Neuro 2 Behavioral Science

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Comorbidity of ADHD

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depression, conduct d/o, bipolar d/o

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Pathophysiology of ADHD

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regions projecting into frontal cortex, mainly fronto subcortical pathways and pre-frontal cortex

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DSM-5 criteria for ADHD

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6 inattentive or hyperactive/impulsive criteria before age 12; 5 symptoms after age 17; present for at least 6 months and in different settings

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Primary neurotransmitters associated with stress/anxiety

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serotonin, GABA, norepinephrine

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Separation anxiety disorder

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developmentally inappropriate or excessive fear/anxiety about separation from, harm to, or events that could load to loss of attachment figures

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Selective mutism

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failure to speak in social situations when expected to; able to speak in other situations; >1 month

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Specific phobia

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fear, anxiety, or avoidance of circumscribed objects/situations; reaction is persistent and out of proportion

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Social anxiety disorder (social phobia)

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fearful, anxious, or avoidant of social situations that involve being scrutinized (most common = fear of public speaking)

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Treatment of social anxiety disorder

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CBT, systematic desensitization, antidepressants

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Panic disorder

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recurrent unexpected panic attacks; persistent concern/worry about having more panic attacks or maladaptive change sin behavior because of panic attacks; >1 month

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Panic attacks

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abrupt surges of intense fear or discomfort; physical and/or cognitive symptoms

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Agoraphobia

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fear/anxiety about 2+ of the following: using public transport, being in open spaces, being in enclosed places, being in line/crowd, being outside of home alone; >6 months

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Generalized anxiety disorder

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excessive anxiety/worry about various domains; 3+ of the following symptoms: restless, fatigued, concentration problems, irritability, muscle tension, sleep disturbance

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Treatment for GAD

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CBT, relaxation techniques, anti-depressants

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OCD

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obsessions = recurrent/persistent thoughts, urges, images; intrusive & unwanted | compulsions = repetitive behaviors/mental acts; feels driven to perform in response to obsession; aimed at reducing anxiety or preventing an event

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Body dysmorphic disorder

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preoccupation with perceived defects/flaws in physical appearance; not observable to others; high suicide rates

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Hoarding disorder

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persistent difficulty parting with possessions; common in older adults

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Trichotillomania

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(hair-pulling disorder) recurrent pullig out of hair => hair loss

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Excoriation

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(skin picking) recurrent picking of skin => skin lesions

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Acute stress d/o

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intrusion symptoms, avoidance, negative mood, arousal, dissociative symptoms; 3 days - 1 month

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PTSD

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intrusion symptoms, avoidance, negative cognitions & mood, alterations in arousal & reactivity; >1 month

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Intrusion symptoms

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memories, dreams, dissociative reactions (i.e. flashbacks), psychological or physiological reactions when exposed to reminds of events

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Avoidance

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persistent avoidance of stimuli associated with: distressing memories/thoughts/feelings, external reminders like people/places...

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Categories of general presentation in mental status examination

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appearance, behavior, attitude towards examiner, level of consciousness

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Categories of cognition in mental status examination

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orientation, memory, attention and concentration, cognition, speech

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Categories of emotional state in mental status examination

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mood, affect, congruence, appropriateness

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Categories of though and perception in mental status examination

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form or process, content, perception

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Categories of judgment in mental status examination

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judgment, insight, truthfulness, aggressiveness and sexual impulses

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Euthymic

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normal mood, no significant depression or elevation

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Labile mood

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alternates between euphoric and dysphoric moods

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Anhedonic

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inability to feel pleasure from activities usually found enjoyable

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Free-floating anxiety

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fright not associated w/ any specific cause

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Somnolent

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abnormal sleepiness

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Neologisms

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newly created words with unknown meaning

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Suicide assessment five-step evaluation and triage

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identify risk factors, identify protective factors, conduct suicide inquiry, determine risk level/intervention, document

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Mini-mental safe examination and Montreal cognitive assessment

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provides reliable estimates of gross cognitive function; low scores indicate greater deficit; more sensitive to mild cognitive impairment

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Neurovegetative signs of depression

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SIGECAPS - sleep distrubance, interest of pleasure, guilt, energy, concentration difficulty, appetite disturbance, pyschomotor retardation or agitation, suicidality

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In order to be diagnosed w/ major depressive disorder, patient must have at least one of what two symptoms?

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depressed mood, loss of interest or pleasure

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Symptoms uncharacteristic of grief

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guilt, thoughts of death, preoccupation w/ worthlessness, psychomotor retardation, functional impairment, hallucinations

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Characteristics of normal grief

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mixture of sadness and pleasant emotions; anguish and pain come in waves/pangs; hopeful and consolable

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Persistent depressive disorder (dysthymia)

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chronic form of depression; depressed mood continues for at least 2 years, for most of the day, for more days than not

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Risk factors for depression in the elderly

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female; single/unmarried/divorced/widowed; lack of support network, stressful life events; physical conditions

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Disruptive mood dysregulation d/o

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children 6-18 y/o; 3+ times a week that have 'temper outbursts that are grossly out of proportion in intensity or duration to the situation'

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Cognitive triad of depression

