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112 Cards in this Set
- Front
- Back
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What is an idea of reference?
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Belief that an object, event or person in one's environment (usually TV, radio) has particular personal significance.
E.g. news anchorman sending special messages to the patient through the TV |
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What is the difference between OCD and OCPD?
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In OCD the symptoms are ego-dystonic
(i.e. the patient realizes the obsessions are not reasonable) whereas in OCPD the symptoms are ego-syntonic (i.e. consistent with the patient's way of thinking). |
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What are the 3 personality disorder clusters?
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Cluster A: mad
- Paranoid, schizoid, schizotypal Cluster B: bad - Borderline, antisocial, histrionic, narcissistic Cluster C: sad - Dependent, avoidant, obsessive-compulsive |
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What are examples and differences between secondary and tertiary TCAs?
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Secondary amines: nortriptyline, desipramine. Preferential NRI.
Tertiary amines: amitriptyline, imipramine. Preferential SSRIs. |
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What is trazodone? What is it used for?
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Serotonin antagonist and reuptake inhibitor (SARI).
Good for insomnia. |
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What is mirtazapine? MOA?
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NE and specific serotonergic antidepressant (NaSSA ).
Alpha-2 antagonism at presynaptic terminal results in increased release of NE and serotonin. |
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What are the components of the MSE?
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Appearance and behaviour
Cooperation, rapport and reliability Speech Mood and affect Perception Thought process/content Insight Cognitive function Judgment |
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What are the negative and positive symptoms of schizophrenia
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Negative symptoms - a loss or diminution of normal function
□ Alogia □ Affective flattening □ Avolition Positive symptoms - an excess or distortion of normal function □ Delusions □ Hallucinations □ Disorganized speech/thinking □ Disorganized or catatonic behaviour |
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Subtypes of schizophrenia
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Paranoid
Catatonic Residual Undifferentiated Disorganized |
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What is used to screen for suicide risk?
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S: Male sex
A: Older age (for males only) D: Depression P: Previous attempt E: Ethanol abuse R: Rational thinking loss S: Suicide in family O: Organized plan N: No spouse, no support systems S: Serious illness, intractable pain |
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What is magical thinking?
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A form of dereistic thinking, where thoughts, words or actions assume power.
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What is a hallucination that occurs when falling asleep called? when waking up?
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Hypnagogic hallucination.
Hypnopompic hallucination. |
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What is jamais vu?
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False feeling of unfamiliarity with a real situation that a person has experienced.
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What are the 5 categories of the MMSE?
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Orientation (time and place)
Memory (immediate and delayed recall) Attention and Concentration Language (comprehension, reading, writing, repetition, naming) Spacial ability (intersecting pentagons) <24 abnormal 20-24 mild, 10-19 moderate, <10 severe |
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Risk factors for delirium.
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Old age
Hospitalization/institutionalization Preexisting brain damage (dementia, stroke, tumor) History of delirium Alcohol dependence Diabetes Cancer Sensory impairment Malnutrition Male gender |
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List the different categories of delirium in the DSM
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Delirium due to GMC
Substance intoxication delirium Substance withdrawal delirium Delirium due to multiple etiologies Delirium NOS |
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Four key features of delirium in the DSM-IV diagnostic criteria.
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1. Disturbance of consciousness with reduced ability to focus, sustain, or shift attention.
2. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia. 3. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. 4. There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a medical condition, substance intoxication, or medication side effect. |
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Main 3 DSM-IV criteria for GAD.
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1. Excessive anxiety and worry occuring more days than not for at least 6 months, about a number of events of activities.
2. The person finds it difficult to control the worries. 3. The anxiety and worry are associated with 3 or more of the following 6 symptoms: - restlessness - fatigue - blanking of mind - irritability - muscle tension - sleep disturbance |
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Symptoms of rabies encephalitis
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Restlessness
Overactivity Agitation Hydrophobia (due to fear of severe laryngeal and diaphragmatic spasms when drinking water) |
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Main DSM-IV criteria for the dementia disorders.
