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360 Cards in this Set
- Front
- Back
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What is sexual identity?
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a consistent, enduring sense of ones own sexuality and of repeated sexual feelings, thoughts, and/or behaviors
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What is gender identity?
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your subjective feeling of being either male or female
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What is included in the sexual response cycle? (5)
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desire
excitement plateau orgasm resolution |
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What are the 2 most common disorders of the sexual response cycle?
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desire
orgasm |
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What is a sexual disorder NOT caused by? (2)
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substance abuse
general medical condition |
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What are 3 common psychological causes of sexual disorders?
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interpersonal problems
guilt fears |
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What are 2 types of "desire" sexual disoreders?
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hypoactive sexual desire
sexual aversion (more severe) |
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What are 2 conditions that may lead to secondary male erectile disorder?
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diabetes
HTn |
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Is primary or secondary male erectile disorder more common and what percentage?
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secondary
10-20% |
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What type of test can be done to see if males have an erection during the middle of the night?
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stamp test
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What is the prevalence of female sexual arousal disorder?
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high (33% of women)
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What happens to a woman with a sexual arousal disorder?
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they are unable to maintain lubrication (not a disorder if happens during or after menopause)
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What are 3 disorders of orgasm?
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female orgasmic
male orgasmic premature ejaculation |
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What may be a secondary condition that can cause an orgasmic disorder?
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taking SSRI
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What % of women have female orgasmic disorder?
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up to 30%
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What is the prevalence of premature ejaculation?
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high (up to 35% of all male sexual disorders)
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What is the Tx for premature ejaculation? (3)
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SSRI
"squeeze technique" topical anesthetic painted on head of penis |
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What are 2 types of sexual pain disorders?
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dyspareunia
vaginismus |
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When does vaginismus have an increased incidence? (2)
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higher socioeconomic status
strict religious upbringing |
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What is included in the Tx for sexual disorders? (9)
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dual sex therapy
behavior therapy hypnosis group therapy :) testosterone (if low) masturbation squeeze technique (PE) gradual desensitization (dyspareunia) regular dilation (vaginismus) |
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What are 3 types of behavioral therapy used for sexual disorders?
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systematic desensitization
relaxation techniques assertiveness training |
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What are paraphilias?
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sexual deviations/disorders characterized by engagement in unusual sexual activities that last AT LEAST 6 MONTHS and cause impairment in daily functioning; more common in men
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Which paraphilia involves prepubertal children?
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pedophilia
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What is voyeurism?
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being aroused by observing sexual activities of others; "peeping Tom"
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Which paraphilia involves exposing self, "flasher"?
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exhibitionism
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What does fetishism involve?
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using inanimate objects (ex. shoes)
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What is transvestic fetishism?
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cross-dressing
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Which paraphilia involves rubbing against a nonconsenting person?
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frotteurism
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Which paraphilia involves enjoying pain/humiliation?
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masochism
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Which paraphilia involves inflicting pain on others?
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sadism
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Which paraphilia involves dead people?
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necrophilia
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Which paraphilia involves obscene phone calls?
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telephone scatalogia
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Which paraphilia involves animal contacts?
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zoophilia
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What are 4 poor prognostic factors of paraphiliacs?
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early age of onset
co-morbid substance abuse frequent paraphilic behavior law enforcement referral |
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What are 3 good prognostic factors of paraphiliacs?
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self-referral for Tx
associated guilt Hx of normal sexual behavior |
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What are 3 Tx plans for paraphiliacs?
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insight-oriented psychotherapy
aversive conditioning (behavior therapy) antiandrogens (dec. sex drive) |
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What is gender identity disorder AKA?
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transexuality
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What makes transsexuality different from transvestic fetishism?
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transsexuals may not neccessarily enjoy the circumstances like fetishism
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What is transsexuality associated with an increased incidence of? (3)
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major depression
anxiety disorder suicide |
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What may pts with gender identity disorder do?
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dress as opposite sex
take sex hormones have sex change operation |
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Is transsexuality more common in men or women?
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men
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What is included in the diagnostic criteria for anorexia nervosa? (4)
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*refusal to maintain normal body weight (less than 85% of expected)
-intense fear of gaining weight -disturbance in the way one's weight or body shape is experienced -amenorrhea in postmenarchal females (absence of at least 3 consecutive menstrual cycles) |
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What are 3 causes of anorexia nervosa?
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cultural emphasis on weight
control issues disturbance in CNS monoamines in acute phase |
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What is the lifetime prevalence of anorexia nervosa in females?
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1 in 100-200
females > 90% of cases |
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Where is anorexia more prevalent?
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industrialized nations
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What is the bimodal peak of onset for anorexia nervosa?
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12-15 years
17-21 years |
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What is included in the diagnostic criteria for anorexia nervosa? (4)
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*refusal to maintain normal body weight (less than 85% of expected)
-intense fear of gaining weight -disturbance in the way one's weight or body shape is experienced -amenorrhea in postmenarchal females (absence of at least 3 consecutive menstrual cycles) |
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What are 3 causes of anorexia nervosa?
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cultural emphasis on weight
control issues disturbance in CNS monoamines in acute phase |
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What is the lifetime prevalence of anorexia nervosa in females?
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1 in 100-200
females > 90% of cases |
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Where is anorexia more prevalent?
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industrialized nations
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What is the bimodal peak of onset for anorexia nervosa?
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12-15 years
17-21 years |
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What are the history of an anorexia patient? (6)
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restricted diet excluding high-calorie foods
excessive exercising inc. fear of being fat distorted body image self-esteem overly linked to weight food-related obsessions |
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What are the signs of starvation in an anorexia patient? (10)
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emaciation
hypotension bradycardia skin dryness lanugo sallow complexion peripheral edema petechiae salivary gland hypertrophy amenorrhea |
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What psychological testing can be done on anorexia patients?
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eating disorders inventory
eating attitudes test |
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What needs to be ruled out and is part of the DD for anorexia? (4)
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IBD
hyperthyroidism malignancies HIV/AIDS |
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What may be part of the Tx plan for an anorexia patient? (8)
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coercion by family
multidisciplinary approach inpatient Tx behavior therapy SSRIs neuroleptics (Thorazine) Cyprohepatadine (appetite booster) Lithium (for mood) |
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What are the common medical complications of anorexia? (6)
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anemia
arrhythmias hypotension osteoporosis dental decay impaired renal fxn (associated w/ chronic dehydration and hypokalemia) |
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What are 3 comorbidities of anorexia?
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depressed mood
obsessive-compulsive S/S excessive need to control one's environment |
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What is the prognosis for anorexia nervosa patients?
