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220 Cards in this Set
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Delirium, agitation, fever, autonomic hyperactivity, auditory and visual hallucinations. Typically seen within 2-4 days after cessation of EtOH, may occur later
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Delirium Tremens
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What is the treatment for Delirium Tremens?
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Tx aggressively with benzo's and hydration
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Fever, rigidity, autonomic instability, clouding of consciousness
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Neuroleptic Malignant Syndrome (NMS)
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How do we treat Neuroleptic Malignant Syndrome (NMS)?
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withhold neuroleptics, hydrate, consider dantrolene.
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which disorder has the highest rate of suicide?
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major depressive disorder
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what is the DSM IV criteria for Major depressive Disorder?
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1. At least one major depressive episode
2. No hx of manic or hypomanic episode |
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Who gets MDD?
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At any age but average is 40 years old.
MC in women during reproductive ages No ethnic or socioeconomic difference |
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How do you dx a major depressive episode?
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Must have 5 of following criteria (including 1of the first 2) for at least 2 weeks
1. Depressed mood 2. Anhedonia 3. Change in appetitie or body weight 4. feelings of worthlessness or excessive guilt 5. insomnia or hypersomnia 6. diminished concentration 7. psychomotor agitation or retardation 8. fatigue or loss of energy 9. recurrent thoughts of death or suicide. Sx cannot be d/t substance use or medical conditions and must cause social or occupational impairment. |
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what does SIG E. CAPS stand for? What doe it describe?
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Sx of major depression
S - sleep I - loss of interest G- guilt E - decreased energy C - loss of concentration A - appetite P - Psychomotor activity S - suicidal ideation |
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How do we dx a Manic Episode?
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Last at least 1 week, or any duration if hospitalization is necessary.
3 of the following (4 if mood is irritable) 1. Distractibility 2. inflated self-esteem or grandiosity 3. Increase in goal-directed activity (socially, at work, sexually) 4. Decrease need for sleep. 5. Flight of ideas or racing thoughts 6. More talkative or pressured speech (rapid, uninterruptible) 7. Excessive involvment in pleasurable activities that have a hight risk of negative consequences (shopping sprees, sexual indiscretions) cannot be d/t substance abuse |
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In order to make the diagnosis of major depressive disorder, symptoms need to be present for how long?
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2 weeks
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What are some side effects of TCAs?
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Dry mouth, retention, fatigue, blurry vision -- attributed to anticholinergic effects
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when prescribing lithium it is important to monitor what?
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lithium levels, creatinine, thyroid levels
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what are the 3 major complications of TCAs?
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Cardiotoxicity
Convulsions Coma |
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describe atypical depression
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increased appetite
increased sensitivity to interpersonal rejection hypersomnia (MEE!!!) |
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What class of medications are most effective with atypical depression?
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MAOIs
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What class of drugs are these?
Phenelzine (Nardil) Tranylcypromine (Parnate) Isocarboxazid (Marplan) |
Monoamine Oxidase Inhibitors (MAOIs)
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How long should you wait before switching from an SSRI to and MAOI? What if a patient was on Fluoxetine?
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Wait at least 2 weeks
If on Prozac then wait 5-6 weeks |
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Risk when MAOIs are taken with tyramine-rich foods or sympathomimetics
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Hypertensive crisis.
foods with tyramine: red wine, cheese, chicken liver, fava beans, cured meats... cause build up of catecholamines. |
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what is the long acting version of Risperidone?
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Consta
atypical antipsychotics |
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What are important side effects of Clozapine (Clozaril)?
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Less likely to cause tardive dyskinesia but associated with:
tachy, hypersalivation, anticholinergic SE, myocarditis may develop 1-2% Agranulocytosis 2-5% seizures |
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What class of drugs are more effective in treating negative symptoms of schizophrenia?
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atypical antipsychotics (clozapine, risperidone, seroquel)
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Atypical Antipsychotics are used to treat what?
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1. negative sx of schizophrenia
2. acute mania 3. bipolar disorder 4. adjunct to unipolar depression 5. sometimes used in personality disorders (clozapine, risperidone, quetipaine) |
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Which is the only mood stabilizer shown to decrease suicidality?
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lithium
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what is the drug of choice in acute mania?
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Lithium
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Used in acute mania, as prophylaxis for both manic and depressive episodes in bipolar and schizoaffective disorders. used in cyclothymia nd unipolar depression as well.
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Lithium
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Where is lithium metabolized?
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the kidney
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a defense process by which an unacceptable feeling is unconsciously replaced with a course of action that is constructive and personally and socially acceptable. The conscious use of work, sports, art or hobbies to divert one's thoughts from a problem or from a rejected wish, is an analog of this.
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sublimation
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is the conscious or unconscious separating off of mental contents (i.e.: thoughts, feelings, and fantasies) from the individual's awareness, which is disowned and separated from one's personality.
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Dissociation
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is the unconscious mechanism where an unacceptable impulse, or idea, is attributed to others or the external world.
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projection
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is the disclaiming and rejecting of any aspects of internal or external reality that, if acknowledged, would cause anxiety.
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denial
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is an unconscious mechanism in which unacceptable feelings, ideas, or impulses are transformed into their exact opposites.
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Reaction formation
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A middle-aged man is angry, frustrated, disillusioned, and disappointed with his wife's involvement with his best friend. He enrolls himself in a men's tennis club to relieve his negative emotions. What defense mechanism is he using?
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Sublimation
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must occur within 1 month following exposure to an extreme trauma. The symptoms are similar to posttraumatic stress disorder and must last at least 2 days and no more than 4 weeks.
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acute stress disorder
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is an anxiety disorder that involves fearfulness and avoidance of situations that may be difficult or awkward to escape from. It can be associated with panic attacks. The situations are not limited to social interactions and must involve more than one specific situation. Some common examples are standing in a line, being on a bridge, traveling in an airplane, and being in a crowd.
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agoraphobia
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is an anxiety disorder involving exposure to social and/ or performance situations. The fearfulness is persistent over time and anticipation of a situation, as well as being in the situation, can elicit intense symptoms of autonomic arousal. Avoidance behavior is common. Examples include speaking to authority figures, initiating conversations, dancing, eating in public and speaking in public.
