Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
265 Cards in this Set
- Front
- Back
|
Illness most frequently encountered?
|
anxiety and depression
|
|
|
mental health issues and ______ usually go hand -in- hand
|
physical illness
|
|
|
A past psychiatric hx includes:
|
1. chronological list of all previous episodes and sx. with description of sx at that time.
2. previous tx 3. hospitalizations |
|
|
Why is it important to ask about religion?
|
if they think its a sin they are less likely to commit suicide
|
|
|
What are the 8 categories of the mental status exam?
|
ICE-ASS TJ: intelligence, cognition, emotional expression (mood and affect), appearance, sensorium, speech, thoughts and perceptions, judgement and insight
|
|
|
What are 4 types of expressive speech?
|
1. flight of ideas
2. pressured speech 3. looseness of associations 4. word salad |
|
|
What sort of expressive speech would you see in someone with mania?
|
Flight of ideas, pressured speech
|
|
|
Define flight of ideas:
|
going from one subject to another. there is a degree of connection between one subject and another
|
|
|
define: pressured speech
|
rapid, cannot get it out fast enough
|
|
|
What expressive speech patterns would we see in someone with schizophrenia?
|
word salad, looseness of associations
|
|
|
the outward expression of pts inner emotional state and experience as noted by the observer is?
|
affect
|
|
|
When observing someones affect what three things are you looking for?
|
1. what the overall affect is
2. is affect appropriate to the situation 3. does it change appropriately with the conversation? (modulation) |
|
|
how the patient feels is known as?
|
subjective mood
|
|
|
physiological disturbances associated with mood. Most commonly seen in depression, signs of somatic dysfunction is called?
|
vegetative signs
|
|
|
what are the signs of somatic dysfunction?
|
diarrhea, constipation, increased appetite, excessive sleepiness, feels slowed down
|
|
|
Overvalued ideas in which a person has a feeling that objects, people, or event in his immediate environment have personal significance for him.
|
Ideas of reference
|
|
|
Everyday natural occurrences carry unique significance to that person.
|
ideas of reference
|
|
|
a man sees a red car parked in front of his house and is convinced that it is a message from the FBI warning him to be alert for drug addicts
|
ideas of reference
|
|
|
intrusive thoughts felt to be beyond the person's control. often unpleasant, and inconsistent with person's usual range of thoughts. (ego-dystonic)
|
obsessions
|
|
|
predominating and recurrent thoughts that are not symptomatic or necessarily unwanted. (ego-syntonic)
|
preoccupation
|
|
|
what are three examples of psychotic thinking?
|
Thought insertion, thought withdrawl, thought broadcasting
|
|
|
thoughts put in one's head by external forces =?
|
thought insertion
|
|
|
thoughts taken from one's head by external forces?
|
thought withdrawal
|
|
|
a person thinks his inner thoughts ar being broadcast to others outside of him =?
|
thought broadcasting
|
|
|
false belief that is based on incorrect inference about external reality. objective and obvious contradictory evidence does not change the individuals thoughts
|
Delusions
|
|
|
Sensory perceptions that are not due to (actual) external stimuli. Can be visual, auditory, olfactory, tactile, gustatory
|
hallucinations
|
|
|
sensory perception triggered by an external stimulus that is misinterpreted or processed incorrectly
|
illusions
|
|
|
shadows on the wall thought to be due to monsters in the room is an example of?
|
illusions
|
|
|
21 yo student has developed sx that prevent him from attending class. when asked the meaning of proverb, people who live in glass houses shouldn't throw stones he answers: be careful or you will break windows. This is an example of?
|
Inability to abstract:
concrete thinking seen in schizo seen in poorly educated people |
|
|
What is the difference between DSM IV and DSM IV TR?
|
DSM IV TR Is evidence based text revision of the DSM IV published in 2000
|
|
|
T or F. DSM dx is usually applied to the current presentation and usually does not include previous dx from which a person has recovered?
|
True
|
|
|
What Axis = major psychiatric dx
|
Axis 1
|
|
|
What Axis = mental retardation and personality dx
|
Axis 2
|
|
|
what axis? Medical Conditions
|
Axis 3
|
|
|
what axis = Psychosocial stressors
|
Axis 4
|
|
|
What axis = global assessment of function
|
Axis 5
|
|
|
Dx of dementia would be listed under what axis?
|
Axis 1
|
|
|
Dx of Parkinsons would be listed under what axis?
