Dsm Iv Criteria For Psych Dz

Front 1

Psychosis

Back 1

-prominent hallucinations or delusions
-Sx don't occur only during episode of delirium
-Evidence to support med or substance related cause from lab, hx or physical
-disturbance not better accounted for by psychotic d/o not substance induced

Front 2

Schizophrenia

Back 2

2 or more for 1 month
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic behavior
-Negative Sxs (like flattened affect)
R/o med, neuro, substance induced
At least 6 mo (includes prodromal or residual periods where above criteria not met)

Front 3

schizoaffective d/o

Back 3

-meet affective d/o criteria
-delusions or hallucinations for 2 weeks in absence of mood sxs.
-have mood sxs for substantial portion of psychotic illness

Front 4

MDD

Back 4

5 of symptoms including 1 or 2 for 2 weeks
-15% chance of committing suicide later in life

Front 5

Manic

Back 5

elevated mood for 1 week and 3 of following. (4 need to be present if mood is irritable)
-75% have psychotic features

Front 6

Mixed episode

Back 6

both criteria are present for nearly everyday and are filled for 1 week

Front 7

hypomanic

Back 7

Difference from mania
-4 day duration
-no psychotic features
-no social impairment

Front 8

SAD triad

Back 8

-irritability
-carbohydrate drawing
-hypersomnia

Front 9

Epidemiology of MDD

Back 9

-15% lifetime prevalence
-age is 40
-2x in women
-25-50% in elderly
-loss of parent b/4 age 11: later development of major depression
-1st degree relatives=2-3x more likely to have MDD

Front 10

Course and Prognosis of MDE

Back 10

-clears up after 6mo-1 year
-episodes occur more frequently as disorder progresses
-risk of subsequent MDE is 50% w/in 1st 2 years after 1st episode
-15% commit suicide

Front 11

5HT syndrome

Back 11

-autonomic instability
-hyperthermia
-seizures
-coma and death

Front 12

adjunctive therapy for SSRI nonresponders

Back 12

-T3/T4
-Li
-L-Tryptophan

Front 13

ECT

Back 13

-premedicate with Atropine
-general anesthesia
-muscle relaxant
-retrograde amnesia

Front 14

Types of depression x4

Back 14

1)melancholic: anhedonia; early morning awakening; anorexia; guilt
2)atypical: MAOI; hyperphagia; hypersomnia; leaden paralysis; hypersensitivity to personal rejection
3)Catatonic: catalepsy; purposeless motor activity; negativism/mutism; echolalia; bizarre postures
4)psychotic

Front 15

Bipolar I epidemiology

Back 15

-75% concordance in twins
-8-18x more likely in 1st degree relatives
-women and men affected equally
-ECT works well, need more sessions than MDD

Front 16

Dysthmic disorder

Back 16

-No discrete episodes, majority of time you are depressed for at least 2 years (In kids, for 1 year)
-not w/o symptoms for >2 months at a time
-no major depressive episode
DDs: 2 Ds: 2 years, 2 listed criteria, never asympto for >2 months
-Concentration; hopelessness; appetite; insomnia/hypersomnia; low self esteem; low energy

Front 17

Course and PX of dysthmic d/o

Back 17

-20% develop major depression
-20% get Bipolar
->25% have lifelong sxs
-onset b/4 25 in 50%
-never w/psychotic features

Front 18

cyclothymic

Back 18

-2 years of hypomania and depression w/many periods (diff from rapid cycling BPD).
-never Sx free for >2 months
-popular w/Borderlines

Front 19

Panic attack

Back 19

-can also occur w/sp phobia and PTSD
-subside w/in 25 min, rarely last >1 hr
-"sudden rush of fear"
-Palpitations; Abdominal distress; Numbness/nausea; Intense fear of death; Choking/chills/CP; sweating/shaking/SOB
(4 of them)