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negative self-view, negative interpretation of experience, negative view of the future

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Premise of CBT

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recognizing and correcting erroneous beliefs can relieve affective distress

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Manic vs. hypomanic episode

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manic episode = marked impairment in social/occupational functioning or necessitates hospitalization or psychotic features; 1 week. | hypomanic episode does not have these features; 4 days

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Diagnosing bipolar II disorder

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met criteria for hypomanic episode and major depressive episode (currently or in the past)

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Diagnosing bipolar I disorder

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meet criteria for manic episode, may be preceded or followed by hypomanic or major depressive episodes

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Cyclothymic disorder

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at least 2 years of numerous periods of hypomanic and depressive symptoms; hypomanic and depressive periods present for at least half the time; has not been w/o symptoms for more than 2 months at a time

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Interpersonal and social rhythm therapy (IPSRT)

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designed to treat bipolar illness; strongly influenced by the relationship between stressful events and bipolar episodes

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Delusions have to do with ___, while hallucination has to do with ___.

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cognition, sensory perception (in absence of external stimuli)

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Catatonia

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marked decrease in reactivity - negativism, catalepsy, mutism or stupor, catatonic excitement, echolalia, echopraxia

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Negative symptoms

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diminished emotional response, avolition, alogia, anhedonia, asociality

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Schizotypal (personality) d/o

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pervasive social and interpersonal deficits, reduce capacity for close relationships, cognitive or perceptual distortions, eccentricities of behavior; begins by early adulthood

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Delusional d/o

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at least one month of delusions; no other psychotic symptoms

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Brief psychotic d/o

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experience at least one of the following: delusions, hallucinations, disorganized speech; lasts more than 1 day, remits by 1 month

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Schizophreniform disorder

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symptomatic presentation equivalent to schizophrenia BUT duration is <6 months, decline in functioning not required

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Schizoaffective d/o

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symptoms of schizophrenia + mood episode; at least 2 weeks of delusions or hallucinations w/o prominent mood symptoms

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substance/medication-induced psychotic d/o

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psychotic symptoms are judged to be physiological consequence of a drug of abuse, medication, or toxin

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Psychotic d/o d/t another medical conditions

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psychotic symptoms are judged to be a direct physiological consequence of another medical condition

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Diagnostic criteria for somatic symptom d/o

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1+ symptoms that result in a significant disruption in daily life; excessive thoughts/feelings/behaviors related to health concerns; symptoms are persistent

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Conversion d/o

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1+ symptoms of altered voluntary motor/sensory functioning; not compatible w/ clinical findings/neurological signs/medical conditions

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Illness anxiety d/o

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preoccupation w/ having/acquiring a serious disease; somatic symptoms are mild/absent; high anxiety about health; performs excessive health-related behaviors; last at least 6 months

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Brief somatic symptom d/o and brief illness anxiety d/o - duration of symptoms

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duration of symptoms <6 months

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Factitious disorder

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falsification of physical/psychological symptoms or induction of injury/disease; in absence of external rewards; behavior not better explained by another mental health condition

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Malingering

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intentional production of false/grossly exaggerated physical/psych symptoms; motivated by external incentives

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Dissociative identity d/o

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at least 2 distinct personalities in one individual; recurrent gaps in recall of everyday events; not attributable to physiological effects of substance or other medical condition

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Dissociative amensia

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inability to remember important personal information that is inconsistent with ordinary forgetting

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Depersonalization and derealization disorders

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experiences of unreality - being detached from one's thoughts or being an outside observer; experience of unreality or detachment wrt surroundings

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Personality traits

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individual's unique ways of responding to the environment and interpersonal relationships; influenced by genetic temperament and life experiences

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Transference

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unconsciously transferring feelings and attitudes from a person/situation in the past onto a person/situation in the present

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Counter-transference

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feelings evoke in doctor by patient's transference

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Personality disorders criterion A

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enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture; manifested in 2+ of the following areas - cognition, affectivity, interpersonal functioning, impulse control

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Paranoid personality d/o

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pervasive distrust and suspiciousness of others; interpret others' motives as malevolent

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Schizotypal personality d/o

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pervasive pattern of social and interpersonal deficits marked by - discomfort w/ and reduced capacity for close relationships; cognitive or perceptual distortions; eccentricities of behavior

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Schizoid personality d/o

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pervasive attachment from social relations and restriction expression of emotions

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Antisocial personality d/o

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pervasive pattern of disregard for and violation the rights of others, occurring since age 15

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Boderline personality d/o

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pervasive pattern of instability in relationships, self-image, and affect with marked impulsivity

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Histrionic personality d/o

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pervasive pattern of excessive emotionality and attention-seeking

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Narcissistic personality d/o

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pervasive pattern of grandiosity (fantasy or behavior), need for admiration, and lack of empathy

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Avoidant personality d/o

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pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

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Dependent personality d/o

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pervasive and excessive need to be taken care of leading to submissive and clinging behavior and fears of separation

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Obsessive-compulsive personality d/o

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pervasive pattern or preoccupation w/ orderliness, perfectionism, and mental + interpersonal control at the expense of flexibility, openness, and efficiency