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A. the development of multiple cognitive deficits manifested by both:
- memory impairment - one or more of the following: aphasia, apraxia, agnosia, disturbed executive function B. causes significant impairment in social or occupational functioning and represent significant decline from a previous level of functioning |
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Good prognostic features of schizophrenia.
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Late onset
Obvious precipitating factors Acute onset Good premorbid social, sexual and work histories Mood disorder symptoms (especially depressive disorders) Married Family history of mood disorders Good support systems Positive symptoms |
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DSM-IV-TR criteria for schizoaffective disorder.
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A. An uninterrupted period of illness during which, at some time, there is either a major depressive episode, a manic episode, or a mixed episode concurrent with symptoms that meet Criterion A for schizophrenia.
B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness. D. The disturbance is not due to substance, or a GMC. |
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What are nonbizarre delusions?
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Delusions that are about situations that can occur in real life, such as being followed, infected, loved at a distance.
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What is the definition of expansive mood?
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A person's expression of feelings without restraint, frequently with an overestimation of their significance or importance.
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Definition of grandiose delusions.
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Delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.
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In delusional disorder, somatic type, what are the three main types of somatic beliefs?
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1. infestation
2. dysmorphophobia 3. foul body odors or halitosis |
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What is Capgras' syndrome?
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Belief that a familiar person has been replaced by an imposter.
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Specify the types of Brief Psychotic Disorder.
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- with marked stressor(s)
- without marked stressor(s) - with postpartum onset: if onset within 4 weeks postpartum |
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Treatment for postpartum psychosis
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It is a psychiatric emergency.
Antidepressants and lithium. Sometimes combined with an antipsychotic. |
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What is the tactile hallucination of bugs crawling on skin most characteristic of?
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Cocaine use.
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Substances that can cause substance-induced psychotic disorder.
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Alcohol
Amphetamine Cannabis Cocaine Hallucinogen Inhalant Opioid Phencyclidine Sedative, hypnotic or anxiolytic |
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Which SSRI causes anticholinergic effect?
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Paroxetine
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Which SSRIs have the shortest halflife? longest halflife?
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Shortest:
Fluvoxamine - 15 hrs Paroxetine - 21 hrs Longest: Fluoxetine - itself has halflife of 1-3 days, but it has potent metabolite norfluoxetine, which has halflife of 4-16 days |
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Which SSRIs cannot be used together with Tamoxifen?
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Tamoxifen required CYP 2D6 to metabolize into active metabolite.
Should not use with paroxetine and fluoxetine, which are potent 2D6 inhibitors. |
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What are the symptoms experienced in serotonin discontinuation syndrome?
Which SSRI is the worst in terms of causing this? |
Dizziness, nausea, fatigue, myalgia, chills, anxiety, and irritability.
Paxil. |
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Which SSRI should be avoided in treating depression in pregnant women?
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Paroxetine - associated with CHD, especially VSD.
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What is the dosing for most SSRIs? Which ones are dosed different?
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For most SSRIs, start at 20 mg/day, titrate to 40 mg/day.
Escitalopram: 10 mg, then 20 mg. Fluvoxamine and sertraline: 50 mg, titrate to 200 mg. For fluvoxamine, split into bid dosing. |
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What is the difference between schizoaffective diorder and mood disorder with psychotic features?