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social phobia
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is characterized by excessive anxiety and apprehension associated with a number of activities or events. Persons often describe feeling they have no control over their worries and anxiety, and they experience symptoms of restlessness, poor concentration, fatigue, muscle tension, irritability, and sleep disturbance. The symptoms must be present a majority of the time over a period of at least 6 months.
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generalized anxiety disorder
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ACUTE post traumatic stress disorder is identified as symptoms lasting for how long? How about chronic PTSD?
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Acute lasts: 1-3 months
Chronic: >3 months acute stress disorder = < 1 month PTSD = >1 month |
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what medication are the first-line treatment options for chronic, sustained treatment of panic disorder?
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SSRIs
Some SSRIs like Paroxetine (Paxil) can be used in conjunction with a benzodiazepine, such as lorazepam or clonazepam, for short periods of time for acute panic attacks. |
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A 31-year-old woman presents with recurrent episodes of palpitations, tachycardia, dyspnea, and impending dread that began shortly after the birth of her first child. She was diagnosed with a panic disorder after the first couple of episodes. What is the best for the sustained treatment of her condition?
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SSRIs
Some SSRIs like Paroxetine (Paxil) can be used in conjunction with a benzodiazepine, such as lorazepam or clonazepam, for short periods of time for acute panic attacks. |
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What is the drug of choice for the treatment of ventricular dysrhythmias and/or hypotension secondary to tricarboxylic acid antidepressant (TCA) poisoning.
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Sodium Bicarbonate
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This psychiatric condition is characterized by emotional turmoil, affective instability, chronic suicidal behavior (suicide ideation and attempts), and instability of interpersonal relationships. DSM-IV-TR requires 5 or more of the 9 criteria
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borderline personality disorder
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Criteria include age of older than 18, evidence of conduct disorder in childhood, a pattern of irresponsible and antisocial behavior since age 15, and absence of schizophrenia or manic episodes.
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Antisocial personality disorder
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Symptoms of cannabis intoxication include
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Impaired motor coordination
Euphoria Anxiety Sensation of slowed time Impaired judgment Social withdrawal And at least 2 of the following Dry mouth Conjunctival injection Increased appetite Tachycardia |
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Visual hallucinations with an absence of auditory hallucinations are commonly associated with...
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substance-induced psychotic disorders, but they are rare in other psychotic disorders.
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a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months and at least one criterion present in the past 6 months: aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules that causes clinically significant impairment in social, academic, or occupational functioning, prior to age of 10.
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conduct disorder
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its central component, a pervasive display of emotionality and attention-seeking behavior; it begins in early adulthood and present in a variety of contexts. Generally, an individual with the disorder has a need to be the center of attention in social circles, may engage in seductive and/or provocative behavior, displays shallow expression of emotions, employs excessively expressionistic speech, is dramatic and self-dramatizing, uses physical appearance to obtain attention, is suggestible by others, and considers relationships to be closer than they actually are.
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Histrionic Personality Disorder
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Patients with__________ react to a traumatic event by developing numbness and severe anxiety symptoms; they may also develop flashbacks, amnesia, mental distress, nightmares, and other stress-related behaviors. symptoms develop shortly after a traumatic event and last less than 1 month. however, if it lasts longer, it may develop into post-traumatic stress disorder (PTSD).
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acute stress disorder
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involves the transferring of feelings to an inappropriate person, situation, or object (e.g., a man who has been yelled at by his boss takes out his anger on his wife).
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Displacement
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involves creating explanations for an action or thought, usually to avoid self-blame.
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Rationalization
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is the unconscious changing of a feeling or idea to its opposite (e.g., a man acts very friendly toward a coworker when in fact he is unconsciously jealous)
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reaction formatiom
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involves turning an unacceptable impulse into an acceptable one (e.g., someone with very aggressive impulses becomes a professional boxer).
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sublimation
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what score on MMSE is normal?
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27 to 30
23 to 26 is borderline A score of 22 or less generally suggests dementia but may also be found in acute confusion, schizophrenia or severe depression. |
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Alteration (fluctuating) level of consciousness. Associated with altered attention and cognition
Rapid Onset May be reversible (not always) Always due to a medical/surgical cause – including medications! |
delerium
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condition resulting from a deficiency of dietary thiamin. Acutely, patients experience high-output cardiac failure with vasodilation, edema, and cardiac enlargement. Symptoms resolve with thiamin infusion.
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Beriberi
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they include altered conscious, altered memory, and incoordination. The feature that distinguishes it, however, is ophthalmoplegia, which reverses rapidly following intravenous infusion of thiamin.
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Wernicke's encephalopathy
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the involuntary exclusion of painful memories from awareness. The person is not aware that they are
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repression
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characterized by childlike behavior under stress. When , a person returns to an earlier, immature way of dealing with the world.
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regressing
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is the voluntary withholding of an idea or feeling from conscious awareness. The person exhibiting this chooses not to think of that painful event.
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suppression
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exemplified by either delusions, hallucination, or severe disorganization of thought/behavior
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Psychosis
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Auditory hallucinations that directly tell the patient to perform certain acts are called
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comman hallucinations
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are fixed, false beliefs that cannot be altered by rational arguments and cannot be accounted for by the cultural background of the individual
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delusions
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Irrational belief that one is being persecuted. "The CIA is after me and tapped my phone"
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delusions of persecuttion/paranoid delusions
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Belief that cues in the external environment are uniquely related to the individual. "Jesus is speaking to me through TV characters"
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Ideas of reference
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Belief that one has special powers beyond those of a normal persons. " I am the all -powerful son of God and I shall bring down my wrath on you if i don't get my way"
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Delusions of grandeur
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to make the dx of schizophrenia the patient must have the sx of the disease for how long?
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6 months
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What are the 5 criteria for identifying someone as psychotic?
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1. Hallucinations
2. Delusions 3. Disorganized Speech 4. Disorganized Behavior 5. Negative symptoms ( avolition, decreased range of expression, reduced speech and fluency) |
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what is akathisia?
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an unpleasant, subjective sense of restlessness often manifested by the inability to sit still
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people born in what moths have a higher incidence of schizophrenia?
