Case files: psychiatry (cases) – Flashcards
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major side effects of TCAs?
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-anticholinergic (dry eyes, dry mouth, constipation)
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what medication should be used to treat recurrent depression when TCAs are not an option?
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-SSRIs, SNRIs, bupropion, mirtazapine
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what is special about bupropion?
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-it is one of the few anti-depressancts that do not cause sexual side effects
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criteria for recurrent major depression
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-2 or more episodes of major depression diagnosed as the following (5 or more of the following symptoms present most of the time for at least 2 weeks [depressed mood, anhedonia, significant weight change or change in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, decreased ability to concentrate or indecisiveness, thourhgts of death or suicidal ideation]) -there has never been a manic, hypomanic or mixed episode -symptoms cause significant distress or impairment in functionning -symptoms are not caused by substance abuse, medication or medical condition -symptoms are not better accounted for by schizophrenia, schizoaffective disorder, delusional disorder, or a psychotic disorder not otherwise specified -symptoms are not better accounted for by bereavement
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what is SIGECAPS?
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-this is the mnemonic used to remember the criteria for an episode of major depression -Sleep changes, (decreased) Interest, (excessive) Guilt, (decreased) Energy, (decreased) Concentration, Appetitie changes, Psychomotor agitation or retardation, Suicidal ideation
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what are risk factors for suicide?
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-older age, alcohol or drug dependence, prior suicide attempts, male gender, family history of suicide
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how postpartum blues and postpartum depression differ?
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-postpartum blues: sadness, strong feelings of dependency, frequent crying spells and dysphoria that lasts for several days to a week--> not treated the same as depression -postpartum depression: characterized by suicidality and severely depressed feelings and exceeds in length as compared to postpartum blues--> treated as one would treat major depression
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what can postpartum depression turn into if left untreated?
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-psychosis
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what is the risk of recurrence in someone that suffers from major depression?
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-50-85% chance of having another episode
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when is electroconvulsive therapy indicated?
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-major depression with psychotic features or where a rapid response is required
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what criteria for depression must be there in order to diagnose it?
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-depressed mood or anhedonia
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how long should medication be continued after the first episode of major depression?
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-6-9 months
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what does DSM V consider adding to the diagnosis of depression?
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-severity of illness rating scale
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what are the diagnostic criteria for schizophrenia?
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-delusions (thinks people are not who they say they are) and auditory hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms -only one of the preceding is needed if the delusions are bizarre, the auditory hallucinations involve comments on the patients or there are 2 or more voices talking to each other -there has to be significant social and/or occupational dysfunction -negative symptoms or less intense positive symptoms must be present for at least 6 months
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what is schizophrenia defined as?
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-a disturbance that lasts 6 months and includes at least 1 month of active-phase symptoms (2 or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior)
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what is the suicide attempt rate in schizophrenics?
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-20-40%
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what are risk factors for schizophrenia?
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-depressive symptoms (especially hopelessness), under 45 years of age, male gender, unemployment, recent discharge from the hospital
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what does paranoid schizophrenia look like?
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-preoccupation with one or more delusions or frequent auditory hallucinations
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what does disorganized schizophrenia look like?
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-disorganized speech and behavior, with flat or inappropriate affect
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what does catatonic schizophrenia look like?
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-2 or more of the following: motor immobility (cataplexy/stupor), excessive puposeless motor activity, extreme negativism (maintenance of rigid posture) or mutism, peculiar voluntary moevements such as posturing, sterotyped movements, prominent mannerisns or graimacing and echolalia/echopraxia
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what does undifferentiated schizophrenia look like?
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-two or more of the following are present: delusions, hallucinations, disorganized speech, grossly disorganized behavior, and negative symptoms
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what does residual schizophrenia look like?
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-characterized by the absence of prominent delusions, hallucinations, disorganized speech or grossly disorganized/catatonic behavior
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what medical conditions can produce psychotic symptoms?
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-delirium, dementias, severe hypothyroidism, and hypercalcemia
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what drug overdose can appear identical to schizophrenia?
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-phenycyclidine intoxication
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how are schizoaffective disorder and mood disorder with schizophrenia differentiated?
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-in schizoaffective disorder, psychotic symptoms are present along with and in the absence of mood disorder but the mood disorder is only present with psychotic symptoms -in mood disorder with psychotic features, psychotic symptoms are only present during mood disorder but the mood disorder is present in the absence of psychotic symptoms
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what agents are used to treat neuroleptic malignant syndrome?
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-dantrolene and bromocriptine
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what is a very specific symptom to schizophrenia?
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-presence of a bizarre delusion
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how long must symptoms be present for the diagnosis of schizophrenia?
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-more than 6 months of psychotic symptoms
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what are the positive symptoms of schizophrenia?
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-hallucinations, delusions, ideas of reference, paranoia, grossly disorganized speech or behavior and loose associations
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what are the negative symptoms of schizophrenia?
