Psych Exam 1

Front 1

Examples of associated features provided in the DSM 5?

Back 1

prevalence,

development & course,

risk & prognostic factors,

gender & culture Dx issues,

DDx, comorbidity

Front 2

Reasons to classify disorders?

Back 2

provides nomenclature,

facilitates research,

provides reliability & validity,

req. for insurance reimbursement

Front 3

disadvantages of classifying disorders?

Back 3

stigma,

stereotyping,

labeling

Front 4

structure of DSM 5

Back 4

22 sections;

contains ICD-9 & ICS-10 codes;

consistent w/ arrangement of ICD-11;

is a categorical classification system

Front 5

describe "cultural syndrome"

Back 5

cluster of co-occuring Sx in a specific cultural group/community/context

(e.g. ataque de nervios)

Front 6

3 concepts for culture-bound syndromes in DSM 5

Back 6

cultural syndrome,

cultural idiom of distress,

cultural explanation or perceived cause

(discussed w/ examples in Section 3)

Front 7

WHODAS

Back 7

36 item questionnaire;

quantifies level of functioning

(in Section 3)

Front 8

Section: Neurodevelopmental Disorders

Back 8

manifest early in development;

characterized by develop. deficits that impair personal, social, academic functioning

(e.g. intellectual, communication, autism, ADHD, learning, motor)

Front 9

Section: Schizophrenia Spectrum et al.

Back 9

abnormalities in 1 or more:

delusions, hallucinations, disorganized thinking, disorganized/abnl motor, neg. symptoms

(e.g. schizotypal, delusion, psychotic, catatonia)

Front 10

Section: Bipolar & related disorders

Back 10

recognized as bridge between:

- schizophrenia/psychotic

- depressive disorders

regarding Sx, FHx, genetics

(e.g. bipolar, cyclothymia)

Front 11

Section: Depressive disorders

Back 11

sad, empty, irritable mood

w/ somatic & cognitive changes

differ in duration, timing, presumed etiology

(e.g. disruptive mood regulation, depressive, premenstrual dysphoric)

Front 12

Section: Anxiety disorders

Back 12

excessive fear, anxiety, related behavioral disturbances

(e.g. separation/social anxiety, mutism, phobias, panic disorder, GAD)

Front 13

Section: Obsessive-Compulsive & related

Back 13

related in Sx & etiology; also related to anxiety

(e.g. OCD, body dysmorphic, hoarding, trichotillomania, excoriation)

Front 14

Section: Trauma- & Stressor-Related

Back 14

explicit trauma or stressful event;

leads to anxiety-based anhedonia, dysphoria, externalizing or dissociative Sx

(e.g. reactive attachment, disinhibited social engagement, PTSD, acute stress, adjustment)

Front 15

Section: Dissociative disorders

Back 15

disrupted integration of consciousness, memory, identity, emotion, perception, body representation, motor control, etc.

(e.g. dissociative, depersonalization, derealization)

Front 16

Section: Somatic Sx & related

Back 16

prominent somatic Sx assoc w/ distress/impairment; commonly present in medical setting

(e.g. somatic, conversion, factitious)

Front 17

Section: Feeding & Eating disorders

Back 17

disturbance in eating-related behaviors

(e.g. pica, rumination, avoidant/restrictive food intake, anorexia, bulimia, binging)

Front 18

Section: Elimination disorders

Back 18

inapprop. elimination of urine/feces;

usually diagnosed in childhood/adolescence;

based on develop. age, may be voluntary/invol.