|
Axis III
|
|
|
80 yo man has an acute onset of chest pain. he lives in a cabin deep in the woods. although he called 911 it took a long time for the paramedics to arrive because it was hard to find his place in the dark. when he arrives to the ED you examine him and find that he is despondent about his declining health. What are his DSM IV -TR dx?
|
Axis I: depression
Axis II: not enough info Axis III: Acute MI Axis IV: problems with access to health services Axis V: GAF - current 50 (serious problems) Past year: 70 (Mild sx) |
|
|
psychological strategies individuals use to cope with reality and to maintain and intact self-image are known as?
|
defense mechanisms
|
|
|
T/F? Defense mechanisms are always seen as unhealthy?
|
False
|
|
|
What are 4 coping processes descriptors?
|
conscious, intentional, learned, associated with normal adjustment
|
|
|
4 qualities of defense mechanisms:
|
unconscious, unintentional, self protective instincts or dispositions, sometimes associated with pathology
|
|
|
When does a defense mechanism become pathological?
|
when it is used persistently and leads to maladaptive behavior or puts an individual's life at risk
|
|
|
what are two factors that make a defense mechanism pathological?
|
1. defense is used in a rigid inflexible and exclusive manner
2. motivation for using the defense comes more from past needs than current. |
|
|
An individual deals with conflict or stress by expelling disturbing wishes, thoughts, or experiences from conscious awareness. This is known as?
|
repression
|
|
|
a person who was abused as a child by a clergy person has no memory of the event but my harbor angry feeling toward the churn and not understand why. This is known as?
|
repression
|
|
|
An individual is aware of having disturbing thoughts but consciously elects to avoid dwelling on them by seeking distractions. This is known as?
|
suppression
|
|
|
refusal to appreciate information about oneself or others
|
denial
|
|
|
not worrying about up coming PANCE exam because I've taken many exams would be known as?
|
denial
|
|
|
refusing to admit or face a threatening object/situation
|
denial
|
|
|
Patterning oneself after or allying oneself with another person to allay anxiety or to bolster one's ego
|
identification
|
|
|
a partial return to earlier levels of adaptation to avoid/or in response to conflict or stress
|
regression
|
|
|
an eight yo girl starts to suck her thumb after her mother is hospitalized for surgery, something she hadn't done since she was 4. This is known as?
|
regression
|
|
|
the individual deals with conflict or stress by compartmentalizing opposite affective states and failing to integrate the positive and negative qualities of self or others into cohesive images. see himself or others as all good or all bad.
|
splitting
|
|
|
a person deals with conflict or stress related to unacceptable thought or feelings by substituting diametrically opposed thoughts or feelings.
|
reaction formation
|
|
|
a person who has latent homosexual feelings vehemently and publicly condemns homosexual unions
|
reaction formation
|
|
|
A five y/o is resentful because with birth of his brother, he is no longer the youngest and most coddled in family. he appears extremely affectionate and attentive to his newly born sibling. this is an example of
|
reaction formation.
|
|
|
separating an unacceptable impulse/thought/situation from its associated feeling so the feeling is repressed
|
isolation
|
|
|
in OCD the emotion is repressed and the seemingly senseless impulse remains -- expressed as a compulsion. Example of?
|
isolation
|
|
|
What defense mechanism is often seen with OCD?
|
isolation
|
|
|
woman who is very angry with her boss and would like to quit her job may instead be overly kind and generous toward her boss and express a desire to keep working there forever. She is incapable of expressing the negative emotions of anger and unhappiness with her job, and instead becomes overly kind to publicly demonstrate her lack of anger and unhappiness.
|
reaction formation
|
|
|
a medical student who dissects a cadaver without being disturbed by thoughts of death is using what defense mechanism?
|
isolation
|
|
|
The individual deals with conflict or stress by transferring negative feelings about one object onto another, usually a less threatening, substitute object. The aggression is displaced onto someone who cannot fight back, over whom there may be power and/or control.
|
displacement
|
|
|
A man who is furious at the way his boss treated him earlier in the day may -shortly after arriving home- become enraged over some minor behavioral infraction by his child.
|
displacement
|
|
|
slamming the door instead of hitting a person.
yelling ar your spouse after an argument with your boss examples of what defensive mechanism? |
displacement
|
|
|
using what appears to be logical explanations to make unacceptable feelings or thoughts more acceptable, to justify our behavior and to protect our self image.
|
Rationalization
|
|
|
Person deals with conflict or stress through a breakdown in the usually integrated functions of consciousness, memory, sensory-motor behavior, and perceptions of self and of environment. this can result in depersonalization or de-realization.
