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162 Cards in this Set
- Front
- Back
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what are teh sx of mania
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F-light of ideas
A-ctivity incr S-leep dcr T-alkitive P-oor judgement E-ssteem incr D-istractibility |
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what is the duration of mania
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1 wk
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what are the subtypes of mania
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psychotic, rapid cycling
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what are disorders related to mania
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mixed
schizo-affective |
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what is the duration of hypomania
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4 days
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what is the difference btwn mania and hypomania
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hypomani occurs wihtout marked impairment, hospitalization or psychosis
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what is the duration of dysthymia
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-at least 2 yrs
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what are the of dysthymia
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2 of the following
-change in appetite -change in sleep -fatigue -low self-esteem -poor concentration/indecisive -hopeless |
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bipolar disorder type 1 is characterized by
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mania
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bipolar disorder type 2 is characterized by
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hypomania and MDE
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cyclothymia is characterized by
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hypomania and dysthymia
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cyclothymia is characterized by
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hypomania and dysthymia
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what are the major depressive disorder subtypes
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psychotic
melancholic atypical post-partum seasonal |
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what are the major depressive disorder subtypes
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psychotic
melancholic atypical post-partum seasonal |
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what percentage of the population is affected by schizophrenia
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1%
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what percentage of the population is affected by schizophrenia
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1%
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what is the onset of schizophrenia
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adolescene/adulthood
recurrent and life long |
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what is the onset of schizophrenia
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adolescene/adulthood
recurrent and life long |
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what asre teh pathologic dimensions of schizophrenia
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positive sx: delusions, hallucinations, disorganized speeche, catatnoa
neg sx: affective flattening, alogia, avolition, anhedonia, social withdrawl mood sx: depression, anxiety, hoplessness, demoralization, stigmatization, suicidality cognitive defects: atention, memory, executive functions substance abuse, suicide, violence |
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what asre teh pathologic dimensions of schizophrenia
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positive sx: delusions, hallucinations, disorganized speeche, catatnoa
neg sx: affective flattening, alogia, avolition, anhedonia, social withdrawl mood sx: depression, anxiety, hoplessness, demoralization, stigmatization, suicidality cognitive defects: atention, memory, executive functions substance abuse, suicide, violence |
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what are essential facts about schiziphrenia
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runs in families
disturbance in chemical neurotransmission structural brain abnormalites |
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what are essential facts about schiziphrenia
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runs in families
disturbance in chemical neurotransmission structural brain abnormalites |
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what is the percentage of MZ twins that develop schizophrenia
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46%
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what is the percentage of MZ twins that develop schizophrenia
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46%
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the majority of indviduals with schizophrenia have
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no relatives with the disease
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the majority of indviduals with schizophrenia have
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no relatives with the disease
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mutated genes in schizophrenia are involved in
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synaptic transmission
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mutated genes in schizophrenia are involved in
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synaptic transmission
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what is teh premorbid period of schizophrenia
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0-15
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what is teh premorbid period of schizophrenia
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0-15
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cyclothymia is characterized by
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hypomania and dysthymia
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what are the major depressive disorder subtypes
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psychotic
melancholic atypical post-partum seasonal |
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what percentage of the population is affected by schizophrenia
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1%
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what is the onset of schizophrenia
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adolescene/adulthood
recurrent and life long |
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what asre teh pathologic dimensions of schizophrenia
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positive sx: delusions, hallucinations, disorganized speeche, catatnoa
neg sx: affective flattening, alogia, avolition, anhedonia, social withdrawl mood sx: depression, anxiety, hoplessness, demoralization, stigmatization, suicidality cognitive defects: atention, memory, executive functions substance abuse, suicide, violence |
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what are essential facts about schiziphrenia
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runs in families
disturbance in chemical neurotransmission structural brain abnormalites |
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what is the percentage of MZ twins that develop schizophrenia
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46%
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the majority of indviduals with schizophrenia have
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no relatives with the disease
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mutated genes in schizophrenia are involved in
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synaptic transmission
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what is teh premorbid period of schizophrenia
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0-15
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when is teh prodromal period of schizophrenia
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15-25
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what is the onset of schizophrenia
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20s
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when does deterioration occur in sfchizophrenia
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20s-30s
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grey matter in schizophrenia pts
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dcr
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what are the most impt neurotransmitters in schizophrenia
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dopamine
GABA |
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what are the components to the mental status exam
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1. appearance, behavior, speech and attitude
2. mood 3. affect 4. thought process 5. thought content 6. perception 7. cognition 8. insight 9. judgement |
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appearance...
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mood
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mood...
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affect
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affect...
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thought process
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thought process...
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thought content
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thought content...
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perception
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perception...
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cognition
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cognition...
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insight
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insight...