(e.g. enuresis, encopresis)

Front 19

Section: Sleep-Wake disorders

Back 19

dissatisfaction w/ quality, timing, amt of sleep;

may be prodrome of existing mental illness;

(e.g. insomnia, hypersomnolence, narcolepsy, parasomnia)

Front 20

Section: Disruptive, Impulse-Control, Conduct

Back 20

problems in self-control of emotions/behaviors; violate the rights of others/societal norms

(e.g. oppositional defiant, intermittent explosive, conduct, antisocial, pyromania, klepto)

Front 21

Section: Substance-Related & Addictive

Back 21

alcohol, caffeine, cannibis,

hallucinogens, inhalants, opioids, sedatives,

stimulants, tobacco, gambling

Front 22

Cluster A personality disorders

Back 22

(aloof; odd)

paranoid PD,

schizoid PD,

schizotypal PD

Front 23

Cluster B personality disorders

Back 23

(dramatic; erratic)

antisocial PD,

borderline PD,

histrionic PD,

narcissistic PD

Front 24

Cluster C personality disorders

Back 24

(anxious; fearful)

avoidant PD,

dependent PD,

obsessive-compulsive PD

Front 25

DSM 5: Section 3

Back 25

WHODAS,

Cultural Formulation Interview (CFI),

disorders for future study,

new model to Dx personality disorders

Front 26

Brief Psychiatric Rating Scale (BPRS)

Back 26

18 item measure of severity

of various psychiatric symptoms

Front 27

Hamilton Rating Scales for Depression & Anxiety

(HAM-D & HAM-A)

Back 27

observer ratings of presence

& severity of specific anxiety/depression Sx

Front 28

Scales for the Assessment of Positive Sx (SAPS)

Back 28

observer ratings of the

pos. & neg. Sx of schizophrenia

Front 29

SAD PERSONS

Back 29

Sex (male),

Age (15-25, 59+),

Depression

Previous attempt,

Ethanol,

Rational thinking (loss of),

Social support lacking,

Organized plan

No spouse,

Sickness

Front 30

ideas of reference

Back 30

believe that others' words/actions have special reference to oneself even though they don't

Front 31

ideas of influence

Back 31

believe they're under the control of someone else, their thoughts are being read, their limbs move without their consent, etc.

Front 32

"infancy" stage of development

Back 32

birth to 15 mo

Front 33

"toddler" stage of development

Back 33

15 mo to 2.5 yrs

Front 34

"preschool" stage of development

Back 34

2.5 to 6 yrs

Front 35

"middle years" stage of development

Back 35

6 to 12 yrs

Front 36

"adolescence" stage of development

Back 36

12 to 19 yrs

Front 37

"adulthood" stage of development

Back 37

20 to 65 yrs

Front 38

Mothers w/ high levels of anxiety are more likely to have babies who...

Back 38

are hyperactive, irritable, low birth wt,

have difficult feeding/sleeping

Front 39

Genetic disorder screening for pregnant women?

Back 39

recommended for all women >35 y/o

(of those tested, 2% have defect)

Front 40

Smoking cigarettes in pregnancy assoc. w/...

Back 40

premature birth, low wt, SIDS

Front 41

Marijuana use in pregnancy assoc. w/...

Back 41

low birth wt, premature,

withdrawal Sx, hyperemesis

Front 42

Cocaine use in pregnancy assoc. w/...

Back 42

increased irritability, crying,

decreased need for human contact

Front 43

Severe radiation exposure in pregnancy assoc. w/...

Back 43

(if between 2-15 wks)

severe deformities, stunted growth, abnl brain development, CA in later life

Front 44

define a "premature" baby

Back 44

gestation <34 wks OR birth wt <5.5 lb

Front 45

define a "postmature" baby

Back 45

born 2 wks beyond expected due date

(42 wks gestation)

Front 46

reflexes present at birth

Back 46

rooting,

grasp,

plantar,

knee,

abd,

startle,

tonic

Front 47

survival systems present at birth

Back 47

breathing,

sucking,

swallowing,

circulatory,

temp. homeostasis

Front 48

When do babies develop vocalization?

Back 48

8 wks

Front 49

By the end of infancy...

Back 49

(15 mo)

reflexes become voluntary,

begin to interact w/ environment,

behaviors more intentional,

begin to use symbolic play & language

Front 50

When do babies start to imitate facial expressions of adult caregivers?

Back 50

3 weeks

Front 51

When does a baby first smile?