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-affective flattening, alogia (diminished flow and spotaneity of speech), avolition (lack of initiative or goals)
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what is the definition of a panic attack?
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-it consists of discrete episodes of at least 4 of the following: palitations, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, dissiness, derealization or depersonalization, fear of losing control or going crazy, fear of dying, numbness or tingling (paresthesias), chills or hot flashes
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what are the criteria for panic disorder?
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-recurrent, unexpected panic attacks -attacks followed by 1 month of one of the following: concerns about having additional attacks, worry about the consequences of attacks or a change in behavior as a result of attacks
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what is the treatment for panic disorder?
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-SSRIs, SNRIs, TCAs -best results are medication combined with cognitive behavioral therapy
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what is specific phobia?
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-this is charatcerized by an excessive fear that is cued by the presence or anticipation of a specific object or situation rather than social or performance situations
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what is the best treatment for bipolar I disorder, single manic episode with psychotic features?
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-mood stabilizer (such as valproic acid or lithium) and atypical antipsychotic agent
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what are the characteristics of bipolar type I disorder?
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-a syndrome with complete manic symptoms occurring during the course of the disorder
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what are the characteristics of bipolar type II disorder?
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-hypomania, characterized by depression and episodes of mania that don't meet the full criteria for manic synfrom
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what are the diagnostic criteria for bipolar disorder?
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-a distinct period of abnormally and persistently elevated, expansive or irritable mood and persistent increased energy lasting at least 1 week -three or more of the following symptoms during the period of mood disturbance and increased energy (inflated self-esteem or grandiosity, decreased need for sleep, greater talkativeness than usual or pressure to keep talking, flight of ideas or subjective experience that thoughts are racing, distractability, increase in goal-directed activity or psychomotor agitation, excessive invovlement in pleasurable activities with a high potential for painful conseuqeunces [buying sprees, sexual activity, foolish investments])
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how do you distinguish ADHD or ODD from bipolar disorder?
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-the presence of symptoms before the age of 7 make ADHD or ODD much more likely than bipolar
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what is the treatment for bipolar disorder?
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-lithium carbonate, carbamazepine and divalproex
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what is the major side effect of carbamazepine?
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-aplastic anemia or agranulocytosis
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what medications can be used to control episodes of mania in bipolar patients?
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-atypical anti-psychotics, such as olanzapine, risperidone and quetiapine
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what should patients that are put on atypical antipsychotics be monitored on?
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-development of metabolic syndrome (weight gain, diabetes mellitus and hypercholesterolemia)
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what are common iatrogenic causes of delirium?
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-benzodiazepines, anticholinergics, antihistamies and narcotics
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what are the diagnostic criteria for delirium?
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-disturbance of consciousness with a reduced ability to focus, sustain or shift attention -change in cognition or a perceptual disturbance not better accounted for by dementia -disturbance develops over a short period of time and tends to fluctuate over the day
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what is sundowning?
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-worsening of a delirium at night
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what is the hallmark of delirium?
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-fluctuation of consciousness
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what is different about the level of consciousness between delirium and dementia?
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-the level of consciousness is altered in delirium whereas in dementia it is not
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how can you distinguish between delirium and a primary psychotic disorder?
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-the hallucinations in delirium are usually visual whereas the hallucinations in primary psychotic disorders are auditory
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what is very sensitive in detecting a delirium?
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-an EEG
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what is the treatment for major depression with psychotic features?
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-an SSRI and an atypical antipsychotic medication
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what are the criteria for major depression with psychotic features?
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-the patient must have 5 or more of the following symptoms, which should be present for a 2 weeks period: depressed moo nearly every day for most of the day, significantly decreased pleasure or interest in usual activities during most of the day for several days, a significant decrease or increase in appetite, weight loss (without dieting) or weight gain, daily insomnia or excessive sleeping, psychomotor slowing or agitation, decreased or absent energy for most of the day for several days, a sense of worthlessness or unusual feeling of guilt most of the day for most days, decrease ability to concentrate or slowed thinking, thoughts of death or suicide
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what are somatic delusions?
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-false beliefs about one's body
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what are vegetative symptoms?
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-symptoms of expression that are physiologic or are related to boy functions
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what are significant predictors for major depression in childhood an adulthood?
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-genetic factors, loss of a parent at an early age (before age 11), and adverse early life experiences
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what are the indications that a person with bereavement is developing major depression?
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-preoccupation with guilt,feeling that one has caused the death of the loved one, an suicidal thoughts
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how do children with major depression often report their mood?
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--they report their mood as angry or mad as opposed to sad or depressed
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what is the best treatment for conduct disorder?
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-multi-systemic tratment approach with involvement of parents an teachers
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what comorbid condition is often seen in patients with conduct disorder?
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-ADHD
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what pharmacologic agent has been shown to be beneficial in conduct disorder?
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-stimulants, risperione, olanzapine, quetiapine and aripiprazole
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what are the diagnostic criteria for conduct disorder?