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Schizoaffective disorder required at least 2 weeks of psychotic symptoms in the absence of prominent mood symptoms
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Diagnostic criteria for Paranoid PD
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Diagnosis requires 4 of:
1. Suspicious that others are exploiting or deceiving them 2. Pre-occupied with trustworthiness of acquaintances 3. Reluctant to confide in others 4. Interpret benign remarks as threatening, demeaning 5. Holds grudges 6. Perceives attacks on character and is quick to counterattack 7. Questions fidelity of partner without justification |
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Diagnostic criteria for Schizoid PD
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Diagnosis requires 4 of:
1. Does not enjoy or desire close relationships 2. Chooses solitary activities 3. Little to no interest in sexual activity with others 4. Takes pleasure in few (if any) activities 5. Few or no close friends 6. Indifference to praise or criticism 7. Emotionally cold, detached, or have flattened affect |
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Diagnostic criteria for Schizotypal PD
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Diagnosis requires 5 of:
1. Ideas of reference 2. Odd beliefs, magical thinking (inconsistent with cultural norms i.e. belief in telepathy, superstitions) 3. Unusual perceptual experiences (i.e. bodily illusions) 4. Suspiciousness 5. Inappropriate or restricted affect 6. Odd, eccentric appearance or behaviour (i.e. involved in cults, strange religious practices) 7. Few close friends 8. Odd thinking, odd speech (i.e. vague, stereotyped) 9. Excessive social anxiety |
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DSM-IV criteria for manic episode.
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A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting >1 week (or any duration if hospitalization is necessary)
PLUS at least 3 of the following: Grandiosity Sleep (decreased need) Talkative Pleasurable activities, Painful consequences Activity (goal-directed activity, or psychomotor agitation) Ideas (flight of) Distractable |
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What is the effective range of lithium?
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0.8-1.2 mEq/L
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Side effects of lithium.
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Renal: thirst, polyuria
Nervous system: tremor, ataxia, confusion, memory loss Metabolic: weight gain GI: diarrhea Derm: acne, psoriasis Thyroid: goiter, myxedema |
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Dosing of lithium.
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Start at 300 mg/day
Titrate up by 300-600 mg every 1-5 days, aim for 900-1800 mg/day |
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Prior to beginning lithium treatment, what investigations should be ordered?
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CBC, BUN, creatinine,
TSH Calcium Pregnancy test for women of childbearing potential ECG for patients over age 40 |
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GAF
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91-100 Superior functioning in a wide range of activities
81-90 Absent or minimal symptoms 71-80 If symptoms are present, they are transient and expected reactions to psychosocial stressors 61-70 Some mild symptoms or some difficulty but generally functioning well (depressed mood, mild insomnia) 51-60 Moderate symptoms or difficulty (flat affect, circumstantial speech, occasional panic attacks) 41-50 Serious symptoms or difficulty (suicidal ideation, obsessional rituals, frequent shoplifting) 31-40 Some impairment in reality testing/communication, impairment in several areas 21-30 Behaviour is influenced by delusions/hallucinations or serious impairment in communication/judgment 11-20 Some danger of hurting self or others or occasionally fails to maintain minimal hygiene or gross impairment in communication 1-10 Persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act 0 Inadequate information |
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DSM-IV criteria of "with catatonic features"
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At least 2 of:
1. motor immobility as evidenced by catalepsy (including waxy flexibility) or stupor 2. excessive motor activity (purposeless, not influenced by external stimuli) 3. extreme negativism (motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism 4. peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing 5. echolalia or echopraxia |
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Psychosocial treatment for schizophrenia.
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Psychotherapy (individual, family, group): supportive, cognitive behavioural therapy (CBT)
Assertive community treatment (ACT) Social skills training, employment programs, disability benefits Housing (group home, boarding home, transitional home) |
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DSM-IV main criterion for mixed episode.
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A. The criteria are met for a manic episode and for a MDE (except for duration) nearly every day during at least a 1-week period.
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What are the features/specifiers for MDD?
