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113 Cards in this Set

  • Front
  • Back
5 axes of DSM-IV-TR
I: Clinical disorders
II: PD's and mental retardation
III: General medical conditions
IV: Psychosocial and environmental problems
V: Global assessment of Functioning Scale
The split mind of schizophrenia refers to
The nonrational divergence between behavior and thought content(laughing while afraid).
Hallmark of schizophrenia
Gross impairment of reality testing and is expressed by alterations in sensory perceptions, such as hallucinations, and abnormalities in thought processes such as delusions
"downward drift" hypothesis
Schizophrenic pts are often found in lower socioeconomic groups because of their social deficits.
Most common hallucinations
Auditory
Phases of schizophrenia
Prodromal: Pt avoids social activities and is quiet and passive. However, the pt may also by irritable. The pt may show a sudden interest in religion or cults. There may also be physical complaints. The pt is in touch with reality.
Psychotic: Loss of touch with reality, with hallucinations and delusions.
Residual phase: Flat or inappropiate affect, peculiar thinking, eccentric behavior, and social withdrawal. However, the pt is in touch with reality
Positive symptoms of schizophrenia
Delusions, hallucinations, agitation, and talkativeness.
Negative symtpoms of schizophrenia
Lack of motivation, social withdrawal, flat affect, poor grooming, cognitive disturbances, and poor speech content.
Criteria A for DSM-IV-TR diagnosis for schizophrenia
At least 2 of the following, each present for a significant portion of a 1-month period:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
Are schizophrenic pts oriented? How does this differ from pts with delirium or substance abuse?
They are oriented to place and time.
There is no clouding of consciousness and memory capacity is intact.
Dopamine hypothesis
Increased dopamine activity associated with schizophrenia, psychosis states, and amphetamine induced psychotic states.
Brain abnormalities seen with schizophrenia
Frontal and prefrontal dysfunction, Ventricle enlargement, metabolic hypofunction(decreased glucose uptake) in frontal lobe.
Repeating the same words over and over
Perseveration
Beginning a response in a logical fashion but then getting further and further from the point
tangentiality
Uttering unrealated combinations of words or phrases
Word salad
Associating words by their sounds, not by their meanings
Echolalia: rhyming phrases
Misperceptions of real external stimuli. Pt believes the chair she's in is a time machine
illusions
Pt believes that her Dr. and his nurses are out to get her
Delusions
Concordance rate of schizophrenia in monzygotic twins
50%
Now thats scary...
A pt stops talking although her lips continue to move and she seems to be concentrating on an inner stimulus
Thought blocking
The fact that schizophrenic pts are born more often during the winter months is attributed to?
Viral infections during the 2nd trimester of pregnancy
EEG's of schizophrenic pts often show?
Decreased alpha waves with increased beta and theta waves.
Besides dopamine what other neurotransmitters have been implicated in schizophrenia
Serotonin hyperactivity
Glutamate hyperactivity
Norepi hyperactivity
What occurs in almost 50% of schizophrenic pts
suicide attempt
25 y/o male pt believes that his cat and dog has been threatening to kill him. What subtype of schizophrenia
Paranoid
A 30 y/o Female pt is dirty with old makeup and unkempt hair. She is posturing and laughing while making incoherent speech.
Disorganized(hebephrenic)
Male pt is posturing in bizarre positions. He refuses to answer any questions and seems very agitated.
Catatonic
A 30 y/o female pt who had severe dellusion and auditory hallucinations 5 yrs ago appears with a flat affect and social withdrawal, but without any positive symptoms of schizophrenia
Residual:
At least 1 schizo episode
Absence of positive symptoms
Continuing negative symptoms
Male pt presents disheveled and hearing voices. Pt also believes that he talks to God, who tells him to be a good person. There is no catatonia, or disorganized speech. There are no mood disturbances.
Undifferentiated
Traditional antipsychotics such as haldol and thorazine are no longer 1st line txmt for schizo because?
They cause parkinsonian like termors and tardive dyskinesia
1st line drug therapy for schizo
atypical antipsychotics:
resperidol, clozapine, olanzapine(Zyprexa), Quetiapine (seroquel), aripiprazole(Abilify)
Disorder in which psychotic and residual symptoms last from 1-6 months w/o evidence of prominent mood symptoms, but then resolve. Same symptoms for less than a month.
Schizophreniform disorder
Brief psychotic disorder
dissheveled female presents with feelings of sadness, guilt and weight loss lasting more than 3 months. She also has been unable to sleep and has trouble concentrating. Upon further discourse, pt admits to hearing her dead husbands voice and feels her children are stealing her money. Disorder?