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-persistent, repeptitive pattern of behavior that infringes on the basic rights of others or violates major age-appropriate societal norms. The pattern is manifested by the presence of at least 3 of the following synmptoms in the last 12 months with at least once occurring in the last 6 months: aggression toward people or animals, destruction of property, deceitfulness or theft, a serious rule violation
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what is anti-social personality disorder?
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-this is a pervasive disregard for an violation of rights of others starting by age 15
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what is wraparound?
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-a framework for organizing services in high-needs, mentally ill children involving a number of core values including cultural sensitivity, strengths focus, creativity, natural supports and team approaches
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how does oppositional defiance disorder differ from conduct disorder?
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-ODD is characterized by a negative behavior pattern however the offense do not typically cause significant harm to others or involve violations of major societal norms
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what aspects of the family history are likely positive in a patient with conduct disorder?
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-it is more common in parents with antisocial personality disorder an alcohol dependence
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how are OCD and obsessive compulsive personality disorder distinguished from each other?
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-OCD has recurrent obsessions while OCPD does not
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what is rationalization?
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-a defense mechanism by which an indiviual deals with emotional conflict or stressors by concealing the true motivation for thoughts, actions or feelings through the elaboration of reassuring or self-serving but incorrect explanations
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what is undoing?
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-a defense mechanism by which an individual deals with emotional conflict or stressors with words or behavior designed to negate or to symbolically make amends for unacceptable thoughts, feelings or actions
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what are the essential features of obsessive compulsive personality disorder?
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-there is a pervasive pattern of perfectionism an inflexibility
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what type of interview techniques should be used with patients with obsessive compulsive personality disorder?
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-they should be treated with the scientific approach and should be provided with documentary evidence and details
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what is the treatment for obsessive compulsive personality disorder?
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-long-term, insight-oriented psychodynamic psychotherapy
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what are risk factors for developing PTSD?
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-female gender, previous psychiatric illness, lower educational level, and lower SES
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what symptoms do people with PTSD often exhibit?
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-hyperarousal, such as insomnia, irritability or angry outbursts, difficulty concentrating, hypervigilance, and/or a pronounced startle response
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what is the treatment for PTSD?
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-SSRIs (sertraline an paroxetine), SNRIs, TCAs, MAOIs -alpha-1 adrenergic antagonists -CBT (cognitive processing therapy and prolonged exposure to relive the traumatic event in his or her imagination)
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what is the best medical therapy for dysthymic disorder?
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-SSRIs, SNRIs an other antidepressants, such as bupropion
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what are the diagnostic criteria for dysthymic disorder?
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-subjective or objective depressed mood most of the day for more days than not for at least 2 years (can only be one year for children and adolescents) -presence of two or more depressive symptoms such as appetite changes, sleep changes, low energy level, low self-esteem, poor concentration or indecisiveness or feelings of hopelessness -during the two-year time period, the person cannot have been without symptoms for more than 2 months -the criteria for major depression are not met during the first two years of the mood disturbance
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what are the major differences between dysthymic disorder and major depressive disorder?
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-dysthymic disorder tends to have an earlier onset an a more chronic course while major depressive disorder tends to be more episodic
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what are the major criteria for cyclothymia?
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-numerous episodes of hypomania and dysthymia for 2 years (1 year for children and adolescents)
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what are the diagnostic criteria for dementia?
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-multiple cognitive deficits involving both memory impairment an one or more of the following: aphasia, apraxia, agnosia, disturbance in executive functioning
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what is agnosia?
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-failure to recognize or identify objects dedspite intact sensory function
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what is aphasia?
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-language impairment
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what is apraxia?
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-impaired ability to carry out motor activities despite intact motor function
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what score on the mini-mental status exam is the cut-off for dementia?
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-25 (anything less than this is considered suggestive of dementia)
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how can dementia be distinguished from dementia?
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-during the cognitive examination, patients with dementia usually make a considerable effort to minimize their disability, whereas those with depression characteristically make little effort, easily become frustrated and complain bitterly about their perceived deficits
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what is the NT that is most affected in alzheimer's disease?
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-acetylcholine
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what pharmacologic agents have been used to treat alzheimer's disease?
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-donepezil, galantamine, rivastigmine, and tacrine (reversible nonacetylating inhibitors of acetylcholinesterase) -memantine (NMDA receptor antagonist) -low dose of high-potency or atypical antipsychotic (to treat aggression)
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what are the diagnostic criteria for hypochoriasis?
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-preoccupation with fears of having a serious illness based on a misinterpretation of bodily symptoms -preoccupation persists despite medical evaluation and reassurance -duration of 6 months
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how do delusional disorder, somatic type and hypochodriasis differ?
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-in delusional disorder, somatic type, the specific illness is always the same an the patient cannot be reassure and will not consider other alternatives
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what is acting out?
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-a defense mechanism in which an individual guards against uncomfortable emotional conflicts or stressors through actions rather than reflections or feelings
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what is projective identification?