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45% good outcome
5-10% poor mortality rate |
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What is included in the diagnostic criteria for bulimia nervosa? (5)
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-recurrent binge eating episodes
-recurrent inappropriate compensatory behavior -above including at least twice a week for 3 months -self-evaluation is influenced by body shape/weight -disturbance does not occur exclusively during episodes of anorexia nervosa |
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What are 2 examples of recurrent episodes of binge eating?
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eating more than normal amount
lack of control over eating |
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What are 4 examples of recurrent inappropriate compensatory behavior (bulimia)?
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self-induced vomiting
misuse of laxatives/diuretics/enemas fasting excessive exercise |
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What are 4 possible causes of bulimia?
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-cultural emphasis on weight
-career choice: dancer/model/actor -preexistent trauma (sexual/physical abuse) -disturbance in CNS monoamines in acute phase |
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What is the prevalence of binge eating? Bulimia nervosa?
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Binge eating: 36% of high school and college students
Bulimia nervosa: 1-3% >98% females |
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What is the average age of onset for bulimia nervosa?
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18-20 years
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Is there a suggested genetic link for anorexia and bulimia?
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yes
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What are the S/S of bulimia?
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binging/purging
consumption of high-calorie foods dental erosions scars on knuckles self-esteem linked to body shape/weight (less so than in anorexia) |
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What is the most widely used compensatory behavior seen in bulimia?
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vomiting (80-90%)
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What psychological testing can be done for bulimia patients?
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eating disorders examination
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If weight is <85% of ideal, then what is the diagnosis?
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anorexia nervosa
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What is included in the DD for bulimia? (2)
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Kluver-Bucy syndrome
brain tumor |
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What is included in the Tx plan for bulimia nervosa?
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cognitive-behavioral therapy
interpersonal psychotherapy group psychotherapy TCA MAOI SSRI trazodone |
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What % of bulimic patients will respond to medication alone?
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15-20%
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What are the comorbidities of bulimia nervosa?
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moods disorders
OCD substance abuse personality disorders |
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What are the common medical complications that may occur with bulimia nervosa? (12)
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arrhythmias
hypotension dehydration electrolyte abnormalities dental decay/erosions *hand abrasions (Russel's sign) amennorrhea/irregular menses GI bleeding constipation gastritis inc. seizure frequency salivary gland hypertrophy (chipmunk face) |
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What is the MCC of mental retardation?
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Down syndrome
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Which childhood clinical disorder has significantly subaverage intellectual functioning, concurrent deficits in presnet adaptive functioning, and onset before age 18?
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mental retardation (axis II)
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What is the IQ of pts w/ mental retardation?
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<70 (normal average 100)
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What is the prevalence of mental retardation?
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1-3%
more common in men |
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Which childhood condition has developmental delays, abnormal appearance of the face, and may not be recognized until the child enters school?
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mental retardation
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What are 2 tests that are used for mental retardation?
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Wechsler Scales
Stanford-Binet Scales |
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What is included in the DD of mental retardation? (4)
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Adverse environment
Sensory impairment Motor impairment Psychiatric disorder |
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What is the Tx plan for mental retardation? (3)
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Aimed at maximizing potential
Special education Behavior management |
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Which childhood disorder has markedly disturbed social relatedness in most contexts beginning before age 5 with either persistent failure to respond to appropriately to most social interactions OR diffuse attachments as evidenced by indiscriminate sociability?
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reactive attachment disorder
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Which childhood disorder has persistent disregard for basic emotional/physical needs and repeated changes of primary caregivers that prevent stable attachments (ex. foster care)?
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reactive attachement disorder
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What are the clinical findings of reactive attachment disorder? (5)
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social withdrawal
emotional constriction anergia socially indiscriminate emotionally shallow |
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What is included in the DD of reactive attachment disorder? (3)
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Developmental disorders
Mental retardation Language disorder |
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What is the Tx plan for reactive attachment disorder? (4)
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-Termination of parental rights in worst cases
-Parent-infant psychotherapy -Parenting classes and support groups -Home monitoring by nurses |
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How many diagnostic criteria are required for autistic disorder?
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6
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What are the choices for 2 of the following for impairment in social interaction of autistic disorder? (4)
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-Marked impairment in using nonverbal behaviors
-Failure to develop peer relationships -Lack of spontaneous sharing of enjoyment or interests -Lack of social or emotional reciprocity |
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What are the choices for impairment in communication of autistic disorder? (4)
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-Delay in, or lack of, spoken language
-Impairment in sustaining a conversation with others -Repetitive use of language or idiosyncratic language -Lack of make-believe play |
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What are the choices for restricted, repetitive and/or sterotyped patterns of behavior of autistic disorder? (4)
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-Preoccupation with one or more restricted patterns of interest
-Inflexible adherence to nonfunctional routines or rituals -Repetitive motor mannerisms -Preoccupation with parts of objects |
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What abnormal functioning must a child before age 3 have if diagnosed with autistic disorder? (3)
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at least one of following:
Social interaction Language as social communication Imaginative play |
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What is the epidemiology of autistic disorder?
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1/1000
males>females 3:1 strong genetic evidence |
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What are 3 clinical findings in autistic patients?
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-Deficits in social relating and reciprocity
-Language difficulties -stereotyped movements |
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What % of autistic pts have mental retardation?
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70-80%
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What are 3 psychological tests that can be used for autistic disorder?
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Childhood Autism Rating Scale
Autism Diagnostic Observation Schedule Parent Interview for Autism |
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What are 3 DD for autistic disorder?
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Asperger’s Disorder
Childhood Disintegrative Disorder Rett’s Disorder |
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What is the Tx plan for autistic disorder? (3)
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No cure
improve functioning Early intervention programs |
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What is the part of the "normal" diagnostic criteria for Rett's disorder? (3)
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prenatal/perinatal development
psychomotor development through 5mo of age head circumference at birth |
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What are the diagnostic criteria of Rett's disorder that occur after a period of normal development? (5)
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Deceleration of head growth
Loss of purposeful hand skills Loss of social engagement Poorly coordinated gait Severe language and psychomotor impairment |
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What is the epidemiology of Rett's disorder?
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1/10,000-12,000 girls
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What are the S/S of Rett's disorder? (7)
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hypotonia
reduced mobility repetitive movements lack of interest in play breathing problems while awake (normal during sleep) muscle wasting |
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What is the Tx plan for Rett's disorder? (4)
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symptomatic/supportive
PT/OT parent education support groups |
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What is the prognosis for Rett's disorder?
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Poor
Sudden death is not uncommon |
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Childhood disintegrative disorder apparently has normal development for at least first ___ years of life.