Schizoaffective disorder:
Psychotic and MDD
Voluntary social withdrawal w/o evidence of psychosis
Schizoid PD
Negative symptoms, bizzare behavior, odd thought patterns, but without psychosis
Schizotypal PD
Extreme mood swings with uncotrollable anger and suicidal thoughts, but psychotic episodes only last minutes
Borderline PD
Major identifying symptom of atypical depression
Weight gain and somnolence
Masked depression
Up to 50% of pts of depressed seem unaware of or deny that they are depressed; instead they report vague physical symptoms
DSM-IV-TR for MDD
At least 5 of the following symptoms over a 2 week period. At least one of these must be symptom 1 or 2:
1. Sadness, hopelessness
2. Decreased pleasure or interest in activities
3. Change in appetite
4. Insomnia or somnolence
5. Agitation or retardation
6. Daily fatigue or loss of energy
7. Guilt
8. Problems concentrating or thinking
9. Thoughts of death/suicide
Seasonal affective disorder. Txmt?
MDD during the winter months
Full spectrum light exposure
Significant risk factor for MDD
Being female
Neurotransmitters implicated in mood disorder
Dysregulation of catecholamines and indolamine
High levels of corticosteroids increase the risk for
mood disorders
Without txmt, most episodes of depression are...
Self-limiting and last 6-12 months
1st line txmt agents of MDD
SSRI's
Discreet episodes of both depression and mania
Bipolar disorder I
Episodes of depression and hypomania
Bipolar disorder II
DSM-IV-TR criteria for Mania
Criterion A:
A distinct period of abnoramlly and persistently elevated, expansive, or irritable mood lasting at least 1 week.
Criterion B: At least 3
1. Inflated self-esteem/grandiosity
2. Decreased need for sleep
3. talkativeness or pressured sleep
4. Flight of ideas
5. Increased Agitation
6. Distractibility
7. Engagement in activites with negative consequences
How is sexual interest and modesty affected in those with manic episodes
decreased modesty and increased sexual interest
Symptoms of mania for a 4 day period, but without sever social or occupational impairment and psychotic symptoms
Hypomania
Psychotic symptoms can occur in any major mood disorder but are more common in?
Bipolar I disorder:
Usually delusions
Mostly occur during manic episodes
Themes of power and influence
Most likely etiology factor for bipolar disorder. Are psychosocial factors involved?
Genetics
No, this is opposite to MDD
What can happen to a bipolar pt if given anti-depressants
Can provoke a hypomaniac or full blown manic episode
The txmt of choice for the maintenance of bipolar disorder. What can be given in its place for those who its contraindicated or show rapid-cycling bipolar episodes
Lithium: may cause renal problems and hypothyroidism
Anticonvulsants: Depakote and carbamazepine
Disorder characterized by anhedonia, neurovegative symptoms, and unreactive mood.
Meloncholic
Disorder characterized by the presence of low self-esteem and decreased productivity for at least 2 yrs
dysthymia
Disorder in which pt has episodes of hypomania and depression w/o MDD, that lasts for 2 yrs. No psychosis
Cyclothymic disorder:
NO Substance Abuse
Common symptoms with anxiety
Shakiness, sweating, mydriasis, tachycardia, hyperventilation, GI symptoms
All anxiety disorders are characterized by symptoms of?
Fear w/o adequate cause
For 6 months
GAD is comorbid with what conditions? Onset usually occurs at what time?
MDD
Childhood or early adoloscence
30 y/o pt complains of her heart racing and tachycardia w/ SOB. She states that she is often worried over little things and feels a need to control most aspects of her life. Condition? Is this situational or free-floating anxiety?
Generalized anxiety disorder
Free-floating
Rates of anxiety disorders between men and women
Women are 2-3x more likely to have panic disorder, 2x as likely to develop PTSD when exposed to an extreme stressor and slightly more likely to have a GAD
Neurotransmitters implicated in anxiety disorders
Decreased GABA, decreased Serotonin, and Increased Norepi
Organic Differential Diagnoses associated with symptoms of anxiety
Excessive Caffeine
Hyperthyroidism
Substance abuse/withdrawal
B12 Deficiency
Pheochromocytoma
Adrenal medullary tumor
Episodes of panic, with intense anxiety tha last for 30 min. and commonly occur 2x a week. Common symptoms?
Panic disorder:
Cardiac and respiratory symptoms that give the feeling of dying
Panic attacks associated with fear and avoidance of public places or situations where escape is impossible or help is unavailable
Panic disorder w/ agoraphobia
Compared with the general population, adults who have panic disorder w/ agoraphobia are more likely to have...?
Experienced seperation anxiety disorder
An exaggerated fear of embarrassing oneself in a social or performance setting such as while giving a speech, eating in public, or using a public restroom.
Social phobia/social anxiety disorder
Irrational fear of things such as snakes...
Specific phobia
Condition of recurrent, unwanted, intrusive feelings, thoughts, and anxiety. How is it relieved initially?