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Psychotic – with hallucinations or delusions
Chronic – lasting 2 years or more Catatonic – at least two of: motor immobility; excessive motor activity; extreme negativism or mutism; peculiarities of voluntary movement; echolalia or echopraxia Melancholic – quality of mood is distinctly depressed, mood is worse in the morning, early morning awakening, marked weight loss, excessive guilt, psychomotor retardation Atypical – increased sleep, weight gain, leaden paralysis, rejection hypersensitivity Postpartum (see Postpartum Mood Disorders) Seasonal – pattern of onset at the same time each year (most often in the fall or winter) |
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DSM-IV criteria for dysthymic disorder
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A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for >2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year
B. Presence, while depressed, of >=2 of the following: poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or difficulty making decisions feelings of hopelessness C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in criteria A and B for more than 2 months at a time |
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What is the onset of postpartum blues, and how long does it typically last?
How about postpartum depression? |
Onset 2-4 days postpartum. Usually lasts 48 h, up to 10 days.
Onset within 4 weeks postpartum. Lasts 2-6 months. |
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Treatment of premenstrual dysphoric disorder.
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1st line: SSRI fluoxetine or sertraline
2nd line: clomipramine, apraxolam for anxiety 3rd line: OCP (Yasmin), GnRH agonist (leuprolide) |
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In bipolar I, the most recent episode should be classified as with ...
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Psychotic features
Postpartum onset Seasonal pattern Rapid cycling (4 episodes in the last 12 months) |
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Psychosocial treatment for bipolar disorder
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Psychological: supportive and psychodynamic psychotherapy, cognitive or behavioural therapy
Social: vocational rehabilitation, leave of absence from school/work, drug and EtOH cessation, substitute decision maker for finances, sleep hygiene, social skills training, education for family members |
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DSM-IV criteria for panic disorder without agoraphobia.
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A. Both (1) and (2):
(1) recurrent unexpected panic attacks: a discrete period of intense fear or discomfort, in which >4 of the following symptoms develop abruptly and reach a peak within 10 minutes -sweating -trembling -unsteadiness, dizziness -depersonalization, derealization -excessive HR, palpitations -nausea -tingling -SOB -fear of dying, losing control, going crazy -chest pain -chills -choking (2) at least one of the attacks has been followed by 1 month (or more) of >1 of the following: -persistent concern about having additional attacks -worry about the implications of the attack or its consequences (e.g. losing control, having a heart attack, "going crazy") -a significant change in behavior related to the attacks B. Absence of agoraphobia |
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What is agoraphobia?
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Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or where help may not be available in the event of having an unexpected panic attack.
Fears commonly involve situations: being out alone, being in a crowd, standing in a line, or traveling on a bus |
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Psychosocial treatment of GAD.
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Psychotherapy, relaxation, mindfulness, and CBT
Caffeine and EtOH avoidance, sleep hygiene |
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DSM-IV-TR criteria of social phobia.
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A. Marked and persistent fear of social or performance situations in which person is exposed to unfamiliar people or to possible scrutiny by others; person fears he/she will act in a way that may be humiliating or embarrassing (e.g. public speaking, initiating or maintaining conversation, dating, eating in public)
B. Exposure to the feared situation almost invariably provokes anxiety which may take the form of a panic attack. C. The person recognizes the fear is excessive or unreasonable (in children, this may be absent). D. The feared social or performance situations are avoided or else are endured with intense anxiety or distress. E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning or social activities or relationships or there is marked distress about having the phobia. |
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Diagnostic criteria for phobic disorders
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Exposure to stimulus almost invariably provokes an immediate anxiety response; may present as a panic attack
Person recognizes fear as excessive or unreasonable Situations are avoided or endured with anxiety/distress Significant interference with daily routine, occupational/social functioning, and/or marked distress If person is <18 years, duration is at least 6 months |
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DSM-IV diagnostic criteria for OCD.