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2
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What are the significant loss of skills that pts w/ childhood disintegrative disorder have before age 10? (5)
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at least 2 of following:
Language Social skills Bowel or bladder control Play Motor skills |
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What are the abnormalities of functioning that pts w/ childhood disintegrative disorder have? (3)
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at least 2 of following:
Social interaction Communication Restricted or repetitive behaviors |
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What is the Tx for childhood disintegrative disorder?
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supportive
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What are the impairments of social interaction that Asperger's pts must have? (4)
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2 of the following:
-Marked impairment in using nonverbal behaviors -Failure to develop peer relationships -Lack of spontaneous sharing of enjoyment or interests -Lack of social or emotional reciprocity |
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What are the resticted, repetitive and/or stereotyped patterns of behavior that Asperger's pts must have? (4)
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must have @ least one:
-Preoccupation with one or more restricted patterns of interest -Inflexible adherence to nonfunctional routines or rituals -Repetitive motor mannerisms -Preoccupation with parts of objects |
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Compared to autism, Asperger's disorder does not have a delay in ___ development.
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language
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What are the S/S of Asperger's disorder?
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eccentric in school
normal or above normal intelligence |
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What is the Tx for Asperger's disorder?
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social-cognitive therapy
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What are the attention deficit S/S that an ADHD pt must have at least six of for at least 6mo to a maladaptive degree? (9)
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Often makes careless mistakes
Difficulty sustaining attention Does not listen Fails to follow through on tasks Difficulty organizing tasks Avoids tasks requiring sustained attention Loses things Easily distracted Often forgetful |
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What are the hyperactive S/S that an ADHD pt must have at least six of for at least 6mo to a maladaptive degree? (9)
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Often fidgets or squirms
Leaves seat Moves excessively Difficulty playing quietly Often “on the go” Talks excessively Blurts out answers Difficulty awaiting turn Interrupts or intrudes on others |
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For diagnosis of ADHD, some symptoms must be present before age ___ and impairment must be present in at least ___ settings.
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7
2 |
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What is the most common chronic behavior disorder?
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ADHD
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Is ADHD more common in males or females? Can it have a familial pattern?
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males
yes |
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ADHD children generally have ___ underachievement, peer ___, and ___ self-esteem.
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academic
rejection low |
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How is ADHD evaluated? (3)
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Psychoeducational evaluation
Rule out medical conditions (such as absence seizures) ADHD tools |
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What are the Tx options for ADHD pts? (9)
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medication (stimulants-Ritalin/Adderall/dexedrine/Concerta/Vyvanse), TCA-Strattera, alpha agonists-clonidine)
behavioral modification educational modification (IEP) |
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What is usually the most difficult period of time for ADHD pts?
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school
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___% of children with ADHD will continue to have symptoms in adulthood and ADHD is associated w/ increase in ___ disorders and ___ abuse disorders.
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50
mood substance |
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Which childhood disorder has a pattern of negative, hostile and defiant behavior lasting at least 6 months that causes significant impairment, does not occur exculsively in the context of a psychotic or mood disorder, and does not meet criteria for conduct disorder?
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oppositional defiant disorder
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What is the diagnostic criteria for oppositional defiant disorder? (8)
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4 or more of the following:
Often loses temper Often argues with adults Often refuses to comply with rules Often deliberately annoys people Often blames others for his or her mistakes or misbehavior Often touchy or easily annoyed Often angry or resentful Often spiteful or vindictive |
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What is the average age of onset for oppositional defiant disorder and is it more common in males or females?
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6 years
males |
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Oppositional defiant disorder pts often appear to have a "___ on thier ___", may be ____ children or gravitate to "outlaws", and often use ___ or ___ precociously.
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chip
shoulder solitary tobacco EtOH |
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What may oppositional defiant disorder be comorbid with?
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ADHD
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What are the Tx options for oppositional defiant disorder? (2)
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Positive Parenting Program
Family therapy |
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Which childhood disorder has a pattern of behavior in which the basic rights of others are violated, causes significant impairment, and if over 18 w/out meeting criteria for antisocial personality disorder?
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conduct disorder
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What are the "presence of 3 or more of the following in the past 12 months, with at least one in the past 6 months" for conduct disorder categories? (4)
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aggression to people/animals
destruction of property (ex. fire setting) deceitfulness or theft serious rule violation |
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What are 7 examples of "aggression to people or animals" for conduct disorder?
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Bullying
Physical fights Use of weapon Has been physically cruel to people Has been physically cruel to animals Stolen while confronting a victim Forced someone into sexual activity |
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What are 3 examples of "deceitfulness or theft" for conduct disorder?
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Breaking and entering
Lies to gain goods or favors stealing |
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What are 3 examples of "serious violation of rules" for conduct disorder?
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Stays out at night before age 13
Running away Truancy before age 13 |
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Which childhood disorder includes dangerous, disruptive behavior at home or in school?
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conduct disorder
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What are 4 DD for conduct disorder?
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ODD
ADHD substance abuse (may be part of it, but behavior changes were there before substance use) mania (time = deciding factor) |
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What is used for prevention/Tx of conduct disorder? (4)
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Early intervention programs
Behavioral therapy Therapeutic foster homes Med (Ritalin, Divalproex, Lithium) |
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What is the diagnostic criteria for encopresis? (4)
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-Repeated passage of feces into inappropriate places
-At least once a month for at least 3 months -Age 4 years or older -Not due to a substance or a general medical condition |
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What is the epidemiology for encopresis?
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Males > females
Prevalence about 1.5% of children under 11 years old |
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What are 3 possible clinical findings of encopresis?
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megacolon
psychosoical stress severe neglect/rejection |
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What is the Tx for megacolon induced encopresis?
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cleansing of colon with laxatives and stool softeners until normal sensation regained
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What type of behavior modification can be used for encopresis? (3)
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Star charts
Avoid punishment Rewards for successful toileting |
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When do most cases of encopresis resolve?
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by adolescence
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What is the diagnostic criteria for enuresis? (4)
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*At least twice a week for at least 3 months; or causes significant distress or impairment
*Age 5 years or older -Repeated voiding of urine into bed or clothes -Not due to a substance or a general medical condition |
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What is the epidemiology of enuresis?
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Males > females
Prevalence about 7.4% of children at 8 years old |
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What is included in the DD for enuresis? (6)
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UTI's
structural abnormalities bladder spasms epilepsy DM diabetes insipidus |
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What are Tx options for enuresis? (4)
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star charts
alarm-and-pad technique TCA DDAVP |
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What are the "at least 3 of the following" inappropriate and excessive anxiety concerning separation from home or loved ones that is included in the diagnostic criteria for separation anxiety disorder? (12)
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-Excessive distress when separation is anticipated
-Excessive worry about harm befalling loved ones -Excessive worry that an event will lead to separation from loved ones -Reluctance or refusal to go to school or elsewhere -Excessive fear of being alone -Reluctance/refusal to go to sleep unless loved one is nearby or to sleep away from home -Repeated nightmares about separation -Physical complaints when separation is anticipated -Lasts for at least 4 weeks -Onset before age 18 -Causes significant impairment -Not related to a developmental disorder or other disorder |
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What is the epidemiology of separation anxiety disorder?