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-this is a defense mechanism that helps an individual deal with emotional conflict or stressors by falsely attributing to another person the individual's own unacceptable feelings, impulses or thoughts
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what are diagnostic criteria for antisocial personality disorder?
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-these patients show a pervasive disregard for and violation of the rights of others starting by age 15. They often appear to have no conscience and no remorse about their activities. They have a reckless disregard for the safety of others and are consistently irresponsible. -diagnosis cannot be made until the person is older than age 18
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what is the difference between people that are antisocial an people that perform antisocial acts?
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-patients with the personality disorder lack empathy for others, have little to no remorse and exhibit reckless, impulsive an antisocial behavior in many areas of life
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what interview tips are indicated for those with antisocial behavior?
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-a firm, no-nonsense approach with firm limit-setting yet non-punitive
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what is the treatment for patients with antisocial behavior?
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-SSRIs and mood stabilizers -socially based interventions (group therapy with inividuals of the same dx)
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what defense mechanisms commonly used in patients with antisocial personality disorder?
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-projective identification and acting out
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what are the diagnostic criteria for schizoaffective disorder?
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-patients must exhibit psychotic symptoms consonant with the acute phase of schizophrenia -psychotic symptoms are accompanied by prominent mood symptoms during part of the illness -at other points in the illness, the psychotic symptoms are unopposed; that is, not mood symptoms are present. Periods of illness in which there are only psychotic symptoms an no mood symptoms, must last for at least 2 weeks
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what is the best therapy for schizoaffective disorer?
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-antipsychotic agent (such as haloiperiol or risperidone)
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what is the key to the diagnosis of schizoaffective disorder?
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-the psychotic episodes occur during the mood episodes, but the mood symptoms do not always occur during the psychotic episodes
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what is formication?
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-this is a hallucinate sensation that insects of snakes are crawling over the skin. It is a common side effect of extensive use of cocaine or amphetamines.
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what is psychosis?
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-loss of mental functioning and loss of the ability to distinguish fantasy from reality. It can be manifested by delusions, hallucinations or thought disorder
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what is the treatment for psychosis cause by general medical illness?
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-treatment of the general medical illness -anti-psychotics
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what is the best treatment for ADHD?
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-use of psychostimulant or atomoxetine along with behavioral parent training an classroom modification programs
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what are the criteria for diagnosing ADHD?
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-patient exhibits 6 or more symptoms of inattention or hyperactivity/impulsivity -there is evidence that these symptoms were present before the age of 7 years -the impairment is present in more than one setting (school, work or home)
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what are inattention symptoms?
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-making careless mistakes -having difficulty focusing one's attention -often seeming not to listen -often failing to follow directions -having difficulty in organizing tasks -avoiding tasks requiring sustained mental effort -often losing things -often becoming distracted by other stimuli -being forgetful
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what are hyperactive symptoms?
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-fidgeting or squirming -often leaving one's seat -running or climbing excessively and inappropriately -difficulty playing quietly -often being "on the go" -talking excessively
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what are impulsivity symptoms?
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-often blurting out an answer before a question is completed -difficulty waiting for one's turn -often interrupting others
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when is atomoxetine consiered first-line ADHD therapy?
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-treatment of ADHD in inividuals or families with substance abuse problems, indiviuals with tics or patients with comorbid anxiety
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what are second line treatments for ADHD?
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-bupropion, imipramine, nortriptyline and pemoline
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what medications are use in ADHD to help with sleep disturbances or agitate behavior?
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-low-dose clonidine or guanfacine
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how long must symptoms of ADHD be present in order to make the diagnosis?
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-at least 6 months
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what are the NT's that are affected in ADHD?
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-it is a disorder involving decreased dopaminergic or noradrenergic tracts in several areas of the prefrontal cortex
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what part of the brain is in selecting what an individual focuses on?
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-the dorsal anterior cingulate gyrus
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what part of the brain is involve with sustaining attention?
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-the dorsolateral prefrontal cortex
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what two other psychiatric illnesses are often present in patients with ADHD?
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-ODD and conduct disorder
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what metal intoxication can lead to hyperactivity?
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-lead intoxication
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what are examples of stimulant medications?
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-methylphenidate and amphetamine
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what is the mechanism of atomoxetine?
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-it is a potent selective inhibitor of the presynaptic NE transporter an is an effective alternative to the stimulants in controlling ADHD symptoms
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what is derealization?
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-a perception that the environment is somehow different or strange, although the individual cannot account for the changes
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what is dissociative amnesia?
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-this is memory loss of some component of an event
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what is the time frame for acute distress disorder?
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-it occurs within 4 weeks of the traumatic event and lasts for a minimum of 2 days
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what symptoms must a patient with acute distress disorder have?
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-must have three of the following: feeling of numbing, detachment or lack of emotional responsiveness; decreased awareness of surroundings; derealization; dissociative amnesia
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how do you distinguish dissociative disorder from ASD?