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A. Either obsessions or compulsions
B. Person recognizes the obsessions or compulsions are excessive or unreasonable (Note: does not apply to children) C. Cause marked distress, are time consuming (> 1 hour a day) or significantly interfere with the person's normal routine, occupational (or academic) functioning, social activities or relationships |
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Pharmacotherapy for OCD
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Clomipramine, SSRIs (higher doses and longer treatment needed than for treatment of depression, i.e. up to 8-12 weeks)
Atypical and typical antipsychotics – risperidone, haloperidol |
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DSM-IV criteria for PTSD
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A. Exposed to traumatic event
B. Re-experiences the event persistently C. Avoidance of stimuli (persistent) and numbing of general responsiveness D. Arousal increased E. Duration >= 1 month F. Significant distress of impairment in social, occupational or other important areas of functioning |
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CBT for OCD
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Flooding
Aversive conditioning Thought stopping Implosion therapy Desensitization |
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DSM-IV-TR criteria for adjustment disorder.
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A. the development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)
B. these symptoms or behaviours are clinically significant as evidenced by either of the following: (1) marked distress that is in excess of what would be expected from exposure to the stressor (2) significant impairment in social or occupational (academic) functioning C. the stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a pre-existing Axis I or Axis II disorder D. the symptoms do not represent bereavement E. once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months |
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Subtypes of adjustment disorder.
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depressed mood
anxiety mixed anxiety and depressed mood disturbance of conduct mixed disturbance of emotions and conduct unspecified |
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Causes of delirium.
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Infectious
Withdrawal from drugs Acute metabolic disorder Trauma CNS pathology Hypoxia Deficiencies in vitamins Endocrinopathies Acute vascular insults Toxins Heavy metals |
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Types of dementia.
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Alzheimer
Vascular Lewy-Body Fronto-temporal |
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Subtypes of Alzheimer's dementia.
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With or without behavioural disturbance (e.g. wandering, agitation)
Early onset (< 65 yo) Late onset (> 65 yo) |
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Differences between substance abuse and dependence.
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1. substance abuse: maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by ≥1 of the following occurring within a 12 month period:
-recurrent use resulting in failure to fulfill major role obligation -recurrent use in situations in which it is physically hazardous (e.g. driving) -recurrent substance-related legal problems -continued use despite interference with social or interpersonal function 2. substance dependence: maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by ≥3 occurring at any time in the same 12 month period: -tolerance (need for increased amount to achieve intoxication or diminished effect with same amount of substance) -withdrawal/use to avoid withdrawal -taken in larger amount or over longer period than intended -persistent desire or unsuccessful efforts to cut down -excessive time to procure, use substance, or recover from its effects -important interests/activities given up or reduced -continued use despite physical/psychological problem caused/ exacerbated by substance Use the 3 C's to remember substance dependence: Compulsive use Loss of Control Consequences of use |
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Legal limit of alcohol for impaired driving.
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17 mmol/L (80 mg/dL)
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Signs/symptoms of delirium tremens
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Autonomic hyperactivitiy (diaphoresis, tachycardia, increased respiration)
Hand tremor Insomnia Psychomotor agitation Anxiety Nausea or vomiting Grand mal seizures Visual/tactile/auditory hallucinations Persecutory delusions |
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What does CIWA-A stand for, and what are the items that are assessed?
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Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A)
1. N/V 2. Paroxysmal sweats 3. Tactile disturbances 4. Visual disturbances 5. Tremor 6. Anxiety 7. Auditory hallucinations 8. Headache, fullness in head 9. Agitation 10. Orientation and clouding of sensorium All scored 0-7, except orientation/sensorium which is 0-4. Max score 67. Mild <10 Moderate 10-20 Severe >20 |
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Features of neuroleptic malignant syndrome.
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Fever
Autonomic changes (i.e. increased HR/BP, sweating) Rigidity of muscles Mental status changes (i.e. confusion) |
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What is Wernicke-Korsakoff Syndrome?
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Wernicke’s encephalopathy (acute and reversible): triad of nystagmus (CN VI palsy), ataxia and confusion
Korsakoff’s syndrome (chronic and only 20% reversible with treatment): anterograde amnesia and confabulations; cannot occur during an acute delirium or dementia and must persist beyond usual duration of intoxication/withdrawal |
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Withdrawal symptoms for opioids
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Depression
Insomnia Drug-craving Myalgias Nausea Chills Autonomic instability (lacrimation, rhinorrhea, piloerection) |
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Cocaine withdrawal symptoms.