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About 2-4% of children and teens
May be slightly more prevalent in girls and lower socioeconomic classes |
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What is the average age of onset for separation anxiety disorder?
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8-9 years old
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With mood disorders, patinets lose their sense of ___ over their moods which causes great distress.
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control
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What are the 2 criteria that major depressive order must include at least one of?
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depressed mood
anhedonia |
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What are the criteria that major depressive disorder patients must have at least 5 of during that same 2-week period? (9)
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depressed mood
anhedonia significant weight loss/gain insomnia/hypersomnia psychomotor agitation/retardation fatigue/loss of energy feelings of worthlessness diminished ability to think or concentrate;indecisive recurrent thoughts of death, suicidal ideation/attempt/plan |
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Symptoms of major depressive disorder are not better accounted for by ___.
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bereavement
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What is the common symptom that children or elderly may present with for major depressive disorder?
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change from baseline to agitation/irritability
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What somatic complaints may major depressive disorder pts complain of? (3)
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HA
abdominal pain joint/muscle pain |
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What is the lifetime prevalence of major depressive disorder? Mean age of onset?
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15-25%
40 years |
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<, >, or =?
Major depressive disorder epidemiology preburty males is ___ to females, adolescent females ___ males, adult females ____ males. |
=
> > |
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Has major depressive disorder shown a relationship to race or SES?
|
No
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What are 3 examples of life events that may "trigger" major depressive disorder?
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recent death
job loss loss of social standing |
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What may be the biological pathophysiology of major depressive disorder? (3)
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NE, Serotonin, Dopamine
neuroendocrine disturbance hypothyroidism |
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What are the risk factors for major depressive disorder? (7)
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*FH of depression
*past personal Hx of depression *chronic dz Sudden loss or major change in life Family/personal history of substance abuse Lack of personal/intimate relationships Amputation/loss of bodily function |
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What types of DD are included with major depressive disorder? (9)
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endocrine
neuro infectious dz metabolic GI CV neoplasia meds (OCP) |
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What are PE "clues" of major depressive disorder? (8)
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Depressed/flat affect
Change in behavior from normal neglect of personal hygiene neglect of clothes/appearance Agitation/restlessness in some patients Poor memory/recollection Slow speech Low voice/monotonic |
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What is the most important lab to always include with major depressive disorder?
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TSH
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What type of Tx is most effective for major depressive disorder?
|
two-prong attack
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What meds may be used for major depressive disorder?
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SSRI (Lexapro)
TCA (Amitriptiline) MAOI SNRI (Symbalta, Welbutrin) |
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Which antidepressant needs a 2wk washout period before changed to a different type of med?
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MAOI
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When is TCA useful for depression? When should TCA not be given?
|
useful w/ pain/sleeping
do not give if suicide risk |
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When is SNRI useful for depression? When should SNRI not be given?
|
if have sexual side effects from SSRI
not given if pt has seizures or at risk for seizure (alcoholic) |
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What type of Tx is used for major depressive disorder when a pt responds poorly/intolerant to other therapies or needs a mroe rapid response?
|
electroconvulsive therapy (ECT)
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What is the Tx plan for ECT for major depression?
|
# of treatments is usually 6-12, usually given 3x/week
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What are 5 relative contraindication to ECT for major depression?
|
Increased ICP
Pheochromocytoma Recent MI/CVA Intracranial Tumor Unstable vascular formation |
|
|
What are 5 possible side effects of ECT?
|
memory loss (usually retrograde)
transient confusion HA N/V myalgias |
|
|
What is the most serious compilcation of major depressive disorder?
|
suicide
|
|
|
What is the most frequent method used in completed suicide?
|
firearms
|
|
|
What is the annual attempts of suicide in US? Completed?
|
200,000 or about 22 people per hour
30,000 or about 3.5 people per hour |
|
|
What are 3 types of bipolar disorders?
|
Bipolar I disorder
Bipolar II disorder Cyclothymic disorder |
|
|
What is Bipolar I disorder characterized by?
|
episodes of mania cycling with depressive episodes
|
|
|
What is Bipoar II disorder characterized by?
|
depressive episodes cycling with episodes of hypomania
|
|
|
What is cyclothymia characterized by?
|
hypomania and less severe episodes of depression
|
|
|
What is mania?
|
– a mood change characterized by significant elation and hyperactivity, over involvement in life activities, increased irritability, flight of ideas, racing thoughts, easy distractibility, little need for sleep/food
|
|
|
What behaviors are commonly associated with mania? (12)
|
Overspending
Sudden resignation from a job Aggressive behavior to others/unreasonable expectations of others Hasty marriage/immediate demand for divorce Suddenly ending relationships with others Promiscuous sexual behavior Buying & wearing flashy/tacky clothes/jewelry Bragging about abilities that may not exist Engaging in physically dangerous stunts, speeding, breaking the law Putting others at risk Inability to keep still or quiet Poor temper control |
|
|
Bipolar disorder has abnormal/persistently elevated, irritable mood lasting at least _____ (___ days for hypomania).
|
1 week
4 |
|
|
What are the criteria that bipolar disorder must have? (at least 3 of 7)
|
-Inflated self-esteem or grandiosity
-Decreased need for sleep -More talkative than normal, feels a pressure to continue to talk -Flight of ideas, feeling that thoughts are racing -Easily distractible and/or attention focused on insignificant details -Psychomotor agitation or goal directed activity -Excessive involvement in pleasurable activity which may have a negative or painful consequence |
|
|
With mania, symptoms are sufficiently severe to cause marked impairment in what 3 areas?
|
occupational function
social activities relationships |
|
|
With hypomania, the changes are ___ to others, but not severe enough to cause marked ___.
|
observable
impairment |
|
|
Compare the prevalence of genetic bipolar disorders of twins (if one twin has, prevalence of other)?
|
80% in monozygotic
24% in dizygotic |
|
|
What are 2 risk factors for bipolar disorder?
|
-Found more frequently in upper socioeconomic classes
-Bipolar patients frequently have both bipolar and unipolar 1st degree relatives |
|
|
Bipolar disorder patients have no relationship to what 4 groups?
|
Personality type
Childhood experiences Race Marital status |
|
|
What is the lifetime prevalence of bipolar disorder in men? Women?
|
0.8 – 1.1%
0.5 – 1.3% |
|
|
Which disorder accounts for a quarter of all mood disturbances?