|
dissociation
|
|
|
spacing out is an example of this defense mechanism. A common occurence is when people space out quickly forgetting an embarrassing moment
|
dissociation
|
|
|
transformation of unacceptable wishes or thoughts into bodily symptoms
|
conversion
|
|
|
patient cannot move leg even though a complete medical and neurologic workup is done and is negative. She is unaware of any psychological problems. ... example of what defense mechanism?
|
conversion
|
|
|
A mature mechanism whereby unacceptable thoughts and feelings are channeled into socially acceptable ones
|
sublimation
|
|
|
a person who has a penchant for violence becomes a policemen or boxer is an example of what defense mechanism?
|
sublimation
|
|
|
placing unacceptable impulses/characteristics/behaviors that exist in yourself onto someone else is know as?
|
projection
|
|
|
annoyed with someone who will not change his schedule to accommodate yours because you do not want to change yours and view it as inconvenient for you , you tell him, you are so inflexible. this is an example of?
|
projection
|
|
|
this term refers to unconscious process of projection of one or more parts of self OR projection of an internalized object (person) into another person. may project an intolderable, painful, or dangerous part of the self or object onto another person. Or project a valued aspect onto the other person
|
projective identification
|
|
|
Ex: john feels angry that he has been assigned to work on a project. Instead of recognizing his resentment, he starts to feel angry with a coworker., veiewing her as lacking commitment to the project
|
projective identification
|
|
|
patient vews psychiatrist as the brightest and most knowledgable of all doctors she has ever met. patient expects the psychiatrist will have an explantion for everything and know about everything there is to know about medicine. This is an example of?
|
projective identification
|
|
|
This DSM axis score rates overallfunciton specific to that person
|
Axis V - GAF score
|
|
|
Orientation to time and place is:
|
level of arousal
|
|
|
ability to recall seven random numbers given by examiner is:
|
recent memory
|
|
|
proverb interpretation
|
Abstract reasoning
|
|
|
36 yo woman in psych unit complains to her nurse on the dayshift that all the nurses from the night shift are lazy , inconsiderate, and rude. she says that she loves the superb nursing care she receives during the day. all of the day nurses are wonderful . Which defense mechanism ?
|
Splitting "all or nothing"
|
|
|
Low levels of 5-HIAA are associated with what?
|
violence and suicide
|
|
|
Dopamine activity may be ______ in depression and ______ in mania?
|
reduced, elevated
|
|
|
_________ of hypothalamic-pituitary-adrenal axis is seen in depression
|
hyperactivity
|
|
|
Evidence for heritability is higher in which disorder? bipolar or depression
|
bipolar
|
|
|
Some believe _____ is a culprit in the cause of depression -- in the mitochondria or elsewhere.
|
glutamate
|
|
|
what test did we have that is thought to be able to dx depression?
|
dexamethasone suppression test
|
|
|
A positive test result (nonsuppression) for dexamethasone was thought to indicate _______ of cortisol secondary to hyperactivity of hypothalamic-pituitary-adrenal axis
|
hypersecretion
|
|
|
what brain imaging finding might we see in someone with a mood disorder?
|
1. enlarged cerebral ventricles (depression and mania)
2. decreased blood flow to ganglia (depressed) 3. smaller caudate nuclei and smaller frontal lobes (depression) |
|
|
Inability to experience feelings of pleasure at all =
|
anhedonia
|
|
|
common somatic manifestations of depression are known as?
|
vegetative symptoms
|
|
|
Name 5 vegetative symptoms
|
1. anorexia/hyperphagia
2. insomnia/ hypersomnia 3. diurnal variation of sx's (worse in am) 4. diminished libido 5. constipation |
|
|
What eating pattern may be seen in atypical depression?
|
insatiable hunger and voracious eating
|
|
|
when major depression occurs along it is referred to as
|
unipolar depression
|
|
|
in order to have major depressive disorder what two symptoms must be present?
|
1. sx present for at least 2 weeks
2. sx represent a change from previous functioning: exhibit depressed mood or loss of interest or pleasure |
|
|
depression is more common in what sex?
|
female, esp, married women
|
|
|
This is often seen in the elderly when depression comes before cognitive impairment and depression can often be the predominating symptom.
|
pseudodementia
|
|
|
How do we dx major depressive episode?
|
5+ sx during 2 wk period and represent a change from previous functioning.