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people born in winter and early spring.
schizophrenia is also found in lower socioeconomic groups d/t "downward drift". |
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belief that cues in the external environment are uniquely related to the individual. i.e.: jesus is speaking to me through TV characters
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Ideas of reference
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Misinterpretation of an existing sensory stimulus
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illusion
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Medical causes of psychosis include?
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1. CNS disease (hunting tons, alzheimers, parkinsons, neoplasm, tertiary syphilis)
2. Endocrinopathies (addisons/cushings, hyper/hypothyrodism calcemias) 3. Nutritional/ vitamin deficiency states (B12, niacin) 4. Other (CT disorders i.e. lupus, temporal arteritis |
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Fixed, false beliefs that cannot be altered by rational arguments and cannot be accounted for by the cultural background of the individual
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delusions
(nonbizarre vs bizarre) |
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sensory perception without at actual external stimulus
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Hallucination
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What is the DSM IV criteria for psychotic disorder secondary to general medical condition? (3)
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1. prominent hallucination or delusions
2. sx do not occur only during episode of delirium 3. Evidence to support medical cause from lab data, hx or pe. |
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What are some medications that may cause psychosis in some patients? (10)
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"5 A's DuMP BoB C. "
1. Anticholinergics 2. Antiparkinsonians 3. Antihistamines 4. Antihypertensives 5. alcohol 6. Drugs/ Digitalis 7. Marijuana/methylphenidate 8. PCP 9. Benzodiazepines/Barbituates 10. Corticosteroids (floroquinolones) |
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What is the DSM criteria for Psychosis Secondary to Medication or Substance Use
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1. prominent hallucinations or delusions
2. sx's do not occur only during episode of delirium 3. evidence to support medication or substance related from lab, hx or PE 4. disturbance is not better accounted for by psychotic disorder that is not substance induced |
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To make the dx of schizophrenia a patient must have symptoms of disease for how long?
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6 months
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what type of symptoms in schizophrenia are more readily treated with medication. Positive or negative symptoms
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positive sx respond better to medication (hallucinations, delusions, bizarre behavior, disorganized speech)
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Symptoms of schizophrenia usually present in 3 phases. what are they?
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1. Prodromal - decline in functioning that precedes the 1st psychotic episode. withdrawn, irritable, newfound interest in religion
2. Psychotic - perceptual disturbances, disordered though process/content, delusions 3. Residual - occurs between episodes of psychosis. marked by flat affect, social withdrawal, odd thinking or behavior. pts. can continue to have hallucinates even with tx. |
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in what subtype of schizophrenia would you see echolalia and echopraxia?
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Catatonic type
2+ of the following: - motor immobility - excessive purposeless motor activity - extreme negativism or mutism - peculiar volunatary movements or posturing - echolalia - echopraxia |
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what subtype of schizophrenia? Prominent negative symptoms (flattened affect, social withdrawal) with only minimal evidence of positive symptoms (hallucinations, delusions)
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Residual type
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the treatment of PTSD
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1. Behavior therapy
2. Psychotherapy 3. Medication (SSRI + MAOIs) |
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what is the downward shift hypothesis?
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postulates that people suffering from schizophrenia are unable to function well in society and hence enter lower socioeconomic groups. Many homeless people in urban areas suffer from schizophrenia
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In schizophrenia what does the dopamine hypothesis say accounts for positive and negative symptoms?
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Decreased amount of dopaminergic activity in the prefrontal cortex accounts for negative symptoms
Increased amount of dopaminergic activity in the Mesolimbic area is responsible for positive symptoms |
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schizophrenia has a very large genetic component. If one identical twin has schizo, the risk of the other identical twin having it is?
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50%
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CT scans of patients with schizophrenia may show ?
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enlargement of the ventricles and diffuse cortical atrophy
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_____ is a predisposing factor to paranoid psychosis
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deafness
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_____% or patients with schizophrenia attempt suicide
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50%
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Common symptoms of______________ are auditory hallucinations that come from within (as opposed to outside of the head), losing time (being unaware of how one ended up places), confusion, dramatic changes in personality, a history of somatic complaints, and nightmares.
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dissociative identity disorder
These patients almost always have a history of severe sexual abuse |
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unjustified distrust and suspicion of others, the inability to confide in others, and the tendency to carry grudges and resent peers or colleagues for no founded reason. People with the disorder appear cold, calculating, and see suspicious meanings in everything. They usually have occupational difficulties, and they only do well if they have a solitary job.
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Paranoid personality characteristics
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being lifelong loners, having a restricted emotional range, exhibiting unsociable behavior, appearing cold and reclusive, and enjoying few activities. Most people with the disorder do not marry or have romantic relationships. They often daydream and carry an unusual attachment to animals, but not to people. They are unaffected by praise or criticism, and they have no interest in sexual behavior.
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Schizoid personality characteristics
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behavior that is influenced by magical thinking, telepathy, and/or aliens; unusual perceptions or bodily delusions; odd behavior and appearance; extreme anxiety in social situations; and an affect that is blunted or inappropriate to the topic at hand.
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Schizotypal personality
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frequent bullying and threatening others, the tendency to start fights, and the tendency towards physical cruelty to animals and later humans. People with the disorder often steal and force sex on other individuals.
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Antisocial personality
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unstable impulse control, early adult life instability in interpersonal relationships, frantic attempts to prevent abandonment, identity disturbance, self-damaging behavior, self-mutilating behavior, severe reactivity to moods, chronic feelings of being no good, and angry and paranoid behavior that may last for short or long periods of time.
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Borderline personality characteristics include
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A 10-year-old boy was diagnosed with ADD and put on methylphenidate, which he takes daily with his afternoon snack. He has been having difficulty sleeping since beginning the medication. In what way do you respond to this concern?
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The medication should be given early in the day
Insomnia is a common side effect of methylphenidate, which is a central stimulant; therefore, it should be administered in the morning or at lunchtime. |
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how common is post partum depression?
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occurs in 10-15% of women up to a year after giving birth.
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The diagnosis of _________, according to the DSM-IV, includes a depressed mood for the past 2 years, as well as 2 of the following: change in appetite, sleep disturbance, fatigue or low energy, poor concentration, and hopelessness.
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dysthymia
The symptoms of major depression are usually more severe and may include feelings of guilt and thoughts of suicide. |
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is a mild form of bipolar disorder. A dysthymic mood is part of the disorder, but the diagnosis also requires hypomania. This patient has no history of manic or hypomanic symptoms (elation, inflated self-esteem, agitation, or risky behavior).