|
bipolar disorder
|
|
|
When do S/S of biplar disoder generally emerge?
|
adolescence
-diagnosed more commonly from adolescence to age 40 |
|
|
If a bipolar pt has an early onset of symptoms then what 2 things are likely to happen?
|
psychotic features (hallucinations)
poorer prognosis |
|
|
If a pt presents after age 40 with first manic episode, then what may it be due to (medical conditions)? (10)
|
Head trauma
Brain tumor Hypo/hyperthyroidism Lupus Epilepsy Neurosyphilis AIDS Sodium imbalance Diabetes |
|
|
What is the risk of suicide in bipolar pts?
|
1 out of 5 (20%)
|
|
|
What condition is very common in pts with bipolar disorder?
|
hypothyroidism
|
|
|
What 3 tests are used to r/o brain disorder or infection in bipor pts?
|
CT
MRI LP |
|
|
How are acute episodes of bipolar disorder treated?
|
Rapid tranquilization with antipsychotics and possibly benzodiazepines
Initiation of mood stabilizer – lithium, valproic acid, carbamazepine, lamotrigine, gabapentin, atypical antipsychotics |
|
|
What is the maintenance for bipolar disorder?
|
mood stabilizer (always before adding antidepressant)
antidepressant ECT therapy |
|
|
What 5 things need to be monitored for pts on lithium?
|
Plasma level q 1-2 months
Free T4, TSH q 6 months Creatinine/UA annually CBC q 6-12 months EKG q 6-12 months if >50yo |
|
|
What are 6 possible side effects of lithium? What drug may help with some of these side effects?
|
polyuria
polydipsia fine hand tremor weight gain edema s/s of hypothyroidism |
|
|
What are 7 s/s of lithium toxicity?
|
N/V/D
slurred speech poor cognition increased tremor fasiculations generalized muscle weakness Seizures, coma and death with level > 3.0 mmol/L |
|
|
What may atypical antipsychotics have problems with? (3)
|
cholesterol
blood sugar weight gain |
|
|
Cyclothymia has chronic, fluctuating mood disturbance involving numerous periods of ___ symptoms and numerous periods of ___ symptoms. Symptoms must last ___ years for adults (___ year for children/adolescents) w/ symptom-free periods lasting no longer than ___ months.
|
hypomanic
depressive 2 1 2 |
|
|
Does cyclothymia typically begin early or late in life?
|
early (adolescence/early adulthood)
|
|
|
With cyclothymia, what is the risk of developing Bipolar I or II disorder?
|
15-50%
|
|
|
What are the S/S for cyclothymia? (6)
|
-Irregular cycling between hypomania and depression
-Periods of mood extremes are shorter, less severe -Difficulty with family, friends, relationships -History of multiple geographic moves -Involvement with religious cults -Inability to maintain jobs |
|
|
What may be included in the Tx plan for cyclothymia?
|
lithium
depakote carbamazepine for hypomania SSRI TCA insight-oriented psychotherapy *mood stabilizer plus anti-depressant |
|
|
Which disorder has depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years?
|
dythymic disorder
|
|
|
What are the criteria for dysthymic disorder that must be present while depressed? (at least 2 of 6)
|
Poor appetite/overeating
Insomnia Low energy/fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness |
|
|
For dysthymic disorder, during the 2 year peroiod of the disturbance, the person has never been w/out symptoms for more than ___ months at a time and has had no major ___ episodes or no manic/hypomanic/mixed episodes?
|
2
depressive |
|
|
What is dysthymic disorder not related to?
|
substance abuse
chronic psychotic disorder (schizophrenia) social class |
|
|
Dysthymic disorder has a lower occurence in ___ than Caucasians, affects ___% of US population, has an increased risk for developing ___, and is more common in ___ (men/women).
|
AA
1.8% major depression women |
|
|
What is included in the Tx plan for dysthymic disorder?
|
SSRI
TCA MAOI psychotherapy cognitive-behavioral therapy |
|
|
When must symptoms be present to be diagnosed as premenstrual dysphroic disorder?
|
-in the last week of the luteal phase of the menstrual cycle
-in most menstrual cycles in the past year -disappear completely shortly after onset of menses |
|
|
What are the symptoms/criteria that a pt must have at least one of for PMDD? (1 of 4)
|
-Very depressed mood, feeling hopeless
-Marked anxiety, tension, edginess -Sudden mood shifts (crying easily, extreme sensitivity) -Persistent, marked irritability, anger, increased conflicts |
|
|
What are the "other" symptoms/criteria included in PMDD (must have at least 5 total)?
|
-Loss of interest in usual activities (work/school/socializing)
Difficulty concentrating and staying focused Fatigue, tiredness, loss of energy Marked appetite change, overeating, food cravings Insomnia or hypersomnia Feeling out of control or overwhelmed Physical symptoms such as weight gain, bloating, breast tenderness or swelling, headache, and muscle or joint aches and pains |
|
|
At least ___% of women in US report minor or isolate premenstrual changes. About ___% of women worldwide experience symptoms that meet the criteria for PMDD.
|
75%
3-8% |
|
|
What is the most affected age with PMDD?
|
30-40
-possible worsening of symptoms w/ age |
|
|
What are the risk factors for PMDD? (6)
|
Female
Child-bearing age Personal Hx of a mood disorder FH of mood disorder Past history of sexual abuse Past/current history of domestic violence |
|
|
What are 4 "tools" that can help w/ the diagnosis of PMDD?
|
Daily symptom diaries
Prospective Record of the Impact and Severity of Menstruation (PRISM) Calendar of Premenstrual Experiences (COPE) Daily Record of Severity of Problems (DRSP) |
|
|
How is PMDD treated?
|
3 pronged approach:
-meds -psychotherapy -nutrition/supplements |
|
|
What meds may be included in the Tx for PMDD? (4)
|
SSRI
diuretics beta blocker anziolytic |
|
|
What intake should be limited with PMDD? (5)
|
EtOH
caffeine salt tobacco refined sugar |
|
|
What should PMDD pts increase their intake of? (2)
|
complex carbohydrates
protein |
|
|
What vitamins/minerals should PMDD pts take?
|
Calcium at least 1200 mg/day
B6 (Pyroxidine) 100 mg/day |
|
|
Which disorder has a depressed mood and associated symptoms occuring from birth of a child to one year? (3)
|
postpartum "baby blues"
postpartum depression postpartum depression w/ psychotic features |
|
|
What % of women experience postpartum affective instability?
|
85%
|
|
|
What are the S/S of postpartum "baby blues"?
|
rapid fluctuating mood
tearfulness irritability anxiety *does not interfere with a mother's ability to function and to care for her child |
|
|
Postpartum "baby blues" symptoms peak on the ___ day after delivery and last for ___ days, but they are generally time limited and spontaneously remit withing the first ___ postpartum weeks.
|
fourth or fifth
several 2 |
|
|
What is the prevalence of pospartum depression?
|
10-15% of women
|
|
|
Postpartum depression meets the criteria for ____ and usually develops ___ over the first ___ postpartum months.
|
major depression
insidiously 3 |
|
|
What are the S/S of postpartum depression?
|
-anxiety can be present
-worries/obsessions about infant's health/wellbeing -mother may have ambivalent/negative feelings toward infant and/or intrusive/unpleasant fears/thoughts about harming infant -often interferes with the mother's ability to care for herself or her child |
|
|
What are 6 risk factors for postpartum depression?
|
Prior postpartum depression (90%!)