1*. depressed mood most of the day 2.* diminished pleasure in almost all activities 3. weight loss or weight gain 4. insomnia/hypersomnia 5. psychomotor agitation or retardation 6. fatigue or loss of energy 7. feelings of worthlesness or increased guilt 8. diminished ability to think or concentrate or indecisive 9. recurrent thoughts of death and suicide |
|
|
what digit in the dx code for MDD indicates whether it is a single or recurrent depression?
|
the 4th digit. 296.2x or 296.3x
|
|
|
Presence of two or more separate major depressive episodes. (each episode at least 2 consecutive months.
|
Major depression recurrent
|
|
|
what are two subtypes of major depression?
|
1. with psychotic features
2. with melancholic features |
|
|
what does it mean to have depression with psychotic features?
|
in addition to depression there are delusions and/hallucinations
|
|
|
During the most severe period of depression when loss of pleasure in almost all activities and there is lack of reactivity to usually pleasurable stimuli is known as?
|
MDD with melancholia
|
|
|
What is the criteria for melancholia?
|
Loss of pleasure from activities or loss of reaction to usually pleasurable stimuli
3+ of the following: 1. depressed mood different form the feeling after a loss. 2. depression worse in morning 3. wake up at least 2 hours before usual 4. psychomotor retardation or agitation 5. significant anorexia or weight loss 6. excessive or inappropriate guilt |
|
|
atypical fetures specifier can be applied when?
|
features predominate during the most recent 2 wks of a current majore depressive episode. Or when features predominate during the most recent 2 years of dysthymic disorder
|
|
|
What are the criteria for atypical features specifier?
|
A. mood reactivity -- get happy when positive things happen .
B. 2 + of the following 1. hypersomnia 2. leaden paralysis or heavy feeling in extremities 3. long-standing pattern of sensitivity to interpersonal rejection that results in social and occupational dyfnx 4. sig. weight gain or increased appetite |
|
|
What are three subtypes of depression?
|
postpartum, seasonal pattern, and catatonic features
|
|
|
This subtype of depression has sx that range from marked insomnia, lability of mood to fatigue to suicide. Most often in women with underlying or preexisting mood /psych disorders, possible homicidal or delusional beliefs about baby
|
postpartum onset
|
|
|
Depression with a seasonal patter is see most often in what months?
|
Fall and winter
|
|
|
What is the treatment for seasonal pattern depression?
|
treat with exposure to bright artificial light.
|
|
|
This subtype of depression has motor immobility
|
catatonic
|
|
|
In order to be dx with catatonic features you must have at least 2 of which sx?
|
1. excessive motor activity that is purposeless, not influenced by external stimuli
2. extreme negativism (manifests as holding a rigid posture) 3. unusual voluntary mvmts. 4. echolalia or echopraxia (imitate sounds and mvmt. |
|
|
this mood disorder shows a chronic insidious presentation with a min. of 2 year period of having the same mood that has never not been without sx for more than 2 months
|
Dysthymic disorder
|
|
|
This disorder has a usual age of onset in early- childhood, adolescence, or young adult hood. Its onset is slow and insidiious
|
dysthymic disorder
|
|
|
presence of two or more of these while depressed is known as?
1. poor appetite or overeating 2. insomnia/hypersomnia 3. low energy/fatigue 4. low self-esteem 5. poor concentration 6. difficulty making decisions 7. feelings of hopelessness |
Dysthymic disorder
|
|
|
what is it called when dysthymic disorder is co-morbid with major depressive disorder?
|
double depression
|
|
|
In this type of affective dz, at least one manic episode is identified with or without major depression
|
bipolar 1
|
|
|
Who gets bipolar more? M or W?
|
the same! although men are more depressed and women are more manic
|
|
|
what are two disorder that tend to follow a seasonal variation?
|
bipolar I and seasonal pattern disorder
|
|
|
In bipolar I, manic episodes are more common in what months?
|
summer
|
|
|
In Bipolar I, depressive episodes are more common in what months?
|
winter and spring
|
|
|
Define mania
|
distinct period of abnormally ad persistently elevated, expansive, or irritable mood lasting at least 1 week with 3 or more of the following sx:
|
|
|
in a manic episode t/f?