Back 51

16th week

(usually elicited by mother)

Front 52

9 observable behavioral dimensions

(temperament)

Back 52

activity level,

distractibility,

adaptability,

attention span,

intensity,

threshold of responsiveness,

mood quality,

rhythmicity,

approach/withdrawal

(~stability over 25 yrs)

Front 53

children w/ "secure" attachment

Back 53

fewer adjustment problems,

had consistent/appropriate parenting

Front 54

Child looks to parents for emotional cues on how to respond to events. Age?

Back 54

Toddler (15 mo - 2.5 yrs)

Front 55

Child shows exploratory excitement & pleasure in developing new behaviors. Age?

Back 55

Toddler (15 mo - 2.5 yrs)

Front 56

Child shows organized demonstration of love (hugs & kisses) & of protest (turns away, cries, bangs, yells). Age?

Back 56

Toddler (15 mo - 2.5 yrs)

Front 57

When does conviction of being male or female begin?

Back 57

begins at 18 mo,

fixed by 30 mo;

is innate

Front 58

toilet training age?

Back 58

daytime urination - 2.5 years

nighttime urination - 4 years

Front 59

sleep habits in toddlers?

Back 59

fear the dark;

sleep 12 hrs/day w/ a 2 hour nap

Front 60

When does a child reach ~50% of their eventual adult height?

Back 60

about 2.5 years

Front 61

When do kids begin to think symbolically?

Back 61

Preschooler (2.5 - 6 yrs)

Front 62

Child has egocentric thinking/no empathy skills. Age?

Back 62

Preschooler (2.5 - 6 yrs)

Front 63

When do kids begin being able to express complex emotions, preverbally & verbally?

Back 63

Preschooler (2.5 - 6 yrs)

Front 64

When do kids begin to move toward more stable/balanced emotions? (e.g. curiosity vs. fear)

Back 64

Preschooler (2.5 - 6 yrs)

Front 65

At what stage do people begin to develop a sense of moral awareness, right vs. wrong?

Back 65

Preschooler (2.5 - 6 yrs)

(but rules are absolute)

Front 66

At what stage do people begin to distinguish reality from fantasy?

Back 66

Preschooler (2.5 - 6 yrs)

(pretend/dramatic play is common)

Front 67

imaginary friends

Back 67

up to 50% of kids age 3-10;

most gone by 12 years

kids w/ above avg intelligence;

relieves loneliness/anxiety

Front 68

At what stage does logical exploration start to bypass fantasy play?

Back 68

Middle years (6 - 12 yrs)

Front 69

At what stage does thinking become organized & logical?

Back 69

Middle years (6 - 12 yrs)

Front 70

At what stage do people develop empathy & concern for others?

Back 70

Middle years (6 - 12 yrs)

Front 71

At what stage do people begin to identify with culturally accepted masculine/feminine ways of behaving?

Back 71

Middle years (6 - 12 yrs)

Front 72

changes in dream awareness

throughout toddler-hood?

Back 72

Age 3: dreams are real/shared; rarely aggressive

Age 4: dreams are real/unique; pleasure vs. fear

Age 5: dreams aren't real

Age 7: dreams are created by self

Front 73

Ages w/ the most disturbing dreams?

Back 73

ages 3, 6, 10

Front 74

kids' initial reactions to divorce?

Back 74

infants: changes in sleep, anxiety, fearful bowel

3-6: don't understand; feel responsible

7-12: bad grades; blame selves; hurt, angry, critical

Front 75

kids' recovery after a divorce?

Back 75

usually takes 3-5 years;

1/3 have lasting trauma

Front 76

"neo-traditional" type of step family

Back 76

resemble traditional families;

absent bio parent is included;

discipline & boundaries

Front 77

"romantic" type of step family

Back 77

expect to be traditional;

absent parent is criticized;

high stress

Front 78

"matriarchal" type of step family

Back 78

house run by strong mom;

new step-parent is a "buddy" to kids

Front 79

parenting style: "Authoritarian"

Back 79

strict, inflexible rules

= low SE, unhappy, social withdrawal

Front 80

parenting style: "Indulgent-permissive"

Back 80

poor limits, unpredictable parenting

= low self-reliance, poor impulse control, aggression

Front 81

parenting style: "Indulgent-neglectful"

Back 81

non-involvement

= low SE, impaired self-control, aggression

Front 82

parenting style: "Authoritative-reciprocal"

Back 82

firm rules, shared decision-making, loving environment

= SE, reliance, social respons.