Hx of depression not related to pregnancy Severe PMS/PMDD Marital difficulties Lack of significant social support Stressful life events during pregnancy or after childbirth |
|
|
Why does postpartum depression often go undiagnosed? (3)
|
fear of divorce/separation, disapproval from family/friends, having baby taken away
|
|
|
What "test" is used to help diagnose pospartum depresssion?
|
Edinburgh Postnatal Depression Scale (EPDS)
|
|
|
What is part of the Tx plan for postpartum depression?
|
SSRI (Prozac, Celexa, Paxil, Zoloft, Lexapro)
SNRI (Effexor, Cymbalta) TCA (Nortriptyline) anxiolytics (Lorazepam, Clonazepam) interpersonal therapy cognitive behavioral therapy hospitalization/ECT (if severe ) |
|
|
What can be used as prophylaxis for postpartum depression? (2)
|
SSRI 4-6wks before birth (high risk pts)
lithium 24h prior to delivery (bipolar pts) |
|
|
What are 3 possible consequences of non/inadequate Tx of postpartum depression?
|
suicide
infanticide poor bonding of mother/child |
|
|
What are children of postpartum depression mothers likely to have? (7)
|
Sleeping/eating difficulties
Temper tantrums cognitive development delays Language delay Emotional/social dysfunction Early onset of depressive illness |
|
|
What is the most severe form of postpartum psychiatric illness?
|
postpartum psychosis
|
|
|
What 2 groups of women have the highest risk for postpartum psychosis?
|
bipolar
previous episode of postpartum psychosis |
|
|
What is the onset of postpartum psychosis?
|
dramatic
emerging as early as the first 48-72h after delivery |
|
|
What are the S/S of postpartum psychosis?
|
restlessness
insomnia irritability rapidly shifting depressed or elated mood disorganized bahavior delusions related to infant auditory hallucinations infanticide/suicide risks |
|
|
What is a form of depression that occurs in relation to the seasons, most commonly beginning in winter?
|
seasonal affective disorder
|
|
|
Seasonal affective disorder is marked by symptoms of depression profound enough to seriously affect ___ and ___.
|
work
relationships |
|
|
What is the epidemiology of seasonal affective disorder?
|
Onset most frequently in adolescence/early adulthood
More frequent in women Affects 1-2% of US population Incidence inc w/ inc latitude |
|
|
What are the criteria for seasonal affective disorder? (4)
|
-Regular temporal relationship b/t onset of major depressive episodes and a particular time of the year (unrelated to obvious season-related psychosocial stressors)
-Full remissions also occur at a characteristic time of the year -Two major depressive episodes in the last 2 years and no nonseasonal episodes in the same period 2Seasonal major depressive episodes substantially outnumber the nonseasonal episodes over the individual's lifetime |
|
|
What are the theories for seasonal affective disorder pathophysiology?
|
*attributed to lack of sunlight
-light dec-->serotonin dec-->depressed -light dec-->melatonin inc-->depressed -hypothalamic dysregulation (lact of pineal gland stimulation) -circadian rhythm dysfunction |
|
|
What are 2 assessment scales used for seasonal affective disorder?
|
*Seasonal Health Questionnaire
Seasonal Pattern Questionnaire |
|
|
What is the Tx for seasonal affective disorder? (6)
|
full spectrum light 30min/day
SSRI/TCA during affected season nutrition exercise psychotherapy |
|
|
What are 3 consequences of anxiety disorders?
|
Increased morbidity
Functional impairment Increased utilization of healthcare resources |
|
|
What 3 neurotransmitters may be involved in anxiety?
|
Norepinephrine
Serotonin GABA |
|
|
What are 15 peripheral manifestations of anxiety?
|
Diarrhea
Dizziness Lightheadedness Hyperhidrosis Hyperreflexia Hypertension Palpitations Pupillary mydriasis Restlessness Syncope Tachycardia Tingling in the extremities Tremors Butterflies in stomach Urinary frequency |
|
|
What is the mean age of onset for panic disorder?
|
25yo
|
|
|
What % of panic disorder pts have at least one other psychiatric disorder?
|
91%
|
|
|
What are 3 possible causes of panic disorder?
|
PNS/CNS dysfunction
learned behavior unsuccessful defense mechanism |
|
|
What are the possible diagnostic criteria that panic disorder musch at at least 4 of with a discrete period of intense fear or discomfort? (13)
|
Palpitations
Sweating Trembling SOB Feeling of choking Chest pain Nausea/abdominal pain Dizziness Derealization Fear of losing control Fear of dying Paresthesias Chills or hot flashes |
|
|
How fast do panic disorder symptoms develop and when do they reach their peak?
|
abruptly
w/in 10mins |
|
|
What is agoraphobia?
|
-Anxiety about being places or situations from which escape might be difficult or embarrassing
-Situations are avoided or endured with marked distress |
|
|
For panic disorder, what are the criteria that pts must have at least one of for at least one month?
|
-Persistent concern about having additional attacks
-Worry about the implications of the attack or its consequences -Significant change in behavior related to the attacks |
|
|
Does panic disorder w/out agoraphobia have agoraphobia?
|
no.....duh ;)
|
|
|
First panic attacks are often completely ____; attack generally last ____mins and symptoms may disappear quickly or gradually.
|
spontaneous
20-30 |
|
|
What is malingering?
|
voluntary faking for secondary gain, external motivation (ex. attention, drugs/meds)
|
|
|
What is the course/prognosis for panic disorder?
|
Chronic disease with a variable course
|
|
|
What is the most effective Tx plan for panic disorder? What may be included in the Tx?
|
combination therapy:
SSRI Benzo (Xanax) TCA cognitive therapy applied relaxation breathing exercises family therapy |
|
|
How long is pharmacotherapy continued for panic disorder?
|
8-12 months
Symptoms may recur once therapy is stopped |
|
|
What is an excessive fear?
