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27 Cards in this Set

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treatment for factitious disorder
must ally with the patient;

can be "managed" rather than treated. be careful not to hate them, because they really are very sick too;
differential diagnosis for factitious disorder
conversion d/o and somatoform d/o both are unconscious - when they don't know it's not real

borderline PD, but this must be pervasive and often has childhood hx of abuse
pseudoseizures are a type of...
conversion disorder
why would a pt make themselves sick by injecting insulin or contaminating their urine sample?
factitious disorder in order to assume the sick role
time cut off for schizophrenic, schizophreniform...
6 months with at least 2 wks of prominent hallucinations etc. = schizophrenia

1-6months schizophreniform

<1month brief psychotic episode?
schizoaffective vs mood disorder with psychotic features vs substance induced Mood disorder?
schizoaffective has psychosis without mood and MDD has mood without psychosis.

with MDD the psychotic symptoms outweigh by far the psychosis; mood sx in schizophrenia are usually transient with respect to the total course of the illness.

with MDD with psychotic symptoms or bipolar d/o, the mood symptoms come before the psychosis;

but substance induced Mood disorder, should be ruled out - it's hard to differentiate
Prognosis of Schizophrenia vs Schizoaffective vs MDD with psychotic features ?
best: MDD
middle: Schizoaffective (depressed or Bipolar type)
worst: Schizophrenia
What's the difference between schizotypal and schizoid PD?
Schizotypal PD is magical thinking, related to Schizophrenia in parents...self later; 50% of schizotypal PD pt have one MDD which should be treated with SSRI

Schizoid is withdrawn, no need for social contact (not associated with schizophrenia)

also, there may be TRANSIENT mild psychotic episodes with schizotypal PD under stress, vs in schizophrenia where it's frank psychosis, prominent and lasting;
bereavement vs adjustment d/o
breavement is normal

adjustment d/o is excessive breavement within 3months of the stressor

adjustment d/o CONTINUES for weeks after the stressor is gone - but not more than 6 months.

there are 5 different adjustment d/o:
..with depressed mood
...with anxiety
...with mixed anxiety and depressed mood
...with disturbance of conduct
...with mixed disturbance of emotions and conduct.

treatment is: psychotherapy; GROUP PSYCHOTHERAPY
treatment of schizoaffective d/o
long term atypical antipsychotic

if depressed type: SSRI might possibly be added, although we just took one pt off their celexa and switched his zyprexa to abilify.

if bipolar type: mood stabilizer
incidence of schizotypal PD d/o
3%
MDD criteria
5/9 for 2 wks
hypomania criteria?
4 days of elevated mood
mania criteria ? vs schizoaffective bipolar type?
BP I is diagnosed when pt has elevated mood, insomnia DIGFAST for

differentiating from schizoaffective the timeline is important: there can't be a manic phase prior to the psychotic symptoms - other wise it might be bipolar I.
what's the difference in presentation when adults vs children are depressed?
children show irritability - it takes time to develop the ability to show depression;
during what sleep period do children get night terrors? vs nightmares?
slow-wave (delta-wave: 0.5-2/s, high voltage) sleep

fever, CNS depressants, sleep deprivation may increase frequency; but usually pt doesn't remember what happened last night and the sleep disturbance is TRANSIENT;

nightmares come during REM sleep
describe "night terrors"
occur in the early phases of sleep

behavioral exhibition of intense emotions and often extreme autonomic response; can't be calmed by parents

pt doesn't remember what happened last night and the sleep disturbance is TRANSIENT;
define parasomnia
sleep disorder with problems during sleep stages

ex: sleep terror, sleep walking, rhythmic movement disorder, sleep talking, nightmares, bruxism, eneuresis
define dyssomnia
sleep disorder with problems with duration and type of sleep;

vs parasomnia being problems during the sleep stages

ex: intrinsic: narcolepsy, OSA,
ex: extrinsic: poor sleep hygiene, allergies, insufficient sleep
another word for sleep walking
somnambulism
another word foe lying
pseudologica phantastica
why do children have more night terrors?
more delta waves
how to differentiate nightmares from PTSD flashbacks and nightmares?
both have vivid memories and autonomic reactions but pt with PTSD will often have flashbacks even during the awake time - not just at night
diagnosis of somatization d/o
UN-INTENTIONAL and severe:
4 pain symptoms
2 GI
1 sexual
1 pseudoneurological

over several years, starting before 30yo


rule out depression by history; in depression the somatic problems come AFTER a period of mood d/o.

rule out somatoform disorders such as hypochondriasis - such patients are convinced that they have A PARTICULAR illness and usually prominent PAIN; another somatoform to r/o: conversion d/o: pt's complaints are limited to neurological symptoms

careful, as pt can have axis I: MDD in addition to somatization

treat: regular brief visits, psychotherapy; poor prognosis
timing of postpartum-depression
peaks within 3-5days and resolves within 7-14 days

no treatment required

incidence of postpartum psychosis: 1-2/1000 women
treatment for Postpartum depression
SSRI, sometimes ECT for faster onset;

due to anticholinergic side effects and cardiotoxicity, TCA are second line
treatment for post partum psychosis
medical emergency! imediate hospitalization for safety of both