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judgement
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what is the appearance, behavior, speech and attitude
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detailed description of the indv as he or she appears including
-grooming -clothing -motor behavior -rate, volume and modulation of speech 0=-interaction with interview |
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what is the mood in MSE
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sujective feeling state of teh individual sustained over much of the interview
-normal = euthymic |
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what are abnormal mood MSE describers
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depressed
sad irritable expansive -- enthusiastic euphoric-- feeling great, as if one just won lottery nervous angry |
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what is the affect in MSE
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objective description of the individuals emotional state as observed by the clinician
-normal = full range |
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what are abnormal affect MSE describers
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constricted--
blunted flat-- inappropriate labile |
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what is the thought process in the MSE
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the organization of the individual's thoughts as reflected in his or her verbal productions
-normal = coherent and goal directed |
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what are abnormal thought process MSE qualifiers
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tangential
circumstantial flight of ideas loosening of associations word salad blocking neologism |
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what is the thought content in MSE
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the theme of the individualos' thoughts during the interview, including preoccupations and ruminations, as well as overt signs and sx of psychopathology
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what is the normal thought content describer
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no evidence of delusions
denies obsessions, suicidial and homocidal ideation |
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what are abnormal qualifiers of thought content
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presence of delusions (gradiose, paranoid, somatic, religious, reference)
over valued ideas (paranoid ideation and ideas of reference) obsessions ruminations suicidal an dhomicidal ideation paucity of thought: describe and give examples |
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what are perceptions in the MSE
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assessment of perpetual sx: illusions, depersonalization, derealization, hallucinations
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what are normal describers of perception
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denies auditory and visual hallucinations
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what are abnormal descriptors of perceptions
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-specify type of hallucination (auditory, visual, olfactory, tactile) and describe
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what is cognitive
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assessment of the individuals abilites with regard to attention and orientation, as well as intelluctual function including memory, calculations, fund of knowledge and capacity for abstract thought
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what are common normal descriptors of cognition
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alatert, attentive and oreitend x 3
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what are abnormal descriptors of cognition
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describe findings of each test administered
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what is insight in MSE
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the pt's understanding of himself in teh context of wanting or needing help
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what is normal descriptor for insight
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intact
excellent |
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what are abnormal descriptors for insigh
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fair
impaired (include explanation) |
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what is judgement in MSE
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actions teh individual will take based on insight
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what are normal descriptors of judgement
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intact
excellent |
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what are abnormal descriptors of judgement
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fair
imparied (included description) |
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what are abnormal descriptors of behavior
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psychomotor agitation (incr in bdy movement, hand wringing, pacing)
psychomotor retardation (significant slowingo f speech and bdy movement) |
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what are abnormal descriptors of mood
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expansive -- enthursiastic
euphoric -- feeling great, as if one just won the lottery |
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blunted
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decr in amplitude of emotioanl expression (affect)
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circumstantial
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(thought process) organzied but overly invlusive, eventually gets to teh point in a painstakingly slow manner
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tangential
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occasional lapses in organization such that the patient suddenly changes the subject and never returns to it; if a question is asked, it isn't answered (thought process)
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flight of ideas
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flow of thoughts is extremely rapid but connections remain intact (thought process)
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loosening of associations
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frequent lapses in connection between thoughts, disorganized (loosening of associations)
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word salad
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incomprehensible speech due to lapses in connections even within a single sentence; incoherent, a "tossed salad" of ideas
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blocking
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patient loses his or her train of thougth; by definition, the patient should confirm the sujective experience of being blocked; the term should not be based on the interviewer's observation alone (thought process)
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neologism
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a created word with an idiosyncratitc meaning (thought process)
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constricted
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normal amplitude but restricted range (affect)
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flat
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virtually complete absence of affective expression (affect)
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inappropriate
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emotions expressed are not congruent with content of patient's thought (affect)
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labile
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unpredictable shifts in emotional state (affect)
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neologism
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a created word with an idiosyncratic meaning (thought process)
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delusion
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a firmly heald, fals belief not shared by members of the pt's culture (by definition, reality testing is not intact, i.e.m the patient is unable to consider the possiblity that the belief is incorrect) (thought content)
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obession
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an idea that is intrusive and egodystnic (by definition, reality testing is preserved, i.e., teh patient will readily acknowledge that teh obessession makes not sense); should not be confused with ruminations which are egosyntonic, or delusions
thought content |
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overvalued idea
