Psychiatry / Behavioral Science

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‘Stereotyped Hand Wringing, Washing &Sucking” ↓Learned Behaviors, decelerations of Head growth in a female child after a period of Normal function after birth.

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RETT'S SYNDROME

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OBSESSION WITH VIDEO GAMES, RACE CARS, CARTOONS, & BUGS. NO LANGUAGE DELAY OR MENTAL RETARDATION. LARGE DEGREASE W/ SOCIAL INTERACTION + REPETITIVE PATTERS & HYPERSENSITIVE TO NOISES, FOOD, ODORS, TASTES & CLOTHING

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ASPERGER'S D/O

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Eating D/O; that is refusal to maintain healthy body weight & fear of gaining wt

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Anorexia Nervosa

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S/S: Depression, Irritability, Insomnia, ↓ Libido/Wt., Amenorrhea, Abdominal pain, Constipation, Cold Intolerance, lethargy, Emaciation (Bony) Hypotension, Dental Erosions, Abrasions/Calluses on the back of Hand (due to Induced Vomiting) Dry Skin

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Anorexia Nervosa

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Eating D/O that is Recurrent Binge Eating followed by Purging

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Bulimia Nervosa

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Normal BMI

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18.5 -24.9

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Development of emotional & behavioral symptoms 3 mo. after stressed Life Event & Ends in 6 mo.
Symptoms are not caused by Bereavement

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Adjustment

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Depression that Occurs in winter months & is due to ↓ Daylight.

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Seasonal Depression

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Treatment for Seasonal Depression in Elderly patients?

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Buproprion

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Major Depression 2 wks – 6 Mo. Postpartum. Symptoms are Severe & concerns of the baby (thoughts of harming/inability to take care of it)

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Postpartum Depression

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Chronic Depressive D/O for 2 years. Sadness Loss of Interest/Withdrawal from activities for 2 years or more. Symptoms are mild but longer lasting.

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Dysthymic:

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Chronic Mood disturbance with Depression & Hypo mania for 2 years. Occasionally will Escalate to Full blown Manic or Depressive episodes

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Cyclothymic Disorder

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White Male > 45 with a detailed plan, Recent Severe Loss, Poor Support System, Health, Substance Abuse are @ an increased risk for?

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Suicide

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Presence of one full-fledged manic or mixed episode & depressive episodes. Alternation of Manic & Depressive Episodes (Commonly begins with Depression)

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Bipolar I disorder

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One or more Major Depressive Episodes + a Hypomanic Episode

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Bipolar II disorder

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Bipolar I disorder & Bipolar II disorder
Treatments

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1. Lithium (monitor lithium Lv. 4-8 wks)
2. Valporic Acid
3. Olanzapine
4. Carbamazapine
5. Group Therapy

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Pervasive distrust & Suspicious of others (M > W)
Has recurrent suspicions of Spouse Cheating
Reluctant to Trust others & has Persistent Grudges

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PARANOID

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Lifelong pattern of Social withdrawal (M > W)
No desire for Close friends Relationships (including Family)
Little to No Desire in sex with another personDetached Flattened Effect

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SCHIZOID

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“Odd beliefs or Magical Thinking”
Odd thinking/Speech/ Eccentric Behavior & belief in Superstition

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SCHIZOTYPAL

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Deceitful/Disregard for rights & feelings of others that starts in childhood (Must be 18 y/o before DX can be made) (M > F)
Exploit/Manipulate others for materialistic gain & personal gratification
Fail to conform to social norms(Unlawful behavior) & Tend to get into fights & Extremely irresponsible
Abnormal EEG may be seen
Episodes ↓ in older age

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ANTISOCIAL

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Pt cannot be alone & self-mutilation & Manipulative Suicides are Common

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BORDERLINE

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Overly Emotional/Dramatic Seductive (F > M) Attention Seeking behavior & exaggerates their thoughts & feelings Easily influenced by others & needs to be the Center off Attention
Will act out a role (VICTIM or PRINCESS)

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HISTRIONIC

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Inflated Self-Image, Grandiosity, Need for Admiration & Lacks Empathy Believe that they are Superior/Unique & expect others to Treat them that way

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NARCISSISTIC

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Sensitivity to Rejection (Inferior Complex/Low Self Esteem)
Feels inadequate & avoid activities for fear of Criticism/Rejection
Feels Unappealing & Inferior to others Described by others as “Shy, Timid, Lonely & Isolated

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AVOIDANT

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Submissive/Clinging Behavior & shows Excessive need to be taken care of (F > M) Difficulty with daily decisions w/o advice from others
Have difficulty disagreeing with people because of Fear of Losing support

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DEPENDENT

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Pattern of Orderliness, perfectionism & Pt’s Are aware of their D/O & will seek help (Unlike the other Personality D/o)
Rigid/Stubborn & insist that thing are done their way

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OBSESSIVE COMPULSIVE

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Non-bizarre delusions (False Beliefs)that last > 1 month
Delusions are situations that can occur in real life (Being followed, poisoned, infected, Deception by a Spouse/Loved one

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DELUSIONAL D/O

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Loss of contact with Reality, Hallucinations, Delusions
Hallmark Symptoms: Delusions, Hallucinations, Disorganized thinking/emotional prob.