|
phobia
|
|
|
What is the peak age of onset for environmental or blood-injection-injury phobias? Situations phobias?
|
5-9yo
mid-20s |
|
|
What are the 6 most feared objects? (phobias)
|
Animals
Storms Heights Illness Injury Death |
|
|
Which specific phobia tends to have genetic factors?
|
blood-injection-injury type
|
|
|
With specific phobias pts have marked or persistent fear that is ___ or unreasonable, cued by the ___ or ___ of an object or situation; pt ____ the fear is excessive.
|
excessive
presence anticipation recognizes |
|
|
What is the duration of specific phobia and social phobia in order to be considered a disorder?
|
6 months
|
|
|
How is phobic disorders and schizophrenia differentiated?
|
Schizophrenia don’t realize that their fears are irrational
|
|
|
How can specific phobias be treated? (3)
|
Systematic desensitization
Intensive exposure to phobic stimulus Hypnosis |
|
|
What is the peak age of onset for social phobia?
|
teens
|
|
|
For social phobia, first degree relatives are ___ times more likely to be affected.
|
3
|
|
|
What is the difference b/t schizoid personality disorder and social phobia?
|
schizod wants to be involed w/ other people but is afraid to
|
|
|
What may be used in the Tx plan for social phobia? (6)
|
beta blocker for performance situations
SSRI (Zoloft) Benzo Venlafaxine (Effexor)-SNRI Buspirone? combo therapy is best |
|
|
What is an obsession?
|
recurrent and intrusive thought, feeling, idea or sensation
|
|
|
What is a compulsion?
|
a conscious, standardized, recurrent behavior, such as counting, checking or avoiding
|
|
|
Is social phobia or specific phobia more common?
|
specific phobia
|
|
|
What is the mean age of onset of obsessive-compulsive disorder?
|
~20yo
|
|
|
What is the epidemiology of OCD? (4)
|
Men = women as adults
Boys > girls as adolescents Single people > married people Whites > blacks |
|
|
What are 3 possible causes of OCD?
|
serotonin dysregulation
genetic strep infection/OCD |
|
|
For OCD, pts ___ that obsessions/compulsions are ___; obsessions/compulsions are ego-alien.
|
recognizes
irrational |
|
|
How are obsessions for OCD diagnostically defined? (4)
|
-Recurrent and persistent thoughts, impulses or images that are intrusive and caused marked anxiety or distress
-Not simply excessive worries about real life problems -Person attempts to ignore or suppress the obsessions -Person recognizes that the obsessions are a product of his/her own mind |
|
|
How are compulsions for OCD diagnostically defined? (2)
|
-Repetitive behaviors that the person feels driven to perform in response to an obsession
-Behaviors are aimed at preventing distress |
|
|
What are 4 possible symptom patterns of OCD?
|
Contamination
Pathological doubt Intrusive thoughts (ex. devil) Symmetry |
|
|
What is included in the Tx options for OCD? (5)
|
*combination
SSRI-Fluoxetine (Luvox) Clomipramine (TCA) mood stabilizer (lithium, valproate, carbamazepine) exposure response prevention |
|
|
What is the lifetime prevalence of posttraumatic stress disorder? Vietnam vets? Who is PTSD most prevalent in?
|
~8%
~30% young adults |
|
|
What is PTSD usually related to in women? Men?
|
rape/assault
combat |
|
|
What % of PTSD pt have a comorbid psychiatric disorder?
|
~67%
|
|
|
What is the "both of the following" that pts exposed to a traumatic event must have in order to be diagnosed w/ PTSD?
|
-Experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury
-Person’s response involved intense fear, helplessness or horror |
|
|
What are the possible ways that a traumatic event is persistently experienced in PTSD pts? (5)
|
-Recurrent and intrusive distressing recollections
-Recurrent distressing dreams -Acting or feeling as if the traumatic event were recurring -Intense psychological distress with exposure to internal or external cues -Physiological reactivity with exposure to internal or external cues |
|
|
What are ways that PTSD pts can persistently avoid stimuli associated w/ the trauma and numbing of general respnsiveness? (7)
|
-Efforts to avoid thoughts, feelings or conversations
-Efforts to avoid places, people or activities -Inability to recall an important aspect of the trauma -Markedly diminished participation or interest in significant activities -Feeling of detachment from others -Restricted range of affect Sense of a foreshortened future |
|
|
What are the symptoms of increased arousal that PTSD pt have at least 2 of? (5)
|
Difficulty falling or staying asleep
Irritability or outbursts of anger Difficulty concentrating Hypervigilance Exaggerated startle response |
|
|
What is the time difference b/t PTSD and acute stress rxn?
|
>1month for PTSD
|
|
|
If untreated, what % of PTSD pt recover completely?
|
30%
|
|
|
Who has the worst prognosis with PTSD?
|
very young & very old
|
|
|
When is hospitalization for PTSD required?
|
risk of suicide or other violence
|
|
|
What may be included in the Tx plan for PTSD? (7)
|
SSRI
TCA (Imipramine/Amitriptyline) Clonidine/Propanolol antipsychotics (short-term) coping mechanisms group therapy family therapy |
|
|
Generalized anxiety disorder has excessive ___ and ___ occurring more days than not for at least ___ months, about a number of events/activities; pt finds it difficult to control the ___.
|
anxiety
worry 6 worry |
|
|
What are the "3 or more of the following" that anxiety and worry are associated with for generalized anxiety disorder? (6)
|
Restlessness or feeling on edge
Being easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance |
|
|
What is the course/prognosis of generalized anxiety disorder?
|
difficult to predict
high rate of comorbidities Chronic and likely LIFELONG |
|
|
What may be included in the Tx plan for generalized anxiety disorder?
|
relaxation
biofeedback cognitive therapy benzo (low dose) Buspirone SSRI |
|
|
For the diagnosis of somatization disorder, there must be a Hx of physical complaints beginning before age ___, lasting several ___, and resulting in impaired ___ or Tx being sought.
|
30
years functioning |
|
|
What may be the etiology of somatization disorder?
|
abusive/neglectful childhoods
genetic components |
|
|
What diagnostic criteria must somatization disorder meet? (4)
|
Four pain symptoms
Two GI symptoms One sexual symptom other than pain One pseudoneurological symptom (impaired coordination, localized weakness, double vision, loss of consciousness, etc.) |
|
|
What is the course/prognosis of somatization disorder?
|
Chronic
Exacerbated by periods of increased stress |
|
|
What is included in the Tx plan for somatiztion disorde?
|
only one PCP
regularly scheduled, BRIEF appts individual/group therapy meds only for comorbid psych conditions |
|
|
What is conversion disorder?
