal range.
- Seen predominantly in adolescent girls
- Findings
- Associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from induced vomiting (Russell sign).
- Definition
