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105 Cards in this Set

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What are the overriding characteristics of personality disorders?
1. self-aggrandisement
2. diminshed capacity for understanding and respecting the needs and rights of others
3. mistrust/distrust of others
4. emotional instability
5. manipulation and exploitation of others
6. blaming others
7. limited capacity for give and take
General Diagnostic Markers of PD
1. difficulty in personal relationships across settings and people
2. personality traits that are inflexible and rigid
3. personality traits/behaviors that are maladaptive
The person does not recognize his traits as undesirable, problematic, or maladaptive
Ego-syntonic
This person views his traits as undesirable, but despite efforts cannot change them
Ego-dystonic
In personality disorders, the earlier the onset...
the more pervasive and chronic the pattern
_____ typically increases symptoms of PD's and decreases self control or increases their impulsiveness.
Stress
______ amplifies personality disorder and decreases self control/increases impulsiveness.
Substance abuse
When are crises most problematic in PD?
young adulthood
PDs that remit or mellow with age
antisocial and borderline
PDs that worsen with age
OCD and schizotypal
Borderline personality disorder is associated with...
mood disorders, substance abuse disorders
Schizotypal PD is associated with...
schizophrenia
OCD is associated with...
family history
PDs rarely require hospitalization unless their condition is complicated by...
1. substance abuse
2. mood disorder
3. major life stressor that results in suicidal, assaultive or homicidal behavior
What PD treatment has the best outcome?
long term psychotherapy...even though its still poor
Cluster A PD
schizotypal
schizoid
paranoid
Cluster B PDs
histrionic
narcissistic
antisocial
borderline
Cluster C PDs
avoidant
dependent
obsessive compulsive
Paranoid PD presents with 4 of these 7
1. suspects without basis that people are exploiting, harming or deceiving him
2. preoccupied with unjustified doubts about loyalty of friends
3. reluctant to confide in others
4. reads benign comments as demeaning or threatening
5. persistently bears grudges
6. perceives attack on character and is quick to anger
7. has recurrent suspicions of infidelity of partner
Whats the main difference between Schizoid and Schizotypal?
Schizotypal have a fear of people and relationships whereas schizoid just have no interest in relationships
Schizoid PD has 4 of these 7
1. no desire for close relationships
2. always chooses solitary activities
3. little/no interest in sex
4. takes pleasure in few/no activities
5. lacks close friends
6. appears indifferent to praise or criticism of others
7. shows emotional coldness, detachment or flattened affect
Schizotypal PD has 5 of these 9
1. ideas of reference
2. odd beliefs or magical thinking
3. unusual perceptual thinking
4. odd thinking and speech
5. suspicious or paranoid ideation
6. inappropriate or constricted affect
7. behavior or appearance that is odd, eccentric, or peculiar
8. lack of close friends
9. excessive social anxiety associated with paranoid fears
Pattern of disregard for and the violation of the rights of others occurring since the age of 15
Antisocial PD
Pervasive pattern of instability of interpersonal relationships, self image and affect, marked impulsivity beginning by early adulthood and present in a variety of contexts
Borderline PD
A pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts
Histrionic PD
A pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning in early adulthood and present in a variety of contexts
Narcissistic PD
A pervasive patten of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Begins in early adulthood
Avoidant PD
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation. Begins in early adulthood
Dependent PD
A pervasive pattern or preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
Obsessive Compulsive Personality Disorder
Criteria for Anorexia
1. Refusal to maintain body weight-usually 85% of expected
2. intense fear of gaining weight even though underweight
3. Disturbance in the way she experiences her body shape or weight, or denial of the seriousness
4. amoenorrhea
What is the onset for anorexia?
teens to early adults
What is the sex ratio for anorexia?
90-95% are female
Onset of anorexia often follows...
a new life situation in which the person feels inadequate or unable to cope
When do anorexics come to medical attention?
usually die to amenorrhea, edema, constipation, abdominal pain or requests for diet pills or diuretics
What % of anorexics recover completely?
40%
What is the 10 year mortality rate for anorexia?
5-10%
What is the 20 year mortality rate for anorexia?
20%
Which anorexics have a better prognosis?
younger onset patients and those with restricting type
In anorexics, lifetime prevalence of ____ is 25%
OCD
In anorexia is cortisol high or low?
high
What are some indicators of favorable prognosis in anorexia?
1. good premorbid level of psychosocial adjustment
2. early age of onset
3. less extreme weight loss
4. less denial of illness
5. restrictive subtype
What are indicators of unfavorable prognosis in anorexia?
1. poor premorbid level of psychosocial adjustment
2. low SES
3. extreme weight loss
4. greater level of denial
5. presence of bulimia, purging behavior
Major depression is associated with anorexia ____% of the time.