|
One or more neurological symptoms that cannot be explained by a known medical disorder
|
|
|
What is the epidemiology of conversion disorder? (5)
|
Women > men
Most common in adolescents and young adults More common in rural areas less educated lower intelligence |
|
|
What are the 3 most common symptoms of converison disorder?
|
paralysis
blindness mutism |
|
|
What is the diagnostic criteria for conversion disorder? (6)
|
-One or more symptoms or deficits affecting voluntary motor or sensory function
-Psychological factors are associated with the symptoms -Not intentionally produced or feigned -Cannot be explained by a medical condition -Causes significant distress or impairment -Not limited to pain or sexual dysfunction |
|
|
What is the course/prognosis of conversion disorder? If there is not spontaneous resolution then do you treat?
|
-Majority resolve within days to one month
-25% will have additional episodes in the future -Prognosis worsens with increased length of symptoms -If no spontaneous resolution --> therapy |
|
|
What is hypochondriasis?
|
Preoccupation with fear of contracting or belief of having a serious disease
|
|
|
What is the epidemiology of hypochondriasis? (4)
|
4-6% of clinic pts
men=women most common in 20s 3% of PA students (oh no!) |
|
|
What are 3 etiologies of hypochondriasis?
|
Misinterpretation of bodily symptoms
Lower than usual pain thresholds Learned “sick role” |
|
|
What is the diagnostic criteria for hypochondriasis? (5)
|
-Preoccupation with serious disease based on the person’s misinterpretation of physical symptoms
-Persists despite medical evaluation and reassurance -Not of delusional intensity, or restricted to concerns about body appearance -Clinically significant distress or impairment -Lasts at least 6 months |
|
|
What is the course/prognosis of hypochondriasis?
|
episodic, lasting from months to years
childhood illness usually subsides by adulthood |
|
|
How is hypochondriasis treated?
|
therapy
-pts generally resistant to psch Tx -med not helpful unless used to treat a comorbid psychiatric disorder |
|
|
What is body dysmorphic disorder?
|
Pervasive feeling that some aspect of their appearance is ugly, despite a normal or near normal appearance
|
|
|
What is the most common age of onset of body dysmorphic disorder? What do the majority of these pts also have a Hx of?
|
15-30
depression or anxiety |
|
|
What is the etiology of body dysmorphic disorder?
|
Cause is unknown but may involve serotonin
|
|
|
What is the course/prognosis of body dysmorphic disorder?
|
usually gradual onset
usually chronic |
|
|
How is body dysmorphic disorder treated?
|
cosmetic surgery/denistry
SSRI effective 50% of time |
|
|
What is pain disorder?
|
Pain in one or more sites that is not fully accounted for by a medical condition
|
|
|
What is pain disorder associated with?
|
emotional distress and functional impairment
|
|
|
What is the peak age for pain disorder? What type of workers is it most common among?
|
30s and 40s
blue-collar workers |
|
|
What is the course/prognosis of pain disorder?
|
abrupt onset
variable prognosis |
|
|
What is included in the Tx plan for pain disorder?
|
SSRI
psychotherapy biofeedback inpatient pain control program *analgesics not generally helpful and may be addictive |
|
|
What is factitious disorder? (4)
|
-Patients intentionally has signs of medical or psychiatric disorders and misrepresent their histories and symptoms
-Only apparent objective is to assume the sick role -Has a compulsive quality -AKA Munchausen syndrome |
|
|
What group of people is factitious disorder most common in?
|
healthcare workers
|
|
|
What may factitious disorder be related to?
|
childhood abuse or neglect
hospital may represent a safe haven |
|
|
Does factitoius disorder or malingering have external incentives?
|
malingering
|
|
|
What is included in the Tx plan for pain disorder?
|
SSRI
psychotherapy biofeedback inpatient pain control program *analgesics not generally helpful and may be addictive |
|
|
What is factitious disorder? (4)
|
-Patients intentionally has signs of medical or psychiatric disorders and misrepresent their histories and symptoms
-Only apparent objective is to assume the sick role -Has a compulsive quality -AKA Munchausen syndrome |
|
|
What group of people is factitious disorder most common in?
|
healthcare workers
|
|
|
What may factitious disorder be related to?
|
childhood abuse or neglect
hospital may represent a safe haven |
|
|
Does factitoius disorder or malingering have external incentives?
|
malingering
|
|
|
What is included in the Tx plan for pain disorder?
|
SSRI
psychotherapy biofeedback inpatient pain control program *analgesics not generally helpful and may be addictive |
|
|
What is factitious disorder? (4)
|
-Patients intentionally has signs of medical or psychiatric disorders and misrepresent their histories and symptoms
-Only apparent objective is to assume the sick role -Has a compulsive quality -AKA Munchausen syndrome |
|
|
What group of people is factitious disorder most common in?
|
healthcare workers
|
|
|
What may factitious disorder be related to?
|
childhood abuse or neglect
hospital may represent a safe haven |
|
|
Does factitoius disorder or malingering have external incentives?
|
malingering
|
|
|
What is included in the Tx plan for pain disorder?
|
SSRI
psychotherapy biofeedback inpatient pain control program *analgesics not generally helpful and may be addictive |
|
|
What is factitious disorder? (4)
|
-Patients intentionally has signs of medical or psychiatric disorders and misrepresent their histories and symptoms
-Only apparent objective is to assume the sick role -Has a compulsive quality -AKA Munchausen syndrome |
|
|
What group of people is factitious disorder most common in?
|
healthcare workers
|
|
|
What may factitious disorder be related to?
|
childhood abuse or neglect
hospital may represent a safe haven |
|
|
Does factitoius disorder or malingering have external incentives?
|
malingering
|
|
|
What are the 3 types of factious disorder?
|
Primarily physical signs/symptoms
Primarily psychological signs/symptoms Mixed signs/symptoms |
|
|
What type of diagnostic tests may help to reveal factitious disorder?
|
psychological testing may reveal underlying pathology
often above-average IQ |
|
|
What is the course/prognosis of factitious disorder?
|
typically begins in early adulthood
poor prognosis |
|
|
What are 3 possible external motivations of malingering?
|
-Avoid difficult situations, responsibilities, or punishment
-Receive compensation, hospital room and board, source of drugs, or haven from police -Retaliation for financial loss, legal penalty or job loss |
|
|
Is malingering more common in men or women?
|
men
|
|
|
When should malingering be "suspected"?
|
-Referred for evaluation by an attorney
-Marked discrepancy between patient’s complaint and the physical findings -Lack of cooperation and lack of compliance -Patient has antisocial personality disorder |
|
|
What is included in the Tx plan for malingering?
|
-Confrontation in anger usually leads to negative consequences
-Careful evaluation will usually uncover the relevant issue without the need for confrontation |
