Case Files Psychiatry

Front 1

treatment for factitious disorder

Back 1

must ally with the patient;

can be "managed" rather than treated. be careful not to hate them, because they really are very sick too;

Front 2

differential diagnosis for factitious disorder

Back 2

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

Front 3

pseudoseizures are a type of...

Back 3

conversion disorder

Front 4

why would a pt make themselves sick by injecting insulin or contaminating their urine sample?

Back 4

factitious disorder in order to assume the sick role

Front 5

time cut off for schizophrenic, schizophreniform...

Back 5

6 months with at least 2 wks of prominent hallucinations etc. = schizophrenia

1-6months schizophreniform

<1month brief psychotic episode?

Front 6

schizoaffective vs mood disorder with psychotic features vs substance induced Mood disorder?

Back 6

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

Front 7

Prognosis of Schizophrenia vs Schizoaffective vs MDD with psychotic features ?

Back 7

best: MDD
middle: Schizoaffective (depressed or Bipolar type)
worst: Schizophrenia

Front 8

What's the difference between schizotypal and schizoid PD?

Back 8

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Schizoid is withdrawn, no need for social contact (not associated with schizophrenia)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

Front 9

bereavement vs adjustment d/o

Back 9

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

Front 10

treatment of schizoaffective d/o

Back 10

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

Front 11

incidence of schizotypal PD d/o

Back 11

3%

Front 12

MDD criteria

Back 12

5/9 for 2 wks

Front 13

hypomania criteria?

Back 13

4 days of elevated mood

Front 14

mania criteria ? vs schizoaffective bipolar type?

Back 14

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.

Front 15

what's the difference in presentation when adults vs children are depressed?

Back 15

children show irritability - it takes time to develop the ability to show depression;

Front 16

during what sleep period do children get night terrors? vs nightmares?

Back 16

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

Front 17

describe "night terrors"

Back 17

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;

Front 18

define parasomnia

Back 18

sleep disorder with problems during sleep stages

ex: sleep terror, sleep walking, rhythmic movement disorder, sleep talking, nightmares, bruxism, eneuresis

Front 19

define dyssomnia

Back 19

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

Front 20

another word for sleep walking

Back 20

somnambulism

Front 21

another word foe lying

Back 21

pseudologica phantastica

Front 22

why do children have more night terrors?

Back 22

more delta waves

Front 23

how to differentiate nightmares from PTSD flashbacks and nightmares?

Back 23

both have vivid memories and autonomic reactions but pt with PTSD will often have flashbacks even during the awake time - not just at night

Front 24

diagnosis of somatization d/o

Back 24

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

Front 25

timing of postpartum-depression

Back 25

peaks within 3-5days and resolves within 7-14 days

no treatment required

incidence of postpartum psychosis: 1-2/1000 women

Front 26

treatment for Postpartum depression

Back 26

SSRI, sometimes ECT for faster onset;

due to anticholinergic side effects and cardiotoxicity, TCA are second line

Front 27

treatment for post partum psychosis

Back 27

medical emergency! imediate hospitalization for safety of both