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Initial “crash” (1-48 hrs): increased sleep, increased appetite
Withdrawal (1-10 wks): dysphoric mood plus fatigue, irritability, vivid, unpleasant dreams, insomnia or hypersomnia, psychomotor agitation or retardation |
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Which drugs are the "date rate drugs"?
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GHB
Flunitrazepam (Rohypnol) Ketamine |
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Difference between passive and active suicidal ideation.
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Passive - would rather not be alive but doesn't admit to idea that involves act of initiation
Active - "I think about killing myself" |
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What are questions to ask in assessment of suicidal ideation?
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Onset and frequency of thoughts - “When did this start? How often do you have these thoughts?”
Control over suicidal ideation - “Can you stop the thoughts or call someone for help?” Lethality - “Do you want to end your life? Or get a ‘release’ from your emotional pain?” Access to means - “How will you get a gun?” “Which bridge do you think you would go to?” Time and place - “Have you picked a date and place? Is it in an isolated location?” Provocative factors - “What makes you feel worse (e.g. being alone)?” Protective factors - “What keeps you alive (e.g. friends, family, pets, faith, therapist)?" Final Arrangements - “Have you written a suicide note? Made a will? Given away your belongings?” Practised suicide or aborted attempts - “Have you put the gun to your head? Held the medications in your hand? Stood at the bridge?” Ambivalence - “There must be a part of you that wants to live - you came here for help” |
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List the DSM-IV somatoform disorders
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Somatization disorder
Conversion disorder Pain disorder Hypochondriasis Body dysmorphic disorder Undifferentiated somatoform disorder Somatoform disorder NOS |
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What is the definition of primary gain and secondary gain?
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In somatoform disorders:
Primary gain: somatic symptom represents a symbolic resolution of an unconscious psychological conflict; serves to reduce anxiety and conflict; no external incentive Secondary gain: the sick role; external benefits obtained or unpleasant duties avoided (e.g. work) |
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What is the difference between somatoform disorders, factitious disorder, and malingering?
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Somatoform disorders - symptoms are not intentionally produced or feigned.
Factitious disorder - intentional production or feigning of physical or psychological signs or symptoms in order to assume the sick role where external incentives (e.g. economic gain) are absent. Malingering - intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external reward (e.g. avoiding work, obtaining financial compensation or obtaining drugs). |
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DSM-IV-TR criteria for Conversion Disorder.
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A. One or more symptoms or deficits affecting voluntary motor or sensory function that mimic a neurological or general medical condition (e.g. impaired co-ordination, local paralysis, double vision, seizures or convulsions).
B. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors. C. The symptoms or deficit is not intentionally produced or feigned. |
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DSM-IV-TR criteria for somatization disorder.
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A. History of many physical complaints beginning before age 30 that occur over a period of several years and result in treatment being sought or significant functional impairment.
B. Each of the following criteria must have been met: - four pain symptoms related to at least four different sites or functions - two gastrointestinal symptoms, not including pain - one sexual symptom, not including pain - one pseudo-neurological symptom, not including pain (e.g. numbness, paresthesias) C. Either 1 or 2: 1. after appropriate investigation, each symptom in Criterion B cannot be explained by a GMC or substance/medication use 2. when there is a related GMC, the physical complaints or resulting functional impairment are in excess of what would be expected from the hx, physical exam, or lab findings. D. The symptoms are not intentionally produced or feigned. |
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DSM-IV-TR criteria for hypochondriasis.
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A. Preoccupation with fear of having, or the idea that one has, a serious disease based on a misinterpretation of one or more bodily signs or symptoms.