Front 83

Increased need for independence,

complicated romantic relationships/sexuality,

groups are more influential. Age?

Back 83

middle adolescence (14 - 16 years)

Front 84

About when do people begin to become aware of style, appearance, sexuality, modesty?

Back 84

Early adolescence (12-14 years)

Front 85

primary marker for physical development in girls?

Back 85

ovulation

Front 86

primary marker for physical development in boys?

Back 86

development of sperm

Front 87

Experiences increased definition of self,

belonging through exploration. Age?

Back 87

Late adolescence (17 - 19 years)

Front 88

Kohlberg levels of morality

Back 88

Preconventional: parental punishment

Conventional: conformity, need for approval

Self-accepted moral principles: compliance based on ethics w/ exceptions

Front 89

developmental tasks in young adulthood?

Back 89

(20-40 years)

establish a self separate from parents;

develop adult friendships;

sexuality & marriage (intimacy);

parenthood

Front 90

climacterium

Back 90

period w/ decreased biophysio functioning

women = menopause

men = ~50 y/o; no clear demarcation

can lead to sudden changes in relationships, depression, EtOH/drug use, alt. lifestyle;

midlife transition & crisis

Front 91

Best indicator of one's longevity?

Back 91

family history

Front 92

leading causes of death?

Back 92

heart disease, CA, stroke

Front 93

For pts over 65 y/o, how much does Medicare pay?

Back 93

40%

(remainder paid for by private/state insurance or personal funds; some not covered - outpt psych services, skilled nursing, etc.)

Front 94

depression among the elderly?

Back 94

lower rates, maybe d/t rarity of late onset depression; but higher mortality/suicidality, can be misdiagnosed as dementia

Front 95

When does a person develop their gender identity?

Back 95

occurs by 2-3 yrs for most

ongoing development from cues/experiences, parents, culture, ext. genitalia, genetics, etc.

Front 96

Major factor in developing one's "gender role"

Back 96

learning

Front 97

brain structures involved in sexual behavior?

Back 97

cortex, limbic system, brainstem, neurotransmitters, spinal cord

Front 98

neurotransmitters in relation to desire?

Back 98

desire is..

increased by: dopamine, testosterone, estrogen

decreased by: serotonin, progesterone

Front 99

define "heterosexism"

Back 99

belief that heterosexual relationships is preferable to all others; implies discrimination

Front 100

Male Hypoactive Sexual Desire Disorder

Back 100

deficiency/absence of sexual fantasies & desire for sex for min. of ~6 mo

prevalence increases w/ age

Front 101

Female Sexual Interest/Arousal Disorder

Back 101

inability to feel interest/arousal;

decreased erotic feelings/thoughts/fantasies, etc;

decreased receptivity to partner

+/- dysfunction across entire range of sexual response/pleasure

Front 102

Genito-Pelvic Pain disorder

Back 102

one or more of the following:

- difficulty having sex

- genito-pelvic pain

- fear of pain

- tension of pelvic floor muscles

Front 103

vaginismus

Back 103

involuntary muscle constriction of the outer 1/3 of vagina d/t involuntary pelvic floor muscle tightening/spasm

interferes w/ intercourse

Front 104

substances that can induce sexual dysfunction?

Back 104

alcohol, amphetamine, cocaine, opioids, sedatives, hypnotics, anxiolytics,

antipsychotics, antidepressants, stimulants

Front 105

Viagra

Back 105

nitric oxide enhancer;

not effective w/o sexual stimulation

Front 106

diagnosing a paraphilia

Back 106

sexuality is restricted to specific stimuli/acts;

inhibited from responding to NL erotic stimuli;

must have acted upon fantasy/impulse

Front 107

exhibitionism

Back 107

recurrent urge to expose genitals to a stranger/unsuspecting person

Front 108

fetishism

Back 108

sexual focus is on object that are intimately assoc. w/ human body or non-genital body parts

(e.g. shoes, gloves, pantyhose, stockings)

Front 109

frotteurism

Back 109

rubbing penis against fully clothed female

in crowded places (buses, subways);

extremely passive/isolated

Front 110

most common paraphilia?