1. easily distracted 2. difficulty concentrating 3. impaired memory 4. abstract thinking is intact 5. hallucinations more frequent |
1. T
2. T 3. f, if not too distracted 4. T 5. F |
|
|
What two things must you see in Bipolar II?
|
1. hypomania
2. major depressive episode |
|
|
Describe hypomania
|
elevated mood associated with decreased need for sleep. Less severe than mania with no psychotic features
|
|
|
symptoms for this disorder are often interpreted as a temperament problem. Individuals my be perceived as moody and unpredictable. Onset is usually during adolescence or early childhood
|
Cyclothymia
|
|
|
this disoder has numerous closely spaced periods of hypmanic sx and periods of depressive sx for at least 2 years but there is no full MAJOR depressive episode
|
cyclothymia
|
|
|
What are the sx of madd hatter's syndrome?
|
1. chronic mercury intoxication
2. mania 3. sometimes see depressive symptoms |
|
|
What are some associated general medical conditions that affect mood
|
parkinsons
huntington's dz cerebrovascular conditions |
|
|
What are some endocrine conditions that affect mood
|
hypothyroidism, hyperthyroidism, hyperparathyroidism, hypoparathyroidism, adrenocortical hyperactivity, adrenal insufficiceny
|
|
|
What is a neoplasm that can affect mood?
|
pancreatic cancer
|
|
|
very low cholesterol and the agents that reduce cholesterol are associated with?
|
depression
|
|
|
Antiphospholipid antibody Sx can mimic?
|
bipolar
|
|
|
Which autoimmune conditions can affect mood?
|
systemic lupus, erythermatosis and other types of vasculitis
|
|
|
Substance induced disorders develops as a direct result and within ______ months of intoxication or withdrawal from a drug.
|
1 month
|
|
|
Pregnant women with bipolar disorder have _____% chance of getting postpartum depression
|
52%
|
|
|
what affective disorder is the most frequent manifestation during and following pregnancy?
|
Major depression
|
|
|
risk of an illness occurring during a first pregnancy is greater if women has what disorder dx before?
|
bipolar disorder
|
|
|
Postpartum risk is greater if dx preceded a first pregnancy for what disorder?
|
bipolar (52%) and unipolar disorders (30%)
|
|
|
what are some factors associated with unipolar and bipolar depression during pregnancy?
|
having illness onset after 1992
never married unemployed and not a homemaker, student or retiree educated beyond high school onset below 33 yo prior dx of bipolar I or II relatively few pregnancies <4 |
|
|
what are some risks associated with not using antidepressants during pregnancy?
|
child that is irritable
child that has developmental delays problematic situations that arise from a disinterested mother low birth weight of baby lower apgar scores preterm delivery poor prenatal care increased risk of fetal abuse |
|
|
The FDA had originally warned that SSRIs may predispose infants to what?
|
persistent pulmonary hypertension
|
|
|
FDA suggests: Healthcare provider are recommended to _______ depression during pregnancy
|
treat!
|
|
|
Crying , irritability, "mild" mood swings are common with what postpartum condition?
|
Baby blues
|
|
|
When is the onset of Baby Blues?
|
0-3-10 days after delivery
|
|
|
How long for Baby blues to resolve?
|
ONE week or Two
|
|
|
evidence indicates that a depressed mother affects child's _____ and _______.
|
temperament and cognitive development
|
|
|
post partum psychosis is frequently a manifestation of?
|
bipolar disorder
|
|
|
if you experience depression for the very first time in the post partum period, researchers believe this to mean
|
mother is likely to have a bipolar outcome
|
|
|
postpartum depressed mood with rapid mood changes is know as?
|
post partum psychosis
|
|
|
this dz may present in new mother with rapid onset of hallucinations, delusions, mood swings, confusion and insomnia
|
postpartum psychosis
|
|
|
if a mother is having postpartum psychosis what do you want to think of as far as tx?
|
definitely counsel women with hx of bipolar disorder and their' SO's to be aware of these sx and report them immediately.
1. many individuals require hospitalization 2. need to determine if they have delusions about or thoughts about harming infants |
|
|
what are risk factors for postpartum psychosis?
|
sleep deprivation in susceptible women
hormonal shifts after birth (drop in estrogen) bipolar disorder hx schizoaffective disorder hx past hx or family hx of postpartum psychosis previous hospitalization for bipolar or psychotic condition |
|
|
Suicidal thoughts or thoughts of harming infant may be present in what disorder?
|
PPD or PPP both!
|
|
|
A woman who experiences intrusive thoughts of accidental or purposeful harm to their baby. Who are not out of touch with reality and whose thoughts are ego-dystonic (more like fears) are likely to have what?
|
postpartum OCD
|
|
|
when evaluating a women for postpartum depression you should also consider....