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-in dissociative disorder, there is not a trauma history or a display of avoidance as there is in ASD
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what is special about beta blockers in ASD?
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-there is evidence that using beta blockers, such as propranolol, are effective in preventing the development of PTSD
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what medications can help to alleviate opioid withdrawal?
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-methadone and clonidine
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what are the symptoms of opioid intoxication?
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-apathy, psychomotor retardation, constricted pupils, and drowsiness
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what are the symptoms of opiate withdrawal?
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-nausea and vomiting, muscle aches, lacrimation, rhinorrhea, diarrhea, diaphoresis, chills, fever, and dilated pupils, sensitivity to touch and light, goose flesh, autonomic hyperactivity, GI distress, depressed and anxious mood
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Is opioid withdrawal life-threatening?
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-no, unless complicated by another pre-existing medical condition
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what are the symptoms of alcohol or benzodiazepine withdrawal?
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-anxiety, restlessness, irritability and insomnia, hyperreflexia and tremor--> tachycardia, HTN, diaphoresis, hyperthermia and muscle fasciculations--> severe cases: seizures, delirium and death
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what are the symptoms of withdrawal from cocaine?
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-crash: hypersomnia, hyperphagia and depressed mood
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what are the symptoms of withdrawal from nicotine?
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-anxiety, depression, irritability, headaches, poor concentration, sleep disturbance and increased blood pressure and HR
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what is the rule of thumb with opioid withdrawal?
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-the shorter the duration of action of the drug ingested, the more acute and intense the withdrawal symptoms
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what is the mnemonic for remembering the signs and symptoms for opioid withdrawal?
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-SLUDGE (salivation, lacrimation, urination, defecation, GI Distress, and emesis)
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what are often the first signs of opioid withdrawal?-
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dilated pupils, sweating and anxiety
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what are the diagnostic criteria for pain disorder?
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-pain at one or more sites that is severe enough for a clinical evaluation; it is the patient's primary complaint -the pain is very distressing to the patient and/or causes significant functional impairment -the clinician judges that psychological factors play an important part in the initiation, worsening or severity of the pain
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what is biofeedback?
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-a relaxation technique by which patient are trained to induce physiologic changes that result in a relaxation response
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what is dyspareunia?
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-this is painful sexual intercourse
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what are effective pharmacologic approaches to pain disorder?
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-antidepressants (TCAs and SSRIs)
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are analgesic medications helpful in pain disorder?
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-no
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which pain disorders is biofeedback particularly helpful?
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-headaches and muscle tension
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what are clues to making the diagnosis of histrionic personality disorder?
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-theatrical and overblown speech, seductive manner, extreme attention seeking, exaggerative of symptoms
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what is dissociation?
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-this is a defense mechanism by which an individual deals with emotional conflict or stressors with a breakdown in the usually integrated functions of consciousness, memory, perception of self or the environment or sensory/motor behavior
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what is limit setting?
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-an activity by which a physician clearly tells a patient what is and what is not appropriate behavior in a given circumstance
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what is repression?
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-this is a defense mechanism by which individuals deal with emotional conflict or stressors by expelling disturbing wishes, thoughts, or experiences from their conscious awareness
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what is supportive psychotherapy?
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-this is therapy designed to help patients support their existing defense mechanisms so that their functioning in the real world improves
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describe the patient with histrionic personality disorder
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-they show a pervasive pattern of excessive emotionality and attention seeking -they are uncomfortable in settings where they are not the center of attention. Their emotions are rapidly shifting and shallow and they often react with others in a seductive manner. -they are dramatic and thatrical and exaggerate their emotional expressions
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what is the treatment for histrionic personality disorder?
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-the clinician should provide emotional support for and show interest in these patients but should not allow a personal or sexual relationship to form
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in what persoanlity disorder is emotional lability seen?
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-histrionic
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in what personality disorder is grandiosity seen?
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-antisocial personality and narcissistic personality disorder
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in what personality disorder is cognitive dysregulation seen?
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-in borderline and schizotypal personality disorder
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in what personality disorder is callousness seen?
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-antisocial personality disorder
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what defense mechanisms are employed by patients with histrionic personality disorder most often?
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-dissociation and repression
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what is the treatment of choice for adjustment disorder?
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-psychotherapy (supportive)
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what are the diagnostic criteria for adjustment disorder with mixed anxiety and depressed mood?
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-development of an emotional response to a specific stressor within 3 months of the onset of the stressor -clinically significant symptoms developed as a response to the stressor -symptoms don't persist longer than 6 months after the stressor is resolved
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how are adjustment disorder and major depression distinguished?
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-in major depression, there is still depression once the stressor is removed -in major depression there is also difficulties involving sleep, appetite, concentration and energy level
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what are the diagnostic criteria for factitious disorder?
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-intentional production or feigning of physical or psychological signs or symptoms -motivation is to assume the sick role (primary gain) -external incentives for the behavior are absent
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what is pseudologia phantastica?