Back 110

pedophilia

(victims 13 or younger;

perpetrator at least 16 y/o

& 5 yrs older than victim)

(most common: fondling, oral sex)

Front 111

voyeurism

Back 111

aka scopophilia;

recurrent preoccupation w/ fantasies/acts that involve observing unsuspecting persons who are naked or engaged in grooming/sexual activity

Front 112

telephone/computer scatologia

Back 112

making obscene phone calls for sexual pleasure;

a form of exhibitionism

Front 113

partialism

Back 113

sexual interest w/ an exclusive focus on a specific part of the body

Front 114

prognosis of treating a paraphilia?

Back 114

poor prognosis: related to early onset, freq, no guilt, alcohol, drugs

better prognosis: Hx of NL sex, self-referred, only one paraphilia, no drugs, avg IQ, no personality disorder, successful adult attachment

Front 115

paraphilia: 5 treatment types

Back 115

external control,

reduction of sexual drives,

Tx of co-morbid condition,

CBT,

dynamic psychotherapy

Front 116

difference between anxiety & fear?

Back 116

both are alerting signals, but...

fear = response to known, external, definite, non-conflictual threat

anxiety = more diffuse; response to unknown, internal, vague, or conflictual threat

Front 117

Yerkes-Dodson law

Back 117

there's an optimal level of anxiety to enhance funcitoning

Front 118

3 primary neurotransmitters involved w/ anxiety

Back 118

NE, serotonin, GABA

(benzos support GABA)

Front 119

Anxiety disorders: which has strongest evidence of genetic predisposition?

Back 119

panic disorder

(though there's evidence for others too)

Front 120

diagnosing panic disorder

Back 120

recurrent/unexpected panic attack;

worried about having another

for at least 1 mo

Front 121

diagnosing agoraphobia

Back 121

marked fear & anxiety about 2 or more:

- public transportation

- open spaces

- enclosed places

- standing in line/crowd

- being alone outside of home

x6 months or more

Front 122

panic disorder: stats

Back 122

more common in females

attacks = 20-30 min duration

onset of attacks: late adolescence/early adult

Front 123

origin of fear in agoraphobia?

Back 123

fear/avoid situations b/c escape may be difficult or help may not be available if panic/incapacitating/embarrassing Sx occur

(more common in females)

Front 124

Tx panic disorder & agoraphobia

Back 124

SSRIs, benzos (risk of addiciton), TCAs (side effects), MAOIs (diet restrictions)

can augment w/ benzo, Buspirone

+ cognitive therapy, applied relaxation, resp. training, exposure therapy, family therapy

Front 125

specific phobias: prevalence

Back 125

2x as common in women;

environment/blood/needle: onset in childhood

situational: onset in mid-20s

Front 126

blood-injection-injury phobia

Back 126

onset in childhood;

often tachycardia, then bradycardia & HOTN;

runs in families

Front 127

diagnosing specific phobia

Back 127

marked fear/anxiety about object/situation

x6 mo or more

Front 128

Tx specific phobia

Back 128

most effective = behavior therapy

(systematic desensitization, exposure therapy)

no evidence for effectiveness of insight-oriented therapy

if severe, can adjunct w/ meds

Front 129

social anxiety disorder: stats

Back 129

most onset in teens (8-15 y/o);

general pop.: more females

clinical pop.: more males

often comorbid w/ avoidant PD

Front 130

diagnosing social anxiety disorder

Back 130

marked fear/anxiety about social situations in which pt is exposed to possible scrutiny by others x6 mo or more

specify if Performance Only

(fear restricted to public speaking/performing)