B. Preoccupation persists despite appropriate medical evaluation and reassurance. C. Belief is not of delusional intensity (as in delusional disorder, somatic type) as person acknowledges unrealistic interpretation, and is not restricted to a circumscribed concern about appearance. D. Causes clinically significant functional impairment. E. Duration is >6 months. |
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List the dissociative disorders.
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1. Dissociative amnesia
2. Dissociative fugue 3. Dissociative identity disorder 4. Depersonalization disorder |
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Classification of sleep disorders.
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Dyssomnias
-Primary insomnia -Primary hypersomnia -Narcolepsy -Breathing-related sleeping disorder -Circadian rhythm disturbance disorder Parasomnias -Nightmare disorder -Sleep terror disorder -Sleepwalking disorder Sleep disorder due to GMC Substance-induced sleep disorder Sleep disorder due to another mental disorder |
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DSM-IV-TR criteria of narcolepsy.
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A. Irresistable attacks of refreshing sleep that occur daily over at least 3 months.
B. One or both of the following: - cataplexy - recurrrent intrusions of REM into transition between sleep and wakefulness as manifested by either hypopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes. C. The disturbance is not due to substance, medication, or GMC |
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Treatment of narcolepsy.
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Stimulants (modafinil)
TCAs, SSRIs Scheduled naps |
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Diagnostic criteria for Borderline PD.
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Diagnosis requires 5 of:
1. Frantic efforts to avoid real or imagined abandonment 2. Unstable and intense relationships 3. Unstable sense of self 4. Impulsivity in two potentially harmful ways (sexual, drugs, spending) 5. Recurrent suicidal behaviour/self-harm 6. Unstable mood/affect 7. General feelings of emptiness 8. Difficulty controlling anger 9. Transient dissociative symptoms or paranoid ideation associated with stress Mnemonic: Impulsive Moody Paranoid under stress Unstable self image Labile intense relationships Suicidal Inappropriate anger Vulnerable to abandonment Emptiness |
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Diagnostic criteria for antisocial PD
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Diagnosis requires 3 of the following:
1. Failure to conform to social norms by committing unlawful acts 2. Deceitfulness, lying, manipulating others for personal gain 3. Impulsive, fails to plan ahead 4. Irritable, aggressive, repeated fights or assaults 5. Recklessness and disregard for personal safety, safety of others 6. Irresponsible, cannot sustain work 7. Lack of remorse for actions |
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Diagnostic criteria for narcissistic PD
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Diagnosis requires 5 of:
1. Exaggerated sense of self-importance (grandiosity) 2. Preoccupied with fantasies of unlimited success, power, beauty, love 3. Believes he/she is “special” and should associate with other “special” people 4. Requires excessive admiration 5. Sense of entitlement 6. Takes advantage of others 7. Lacks empathy 8. Envious of others or believes that others are envious of him/her 9. Arrogant attitudes |
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Diagnostic criteria for histrionic PD
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Diagnosis requires 5 of:
1. Not comfortable unless center of attention 2. Inappropriately sexually seductive 3. Uses physical appearance to attract attention 4. Speech is impressionistic, lacks detail 5. Theatrical and exaggerated expression of emotion 6. Easily influenced by others 7. Perceives relationships as more intimate than they actually are |
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Diagnostic criteria for avoidant personality disorder
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Diagnosis requires 4 of:
1. Avoids occupational activities that involve significant interpersonal contact for fear of criticism or rejection 2. Unwilling to get involved with people unless certain of being liked 3. Restrained in intimate relationships for fear of being shamed or ridiculed 4. Preoccupied with being rejected or criticized in social situations 5. Inhibited in new interpersonal situations due to fear of inadequacy 6. Views him or herself as inferior, socially inept or personally unappealing 7. Reluctant to engage in new activities for fear of embarrassment |
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Diagnostic criteria for dependent personality disorder
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Diagnosis requires 5 of:
1. Difficulty making everyday decisions without advice and reassurance from others 2. Needs others to assume responsibility for most major areas of his/her life 3. Difficulty expressing disagreement 4. Difficulty initiating projects due to lack of self-confidence 5. Goes to excessive lengths to obtain support 6. Uncomfortable or helpless when alone because of fear of being unable to take care of him/herself 7. Urgently seeks another relationship as a source of care and support when a close relationship ends 8. Unrealistically preoccupied with fears of being left to take care of him/herself |
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Diagnostic criteria for obsessive compulsive personality disorder
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iagnosis requires 4 of:
1. Preoccupation with details, rules, lists, order, organization, or schedules to extent that point of activity is lost 2. Perfectionism interferes with task completion 3. Excessively devoted to work to the exclusion of leisure activities and friendships 4. Inflexible about morality/ethics/values 5. Unable to discard worthless objects of no sentimental value 6. Reluctant to delegate tasks to others 7. Miserly spending style (money is hoarded for future disasters) 8. Rigid and stubborn |
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List the pervasive developmental disorders.