Front 20

Panic disorder

Back 20

-w/or w/o agoraphobia
1)No precipitant for panic attacks
2)At least one of the attacks has been followed by a min of 1 month of: worry of the attacks, change in behavior to avoid the attacks
-1st episode: may think they are going insane
-anticipatory anxiety
-usually 2x/week
-last 20-30 min

Front 21

Specific phobia/social phobia

Back 21

-intense anxiety when in situation that is tried to be avoided
-patient knows fear is excessive
-if <18, present for >6mo
-phobias are most common mental d/o
-F>M
-substance abuse is common
-neuro: too much NE, so B blockers
-use paxil for social ph; benzo or B blcok for sp ph during desensitize

Front 22

OCD

Back 22

-egodystonic (have insight)
-obsessions: suppresses thoughts, person knows they are product of his mind
-compulsion: no link b/w behavior and distress, but try to calm down w/behavior
-obsessions of locking door, symmetry

Front 23

PTSD

Back 23

-symptoms for 1 mo
-persistent sxs of arousal
-numbing of responsiveness (ltd affect, detachment feelings)
-comorbid w/substance abuse and depression

Front 24

Acute stress disorder

Back 24

PTSD but sx at most for 1 mo
-event occured <1 mo ago (PTSD: event at any time in past)

Front 25

GAD

Back 25

-persistent, excessive anxiety and hyperarousal for 6 mo
-difficult to control the worry
-3 of following: restless, muscle tension, fatigue, poor concentration, sleep problems
-more women
-pts seek help b/c of medical problem: fatigue or muscle tension

Front 26

Adjustment d/o

Back 26

-Sxs begin w/in 3 mo after event; end w/in 6 mo
-severe distress in excess
-not bereavement
-resolve w/in 6 mo after terminated stressor
-supportive TX is best; pharm for sxs (depression, insomnia, etc)

Front 27

Paranoid PD

Back 27

-suspicion of others
-preoccupation of trustworthiness
-reluctant to confide in others
-persistent grudges
-quick to counterattak
M>F
-may have transient psychosis: give meds
-psychotherapy

Front 28

PMDD

Back 28

-not severe or sufficient duration for MDD
-remittance of sxs in a week

Front 29

most predictive factors for suicide

Back 29

age >45 >> EtOH dependence>>rage or violence >>prior suicide attempt >> male gender

Front 30

worst withdrawal

Back 30

-etoh and benzos

Front 31

substance abuse

Back 31

-failure to fulfill obligations at home, work
-use in dangerous situations
-recurrent legal problems
-continued use despite interpersonal problems

Front 32

receptors involved in etoh

Back 32

activates: i)GABA ii)5-HT
Inhibits: i)glutamate receptors

Front 33

what do etoh, meoh, and ethylene glycol cause

Back 33

metabolic acidosis with increased anion gap
-1st step in management is CT to r/o subdural hematoma

Front 34

treatment of etoh intox

Back 34

ABCs and lytes and acid-base status
F.S to exclude hypoglycemia
thiamine, naloxone, folate
No gastric lavage
can give SSRI

Front 35

EtOH w/drawal sxs:mild, moderate, severe

Back 35

mild: irritable, tremor, insomnia
moderate: diaphoresis, fever, disorientation
severe:Seizure, DTs
5% get DTs, 15-20% mortality rate untreated

Front 36

treatment of DTs

Back 36

benzos tapered off
nutritional stuff
MgSO4 for postw/d seizures

Front 37

wernicke:
korsakoff

Back 37

w: ataxia, nystagmus, confusion
K: antero/retrograde amnesia; confabulation

Front 38

causes of death for cocaine

Back 38

seizure
arrhythmia
respiratory depression
drug screen pos x3 days

Front 39

treatment of intox of coke

Back 39

mild-moderate agitation: benzo
severe: haldol
symptomatic support

Front 40

treatment of dependence on coke

Back 40

psychotherapy
TCAs
DA agonists: amantadine, bromocriptine

Front 41

diff b/w classic amphetamines and designer

Back 41

classic: cause release of DA from nerve endings, stimulant effect
designer (MDMA): release DA and 5HT, getting stim and hallucinogenic