Front 131

Tx social anxiety disorder

Back 131

CBT, meds, or combo;

restructures neg. automatic thoughts,

may include exposure therapy

meds: SSRIs, benzo, Effexor, BuSpar

if severe, MAOI

Front 132

generalized anxiety disorder: stats

Back 132

2x more common in females;

very highly comorbid w/ other anxiety, mood, substance-use disorders

Front 133

diagnosing GAD

Back 133

excessive anxiety/worry more days than not

x6 mo or more

Front 134

Tx GAD

Back 134

CBT + meds

benzos PRN,

SSRIs (best when comorbid depression),

Effexor (reduces insomnia, poor concentration, restlessness, irritability, tension)

BuSpar (reduces cognitive Sx,

less effective at somatic Sx)

Front 135

obsessive compulsive disorder: stats

Back 135

females more than males overall;

but males more often in childhood

avg onset = 19.5 yrs

w/o Tx, is chronic;

most common obsession = contamination

Front 136

specifiers assoc. w/ OCD?

Back 136

with good/fair insight;

with poor insight;

w/ absent insight/delusional beliefs

must also specify +/- Hx of tic disorder

Front 137

OCD Tx

Back 137

most effective = behavior therapy

(esp. Exposure & Response Prevention)

Meds: SSRIs, Clopramine (TCA)

(high rates of relapse upon d/c of meds)

some use of psychosurgery, transcranial electromagnetic stimulation

Front 138

body dyspmorphic disorder: etiology

Back 138

unknown etiology;

may involve serotonin;

higher than expected FHx mood disorder, OCD

Front 139

Most common areas of focus in body dysmorphic disorder?

Back 139

skin (acne, scars, lines),

hair (thinning, excessive),

nose (size, shape)

(time consuming preoccupation;

avg 3-8 hrs/day)

Front 140

Bias for detail rather than holistic aspect of visual stimuli. What disorder?

Back 140

Body Dysmorphic Disorder

(visual processing abnormalities,

executive dysfunction)

Front 141

body dyspmorphic disorder: prevalence

Back 141

more common in females;

avg onset: 12-13 y/o;

gradual & chronic

area of focus may remain same or change

Front 142

Tx body dysmorphic disorder

Back 142

serotonin specific drugs (Anafranil, Prozac)

tricyclics,

MAOIs,

Orap

Front 143

hoarding disorder: prevalence

Back 143

equal among men/women;

more common if unmarried

onset: early adolescence

deficits may resemble ADHD

Front 144

hoarding disorder: driving force?

Back 144

items may be of use at some point;

distorted beliefs about importance;

emotional attachment to items

Front 145

hoarding disorder: comorbidities

Back 145

highest co-morbidity w/ OCD

also PDs (dep., avoidant, schizotypal, paranoid),

schizophrenia, dementia, other neurocog. disorders

Front 146

Tx hoarding disorder

Back 146

most effective: CBT (training in decision-making, categorizing, exposure, etc)

meds: SSRIs (mixed results, even tho effective in OCD)

limited studies b/c only recently a Dx

Front 147

Trichotillomania onset may be related to...

Back 147

stressful situation;

e.g. disturbances in mother-child relationships, fear of being left alone, recent object loss

Front 148

trichotillomania: most commonly affected areas

Back 148

scalp

(others: eyebrows, eyelashes, beard)

Front 149

trichotillomania: 2 types described

Back 149

focused pulling: intentional

automatic pulling: unaware; usually during sedentary activities

Front 150

Tx trichotillomania

Back 150

no consensus; SSRIs

(if poor response, add pimozide (Orap), - dopamine receptor antag.)

misc: Luvox, Celexa, Effexor, ReVia, lithium

insight-oriented therapy

Front 151

excoriation disorder: stats

Back 151

women more than men;

most common site: face

(others: legs, arms, torso, hand, cuticles, fingers, scalp)

picking relieves stress, tension, etc.

Front 152

Tx excoriation disorder

Back 152

SSRIs (e.g. Prozac)

ReVia (opioid antag;

reduces urge, esp. if pleasurable)

misc: lamictal, brief CBT

Front 153

diagnosing PTSD - for how long?