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a false belief not shared by members of the patient's culture that is not fixed, i.e., it is held to more firmly than one would expect but reality testing is maintained
thought content |
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paranoid ideation
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specific type of overvalued idea characcterized by suspiciousness about other's motives
thought content |
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ideas of reference
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specific type of overvalued idea characterized by misinterpretation of external events as having particular menaing fo rthe individual
thought content |
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phobia
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a specific fear that results in avoidance of a situation despite the individual's realization that the fear is irrational
thought content |
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illusion
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misinterpretation of a sensory stimulus that can occur in any sensory modality (misperceiving billowing curtains in a darkened room to be an intruder)
perception |
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hallucination
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preceiving a sound, sight, taste, smell or touch in the absence of external sensory stimulation taht seems indistinguishable from such an experience in reality
perception |
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depersonalization
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the sense that one is outside of oen self
perception |
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derealization
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a vague sense of unreality in one's perception of teh external world
perception |
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sx of depression
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S-leep incr or dcr
I--nterest lost G--uilt E-- nergy less C--oncentration reduced A--ppetite icr or dcr P--sychomotor retardation S--uicide |
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what is the epidemiology of major depression
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general population:
current --5% lifetime--17% (women 20-25%, men 7-12%) primary care current-- 10% |
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what is the DSM criteria for major depressive episode
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5 or more of the sx during the same 2 wk period that represent a change from previous function
at lease one sx is depressed mood or lost of interest or pleasure |
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what are 4 key characteristics of schizophrenia
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dementia with at times intact reasoing
delusions an dhallucinations chronic, unremitting, and detering course (as opposed ot manic de[pressive psychosis) caused by specific brian lesions |
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what is the pathognomoic feature of schizophrenia
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dissociation of mental functions
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what are the primary sx of schizophrenia
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association defect
autistic behavior/thinking abnormal affects ambivalence |
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what are acessory sx of schizophrenia
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hallucinations and delusions
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what are positive psychotic sx
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hallucinations (auditory more common that visual)
delusions: -persecutory -grandiose (special relationship with God) -erotomanic (special relationship with a celebrity) -thought insertion -thought withdrawl -thought control -religious -thought broadcasting -somaticq |
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what are negative sx assoc with schizophrenia
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affective flattening
attentional disturbance poverty of content of speech anhedonia asociality alogia |
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what are disorganized sx of sxhizophrenia
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derailment (loose assoications)
-illogicality -thought blocking -incoherence -catatonic disturbances (mutism, negativism, sterotypic movements, excitement/agigation) |
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pts with schizophrenia preforme poorly on all cognitive and neuropsychologic test and the most marked deficts ar ein
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attention
short term memory, leanirng working memory executive functioning |
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waht are mood syndromes of schizophreina
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depression
suicidality agigation |
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what is the diagnostic criteria for schizophrenia
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2 or more sx, each present for a significant portion of time during a 1 month period:
1. delusion 2. hallucination 3 disorganized speech 4. groosly disorganized or catatonic behavior 5. neg sx |
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what is the time course of schizophrenia
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a tleast 6 mths including prodromal and or residual sx
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what is the ddx of schizophrenia
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-drug induced psychosis
-organic psychosis -breif psychotic disorder (typically in context of sstressor, 20-30 dyas duration with full resolution) -schizophreniform-- delusional disorder bipolar manic/depressed with psychotic features schizoaffective disorder |
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what is schizoaffective disorder
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major depression, manic or mixed episodes concurrent with active phase sx
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what is schizophreniform
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meets all criteria except duration of 1-6 mths and not requiring impaired functioning
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what are teh subtypes of schizophrenia
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paranoid (organized systematic delusions)
disorganized (thought disorder and bizzare behavior) catatonic undifferentiated residual (few active psychotic sx) |
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what is the lifetime risk of schizophrenia
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1% life time
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how many pts are affected with schizophrenia in US
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2 million, higher in males who hoave realy onset and worse prognosis
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what is assessed in the MSE cognitive exam
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attention and orientation
memory fund o fknowledge complex function abstract thought |
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what are 3 cognitive disorders
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delirium
dementia amnestic disoreder |
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what arei symptoms of a pt who has delirium
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fluctuating level of consciusness
inability to acquire new information confusion sleepiness alternating with periods of agitation poor motor coordination incontinence inability to perfome simple mental tasks disorientation to person place or time confusion memory impairment |
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what is teh definition of delirium
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an acute change in mental status that leaves them feeling bewildered
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what is characterized by waxing and waning (fluctuation in orientation and sensorium)
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delirium
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what is dementia characterized by
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a slow progressive decline in intellectual capacity and memory in the presence of a clear sensorium; pt tries to conceal defect
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what is DSM for dementia
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-multiple cognitive deficits manifested by
-memory impairment -one or more of : aphasia (language disturbance); apraxia (impaired ability to carry out motor activites despite tinact motor function); (agnosia (failure to recognize or identify objects despite intact sensory function); disturbance in exeecutive functioning |
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what is amnestic disorder
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isolated, short term memory defect