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-the telling of "tall tales," or lying, commonly seen in factitious disorder
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what is munchhausen syndrome?
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-factitious disorder, especially involving repeated episodes, seeking admission at different hospitals and pseudologia phantastica
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what is munchausen syndrome by proxy?
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-this is factitous disorders induced in children by parent, who are usually very cooperative after taking them to the hospital
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in what population is factitious disorder most common in?
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-hospital and healthcare workers
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what are the treatments for primary insomnia?
answer
-sleep hygiene education, stimulus control therapy, relaxation therapy and cognitive behavioral therapy
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what medications are helpful for primary insomnia?
answer
-ramelteon, trazodone, zolpidem, zaleplon and triazolam
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what is the mechanism of ramelteon?
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-it is a melatonin receptor agonist
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What are the diagnostic criteria for somatization disorder?
answer
-the patient has a history of many physical symptoms that began before age 30, have persisted over several years and caused considerable distress and impairment in function. The patient's symptoms have met the following criteria over the course of the illness: 4 pain symptoms (involving 4 different sites of the body), 2 GI symptoms (nausea, vomiting, abdominal pain), one sexual or reproductive symptom, one pseudoneurologic symptom, such as localized weakness or sensory loss
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what is the best treatment for somatization disorder?
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-identify one physician as the primary caregiver and schedule regular, brief, usually monthly visits -psychotherapy is helpful if it is accepted by the patient
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what are the postpartum blues?
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-transient mood changes occurring shortly after delivery characterized by mood lability, depressed or irritable mood, interpersonal hypersensitivity and tearfulness
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what is the most likely etiology of postpartum psychosis?
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-bipolar disorder
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what is the medication for postpartum depression?
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-SSRIs
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what is the treatment for acute dystonic reaction?
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-benztropine
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which dopamine pathway is blocked in EPS?
answer
-the nigrostriatal pathway
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what are extrapyramidal side effects?
answer
-acute dystonic reactions, parkinsonism, akathisia, NMS and tardive dyskinesia
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what are acute dystonic reactions?
answer
-brief, often painful muscle contractions, usually occurring early, within several hours to days of initiating treatment with or increasing the dose of antipsychotics
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what is antipsychotic-induced parkinsonism?
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-this consists of the triad of resting (pill-rolling) tremor, (cogwheel) rigidity and bradykinesia
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what is akathisia?
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-this is the subjective feeling of restlessness, which may include anxiety, pacing or frequent sitting/standing
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what is neuroleptic malignant syndrome?
answer
-this is a medical emergency consisting of muscle (lead-pipe) rigidity, fever, autonomic instability, diaphoresis, tremor, mutism, leukocytosis and elevated CPK
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what is tardive dyskinesia?
answer
-this is a late-onset development of choreoathetoid movements, particularly of the face, orobuccal region, neck, fingers and toes
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what is denial?
answer
-this is a defense mechanism in which an individual deals with emotional conflict or stress by refusing to acknowledge some painful aspect of external reality or subjective experience that is apparent to others
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what is devaluation?
answer
-a defense mechanism in which an individual deals with emotional conflict or stress by attributing exaggerated negative qualities to themselves or to others
question
what is grandiosity?
answer
-an exaggerated concept of one's importance, power or fame
question
what is idealization?
answer
-a defense mechanism in which an individual deals with emotional conflict or stress by attributing exaggerated positive qualities to themselves or to others
question
what type of behavior do people with narcissistic disorder exhibit?
answer
-a pervasive pattern of grandiosity, a need for admiration and a lack of empathy for others. they often exaggerate accomplishments and are jealous of the achievements of others.
question
what are the prominent personality traits of narcissistic personality disorder?
answer
-narcissism, manipulativeness, histrionism and callousness
question
what is the first-line treatment for tourette disorder?
answer
-alpha-adrenergic medication, such as clonidine and guanfacine--> if ineffective, atypical antipsychotics can be used
question
what are the diagnostic criteria for tourette syndrome?
answer
-presence of both motor and vocal tics during the course of the illness but not necessarily at the same times -tics occurring almost every day for a period of at least a year and during this year there is never a tic-free period lasting more than 3 consecutive months -onset must be before 18 years of age
question
what are athetoid movements?
answer
-slow, irregular, writhing movements
question
what are choreiform movements?
answer
-dancing, random, irregular, nonrepetitive movements
question
what is corprolalia?
answer
-vocal tic involving the involuntary vocalization of obscenities
question
what is dystonic movements?
answer
-slower than choreiform movements, these are twisting motions interspersed with prolonged states of muscular tension
question
what are hemiballistic movements?
answer
-intermittent, coarse, large-amplitude, unilateral movements of the limbs
question
what are myoclonic movements?
answer
-brief, shocklike muscle contractions
question
what are tics?
answer
-a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization
question
what is the best treatment for PANDAS?