Back 153

more than one month

Front 154

PTSD specifiers

Back 154

w/ dissociative Sx: depersonalization, derealization

w/ delayed expression: doesn't meet criteria till at least 6 mo after event

(note: separate criteria for kids 6 & younger)

Front 155

PTSD Tx

Back 155

SSRIs, tricyclics, MAOIs,

trazodone, anticonvulsants

CBT (refer to trauma specialist)

Front 156

diagnosing adjustment disorder: how soon after stressor?

Back 156

Sx must begin within 3 mo of the stressor

Front 157

adjustment disorder: examples of stressors

Back 157

beginning school,

leaving home,

getting married,

becoming a parent,

not reaching occupational goals,

empty nest,

retiring

Front 158

adjustment disorders: 6 subtypes

Back 158

w/ depressed mood,

w/ anxiety,

w/ depressed mood + anxiety,

w/ disturbance of conduct,

w/ disturbance of emotion + conduct;

unspecified

Front 159

Tx adjustment disorder

Back 159

Tx of choice = psychotherapy

(group therapy, etc.)

maybe meds for a brief time

Front 160

define "epileptoid personality"

Back 160

may include auras, sound/light sensitivity

seen in Intermittent Explosive Disorder

Front 161

course/prognosis: Intermittent Explosive Disorder

Back 161

onset: late adolescence, early adulthood

decreased severity w/ age

Front 162

Tx Intermittent Explosive Disorder

Back 162

meds + therapy

Lithium, Depakote, anticonvulsants, antipsychotics, SSRIs

Front 163

diagnosing Intermittent Explosive Disorder?

Back 163

no damage: 2x weekly for 3 mo

damage: 3x within one year

must be at least 6 y/o

Front 164

comorbidities w/ kleptomania?

Back 164

mood disorders, anxiety;

gambling, compulsive shopping,

AoD, eating disorders

Front 165

DDx kleptomania

Back 165

for personal gain (personality disorder),

w/ psychosis (hallucinating, depersonalization),

Alzheimers/Dementia,

malingering

Front 166

repetitive self-mutilation?

Back 166

is always co-morbid to something

(think Borderline PD, paraphilia, etc;

interpersonal or physiological gain)

Front 167

paranoid PD: who has it?

Back 167

males more than females;

more among minorities, deaf

Front 168

paranoid PD vs. Delusional disorder?

Back 168

paranoid PD doesn't have fixed delusions;

no hallucinations or thought disorder

Front 169

Paranoid PD vs. Borderline PD?

Back 169

paranoid PD: no over involvement in relationships; no Hx of antisocial behavior

Front 170

Tx paranoid PD

Back 170

Tx of choice = psychotherapy

meds: anti-anxiety

(+ anti-psychotics if severe)

Front 171

Schizoid PD: who has it?

Back 171

males more than females;

ppl w/ solitary jobs

(night, minimal contact w/ others)

Front 172

clinical features of Schizoid PD?

Back 172

cold, aloof, social withdrawal,

eccentric, isolated, difficulty w/ intimacy,

difficulty expressing anger,

+/- fantasy sex life

Front 173

How is schizoid PD different from paranoid PD?

Back 173

schizoid PD has less social engagement

& less self-expression

Front 174

Tx schizoid PD

Back 174

Tx of choice = psychotherapy

(distant but devoted clients)

meds: small doses of anti-psychotics, anti-depressants, benzos, stimulants

Front 175

Pt is detached from social relationships & has a restricted range of emotional expression. Dx?

Back 175

schizoid PD

Front 176

How is schizotypal PD different from schizophrenia?

Back 176

unlike schizophrenia, schizotypal PD has no psychosis

(note: but schizotypal can be co-diagnosed w/ Borderline PD!)

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Tx schizotypal PD

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Tx of choice = psychotherapy

meds: antipsychotics

(if depressive features, SSRIs)

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antisocial PD: who has it?