OCD
By repetitive actions
OCD is genetically related to what condition, with a high correspondance rate in 1st degree relatives
Tourette's
Symptoms of ASD and PTSD
Re-experiencing episodes
Hyperarousal
Emotional numbing
Avoidance
Difference between ASD and PTSD
ASD lasts 2 days to 4 weeks
PTSD lasts more than 1 month
Disorder characterized by emotional symptoms that cause social, work, and school occuring within 3 months and lasting less than 6 months after a serious life-stressor
adjustment disorder
1st line emergency txmt of anxiety
Benzo's: clonazepam, alprazolam, diazepam, and lorazepam
Long term txmt of anxiety
SSRI's: paroxetine, fluoxetine, sertraline
Most effective form of txmt for phobias
Cognitive behavioral therapy and systematic desensitization
Condition of sleep apnea, cardiovascular problems, alveolar hypoventilation and obesity
Pickwickian syndrome
Does the prevalence of obesity vary by ethnic group in men
NO! but it does vary by women
Obesity in children is currently highest in what ethnic group?
Mexican American and African Americans
How does insurance define obesity
20% over ideal bodyweight based on standard height and weight
For most people, maintenance of weight loss is best achieved by?
A combo of sensible dieting and exercise tailored to the persons needs.
What is melanosis coli? How does it happen?
Laxative abuse leads to a blackened area of mucosa identified during exam of the colon.
Hypergymnasia
Pts with eating disorders tend to engage excessively in sports and strenuous exercise
Do pts with anorexia or bulimia have appetite problems
No
16 female pt presents w/ Syncope episode and significantly low bodyweight. She states she has not had a period in months, and is cold all the time. She denies any problems. What major conditions should you be aware of?
Anorexia nervosa:
Malnutrition can lead to metabolic acidosis and elctrolyte disturbances such as hypokalemia. This may lead to cardiac arrhythmias and brain deterioration/coma.
20 y/o female dancer presents with signs of bulimia. What are you looking for on physical exam
-Relatively normal weight
-Menstrual irregularities
-Hypokalemia/metabolic abnormalities
-Esophageal varices
-Enamel erosion/Dental Caries
-Infection of the parotid glands
Russel's sign
What is Russel's sign?
Calluses on the Metacarpal-phalangeal joint do to induced gagging with bulimia
Difference in Psychological characteristics of anorexia and bulimia
Anorexia:
Intense fear of obesity
Denial of disorder
No sexual interest
Denies depression
SSRI's may not work

Bulimia:
Worry about gaining weight
Distress about having disorder
Normal sexual function
Reports Depression
SSRI's may work
Bodyweight to qualify for anorexia diagnosis
less than 85% ideal bodyweight
BMI less than 17.5
First stage of txmt for anorexia
Restore bodyweight and save pts life. 2nd stage is to prevent relapse.
Most effective form of psychotherapy in anorexia
Family therapy
Etiology of anorexia nervosa
Family difficulties such as marital problems or an overcontrolling mother
Most effective therapy for bulimia
Antidepressants w/ psychotherapy
Bulimia diagnosis requires what?
Recurrent episodes of binge eating couple with feeling out of control.
A syndrome of cognitive impairment that results from central nervous system dysfunction. It is hallmarked by impaired and clouding of consciousness. Are these pts oriented?
Delirium
No; they know person, but not place or time.
Most common psychiatric syndrome seen in hospitalized pts, particularly those in intensive care units and nursing homes.
Delirium
Common causes of delirium
meningitis and encephalitis, substance abuse, systemic illnesses
Gradual loss of memory and intellectual ability without impairment of consciousness
Dementia
Most common form of dementia
Alzheimers
Common microscopic finding in alzheimers
neurofibrillary tangles and amyloid plaques
Alzheimers usually affects what part of the cortex
Begins in the temporal lobes and spread to the frontal and parietal.
Txmt that slows alzheimers in 25% of pts
cholinesterase inhibitors
Form of dementia that is caused by multiple, small cerebral infarctions resulting from atherosclerosis.
Vascular:
Sudden onset
Abrupt loss of function w/ each infarct
Unique symptoms of Lewy body dementia
Positive symptoms that have adverse responses to anti-psychotic meds
Fabrication of forgotten information to cover up memory loss
Confabulation
Is there normal level of consciousness with amnesia
Yes
Primary cause of amnestic disorder
Thiamine deficiency as a result of long term alcohol abuse
Differential diagnosis for dissociative disorders
PTSD
Syndrome in which one forgets pertinent personal info and wanders from home adopting a new identity. Major cause?
Dissociative fugue
Failure to remember personal info
Dissociative amnesia
Recurrent feelings of detachment and unreality about ones own body, the social situation, or the environment
Depersonalization disorder
Dissociative disoders are the result of
emotional factors