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EOR Exam - Behavioral Medicine > Psychotic and Conduct Disorders > Flashcards

Psychotic and Conduct Disorders Flashcards

1
Q

What is critical to determine when first assessing a patient with a suspected psychosis?

A

Rule out an organic/medical cause of the mental status change.

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2
Q

What S/S help to distinguish and organic cause of psychosis from a functional (psychiatric) cause?

A

Sudden onset, abnormal vitals, recent memory deficits, psychomotor retardation, emotional lability, occasional periods of lucidity, disorientation, visual/tactile hallucinations (functional cause usually auditory only).

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3
Q

Define and describe the diagnostic criteria for delusional disorder.

A

Persistent, non-bizarre delusion not otherwise explained - fixed, false belief that has a certain level of plausibility. Must be present for 1+ month with no hallucinations nor disorganized speech/behavior.

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4
Q

Define and describe paranoid delusions.

A

Delusions about things that COULD happen. Behavior not obviously odd and functioning not significantly impaired.

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5
Q

Define/describe the following types of delusions: erotomatic, somatic, jealous, persecutory, grandiose, reference, control, nihlism.

A

Erot: famous or powerful person is in love with Pt.
Som: Pt has physical defect or medical condition
Jeal: Pt’s partner having an affair
Pers: Pt or another person is mistreated
Grand: inflated self-worth, power, knowledge
Ref: random events take on personal significance
Cont: some agency controls thoughts, feelings, behaviors
Nihl: exaggerated belief in futility of everything

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6
Q

What is the most common type of delusion?

A

Persecutory

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7
Q

Describe delusions of parasitosis.

A

Firm belief that pruritis is caused by infestation of insects or parasites. Presents with self-inflicted skin manifestations.

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8
Q

What are the treatment options for delusiions?

A

Anti-psychotics 1st line –> aripiprazole (abilify)
SSRIs
Avoid directly challenging the Pt

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9
Q

What distinguishes delusions from schizophrenia and other psychotic conditions?

A

Minimal deterioration in personality or function and the relative absence of other psychopathologic symptoms.

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10
Q

Define and describe schizoaffective disorder.

A

Schizophrenia + a mood disorder (depression, bipolar, etc.). Delusions or hallucinations lasting 2+ weeks without mood disorder symptoms differentiate schizoaffective from mood disorder with psychotic features.

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11
Q

What treatment options are available for schizoaffective disorder?

A

Atypical anti-psychotic is first line. Mood stabilizer or anti-depressant may be added. . Psychosocial support may help as well.

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12
Q

Describe the diagnostic criteria for schizophrenia.

A

6+ month illness with 1+ month acute symptoms along with functional decline. Must have 2+ of the following: hallucinations, delusions, disorganized speech, disorganized/catatonic symptoms, negative symptoms.

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13
Q

Differentiate positive from negative symptoms of schizophrenia.

A

Pos: any change in behavior or thoughts - hallucinations, delusions, etc.
Neg: withdrawal from the outside world - appear emotionless and flat

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14
Q

Describe the terms catatonia and residual with regard to schizophrenia.

A

Cat: silent, no response to external stimuli
Res: socially withdrawn

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15
Q

What is the most common type of hallucination associated with schizophrenia.

A

Auditory

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16
Q

Other than the most common, list various types of hallucinations associated with schizophrenia.

A

Visual, olfactory, tactile, somatic (sensation arising from within the body), gustatory( tasting things that aren’t there - thinking poison is in food, for ex)

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17
Q

Define neologisms.

A

Nonsense words invented by the patient –> common symptom of schizophrenia.

18
Q

Describe the pathophysiology of positive and negative symptoms associated with schizophrenia.

A

Pos: excess DA receptors in mesolimbic pathway
Neg: low DA in mesocortical pathway
Serotonin hyperactivity and decreased grey matter are also thought to play a role in the disease.

19
Q

What is the main treatment of schizophrenia and describe the subtypes of the medication.

A

Antipsychotics are 1st line
1st gen/typical: risk of extrapyramidal symptoms (EPS) and treat only positive symptoms
2nd gen/atypical: less risk of EPS and treat both positive and negative symptoms.

20
Q

Define schizophreniform disorder.