|
postpartum psychosis
|
|
|
name some pharmacologic causes of depression and mania
|
1. cocaine
2. opiods 3. hallucinogens 4. amphetamines 5. antidepressants 6. corticosteroids 7. levodopa |
|
|
interferon and nueropsychiatric Sx are associated with treatement of ?
|
Hep C
|
|
|
After contolling variables, _______ was a stronger risk factor for AMI than HTN, DM or obestiy
|
depression
|
|
|
The psychosocial Factor Index includes:
|
1. depression
2. general stress 3. life events 4. loss of control |
|
|
depression predicts mortality and morbidity in patients who have had ______
|
coronary bypass procedures
|
|
|
what are two proposed mechanisms for depression leading heart disease?
|
1. increased platelet reactivity causes increased aggregation and thrombus formation
2. inflammatory markers increased in depression likned to CHF, atherosclerosis, MI, stroke. |
|
|
in addition to depression what other factor was found to increase cardiovascular disease in young adults?
|
stress
|
|
|
A person develops a socialized attitude or interest that is the direct antithesis of some infantile wish or impulse that is harbored.
|
Reaction formation
|
|
|
Repetitive in nature by which person symbolically acts out in reerse something unacceptable that has already been done or against which the ego must defend itself. magical expiatory action is known as?
|
undoing, common in OCD
|
|
|
MC psychiatric disorder is?
|
phobia
|
|
|
Depersonalization and derealization is often seen in this disorder
|
panic attack
|
|
|
what is the definition of cyclothymia
|
many, closely spaced periods of hypomanic sx and depressive sx for a least 2 years. No full major depressive episode.
|
|
|
Hypomanic episode and major depressive episode is known as what sort of mood disorder?
|
Bipolar II
|
|
|
Do we treat mothers with psychosis during pregnancy?
|
yes
|
|
|
rapid onset of hallucinations, delusions, mood swings, confusion and insomnia after delivery is known as?
|
postpartum psychosis
|
|
|
If a new mother experiences intrusive thoughts of accidental or purposeful harm to their baby but is not out of touch with reality and their thoughts are ego-dystonic what does she have?
|
postpartum OCD
|
|
|
______ is a response to a threat that is unknown, vague or conflictual
|
anxiety
|
|
|
A state associated with intense feelings of discomfort accompanied by somatic complaints that indicate a hyperactive autonomic nervous system such as palpitations and sweating is known as?
|
anxiety
|
|
|
How is anxiety different than fear?
|
fear is an appropriate response to a known threat
|
|
|
What are the most common groups of psychiatric disorders?
|
anxiety disorders
|
|
|
What are the 12 different types of anxiety disorders?
|
1. GAD
2. Panic disorder (w/or w/o agoraphobia) 3. agoraphobia w/o hx of panic disorder 4. social phobia 5. OCD 6. Specific phobia 7. PTSD 8. acute stress disorder 9. substance-induced anxiety disorder 10. anxiety disorder due to a general medical condition 11. separation anxiety disorder 12. anxiety disorder NOS |
|
|
Panic disorders occur more frequently in men or women?
|
women
|
|
|
up to what percent of the pop'n has had a specific phobia?
|
25%
|
|
|
GAD occurs more in men or women?
|
women
|
|
|
PTSD occurs more often in men or women?
|
women 2x more!
|
|
|
OCD occurs more common in men or women?
|
the same. onset is late teens to early 20s
|
|
|
What defense mechanisms are used in phobia?
|
displacement, symbolization
(Anxiety detached from idea or situation and displaced on other symbolic object) |
|
|
define displacement
|
unconscious Defense Mech. by which the emotional component of an unacceptable idea or object is trasferred to a more acceptable one
|
|
|
What defense mechanisms are used in Agoraphobia?
|
projection, displacement
(repressed hostility, rage, or sexuality projected on environment, which is seen as dangerous) |
|
|
What defense mechanisms are seen in OCD?
|
Undoing, isolation, reaction formulation
(severe supergo acts against impoulses about which pt. feels guilty. anxiety controlled by repitious act or thought |
|
|
What defense mechanisms are seen in Anxiety?
|
regression
(repression of forbidden sexual, aggressive or dependency breaks down. ) |
|
|
In order to Dx GAD the patient has to have difficulty controlling their worry for how long?
|
greater than or = to 6mo
|
|
|
What defense mechanisms are seen in Panic?
|
regression
(anxiety overwhelms personality and is discharged in panic state. total breakdown of repressive defense and regression occurs) |
|
|
What defense mechanisms are seen in PTSD?