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cyclothymia
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The major features of _________ are grandiosity (an inflated sense of self importance), a need for admiration, and a lack of empathy for others. If criticized, the narcissistic individual often reacts with rage, and he/she often exploits others. Feelings of grandiosity usually preoccupy the individual, and there is often a profound sense of entitlement.
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narcissistic personality disorder
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characterized by a lifelong pattern of being preoccupied with perfectionism, orderliness, and control. Individuals with this disorder have difficulty being open with others, they are unable to be flexible because it means giving up control, and their perfectionism usually makes them very inefficient in their accomplishments. Other symptoms include excessive devotion to work or to other tasks, being overly conscientious about moral or ethical issues, and having restricted expression of affect
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Obsessive compulsive personality disorder
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associated with a pattern of unstable interpersonal relationships. Self-image is poor, affect is often labile or depressed, and these individuals are highly impulsive - especially with regard to self-destructive behaviors. Individuals with this disorder are chronically bored and empty feeling. They alternate between overly idealizing others and devaluing them. Their emotions are intense. Although individuals with this disorder are said to have a need to be taken care of, they have difficulty accepting the help of others because they mistrust their intentions.
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Borderline personality disorder
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tend be clingy and submissive in their behaviors because their need to be taken care of is so pervasive. They have difficulty making everyday decisions without consulting others, and they agree with others even if they believe the person to be wrong due to their intense fear of rejection. They have difficulty doing things on their own, and their most pervasive fear is that of being abandoned.
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dependent personality disorder
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characterized by social inhibition and feelings of inadequacy. Individuals who suffer from this disorder are extremely sensitive to negative feedback from others. They avoid social activities due to their fear of having to participate.
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avoidant personalty disorder
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is the most prevalent of the anxiety disorders; it is frequent in children of divorce and marital separation. Patients have difficulties controlling their strong feelings of betrayal and anger. Their anger is regularly misdirected at the other parent or teachers.
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Separation anxiety disorder
he excessive anxiety that separation causes should be beyond what is considered normal for the patient's developmental stage and should last for at least 4 weeks to satisfy the diagnostic criteria of this disorder. |
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how long must symptoms be present to make a dx of panic disorder?
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1 month
at least 1 month of concern or worry about the attacks or a change in behavior related to them. A diagnosis has to be made after a medical etiology for the panic attacks has been ruled out. |
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occurs commonly in patients with panic disorder; it is an acquired irrational fear of going outside and being in places where one might feel trapped or unable to escape. Usually the patient becomes housebound and dependent on the company of others to go out.
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agoraphobia
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will present with difficulties in social situations, such as speaking in public, eating in a restaurant, and using public washrooms because of the fear of scrutiny by the others or a fear of being embarrassed or humiliated.
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social anxiety disorder
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Oral activated charcoal adsorbs acetaminophen if administered within?
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4 hours
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A woman is reported to have ingested 30 tablets of extra strength (500 mg) acetaminophen (Tylenol) 7 hours prior. Lab tests confirm elevated acetaminophen levels. Currently, she feels nauseous and fatigued. No signs of jaundice are appreciated. What is the most appropriate treatment for this patient at this point?
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N-acetylcysteine IV
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Excessive emotionality and attention-seeking behaviors characterize individuals with
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Histrionic personality disorder
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In order to make dx of histrionic personality disorder you need 5 out of the following symptoms to be present. what are the 6 symptoms?
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1. A need to be the center of attention
2. inappropriate sexual behavior such as seductiveness or provocativeness 3. shallow emotions that change quickly 4. excessively emotional speech 5. exaggerated emotional expression 6. history of believing that relationships with others are more intimate than they really are. |
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characterized by distrust and suspicion that leads the individual to assume that others' motives are malicious. At least 4 symptoms must be present to diagnose an individual with this disorder.
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Paranoid Personality Disorder
1. Suspicion without cause 2. preoccupation with the loyalty or trustworthiness of others 3. reluctance to confide in others 4. misinterpretation of benign events 5. perception that remarks made to them are threatening. |
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In order to diagnose paranoid personality disorder you need 4 out of 5 symptoms to be present. what are the 5 symptoms?
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1. suspicious without a cause
2. preoccupation with loyalty or trustworthiness of others 3. reluctance to confide in others 4. misinterpretation of benign events 5. perception that remarks made to them are threatening. |
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Ideas of reference (but not full-blown delusions), odd beliefs or magical thinking, illusions or unusual perceptual experiences (but not classic hallucinations), odd thinking and speech, eccentric behavior or appearance, paranoid thinking or suspiciousness of others, no close friends, and social anxiety that is related to paranoid fears, rather than to negative feelings about oneself.
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5 or more of the following symptoms are present in the typical individual with schizotypal personality disorder
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what is the difference between paranoid personality disorder and schizotypal personality disorder?
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schizotypal personality disorder is characterized more by pervasive social and interpersonal deficits that result in extreme discomfort with close relationships.
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Tend to be socially isolated, they display restricted affect (expression of mood), and they almost always prefer to be alone. These individuals appear to others to be introverted and preoccupied, and they do not do well in jobs that require social performance. An individual must display at least 4 of the following symptoms
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schizoid personality disorder: few activities are pleasurable, close relationships are shunned - even those with family members, a clear preference for solitude (activities are usually chosen accordingly), indifference to praise or criticism, and a profound lack of displayed emotions.
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characterized by persistent patterns of disregard for others and violations of the rights of others. Symptoms usually begin before age 15 years, but the diagnosis cannot be officially established until the age of 18. There must be at least 3 of the following current symptoms: nonconformity to social norms and lawful behavior, deceit, impulsivity, pervasive irritability or aggression, a reckless disregard for the safety of themselves or others, irresponsibility, and lack of remorse.
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antisocial personality disorder aka sociopaths
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What type of schizophrenia? usually appear normal because disorganized speech, disorganized behavior, flat affect, and catatonic behavior are not prominent. They are usually able to take care of themselves, and their daily lives are not very disruptive. They do, however, present with a theme of suspiciousness or paranoia, and they have delusions of persecution. They believe that someone is trying to do them harm, poison their food, is following them, or is trying to kill them.