A

Fits criteria for schizophrenia but symptoms last less than 6 months (but greater than 1 month)

21
Q

Describe requirements for a diagnosis of ADHD to be made.

A

S/S > 6 months present in more than one environment with onset < age 7 and no association with psychosis. S/S –> short attention span, easily distracted, sometimes hyper-focus, hyperactivity, impulsivity.

22
Q

Describe some of the secondary effects/symptoms of ADHD.

A

emotional lability, poor social skills, motor incoordination, peer rejection and deflated self-image, often don’t comply with parents requests

23
Q

Name two rating scales used to assist in the diagnosis of ADHD.

A

Conners Comprehensive Behavioral Rating Scale

ADHD Rating Scale IV

24
Q

Describe treatment options available for ADHD.

A

Pharm: stimulants are first line

Non-pharm: behavior modification (1st line), group therapy, family therapy

25
Q

What stimulants are commonly used most commonly in the management of ADHD?

A

methylphenidate (Ritalin), dexmethylphenidate (focalin), amphetamine + dextroamphetmine (adderal)

26
Q

If a patient with ADHD has a personal or family history of SUD, what medication is indicated as an alternative to controlled substances (stimulants)?

A

Atomoxetine - SNRI

27
Q

What medications may be used as adjunctive therapy in the management of ADHD?

A

Anti-depressants - bupropion, venlafaxine, clonidine, imipramine
Guanfenacine - centrally acting anti-HTN

28
Q

What characteristics are consistent with autism spectrum disorders and considered primary signs?

A

significant emotional discomfort or detachment, communication difficulties (inability to communicate or chooses not to), repetitive behaviors

29
Q

What characteristics are considered secondary signs of autism?

A

persistent failure to develop social relationships, failure to show preference to parents over other adults, unusual sensitivity to visual, auditory, olfactory stimuli, unusual attachments to ordinary objects.

30
Q

By what age are characteristics of autism typically seen and what S/S will be present at that age?

A

Age 3-6 months –> aloof, withdrawn, lack facial expression

31
Q

T/F: Autism is more common in males than females.

A

True: 3-5 times more common in males

32
Q

What diagnostic tool is used at 18 months to aid in the diagnosis of autism?

A

M-CHAT

33
Q

What treatment options are available in the management of autism?

A

Behavioral therapy is first line
Anti-psychotics (risperidone, aripiprazole, haloperidol) and neuroleptics (carbamazepine) to reduce impulsivity and irritability.
SSRIs can help control repetitive behaviors

34
Q

Describe the DSM-V diagnostic criteria for conduct disorder.

A

Age < 18 and 3+ acts of misconduct in the last 12 months in any of the following categories:

  • Aggression to people or animals
  • Destruction of property
  • Deceitfulness or theft
  • Serious violations of rules
35
Q

What condition do children with conduct disorder commonly develop in adulthood and what is the percentage risk of developing said condition?

A

40% diagnosed with conduct disorder have anti-social personality disorder as an adult.

36
Q

T/F: Conduct disorders are more common in males than females.

A

True

37
Q

What comorbid conditions commonly coexist with conduct disorder?

A

ADHD, IDD, SUD, mood disorders

38
Q

What differentiates conduct disorder from oppositional defiant disorder?

A

The presentations are similar. But, conduct disorder typically presents with more physical aggression and other severe forms of antisocial behavior. Conduct disorder would generally be considered a more severe presentation than ODD.

39
Q

What are the treatment options for conduct disorder?

A

Environmental/behavioral modification, family therapy
Stimulants, bupropion, clonidine, lithium, haloperidol, 2nd gen antipsychotics, valproic acid to reduce aggression, SSRIs for mood lability and impulsivity.

40
Q

What is the diagnostic criteria for oppositional defiant disorder?

A

< 8 y/o with 6+ months of at least four of:

  • frequent loss of temper
  • arguments with adults
  • defying adults’ rules
  • deliberately annoying others
  • easily annoyed
  • anger and resentment
  • spitefulness
  • blaming others for mistakes or misbehaviors
41
Q

What percentage of children diagnosed with ODD progress to conduct disorder?

A

25%

42
Q

What are the treatment options for ODD?

A

Family therapy, psychotherapy, behavior modification focused on problem solving skills.

EOR Exam - Behavioral Medicine (6 decks)

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