answer
-SSRI and CBT -risperidone for any associated tics
question
what is amenorrhea?
answer
- the absence of at least three consecutive menstrual cycles
question
what is lanugo?
answer
-fine body hair present on prepubertal children and commonly seen in patients with anorexia
question
what are the diagnostic criteria for anorexia nervosa?
answer
-refusal to maintain weight at or above the normal weight for one's age and height -intense fear of gaining weight or becoming fat despite being underweight -disturbance in the way one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the severity of the current low body weight
question
how are anorexia nervosa and body dysmorphic disorder distinguished between each other?
answer
-patients with body dysmorphic disorder typically fixate on one particular part of their body that they consider imperfect rather than having the more global desire for thinness expressed by patients with anorexia
question
what are common lab abnormalities in patients with anorexia nervosa?
answer
-hypokalemia, hypochloremic metabolic acidosis, low albumin levels, elevated liver enzymes, or leukopenia and a relative lymphocytosis
question
what is the treatment for anorexia nervosa?
answer
-nutritional rehabilitation, individual psychotherapy and family therapy
question
what is thought blocking?
answer
-the unpleasant experience of having one's train of thought curtailed absolutely
question
what is factitious disorder?
answer
-in this disorder, a patient intentionally produces a physical or psychiatric illness in order to assume the sick role
question
what are typical autistic symptoms?
answer
-difficulty with social reciprocity, poor peer interaction, poor language development and repetitive and odd play
question
what is asperger disorder?
answer
-a disorder of unknown etiology in which affected individuals display social impairment and restricted interests and behavior but have normal language and cognitive skills
question
what is rett disorder?
answer
-a childhood development disorder of unknown etiology in which the patient develops progressive encephalopathy, loss of speech capacity, gait problems, stereotyped movements, microcephaly and poor social interaction skills. Only females are affected.
question
what is the treatment for autism?
answer
-family education, behavior shaping, speech therapy, occupational therapy and educational planning
question
what is the best predictor of the ability to improve the development of an autistic child?
answer
-the extent to which the have, or have beun to develop, language skill, which is often measured in verbal IT testing
question
in what way is Rett syndrome best distinguished from autism?
answer
-in Rett syndrome, there is a period of normal development followed by a gradual loss of skills and further deceline
question
what is the key aspect of avoidant personality disorder?
answer
-although there is a desperate desire to have friends and intimate relationships, the patient is excruciatingly sensitive to rejection and therefore avoids all but a few safe relationships
question
what is displacement?
answer
-a defense mechanism in which an individual avoids emotional conflict or stress by transferring a feeling about, or a response to, one object to another
question
what is projection?
answer
-a defense mechanism in which individuals attribute feelings they have about themselves or the world to others
question
what is the experience of people with avoidant personality disorder?
answer
-patients with this disorder experience pervasive social discomfort, feelings of inadequacy and hypersensitivity to criticism and rejection
question
what is the treatment for avoidant personality disorder?
answer
-psychotherapy -SSRIs and beta blockers
question
what are the two defense mechanisms most used by avoidant personality disorder?
answer
-displacement and projection
question
what is the treatment for separation anxiety disorder?
answer
-SSRIs, relaxation techniques
question
what are the diagnostic criteria for separation anxiety disorder?
answer
-developmentally inappropriate anxiety about separation from home or from the care taker to which an individual is attached -duration of the illness must be at least 4 weeks -onset of the illness should be prior to 18 years of age -the disturbance should cause clinically significant impairment in important areas of functioning
question
what two psychiatric disorders are patients with separation anxiety disorder at risk of exhibiting as adults?
answer
-panic disorder and major depression
question
what are the diagnostic criteria for dissociative fugue?
answer
-unexpected, sudden departure from home and travel to a new location; the individual is unable to recall his or her past -the individual is not aware of his or her indentity and may create a new one -the condition does not occur in an individual with dissociative identity disorder and is not caused by a medical condition or substance
question
what is depersonalization?
answer
-persistent or recurrent alteration of one's perception of oneself as unreal or strange
question
what is dissociattive amnesia?
answer
-this is the inability to recall specific information, usually about one's identity, but having an intact memory about general information; usually caused by traumatic or stressful memory
question
what is dissociative identity disorder?
answer
-this is a disorder in which a person invents multiple personalities to help deal with a traumatic event, usually one that has occurred in childhood
question
what are the signs of cocaine withdrawal?
answer
-fatigue, decreased energy, hypersomnia, and an increased appetite
question
what symptom is highly suggestive of a patient with bipolar disorder?
answer
-a patient with a pattern of decreased need for sleep, yet with no decrease in energy level
question
what are typical symptoms of opioid intoxication?
answer
-miosis, slurred speech, drowsiness
question
what are the typical symptoms of PCP intoxication?
answer
-nystagmus, HTN and muscle rigidity
question
what are the typical symptoms of cannabis intoxication?
answer
-conjunctival injection, increased appetite and dry mouth
question
what are the typical symptoms of cocaine withdrawal?