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schizo paranoid type
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has prominent symptoms of disorganized speech and behavior. Patients usually talk gibberish, and they are typically unable to take care of themselves. They have very poor personal hygiene and appearance. Again, hallucinations and delusions are not manifest.
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schizophrenia disorganized type
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What type of schizo? have stupor or retarded immobility, are sometimes mute, or display very negative speech. They have bizarre posturing and grimacing.
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catatonic type
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what type of schizo? does not meet the criteria for the other types, and it is a diagnosis of exclusion. It applies to patients that do not have the apparent symptoms of catatonic, paranoia, or disorganized behaviors.
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undifferentiated type
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what type of schizophrenia? diagnosis that is given to patients who once had another type of schizophrenia; however, these patients have been treated, and their symptoms are not as pronounced as they once were. It is often applied to patients who have been treated and are in the process of partial remission.
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residual type
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A BMI of what is considered to be overweight? obese?
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overweight = 25 - 29.9
obese = 30 - 39.9 underweight = <18.5 |
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a defense process in which an unacceptable feeling is unconsciously replaced with a course of action that is constructive as well as personally and socially acceptable. The conscious use of work, sports, art, or hobbies to divert one's thoughts from a problem or from a rejected wish is an analog of this.
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sublimation
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an unconscious mechanism in which unacceptable feelings, ideas, or impulses are transformed into their exact opposites.
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reaction formation
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A middle-aged man feels anxious, angry, and hostile because he is stressed out due to work. He enrolls himself in the neighboring gym in order to relieve his tension. What is the primary defense mechanism that this man is using?
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sublimation
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Presenting symptoms of cocaine intoxication include?
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hypertension, tachycardia, diaphoresis, anxiety, dilated pupils, agitation, nasal congestion, and psychosis.
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the most common age for onset of adult schizophrenia is?
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mid 20's
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cluster B disorder. These individuals exhibit traits that often involve them with the criminal justice system. Traits include a lack of remorse or regret for even violent and hurtful acts, an artificial charm turned on for purely manipulative purposes, reckless disregard for the rights and safety of others, deceitfulness, impulsivity, and irresponsibility.
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antisocial personality disorder
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characterized by detachment, indifference towards others, and marked coldness of emotion. These patients are often life-long loners.
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schizoid personality disorder
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manifests as odd beliefs, magical thinking, social anxiety, unusual perceptual experiences, odd speech, and peculiar appearance.
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schizotypal personality disorder
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manifests as pervasive distrust of others and constant suspiciousness toward their motives. Interpretations of others' behavior made by these individuals will usually include maliciousness, hidden meanings, jealousy, and long-term grudges.
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paranoid personality disorder
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Carbamazapine is associated with what potential side effects?
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is known to cause aplastic anemia and agranulocytosis in a small number of patients; therefore, patients must be monitored during treatment.
they should let their care provider know if they experience sore throat, rashes, or easy bruising. They also need to avoid alcohol, grapefruit juice, and they should not drive. |
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what is the first line med for treatment of mood stabilization?
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lithium
However, if it does not work or if the side effects are intolerable, then carbamazepine may be tried. Lithium should not be used in patients with poor renal function, pregnant women, those with hypersensitivity to the drug, or those with cardiovascular disease. |
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Characterized by depression that is less severe than that which is associated with major depression and it has a chronic course. A general depressed mood must be present for at least a 2-year period in order to qualify an individual for this diagnosis, and there will likely be sleep and/or eating disturbances, low self-image, low energy, difficulty concentrating, and hopelessness. Daily functioning is usually not seriously impaired; however, on occasion, exacerbate into an episode of major depression.
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dysthymic disorder
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characterized by a depressed mood that lasts at least 2 years (or 1 year in children), but in this case the individual alternates between periods of depression and periods of hypomania. The depressive episodes are not severe enough to be considered major depression, and the hypomanic episodes are not severe enough to be considered manic episodes. Like dysthymia, daily functioning is not usually significantly impaired.
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cyclothymia
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what drug is most likely to help with people suffering from seasonal affective disorder?
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buproprion - wellbutrin
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subtype of major depressive mood disorder characterized by recurrent seasonal patterns of depressive episodes; its onset is most commonly in the fall or winter, and remission occurs in spring or summer. It usually begins in October or November and ends by February or March
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seasonal affective disorder
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which SSRI is the MOST Sedating?
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Paroxetine hydrochloride is a selective serotonin reuptake inhibitor (SSRI). One of its side effects is sedation in elderly and it is the most sedating of the SSRIs. Because of its sedation, it is not preferred in SAD patients who are likely to have hypersomnia. Other side effects include low blood pressure, headaches, dizziness, insomnia, ear pain, or eye pain. Typical dosing in the elderly is 20-30 mg.
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Borderline personality disorder can be differentiated from dependent personality by the fact that those with borderline personality react to abandonment with _______
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an outward expression of anger; those with dependent personality disorder, however, react to abandonment with increased submissiveness.
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Name 5 etiologies of major depressive disorder
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1. low serotonin
2. low 5-HIAA 3. High cortisol 4. Abnormal thyroid axis 5. genetics |
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What is the Hamilton Ratin score?
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standard measure of depression severity
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how long must symptoms be present to dx major depressive episode?
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2 weeks.
5 + symptoms including depressed mood or anhedonia |
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what is the difference between MANIA vs HYPOMANIA?
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Mania is >= 7 days
causese SEVERE impairment in social and occupational fnx. may need hospitalization may have psychotic features Hypomania >=4 days NO impairment No hospitalization required No psychotic features |
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what kind of antidepressant medication is most lethal in overdose?
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TCAs
also causes prolonged QTC syndrome |
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What antidepressant medication can you consider using for refractory cases of depression
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MAOIs
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What are side effects of SSRIs?
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Sexualy dysfunction
HA GI rebound anxiety |
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what are side effects of TCA's
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most lethal in overdose
Sedation, weight gain, orthostatic hypotension, anticholinergic effects, prolonged QTC syndrome |
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What are side effects of MAOIs?
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Useful for tx of refractory depression
SE: hypertensive crisis if used with sympathomimeics or ingestion of tyramine rich foods Risk of Serotonin Syndrome with SSRIs ORTHOSTATIC hypotension |
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what class of antidepressants are often used in atypical depression?