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more in males;

more in poor, urban areas,

more in prison

conduct disorder before age 15

(can't Dx antisocial till 18);

runs in families

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"mask of sanity" Dx

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Antisocial PD

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course/prognosis: antisocial PD

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once developed, is lifelong;

but symptoms decrease later in life

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Tx antisocial PD

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Tx of choice = psychotherapy

(firm limit-setting, focus on fear of intimacy,

self-destructive behaviors)

meds: stimulants, anti-epileptic (Depakote, Tegretol)

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Borderline PD: who has it?

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more common in women;

1st deg. relatives may have depression, AoD

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How is Borderline PD different from schizophrenia?

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Borderline PD has no prolonged psychosis

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Tx Borderline PD

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Tx of choice = psychotherapy + meds

hospitalizations w/ Dialectical Behavior Therapy (DBT)

meds: anti-psychotics, SSRIs, MAOIs, benzos

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possible co-existing diagnoses w/ histrionic PD?

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brief psychotic, dissociative,

& somatization disorders

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Tx histrionic PD

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Tx of choice = psychotherapy

(bring inner feelings into awareness)

meds: SSRIs, anxiolytics, anti-psychotics

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Tx narcissistic PD

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Tx of choice = psychotherapy

lithium, SSRIs

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Infant has timid temperament. What PD might this suggest later in life?

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avoidant PD

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Tx avoidant PD

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Tx of choice = psychotherapy

meds: anti-depressants, anxiolytics

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Chronic physical illness in childhood leads to risk of developing what PD?

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dependent PD

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Tx dependent PD

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Tx of choice = psychotherapy

(insight-oriented, family/group, etc)

anti-depressants, anxiolytics

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obsessive-compulsive PD: who has it?

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more common in males;

more in oldest child;

Hx of harsh discipline

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Tx obsessive-compulsive PD

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Tx of choice = psychotherapy

clonazepam (Klonopin), Prozac

(anxiolytic, antidepressant)

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diagnosing a "major depression episode"?

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Sx appearing in the same 2 wk period

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manic episode: duration?

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at least one week;

most of the day, nearly every day

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hypomanic episode: duration?

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at least 4 consecutive days;

present most of the day, every day

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untreated episode of depression: duration?

What if treated? What about over time?

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untreated: 6-13 mo

treated = 3 mo

over time, freq & length of episodes increases

(over 20 yrs, avg. 5-6 episodes)

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major depressive disorder:

who generally experiences a more chronic course, men or women?

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men

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Most common mistake leading to unsuccessful trial of an antidepressant?

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too low a dosage for too short a time

(before considered unsuccessful, should be at max dose for at least 4-5 wks)

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MDD: How long to keep a pt on anti-depressants?

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at least 6 mo,

or the length of a previous episode

(then taper gradually over 1-2 wks)

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Name some SSRIs

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Prozac, Paxil, Zoloft, Celexa, Lexapro

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Name some SNRIs

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Cymbalta, Effexor, Pristiq

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Name an NDRI

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Wellbutrin

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What should we know about trazodone & Remeron?

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atypical antidepressants;

are sedating (take in the evening)

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Diagnosing dysthymia: duration?

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at least 2 years;

most of the day for more days than not

never w/o Sx for more than 2 mo at a time

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What might present diagnostically like dysthymic disorder?

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long-term substance abuse

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Tx dysthymia

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CBT + meds

SSRIs, SNRIs, TCAs

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How far apart do manic episodes need to be in order to be considered distinct?

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separated by at least 2 mo

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how long does an untreated manic episode last?

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about 3 mo

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as bipolar I progresses, how do the episodes change?

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time between episodes decreases;

stabilizes after 5 episodes

to about once every 6-9 mo

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Tx bipolar disorder

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lithium, Depakote, valproic acid,

Lamictal, Tegretol, Abilify, etc.

Prozac, Paxil, Zoloft

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cyclothymia vs. bipolar II?

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cyclothymia is less severe w/ shorter cycles

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Tx cyclothymia

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psychosocial therapy,

lithium, depakote