answer
-fatigue, increased appetite, vivid and unpleasant dreams
question
what are the typical symptoms of opioid withdrawal?
answer
-mydriasis, gooseflesh, rhinorrhea and muscle aches
question
what is the treatment for neurosis?
answer
-insight-oriented psychotherapy or psychoanalysis
question
what is the treatment of choice for neurosis?
answer
-psychoanalysis or intensive psychodynamic therapy
question
what is the treatment for alcohol withdrawal?
answer
-high doses of benzodiaezpines and taper as she recovers
question
what are the diagnostic criteria for alcohol withdrawal?
answer
-cessation of or reduction in heavy, prolonged alcohol use -two or more of the following develop within hours to days: autonomic hyperactivity, hand tremor, insomnia, nausea and vomiting, transient hallucinations, agitation, anxiety, seizures
question
what receptors does alcohol work on?
answer
-serotonin and GABA-A receptors
question
what is the definition of abuse?
answer
-continued use of a substance despite negative consequences
question
what is the definition of dependence?
answer
-loss of control of drug use, as opposed to physiological dependence
question
what type of benzodiazepine is preferred in the presence of good liver function?
answer
-a long-acting benzo, such as chlordiazepoxide or diazepam
question
what benzodiazepine is used when liver function is questionable? why?
answer
-lorazepam is used because it is not hepatically metabolized
question
what is intersex?
answer
-this is a condition where a newborn's sex organs (genitals) appear unusual, making it impossible to identify the sex of the baby from its outward appearance
question
what are ideas of reference?
answer
-a person's false beliefs that people are talking about him or her
question
what are the prominent personality traits of paranoid personality disorder?
answer
-suspiciousness, intimacy avoidance, hostility and unusual beliefs
question
how are borderline personality disorder and paranoid personality disorder differentiated?
answer
-patients with paranoid personality disorder typically do not have other features in borderline personality disorder, such as involvement in many short-lived, tumultuous relationships or chronic feelings of emptiness
question
what are the diagnostic criteria for anxiolytic withdrawal?
answer
-cessation or reduction in the use of an anxiolytic drug -two or more of the following symptoms occur following cessation of the use of the drug: autonomic hyperactivity, hand tremor, insomnia, nausea, hallucinations, agitation, anxiety and seizures
question
what is used in benzodiazepine overdose?
answer
-flumazenil
question
what are adaptive functioning tests?
answer
-psychological assessments that measure social, communication, daily living and community functioning skills
question
what psychiatric states are common in patients with mental retardation?
answer
-depression, anxiety, psychosis and conduct disorders
question
what two requirements are necessary for the diagnosis of mental retardation?
answer
-an intelligence quotient score and evidence of deficits in adaptive functioning
question
what is the best treatment for conversion disorder?
answer
-hypnosis, anxiolytic or behavioral relaxation exercises -amobarbital or lorazepam can be used to gain more info
question
what are the diagnostic criteria for conversion disorder?
answer
-one or more sensory or motor deficits suggesting a neurologic or medical illness -the deficit is preceded by conflicts or stressors -symptom is not intentionally produced -deficit can't be fully explained by a medical condition, substance of abuse or a culturally sanctioned response -deficit causes significant distress and impairment in functioning and warrants medical evaluation -symptom is not limited to pain or sexual dysfunction and does not occur exclusively during somatization disorder
question
what is la belle indifference?
answer
-inappropriate lack of concern about one's disability
question
how is conversion disorder distinguished from somatization disorder?
answer
-conversion disorder is distinguished by only having a motor or a sensory deficit
question
what is associated with a poor prognosis in fetishism?
answer
-early age of onset, high frequency of acts, no guilt or shame about the act and substance abuse
question
what interventions can be employed to treat fetishism?
answer
-CBT and insight-oriented psychotherapy
question
what medications have been used to treat fetishism?
answer
-fluoxetine, sertraline, mirtazapine, tpoiramate, and buspirone
question
what are the diagnostic criteria for amphetamine intoxication?
answer
-recent use of amphetamine or a related substance -clinically significant maladaptive behavioral or psychological changes that developed during or shortly after use of the amphetamine or related substance -two or more symptoms develop during or shortly after use of the amphetamine or related substance such as a change in heart rate, dilation of pupils, a change in blood pressure, perspiration, chills, nausea/ vomiting, weight loss, muscular weakness, respiratory depression, chest pain, arrhythmias, confusion, seizures, dyskinesia, dystonia or coma
question
what are dyskinesias?
answer
-abnormal movements
question
what are dystonias?
answer
-abnormal contracture of muscle or muscle groups
question
what are the symptoms of amphetamine withdrawal?
answer
-anxiety, tremors, lethargy, fatigue, nightmares, headache and extreme hunger
question
what defense mechanisms are used by people with borderline personality disorder?
answer
-splitting, devaluation, idealization, projection, projective identification