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MAOIs
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When would we use electroconvulsive therapy?
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Indicated if patient is unresponsive to pharmacotherapy or if they can't tolerate the meds, or if rapid reduction of symptoms is desired.
performed by premedication with atropine. followed by anesthesia and them mm relaxant and then inducing a generalized seizure. said to be safe. |
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what are the features of atypical depression?
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1. reactive mood
2. hypersomnia 3. eating a lot 4. increased sensitivity to rejection by others 5. leaden paralysis |
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how would you treat the catatonic type of major depression ?
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antidepressant along with antipsychotics
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what are the Kubler Ross model 5 stages of grief?
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1. denial
2. anger 3. bargaining 4. depression 5. acceptance |
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symptoms of normal bereavement should last how long?
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often last around <2 months
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Narcissistic Personality Disorder is centrally characterized by what feature?
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pervasive pattern of grandiosity is the central feature of Narcissistic Personality Disorder.
Preoccupation with fantasies, a sense of entitlement, envy, and arrogance are all criteria for a diagnosis of Narcissistic Personality Disorder, but they are components of the list of criteria that need to be evaluated in making this diagnosis. |
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A 25-year-old woman has endured panic attacks more than 3 times a week for the past 2 months. After a thorough history and examination of the patient, she is diagnosed with a panic disorder. What is the first line drug used in the pharmacological management of a panic disorder?
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SSRIs - Specifically Paroxetine
The SSRI's that are used in the treatment of panic disorder include paroxetine, fluoxetine, fluvoxamine, sertraline, and citalopram. The mechanism of action of SSRIs is the selective inhibition of presynaptic reuptake (reabsorption) of serotonin. As a result, more serotonin is available in the brain, which enhances the neurotransmission and improves mood. Paroxetine is administered in the dose of 10-40 mg daily. Adverse effects include agitation, restlessness, nausea, diarrhea, headache, nervousness, diaphoresis, and weight gain. |
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In this type of toxicity ------ the CNS signs are the most common, especially tremors, fasciculations, movement disorders and a Parkinsonian-like syndrome.
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Lithium toxicity,
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Patients with this kind of overdose ______ may be euphoric, anxious, paranoid, and agitated; they may experience chest pain, hypertension, and cardiac dysrhythmias.
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Patients with cocaine overdose
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A 42-year-old man was found unconscious in his apartment. A friend relates the patient was in treatment for depression, but he does not know what kind of medicine his friend was taking. At physical examination patient has a BP=90/58, Pulse=100/min (irregular), Respiratory rate=12/min. The patient is lethargic and has dry skin, mydriasis, irregular cardiac rhythm at auscultation, superficial respiration, absent bowel sounds, urinary retention, decreased motor power in extremities, and absent tendon reflexes. What is the most likely diagnosis?
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Cyclic antidepressant overdose
Cyclic antidepressants are the leading cause of death by intentional overdose of a prescription medication. Most cyclic antidepressants have an anticholinergic effect, which is characterized by xerostomia, dry skin, blurred vision, mydriasis, urinary retention, and delirium. Agitation and myoclonic jerks are also common findings. In severe poisonings, hypotension, seizures, respiratory depression, and cardiac dysrhythmias are classic findings. In advanced poisonings, findings include adult respiratory distress syndrome (ARDS), rhabdomyolysis, and disseminated intravascular coagulation (DIC). |
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A diagnosis of alcohol dependence requires ...
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that during a single 12-month period, an individual exhibits 3 or more of the following: tolerance; withdrawal; using more alcohol than intended or using for a longer period than intended; repeated failure to control use; excessive time spent using, recovering from, or obtaining the substance; ignoring important activities in favor of using alcohol; and/or continued use despite knowledge of alcohol’s physical and psychological dangers.
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A 30-year-old woman has been acting strangely for several weeks. She attends conscientiously and regularly to her work in an insurance office, but lately she has been talking about her co-workers "plotting against her". She claims that she is the sole possessor of a digital encryption key that, if discovered by the wrong people, could result in the collapse of the entire U.S. economy. Despite the dangerous implications of this belief, if it were true, she appears to be oddly unaffected by it. In the absence of evidence of substance abuse or of a precipitating general medical condition, what psychiatric diagnosis might be suggested at this time?
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schizophreniform disorder
has been present for less than 6 months |
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A 10-year-old girl is referred to you. Her teachers have complained since preschool that, although she is bright enough to do her schoolwork, she rarely pays attention or completes any assignments.
When she does do her work: She makes careless mistakes, Has difficulty organizing tasks, Often loses her papers and books, Is forgetful, and Is highly distractible. |
ADHD predominately inattentive type
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Constant fidgeting
Excessive talking Inability to "take turns" Runs and climbs excessively Constantly interrupts and intrudes upon others Perpetual activity that seems "driven by a motor." |
ADHD predominately hyperactive impulsive type
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The highest rate of completed suicides is seen in what race and gender?
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white boys
Firearms are the most commonly used method in completed suicides. |
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can manifest with many of the physical signs and symptoms of pregnancy. It may occur in women who have a great fear of being pregnant or in women who strongly desire to be pregnant.
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Pseudocyesis, or false pregnancy
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a conversion disorder characterized by pain as the strongest symptom. Conversion disorder refers to neurologic type complaints that do not make medical sense (for example, anesthesia not running along a nerve). Paralysis, blindness, tunnel vision, aphonia, insensitivity to pain, seizures, impaired coordination, and paresthesia are among the most frequent complaints. It is more common in persons with dramatic emotional personality disorder, in the less educated, and in persons from low socioeconomic backgrounds.
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Somatoform pain disorder
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characterized by multiple medically unexplained symptoms in multiple body systems causing needless surgery or unnecessary medical treatments. The disorder begins before age 30, usually by the teens. It is more common in women than in men. It is familial in the sense that it is more common in families with alcoholism in male relatives and antisocial personality disorder. The patient must exhibit the following medically unexplained symptoms: 4 pain symptoms, 2 GI symptoms, 1 sexual symptom, and 1 pseudoneurological symptom.
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Somatization disorder
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what are the symptoms someone must complain of to be dx with somatization disorder?