|
regression, repression, denial, undoing
(trauma reactivates unconscious conflicts: ego relives anxiety and tries to master it) |
|
|
existence of unpleasant realities is disavowed. keeping out of conscious awareness because if acknowledged would produce anxiety is what kind of defensive mechanism?
|
denial
|
|
|
what are the causes of NMS?
|
antipsychotics - antidopaminergic activity
some antimetic meds |
|
|
What are the Sx of NMS?
|
tachycardia, hyperthermia, increased BP with fluctuations, increased levels of CK, altered mental status, lead pipe rigidity
|
|
|
most cases of specific phobia occur before what age?
|
12
|
|
|
this technique exposes individuals to painful memories or experiences in a controlled environment. can be traumatic but effective
|
flooding
|
|
|
People with OCD usually have a co-morbidity with...
|
major depressive disorder
|
|
|
subgroup of children have onset of OCD abruptly following this...
|
B-hemolytic streptococcal upper respiratory infection
|
|
|
What does PANDAS stand for?
|
pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
|
|
|
This term describes the subset of pediatric pts who manifest with OCD and or tic disorders such as Tourettes following infection with strep
|
PANDAS
|
|
|
How do we treat PANDAS?
|
abx
|
|
|
What are sx of PANDAS?
|
abrupt onset with hyperactivity, agitation, tics, anxiety, psychotic thoughts.
onset related to strep infection or undetected strep infection. |
|
|
recurrent intrusive ideas, thoughts, or images that cause sig. anxiety and distress is known as?
|
Obsessions
|
|
|
repetitive purposeful physical or mental actions that are performed in response to obsessions
|
compulsions
|
|
|
magical thinking is seen in ?
|
OCD
|
|
|
Treatment of OCD?
|
CBT with or w/o meds.
|
|
|
a pt. who has excessive anxiety and worry occuring more days than not for at least 6mo about a number of events or activities and who finds it difficult to control the worry may have?
|
GAD
|
|
|
In order to dx GAD you must have anxiety and worry associated with at least 3 of the following...
|
1. reslesness or feeling keyed up or on edge
2. being easily fatigued 3. difficulty concentrating, or mind going blank 4. irritability 5. muscle tension 6. sleep disturbance |
|
|
What other medical conditions should be worked up for before Dx GAD?
|
1. rule out endocrine issues (thyroid, parathyroid, adrenal)
2. vit. b12 deficiency 3. neurologic issues 4. hypoglycemia 5. carcinoid 6. use of substances or Rx |
|
|
Treatment of GAD
|
medication, CBT, sx management (self hypnosis elongated telomeres)
|
|
|
What are some medical and neurological causes of anxiety?
|
1. neurological - migranes, Wilsons, encephalitis
2. systemic - hypoxia, cvd, pul. insufficiecnty, anemia 3. endocrine - thyroid, adrenal 4. inflammatory disorders - Lupus, RA, TA 5. deficiency states - vit b12 6. toxic conditions - ETOH, drugs |
|
|
How long do panic attacks last?
|
10 min to peak, done by 20 minutes because NE gets depleted
|
|
|
What are some sx of a panic attack?
|
1. SOB
2. feeling of choking 3. palpitations, pounding heart, fast heart rate 4. chest pain, discomfort 5. sweating 6. nausea or abd. distress 7. trembling or shaking 8. Depersonalization 9. Derealization |
|
|
Depersonalization and derealization are seen in what disorder?
|
panic attacks
|
|
|
sensation of unreality concerning oneself, parts of oneself, that may occur under extreme stress or fatigue. sometimes described as being detached from onself is known as
|
depersonalization
|
|
|
sensation of changed reality or that one's surrounding have altered
|
derealization
|
|
|
What two criteria do we need to dx panic disorder?
|
1. recurrent unexpected panic attacks
2. at least one of the attacks has been followed by 1 month or more of: a. persistent concern about having the attacks b. worry about implicaions of the attack or its consequences. |
|
|
anxiety about being in places or situations from which escape might be difficult or in which help may not be available is known as
|
agoraphobia
|
|
|
What 2 other conditions must you consider before dx agoraphobia?
|
specific phobia, social phobia
|
|
|
what is the tx for panic disorders
|
CBT with and w/o SNRIs SSRIS, sx management, behavioral desensitization w, or w/o flooding
|
|
|
What two things must have occurred in order to dx a pt with PTSD?
|
1. experienced, witness, or was confronted with an event that invovled acutal or threatened death or serious injury or threat to the physical integrity of self or others.