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Autistic disorder
Asperger's disorder Rett's disorder Childhood disintegrative disorder PDD NOS |
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DSM-IV-TR criteria for autistic disorder.
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A. A total of six items from 1,2,3, with at least two from 1, and one from 2,3
1. impaired social interaction 2. impaired communication 3. restricted and repetitive behaviours, interests and activities D. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: social interaction, language as used in social communication, or symbolic or imaginative play C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder |
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DSM-IV-TR criteria for Asperger's disorder
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A. Impaired social interaction.
B. Restricted repetitive and stereotyped patterns of behaviour, interests and activities. C. The disturbance causes clinically significant impairment in social, occupation, or other important areas of functioning. D. There is no clinically significant impairment in language. E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behaviour and curiosity about the environment in childhood. |
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DSM-IV-TR criteria for ADHD.
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A. 6 or more symptoms of inattention and/or hyperactivity.
B. Onset before age 7 C. Symptoms present in at least two settings. D. Interferes with academic, family and social functioning. E. Does not occur exclusively during the course of another psychiatric disorder |
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Symptoms of inattention in ADHD.
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Careless mistakes
Cannot sustain attention in tasks or play Does not listen when spoken to directly Fails to complete tasks Disorganized Avoids, dislikes tasks that require sustained mental effort Loses things necessary for tasks or activities Distractible Forgetful |
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Symptoms of hyperactivity and impulsivity in ADHD.
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Fidgets, squirms in seat
Leaves seat when expected to remain seated Runs and climbs excessively Cannot play quietly On the go, driven by a motor Talks excessively Blurts out answers before questions completed Difficulty awaiting turn Interrupts/intrudes on others |
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DSM-IV-TR criteria for conduct disorder.
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A. >=3 of these in past 12 months, and >=1 in past 6 months
-Theft -Rule breaking -Aggression to ppl, animals, weapons, forced sex -Property destruction B. Disturbance causes clinically significant impairment in social, academic or occupational functioning C. If the individual is 18 years or older, criteria is not met for antisocial personality disorder. |
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What skills does dialectical behaviour therapy focus on?
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Mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance
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Contraindications for bupropion.
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Seizure, stroke, brain tumour, brain surgery or closed head injury
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Side effects of ECT.
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Risk of anesthesia, memory loss (may be retrograde and/or anterograde, tends to resolve by 6 to 9 months, permanent impairment controversial), headaches, myalgias
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Contraindication to ECT.
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Increased intracranial pressure
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What disorders are Tourette's disease often associated with?
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ADHD and OCD.
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Pharmacological treatment of Tourette's disease.
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Clonidine start at 0.025 mg/day
Tetrabenazine start at 6.25 mg/day Risperidone start at 0.25 mg/day Haloperidol start at 0.25 mg/day Pimozide start at 0.5 mg/day |
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DSM-IV-TR criteria for mental retardation.
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A. IQ <=70.
B. Concurrent deficits in present adaptive functioning in at least two of the following areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety. C. Onset before age 18 |