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1. 4 pain symptoms
2. 2 GI symptoms 3. 1. Sexual sx 4. 1 pseudoneurological sx |
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disorder in which a patient is convinced that a part of their body, usually the face, is deformed. A history shows frequent visits to the doctors, especially plastic surgeons and dermatologists. Depressive mood and obsessive-compulsive traits are common. If the symptom is of delusional intensity, it should be classified as a delusional disorder, somatic subtype, which could be responsive to antipsychotic medicine. Fluoxetine and clomipramine demonstrate a good response, and European literature suggests that pimozide may be effective.
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body dysmorphic disorder
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A 25-year-old woman presents with inability to achieve intercourse with her partner since their relationship began 6 months prior. She states that she has been sexually active for 5 years, and penetration had been possible until recently; now, she cannot even insert a tampon due to the pain. Further history reveals that a year ago, her partner at that time forcefully made her have intercourse on several occasions. What is the next step in the workup of this patient to confirm the suspected diagnosis?
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gynecological exam
To confirm diagnosis, a gynecologic exam in which the same muscle spasm is elicited must be performed. However, the physician must be aware that the stimulus may only be due to coitus; thus, an absence of the muscle spasm does not rule out the diagnosis of vaginismus. |
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Boys often have enlarged ears, long face with a prominent chin, and large post pubertal testicles. They may have mitral valve prolapse, flat feet, hyper flexible joints, and recurrent ear infections and skeletal problems. ADHD, a rapid, mumbling speech pattern, poor eye contact with heightened sensory awareness and response, hand biting, or flapping may also be present.
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fragile x syndrome
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What is the most effective antidepressant therapy?
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Electroconvulsive therapy (ECT)
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An 18-year old high school dropout recently set a fire in his old school classroom because he was dared to do so by other students. He has been sent to you for evaluation. You interview him and find that he had a number of problems related to truancy and fighting in school; he has been found with liquor in his locker at school, and he always seems to feel that someone else is responsible for his having done something. When he was 10, Sam burned down a barn; last year, he and some friends threw rocks at passing cars on the expressway. What is the provisional diagnosis?
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antisocial personality disorder
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Unconsciously making up answers when one's memory is impaired is known as what?
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confabulation
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a period of how long is needed to make a dx of dysthymic disorder?
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2 years!
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is a somatization disorder in which the patient intentionally develops physical or mental symptoms in order to play the sick role and get attention from health care professionals.
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factitious disorder
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develop the signs and symptoms in order to have material gain such as drugs or money.
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malingering
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type of group therapy in which subjects play roles of significant persons in their lives and act out emotional conflicts with other group members.
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Psychodrama
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characterized by a sudden onset of symptoms. Patients often have multiple cognitive deficits, such as an inability to maintain attention to external stimuli and/or perseveration, disorganized thinking (e.g., rambling, irrelevant, or incoherent speech), and reduced levels of consciousness (e.g., perhaps having difficulty staying awake during the examination); they may have disturbed sleep patterns, psychomotor agitation or retardation, disorientation, and/or memory impairment. Symptoms usually develop over a short period of time (spontaneously in many cases), and they fluctuate throughout the course of the day.
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delerium
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Occurs most often in old age and in most cases it is caused by a primary, permanent, degenerative process affecting an individual's orientation, memory, perception, intellectual function, reasoning, and judgment. Frequently, individuals have poor impulse control and lability of mood that are not characteristic of the individual's premorbid personality. Early signs of include difficulties in mental performance (e.g., memory), fatigue, and an inability to perform new or complex tasks. As the disorder progresses, everyday and familiar tasks become difficult to perform successfully, and taking care of basic needs eventually becomes impossible. Language may or may not be affected, and affected individuals often will attempt to compensate for deficits by joking, changing the subject, or by diverting the interviewer's attention.
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Dementia
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Characterized by an impairment of memory but is not characterized by global deficits in intellectual and cognitive functioning. Short-term memory and recent memory are affected, and the individual usually lacks insight into these memory deficits and will try to minimize, deny, or rationalize them.
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amnestic disorder
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A disturbance of interpersonal relationships due to discomfort with close interaction with others. Marked by interpersonal deficits in one's ability and comfort in relating to others. Typically, an individual will display discomfort and a reduced capacity for close relationships, which is the essential feature of the diagnosis. The diagnosis also features perceptual distortions and eccentricities of behavior, beginning in early adulthood and present in a variety of contexts.
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Schizotypical Personality Disorder
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An alcoholic blackout may cause _________ amnesia.
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Anterograde
Alcohol can cause temporary, short-term anterograde amnesia in which recent past events are not remembered. Retrograde amnesia involves loss of memories for events occurring before a trauma. |
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a means of coping with or defending against emotional conflict through excessive abstraction or generalizations to control disturbing or upsetting feelings. An example is Jane feeling very angry and aggressive toward Susan for beating her in a tennis match and then telling herself that it isn't that important in the big scheme of things and that she is lucky to just be able to play tennis.
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intellectualization
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An example is Jane feeling very angry and aggressive toward Susan for beating her in a tennis match and after complaining how competitive and mean Susan is, immediately challenges Susan to a second match where she hopes Susan won't be focusing on having to be number 1 all the time. Susan bristles at the comment and plays very aggressively in the second match.
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Projective identification
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what type of amnesia? the individual fails to recall any of the details of a particular event, usually one that is traumatic
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localized amnesia
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what kind of amnesia? the individual blanks out certain details of a traumatizing experience.
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selective amnesia
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what kind of amnesia? the individual may be unable to recall the details of an entire lifetime.
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generalized amnesia
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what kind of amnesia? the individual forgets everything subsequent to a specific time or event, including the present.
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continuous amnesia
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You have been working with a 35-year-old female for the past three years. She has a history of both full manic and major depressive episodes. According to the most current research regarding etiology, what is the most likely environmental cause for this woman's disorder?
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perinatal viral infection
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is characterized by the inability to recall important biographical information, usually as a result of a trauma.
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dissociative amnesia
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involves confusion about one's identity and frequently the assumption of a new identity, usually due to a traumatic event
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dissociative fugue
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would involve the presence of two or more distinct personalities or personality states.