Front 42

MOA PCP and ketamine

Back 42

hallucinogen antagonizing NMDA glutamate receptors
activates DA neurons

Front 43

Treat PCP intox

Back 43

[PCP can cause seizure and coma]
i)Monitor BP, Temp, Lytes
ii)Acidify urine w/NH4Cl and Vit C
iii)Benzos for agitation and anxiety, spasms and seizures
iv)Haldol for psychotic symptoms/agitation

Front 44

Eval for PCP

Back 44

elevated CPK; AST

Front 45

Benzos/sedative hypnotics:
i)Eval
ii)Treat

Back 45

i)1 week positive urine screen
lytes, EKG
ii) ABCs, charcoal
flumazenil (causes seizures also)
barbiturate: alkalinize urine w/NaHCO3

Front 46

Triad of opioid overdose

Back 46

Rebels admire morphine
i)resp depression
ii)altered mental status
iii)miosis (pinpoint)

Front 47

opioid w/d

Back 47

-rhinorrhea
-piloerection
-yawning
-sweat/lacrimation

Front 48

caffeine moa

Back 48

-adenosine antagonist, causing increased cAMP
-stimulant effect via DA system

Front 49

Defn of cognitive d/o

Back 49

affect memory, attention, orientation, judgment

Front 50

necessary minimum workup of dementia

Back 50

CBC
TFTs
VDRL
CT
B12 Folate
Electrolytes

Front 51

Treatment of delirium

Back 51

-treat underlying cause
-antipsychotics 1st line (seroquel). Haldol PO/IM but not IV b/c of torsades

Front 52

causes of delirium

Back 52

-Iatro: BP meds, insulin, H2 receptor blocker, antiparkinsonians
-O2 hypoxia: bleed, central venous, pulm
-seizures: post ictal

Front 53

diff b/w delirium and dementia

Back 53

-delirium has immediate/recent memory impaired; dementia recent and longterm impaired
-symptoms worse at night in delirium; stable in dementia
-EEG changes in delirium

Front 54

aphasia

Back 54

problems with speech and understanding

Front 55

Neurophys of AD

Back 55

-decreased level of Ach (loss of NE neurons in locus ceruleus of brainstem)
-decreased NE: Basal nucleus of Meynert of midbrain.

Front 56

Diff b/w vascular dementia and AD

Back 56

-vascular caused by small brain infarcts, so pts w/focal neuro problems (hyperreflexia or paresthesia)

Front 57

What are the cortical dementias and what are subcortical?

Back 57

Cortical: AD, FTD, CJD
Subcortical: NPH, Huntingtons, Parkinson's, multi-infarct
Cortical=cognitive
subcort=affective and movement d/o

Front 58

Treat Parkinson's as last resort

Back 58

thallotomy or pallidotomy

Front 59

CJD hallmarks

Back 59

myoclonus
EPS
ataxia
long latency period b/w exposure and dz onset
EEG=periodic sharp waves/spikes

Front 60

delirum, fever, nuchal rigidity, photophobia

Back 60

meningitis; need LP

Front 61

delirium+dilated pupils+tachycardia

Back 61

utox; drug intox

Front 62

delirium+elevated BP+papilledema

Back 62

HTNive encephalopathy
CT/MRI

Front 63

treat delirium

Back 63

FEUD
Fluid
Electrolytes
Underlying Cause
Drug w/d. Avoid BeNZOS!

Front 64

Methods of gathering information in children

Back 64

-play, stories, drawing
-K-ABC: Intelligence for 2.5-12
-WISC-R: IQ for 6-16
-PIAT: academic achievement

Front 65

MR DX criteria

Back 65

-IQ <70
-Onset b/4 age 18. Most are mild (50-70 IQ)

Front 66

Types of learning d/o and what must be r/o?