sensorium is clear |
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what is a personality disorder
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an enduring pattern of inflexible and maladaptive thinking, feeling and acting that cuases significant subjective distress and or impairment ins ocial or occupational function
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what is the difference btwn personality disorder and personality traits
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personality traits are patterns of experinc and interacting with environment and people
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what are the 6 DSM criteria that must be met to be a personality disorder
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1. enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individua'ls culture manivesting in cognition, affectivity, interpersonal function or impulse control (2 must be present)
2. enduring pattern is inflexible and pervasive across a broad range of personal and social situations 3. the enduring pattern leads to clinically significant distress or impairment ins ocial, occupational, or other important areas of functiong 4. teh pattern is stable and of long duration and its onset can be traced back at least to adolescene or early adultooh 5.the enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder . enduring pattern is not due to a substance or medical condition |
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what is a behavior restricted to one person or situation
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a relational problem or adjustment disorder
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what si teh reason ofr maladaptive and enduring nature of personality disorders
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inflexibility
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what are complicating factors in determining significance of the distress in personality disorders
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pts are ego-syntonic
reluctant to acknowledge unflattering traints denial or exaggeration may be characteristic clincians PD, culture or bias |
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what is the difference btwn Axis I and Axis I
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Axis II was created to counteract underrecognition of PD
many axis I disoders are chronic with early onset |
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what are the 3 clusters of personality disorders
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cluster A: odd
cluster B: dramatic Cluster C: anxious |
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what disorders fall under the odd personality disorder
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schizoid
schizotypal Paranoid |
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what disorders fall under the dramatic disorder
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antisocial
borderline histrionic narcissistifc anxious |
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what are traits of the paranoid personality disorder
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tendency to be suspicious, mistrustful, hypervigilant and preoccupied with being exploited or betrayed by others
hostile, irritable, avoidance, and anxiety secondary to paranoid beliefs self-fulfililng prophies: mistrustful behaivor causes otehrs to act in an overly cautios way |
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what are the traits of a schizoid personality disorder
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profound defect in the individual's ability to form personal relationsihps or to respond to others in an emotiaolly meaningful way
indifferent, aloof, detached, and unresponsive to praise criticism or any other feelings expressed by others |
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indifferent, aloof, detached, and unresponsive to praise criticism or any other feelings expressed by others
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schizoid personality disorder
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profound defect in the individual's ability to form perosnal relationships
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schizoid personality disorder
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what are characteristics of schizotypal personality disorder
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idiosyncratic speech patterns
eccentric beliefs paranoid tendencies perceptual illusion unusual appearnce inappropriate affect social anxiety some go on to develop schizophrenia |
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schizoid
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can't connect
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schizotypal
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wierd/odd
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paranoid
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paranoid
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what are characteristics of antisocial personality disorder
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pattern of socially irresponsible exploitative and guiltless behaivor
deception and manipulation of others for personal gain doesn't abide by law, sustain consistant employment and develop stable relationships lacks remorse |
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what are characteristics of borderline personality disorder
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pattern of intense and chaotic relationships with fluctuating and extreme attitudes toward others
engate in self-destructive behaviors, affectively unstable and impulsive, lack a clear sense of identity sucide attempts or suf mutilation |
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lives are chaotic, unstalbe, and marked by frequent disappointments and rejections
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borderline personality disorder
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underlying mood is labile and quick to anger
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borderline personality disorder
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in a crisis or with substance sue, may experience transient psychotic breaks
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borderline personality disorder
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what are characteristics of histrionic personality disorder
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attention seeking
self-dramatizing excessively gregarious, seductive, manipulative, exhibitionist shallow emotions, labile, vain and demanding |
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what are characteristics of narcisstic personality
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egocentric
grandiose craves admiring attention and praise desplays beauty, power, fame, and wealth use relationship to meet pown selfish needs with little consideration for the needs of othe other person fells entitled to speical rights attention priviliges and consideration |
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center of attention
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histrionic
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fells entitled to speical rights attention priviliges and consideration
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narcissistic
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characteristics of avoidant personality disorder
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inhibited
ointroverted anxious low self esttem hypersensitivity to rejection, social awkwardness, timidity soccial discomft and self consicou fears of being embarrassed ora cting foolish |
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what are characteristics of dependent personlaity disorder
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excessive reliance on others
tendenccy to permit others to make important decisons, to feel helpless when alone, to subjugate needs to those of others, to tolerate mistreatment not uncommon for such a person to be living with a controlling, domineering or overprotective person |
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what are characteristics of obsessive-compulsive personality disorder
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perfectionistic, constricted and excessively disciplined
rigid behavior, distant driven, aggressive, competitive, and impatient witha chronic sense of time pressure and inability to relax controlling |
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what is the order of the case write up
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ID
CC HPI PPH PMH Shx Fhx MSE |
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understading yourself in terms of needing help
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insight
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actions you will take
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judgement
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