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dissociative identity state
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A patient known to be a victim of childhood sexual abuse is currently in a volatile relationship. She reports that when she and her boyfriend argue, she feels as though she is standing outside herself watching the scene. A secondary diagnosis might be
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depersonalization disorder
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Research has shown that as many as 75 percent of those with antisocial personality disorder have comorbid __________
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substance abuse problems.
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A 25-year-old man has a long history of criminal behavior, and he has been in and out of prison for assaultive behavior, theft, armed robbery, and sexual assault. He shows no remorse for his behavior and states that he is the real victim. He also shows little emotion regarding his family history, and he prefers to brag about his sexual exploits. The patient denies a history of mood disorders or schizophrenia. What disorder commonly co-occurs with this patient's symptoms?
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susbtance abuse
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The rate-limiting enzyme in the synthesis of dopamine is
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Tyrosine hydroxylase
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An individual who leaves home, forgets who they are, and assumes a totally new identity is most likely suffering from what condition?
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dissociative fugue
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who attempts suicides more often. males or females?
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females attempt more often but men are more successful and violent
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The management of focal dystonia, i.e. hemifacial spasm, torticollis, spasmodic dysphonia, writer's cramp, and blepharospasm, has been revolutionized with the introduction of local administration of
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botulinum toxin
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Psychostimulants are useful medications in consultation-liaison psychiatry. They are useful tools in diagnostic dilemmas, short-term treatment, and in allowing symptomatic relief in patients who are unable to tolerate antidepressant medications. Psychostimulant medication is an important option in what clinical situation?
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post stroke depression
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what is the treatment of choice for manic patients?
|
Lithium
If fails you can try Carbamazapine and Valproate |
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have no other motive in mind except to play the "sick role" in order to gain attention. They intentionally make up mental or physical signs and or symptoms of disease.
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factitious disorder
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A 21-year-old man was brought to the emergency room following a car accident. The patient had splenic injury and subsequently a splenectomy was performed. The patient exhibits the onset of apprehension, generalized twitching, tremors and nausea on the third postoperative day. The patient started tonic/clonic seizures on the fourth day in the hospital. The patient admits to taking 1,000 mg of Pentobarbital per day ("popping yellow jackets"). What is the most appropriate immediate step in this patient's management?
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200 mg of Pentobarbital by mouth and observe for sedation, slurred speech and nystagmus
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A 29-year-old male who is an architect by occupation approaches a psychiatrist regarding sexual dysfunction. He has been married for 5 years and has 1 child, a 3-year-old daughter. He complains of ejaculation prior to complete penetration. what is a good treatment option?
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ssri's ie paroxetine
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Patients with this disorder suffer chiefly from chronic anxiety and worry which are difficult to control. They may have feelings of restlessness, easy fatigability, difficulty concentrating, irritability, and muscle tension. Sleep may be disturbed. These symptoms cause significant distress or impairment.
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generalized anxiety disorder
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A 42-year-old homeless male is escorted to your emergency room in handcuffs by 3 police officers at 3 A.M. He was evicted from 3 homeless shelters for reciting limericks and from 3 restaurants for ordering lavish meals without having any money to pay for them. He recites a bawdy song in your presence and then laughingly tells you that tonight he telephoned each of his 5 ex-wives "person-to-person collect." His urine drug screen and blood alcohol level are both negative. What initial treatment do you provide?
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haloperidol
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These patients are exceedingly timid, shy, lonely, and hypersensitive to rejection. They have low self-esteem and often would rather avoid personal contact than face any potential social rejection. Additionally, they have a strong desire for acceptance and affection, and thus are very distressed by their isolation and inability to relate comfortably with others.
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avoidant personality disorder
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are usually cold, aloof, and distant in interpersonal relationships or are controlling and jealous if they do become attached. They often ascribe hostile or negative motives behind others' actions, which may represent projections of their own hostilities onto others. These patients are excessively litigious, grandiose, and rigid, and are thus often isolated and disliked.
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paranoid personality disorder
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what is the treatment of choice for bulimia patients?
|
CBT - cognitive behavioral therapy
CBT emphasizes the relationship of thoughts and feelings to behavior and helps patients recognize the thoughts and feelings that lead to disordered eating. CBT helps the patient manage the anxiety related to eating and poor body image by developing more adaptive thoughts and coping strategies. CBT is more effective than simplified behavioral therapy or interpersonal psychotherapy for patients with bulimia nervosa. |
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A 32-year-old woman lives alone, has no friends, dresses strangely, and talks in an unusual manner. Although odd, she is able to maintain employment and has not been known to have trouble with the law. What most likely contributes to the above scenario?
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schizotypal personality disorder
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The patient is a 36-year-old man who presents to your office suffering uncontrollable shaking, which manifests in social situations. Her confides in you that it has ended 3 jobs and 3 relationships in the previous 6 years. Which of the following do you recommend?
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Escitalopram (Lexa pro)
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A 47-year-old homeless, recovering heroin-dependent male collapses on the sidewalk after receiving 500mg of methadone from a maintenance clinic. The paramedics note tachyarrhythmia and shock. Which of the following cardiac arrhythmias is most likely to have developed in this patient?
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Torsades de Pointes
Methadone has the potential to induce QT prolongation, hence Torsades de pointes is most likely to have developed in this patient. |
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A 42-year-old male is diagnosed with Bipolar I disorder following an episode of mania. What is the probability that his Bipolar I disorder will respond to lithium as a mood stabilizer and that he will not initially need the antidepressants?
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80%
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A 19-year-old man with a family history of schizophrenia is receiving medical attention for his 1st presentation of psychosis. After ruling out organic causes and substance abuse as etiologies of his symptomatology, antipsychotic therapy with haloperidol is initiated. Within 48 hours, the patient begins to experience involuntary spasmodic contractions of the muscles in his face and neck.
Inhibition of what neurotransmitter/receptor is causing the patient's symptoms? |
Dopamine (D2)
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conversion disorder typically occurs within what ages?
|
10-35
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|
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consists of deficits in voluntary motor or sensory functions; they are connected with psychological factors, and they are not intentionally produced. They are also unrelated to any medical causes.
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Conversion disorder often occurs after a stressful event, and no reasonable medical explanation for the symptoms can be found.
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Shift of ideas from one subject to another in an unrelated way
The patient begins to answer a question about her health and then shifts to a statement about baseball |
loosening of associations
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