Psychology Flashcards
What must be ruled out before a pervasive development disorder can be diagnosed?
What are the 4 most common pervasive developmental disorders with characteristics?
Must rule out metabolic or other medical cause for developmental disorder and must rule out hearing/vision impairment.
Autistic: M>F, symptoms noticed by 3 years, “living in another world”, poor eye contact, repetitive behaviors, below normal intelligence
Rest disorder: F>M, are normal in the beginning of life with a progressive encephalopathy with regression, characteristic midline hand wringing, ataxia and psychomotor retardation.
Childhood disintegration disorder: M>F, normal development for first 2 years and marked regression in functioning (social, language, motor).
Aspergers disorder: M>F, problems with social interactions and behavior but no language or intellectual deficits. Preoccupation with rules.
Describe the personality disorders belonging to each cluster
Cluster A:
ADHD: presentation, diagnostic criteria, first and second line treatments
Present with inattention, short attention span or hyperactivity. “Careless school mistakes”
Criteria: interefers with daily functioning in at least two areas (home,school, sports) for more than 6 months and before the age of seven.
First line: methylphenidate and dextroamphetamines
Second line: atomoxetine, TCA, buproprion, clonidine.
Diagnose with questionnaires of patients behavior in more then one setting.
ADHD: in who can medications be started? What are common side effects of ADHD medications?
Must be at least 6 years old before medication is started.
SE of stimulants is insomnia, decreased appetite and headache.
Difference between oppositional defiant disorder and conduct disorder.
Oppositional defiant: M>F before puberty, equal after puberty. Usually noted by age 8. Argue with others and lose temper easily and blame others for mistake. Have problems with authority figures.
Conduct disorder: M>F and in parents with antisocial personality disorder or alcohol abuse. Persistent behavior where rules are broken, aggressive, little regard for others rights, animal cruelty. If this continues into adulthood it is considered anti-social personality disorder.
Major depressive disorder: criteria for diagnosis, differentials, treatment
2 week period of depressed mood or anhedonia with at least 4 of: weight changes, sleep changes, psychomotor disturbance, fatigue, poor concentration, guilty/worthlessness or suicidal ideation.
Differentials: part of dementia, Parkinson’s, hypothyroid, chronic steroid use, cushings, etc.
Treatment: first line SSRI and psychotherapy
Alternatives: if weight gain concern buproprion,
Bipolar disorder: criteria for diagnosis, treatment
Mania listing at least one week with impaired functioning is sufficient for diagnosing bipolar disorder; depression will eventually predominate. Symptoms of mania include (dig fast): distractability and easy frustration, irresponsibility with erratic behavior, grandiosity, flight of ideas, activity increase with weight loss and increased libido, sleep decrease, talkativeness.
Must rule out substance abuse ; less than a week is hypo mania.
Treat acute mania with mood stabilizers: lithium, valproic acid and if severe atypical antipsychotics ( risperadone, quiteapine, clozapine).
Treat bipolar depression with lithium or lamotrigine.
For who is lithium not an appropriate treatment in bipolar disorder?
People with diminished kidney function
Define hypomania, dysthymia and cyclothymia.
Hypomania is mania symptoms that are mild, not requiring hospitalization and lasting less than a week.
Dysthymia is depressed mood that last most days and is almost continuos for more than 2 years; usually not as severe as MDD and no component of suicidality. Treat like MDD.
Cyclothymia is combination of hypomania episodes and dysthymia present for more than 2 years. Treat like bipolar disorder.
What are the symptoms of atypical depression and what medications are first line treatment?
Increased appetite, increased weight gain, increased sleeping with more psychomotor retardation.
Treat with MAOI and SSRI.
What is seasonal affective disorder and how is it treated?
Seasonal changes in mood during fall and winter, usually atypical depression symptoms.
Treat with phototherapy and buproprion.
Differentiate between post-partum Blues, post-partum depression and post-partum psychosis and recommended treatment for each.
post-partum Blues: occurs immediately after birth and lasts about 2 weeks, moms can be tearful with emotional lability. No negative feelings towards baby. Usually self-limited and not requiring treatment.
post-partum depression: within 1-3 months after birth with depression and anxiety symptoms, may have negative feelings towards baby. Treat with anti-depressant meds.
post-partum psychosis: within 2-3 weeks after birth with depression, delusion and thoughts of harm; may have thoughts of harming baby. Antipsychotic meds, lithium and maybe anti-depressants.
What is the difference between bereavement and depression?
Bereavement is a normal period of sadness, decreases appetite and decreased energy following the death of a loved one; it can last up to 6 months and usually resolves on its own.
If however:
- the intensity of these feelings has not resolved in 6 months
-there is inability to move on, trust or re-engage in life after 6 months
-there are any elements of helplessness, hopelessness, guilt or worthlessness
-any suicidal ideation
- the person meets depression criteria for 2 wks after 2 months of the death
Then this person is considered depressed and warrants further treatment.
Tricyclic antidepressants: name a few medications in this class, side effects, toxicity and treatment for overdose
TCA: amitriptyline, nortriptyline and imipramine
Side effects: hypotension, dry mouth, constipation, confusion, arrhythmia, sexual side effects, weight gain, GI disturbance.
Toxicity: cardiotox, CNS toxicity and anti-cholinergic symptoms.
Treatment for OD: charcoal only if within 30 minutes of ingestion, sodium bicarbonate to increased urine excretion especially if prolonged QRS, benzo if seizure
MOAI: name medications in this class, side effects, concerns for patients taking these medications
MAO(A) inhibitors: phenelzine, isocarboxazid and tranylcypromine
Side effect hypertensive crisis if tyramine rich foods, usually aged foods, are taken with this medication.