Back 66

-R/o hearing or visual deficit
-Reading d/o: more boys
-Math d/o: girls
-Written expression: unknown.

Front 67

Most common outpt diagnosis in kids?
-risk of developing ASPD?
-pharm therapy?

Back 67

CD
-40%
-antipsychotics or Li for aggression
-SSRI for impulsivity, irritability, mood lability

Front 68

Diff of ODD from CD?
-comorbidity?

Back 68

-ODD doesn't involve violation of basic rights of others. Bad towards adults but good w/peers
-ADHD, substance abuse, mood d/o

Front 69

what are the symptom categories for autism (x3)

Back 69

-problems w/social interaction
-communication problems
-repetitive and stereotyped behavior and activities

Front 70

treatment of autism

Back 70

-Neuroleptics: control aggression, mood lability
-SSRi: repetitive actions

Front 71

etiology of Tourettes
-treat tourettes

Back 71

-impaired regulation of DA in Caudate
-clonidine or pimozide (DA-R antag)

Front 72

Enuresis r/o dx's
-treatment of enuresis
-DX:

Back 72

-urethritis, diabetes, seizures
-ADH or TCAs (imipramine)
-2x/week x3 months

Front 73

etiology of enuresis

Back 73

-genetics
-psychological
-small bladder or low nocturnal levels of ADH

Front 74

r/o dx's for encopresis
Comorbidity

Back 74

-metabolic: hypothyroid
-GI: anal fissure, IBD
-dietary factors
Comorbid w/CD and ADHD

Front 75

dissociative amnesia

Back 75

-1 episode of inability to recall imp personal info, usually involving traumatic or stressful event
-often unable to recall name or imp info but remember obscure information

Front 76

dissociative fugue

Back 76

-unaware that they have forgotten anything (unaware of their amnesia)
-assume new id and occupation after arriving to new place
-usually a response to traumatic event
-lasts up to days, forget their fugue

Front 77

dissociative identity disorder

Back 77

-2 or more id's that recurrently take control of their life
-can't recall other personality's info
-sxs like Borderline; same comorbidity as fugue and amnesia; 1/3 suicidal

Front 78

levels of __ and impulsivity and aggression? (impulse d/o's)
-predisposing factors

Back 78

-5HT
-child abuse, head trauma, seizures

Front 79

anorexia dsm

Back 79

-<15% ideal body weight
-fear of being fat
-amenorrhea
-distorted body image

Front 80

Primary insomnia

Back 80

-problem falling or maintaining sleep
-at least 3x/week x 1month

Front 81

narcolepsy

Back 81

-cataplexy (lose tone ass'd w/laughter)
-short REM latency
-sleep paralysis
-hypnagogic or hypnopompic
-repeated, sudden attacks of sleep in daytime x3months

Front 82

hepatic encephalopathy

Back 82

-asterixis
-tremors
-increased DTR
-personality change
-change in cognitive ability

Front 83

HIV dementia

Back 83

-MMSE goes down (demented) and forgetful
-behavioral change, apathy, social w/d
-weak, imbalance, ataxia
(aphasia, ataxia, apraxia)

Front 84

hyperthyroidism

Back 84

-can cause mild cognitive deficits in calculation and recent memory
-tremor
-brisk DTR
-myalgia and muscle wasting
-sensitive to heat

Front 85

hypoglycemic delirium

Back 85

-tachycardia
-tremor
-hn
-seizure

Front 86

triad for MDD

Back 86

-feeling ineffectual
-believing world is hostile to her
-knowing that things won't change

Front 87

brain changes of schizo

Back 87

enlarged ventricles and prominent sulciIED

Front 88

brain abnormalities in IED

Back 88

-5HT pathway of limbic system

Front 89

buproprion required test with nicotine patch

Back 89

frequent blood pressure monitoring

Front 90

GAD characterized by

Back 90

-anxiety about multiple events in conjunction w/ 3 for 6 mo
-impaired sleep
-poor concentration
-easy fatigue, irritable, muscle tension, restless