60%
Anxiety disorders are associated with anorexia ___% of the time
20%
Personality disorders are associated with anorexia ___% of the time
40%
What meds can be used in moderate to severe cases of anorexia?
imipramine and desipramine
SSRI's
-the book says they have no role in anorexia-
_____ or ______ is associated with bulimia is 75% of cases.
major depression or anxiety
When does bulimia begin?
adolescence or young adulthood
Bulimia onset often follows...
change in living situation or relationship
What two methods of assessment are employed in evaluating kids?
1. obtaining information from collateral sources.
2. observation
Most common behavior disorder diagnosed in kids and teens
ADHD
3 groups of ADHD symptoms
inattention
impulsiveness
hyperactivity
Who gets ADHD?
males 3:1
Hallmark of ADHD
variability of symptoms from time to time and in different situations
What 2 disorders are often associated with ADHD?
oppositional defiant disorder
conduct disorder
Children with coexisting ADHD and conduct disorders tend to have...
1. earlier age of onset
2. exhibit a greater total number of antisocial behaviors
3. display more physical aggression
What % of ADHD persists into adulthood?
60-70%
25% of ADHD kids go on to be adults with ____.
antisocial personality disorder
Girls with ADHD have a _______ than do boys with ADHD.
stronger family history
Psychiatric disorders that aggregate with ADHD
mood disorder
learning disorder
substance abuse
antisocial personality disorder
______ is associated with novelty seeking behavior
Dopamine D receptor
Most common complaint in referrals to child and adolscent clinics and hospitals
conduct disorders
Conduct disorder is associated with...
chaotic/dysfunctional families
________ is a strong factor is the development of conduct disorder in males.
having an anti-social mother
_____ and ____ often precede the development of conduct disorder.
ADHD and ODD
Among children, the strongest predictors for conduct disorder include:
drug use
stealing
truancy
lying
low educational achievement
Conduct disorder involves at least 3 of the 4:
1. aggression to people or animals
2. destruction of property
3. deceitfulness and theft
4. serious violation rules
Who gets tourette's?
males 3:1
Tourette's is highly familial and comorbid with...
OCD
Some kids get Tourette's after...
infection with Group A beta-hemolytic strep-PANDAS
Treatment of Tourettes
alpha adrenergic drugs like clonidine or guanfacine.
Haldol, pimozide and atypical antipsychotics can be used when others fail
Nocturnal enuresis is largely a consequence of...
delayed maturation of bladder control mechanism
___% of enueretic kids have a 1st degree relative with a history of enuresis
75%
Nocturnal enuresis in kids under 7 should be treated with...
patience
Encopresis is often a sign of...
severe emotional/psychological disturbance
3 groups who have encopresis
1. kids who haven't been systematically toilet trained-MR
2. Secondary to psychiatric disorders-ODD, ADHD, Conduct disorder, Phobia
3. Chronic, severe constipation, megacolon
In schizophrenia, ______ are more common in children than adults.
visual hallucinations
Prior to puberty, depression is more common in...
boys
Mania in young children may appear similar to...
ADHD
In childhood mood disorders, _____ may be more pronounced.
irritability
Who gets autism?
boys 3-4:1
70% with autism show evidence of ______
mental retardation
____% with autism have seizure disorders
25%
when a person echoes back what another has said
echolalia
Deceleration of head growth between 5 and 48 months, loss of hand skills, social engagement, poor coordination and impaired language
Rett's disorder
severe and sustained impairment in social interaction and development of restricted and repetitive patterns of behaviors, interests, and activities
Asperger's
clinically significant loss os previously acquired skills before the age of 10
Childhood Disintegrative Disorder
Mild Mental Retardation
50-55 to70
Moderate MR
35-40 to 50-55
SevereMR
20-25 to 35-40
Profound MR
<20-25
Most common chromosomal cause of MR
Down's
Most common inheritable cause of MR
Fragile X
What is the PLISSIT model
sex therapy:
P-give permission to discuss sexual concerns
LI-clinician provides limited information
SS-clinician makes specific suggestions
IT-patients who don't respond are referred for intensive therapy
Hallmark of Hypoactive Sexual Desire Disorder
baseline of sexual desire (libido) remains significantly low
Most common cause of orgasm disorders
SSRIs
_______ have the highest rate of recidivism
Males who molest young males
The best treatment for pedipohilia
protection of potential vicitms ie jail-ie keepin Dr H in business
Psychiatric emergencies respresent...
life threatening situations
Psychiatric urgencies represent...
wants and demands
What is the most likely form of psychiatric emergency?
suicide attempts
The most important decision in evaluation of psychotic patients is...
differentiate between mental disorders due to medical, neurological and toxic causes
Clinical features highly suggestive of delirium include...
1. Clouding of consciousness
2. age over 40
3. no previous psychiatric history
4. disorientation
5. abnormal vital signs
6. visual hallucinations and illusions
______ is the mainstay of evaluation and treatment in psychiatric emergencies.
verbal intervention
What can you use for rapid tranquilization?
lorazepam combined with haldol or thiothixene-most patients respond in 1-3 doses