2. the person's response invoeld intense fear, helplessness, or horror |
|
|
Defense mechanisms associated with phobia
|
symbolization, displacement
|
|
|
normal bereavement is how long?
|
less than 2 months
|
|
|
what are the 1:1 ratios of anxiety disorders?
|
social phobias and OCD
|
|
|
What is the timeline for cyclothymia
|
2 years
|
|
|
What is the timeline for dysthymia?
|
2 years
|
|
|
What is the timeline for depression
|
2 weeks
|
|
|
what is the timeline for bipolar I?
|
1 weeks
|
|
|
For PTSD the disturbance has to be greater than
|
1 month
|
|
|
For PTSD to be acute is has to be
|
3 months
|
|
|
For delayed PTSD it has to be seen when?
|
6 months after
|
|
|
Panic disorder timeline is
|
greater than 1 month of worrying
|
|
|
GAD timeline is
|
greater than 6 months
|
|
|
major depression with catatonic features =
|
echolalia, echoproxia, immobility?
|
|
|
CHaracterized by alternating periods of mild depression with hypomania is called? HOw long does it have to be present for, for dx?
|
Cyclothymic, present for at least 2 years!
|
|
|
following a stroke the high risk period for depression lasts how long?
|
2 years
|
|
|
How long can sx persist in normal bereavement?
|
less than 2 months
|
|
|
the percentage of new mothers who develop postpartum depression is believed to be approx?
|
10-15%
|
|
|
disturbance in conduct in which there is violation of the rights of others or of major age-appropriate societal naorms and rules is called?
|
adjustment disorder with disturbance of conduct
|
|
|
when predominant manifestations are both emotional sx (depression, anxiety) and a distrubance of conduct
|
adjustment disorder with mixed disturbance of emotions and conduct
|
|
|
maladaptive reactions yet do not meet criteria for other adjustment disorders
|
unspecified
|
|
|
when giving a dx of adjustement disorder what must be included?
|
stressors in axis IV
|
|
|
how do you treat adjustment disorders?
|
interventions that reduce stressor, strengthen coping mechanisms and maximize the patient's support system
|
|
|
present with nervousness, worry, jitteriness. would not meet criteria of PTSD
|
adjustment disorder with anxiety
|
|
|
patient presents with dperssed mood, terfulness, feelings of hopelessness but does not meet criteria of major depression
|
adjustment disorder with depressed mood
|
|
|
Mood reactivity is seen in what type of depression?
|
atypical
|
|
|
depressed mood needs to be present more days than not for a 2 year period, and the person has never been without the sxs for more than 2 months are criteria for what disorder?
|
dysthymic
|
|
|
what is it called with dysthymic disorder is co-morbid with major depressive disorder?
|
double depression
|
|
|
sensory perceptions that are not due to external stimuli
|
hallucinations
|
|
|
are all hallucinations pathologic?
|
no, can be psychiatric, cultural, substances
|
|
|
when does PTSD begin?
|
hour days or years after trauma
|
|
|
35% of 1st degree relative of individuals with ____ also have _____
|
OCD
|
|
|
repetitive purposeful physical or mental actions that are performed in reponse to obsesssion
|
compulsions
|
|
|
How long must pt have excessive anxiety and worry for them to be dx with GAD?
|
at least 6 months
|
|
|
the following sx are seen in what disease?
feeling for detachement from others diminshed interest or participation in significant activities restricted range of affect unable to have love feelings |
PTSD
|
|
|
in acute stress disorder
sx occur within _____ of the event lasts for a min of ______ lasts a max of _______ |
occur within 4 weeks
lasts min of 2 days lasts max of 4 weeks |
|
|
this disorder must occur within 4 weeks of the traumatic event and resolve within that 4 week period
|
ACute stress disorder
|
|
|
Anticipatory anxiety which can appear days or weeks beore feared event. which many then become a self fulfilling prohecy is seen in what diorder?
|
social phobia
|
|
|
social phobias usually occur before what age?
|
25yo
|
|
|
Average of ____% of persons with SAD met dx criteria for another lifetime psych disorder (fond in angst study)
|
85%
|
|
|
Lifetime risk of depression is _____ times higher in persons with social phobia
|
2-4x
|
|
|
______ use disorders are commonly co-morbid with social phobia
|
ETOH
|
|
|
How long is the duration of illness for separation anxiety dx?
|
4 weeks
|
|
|
onset is prior to ____ for separation anxiety disorder
|
18
|