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SCHIZOPHRENIA

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Delusions or Auditory Hallucinations with Preservation of Cognitive Function/Affect

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PARANOID SCHIZOPHRENIA

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Disorganized Speech/Behavior & Flat or Inappropriate Affect

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DISORGANIZED SCHIZOPHRENIA

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Motor disturbance (Immobility, Excessive motor activity, Mutism, Stupor (Lacks Cognitive Function & ↓ LOC)

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Catatonic Schizophrenia

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Schizophrenia Symptoms are Mixed & Don’t meet the criteria of the other Subtypes

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Undifferentiated Schizophrenia

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Schizophrenia + Major Depressive Episode or Manic Episode or Mixed Episode + Delusions or Hallucinations > 2 weeks

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Schizoaffective Disorder

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The expression of Mental Phenomena’s as Physical (Somatic) Symptoms that can't be explained by a Physical D/O & Leads to Seeking Medical Eval & TX

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Somatization

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Many physical Complaints < 30 y/o (W > M)
Pain, GI, Sexual, & Neuro c/o with Many Health care Visits w/o a Medical Dx being found.
Pt will c/o of symptoms of GI Tract, Reproductive, Back pain, Neuro complications

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Somatization Disorder

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Preoccupation with a Imagined or Slight defect in Appearance that Pt. feels it causes Stress in Occupational, Social Functioning (Any Body part)
Many undergo Medical, Dental, Surgical treatment to Correct Flaw

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Body Dysmorphic Disorder

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Neuro complaints that can not be explained (W > M) Symptoms are NOT INTENTIONALLY Produced & may be Tics, Weakness, Parasthesia’s Tunnel Vision, Deafness, Seizures & Commonly Dx in Adolescents/ early adulthood

*Most Common Symptoms* Shifting Paralysis, blindness & Mutism

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Conversion Disorder

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Pt’s Fake the Sick Role w/o External Gain Symptoms may be Mental, Physical or Both If confronted they will become Angry & Check out

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Factitious Disorder

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Pt’s Fake the Sick Role for External Gain (Lawsuit, Work, free Hospital Stay)

Symptoms will be more severe than what is Observed & pt will not except a Clean Bill of Health

Symptoms Improve when Objective Met or Plot Exposed

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Malingering

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Belief or Fear of having or contracting a Serious Illness
Coexists with Anxiety & Depression

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Hypochondriasis

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Pain in one or more areas w/o an Identifiable cause & impairs function
> 6months
W > M onsets @ 30 y/o

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Pain Disorder

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WHAT ARE THE C.A.G.E. SCREENING ?'S FOR ETOH & DRUG USE?

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C: CUT DOWN
A: ANNOYED
G: GUILTY
E: EYE OPENER

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Overwhelming involvement & spending a lot of time obtaining the drug & results in Substance-seeking Behavior

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Addiction:

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Need to increase drug dose to produce effect originally achieved with smaller doses

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Tolerance:

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Results in Physiological changes with drug use & withdrawal symptoms when stopping drug

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Physical Dependence

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Feelings of satisfaction & a desire to repeat the drug

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Psychological Dependence

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*Most common abused drug:

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Alcohol, Nicotine, & Caffeine*(Opiates, Barbiturates, Benzodiazepines & OTC meds

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Episodic drinking that result in failure to fulfill obligations, Legal, Social problems w/o evidence of Abuse

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ETOH ABUSE:

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Frequent consumption of large amounts of ETOH over time that results in Tolerance/Dependence & Dangerous Withdrawal Syndrome

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ETOH DEPENDENCE

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Prevention of Wernicke-Korsakoff Syndrome in an Alcoholic?

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1. THIAMINE + VIT. B12
2. Valium

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ETOH ABUSE/DEPENDENCE TREATMENTS?

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1. THIAMINE + VIT. B12
2. Valium
3. Antabuse
4. 12 Step Program AAA

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Drug that reverses any Opiod Drug?

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Naloxone

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Drug that causes "Extreme Pupil Dilation" & is TX with?

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Cocaine:
IV Barbiturates (Phenobarbital) or Diazepam

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Tobacco Use/Tobacco Dependence is TX with ?

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TX: Nicotine patches/gum/Nasal spray or Buproprion (Zyban) or Clonidine

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Young patients present with conditions that are questionable for Physical/Emotional/Sexual abuse or Neglect
*Must consult with a Mental Health Provider & Family Services*

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Child Abuse

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Child with Unexplained Injuries inconsistent with HX, Doughnut shaped bruises in a Stocking Glove distribution

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Child Abuse

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Child w/ STD’s, Bruises, Pain, Itching of the Genital or Anal Area. Sexual Knowledge not for current age

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Child Sexual Abuse

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Domestic Violence Plan of Actions ?
1.
2.
3.
4.

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1. Immediate Medical attention
2. Inform patient there are choices
3. Referral to Shelters/Support Grp
4. Pt.to choose course of Actions
**Estimated that a woman who leaves an Abusive partner has a 70% risk of being Killed*

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Normal Response to a Major Loss
Normal Grief symptoms < 1 year

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Uncomplicated Bereavement

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Sudden Onset of Intense Fear in the Absence of Real Danger

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PANIC ATTACK

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Recurrent unexpected Panic Attacks; Persistent concerns of having another Panic Attack
Some Pt’s may Change behavior to response of attacks (ex. Quit Job)

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PANIC D/O

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Excessive, daily anxiety & worrying X > 6 months

Most Patients will have another Psychiatric D/O ( Major Depression, Phobia

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GENERALIZED ANXIETY D/O

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Severe anxiety disorder that develops after exposure or witness to a Traumatic event
Can be due to War, Rape, MVA, Threats of death, Child abuse, Learning about death harm to a close friend/family member

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PTSD

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An irrational, intense and persistent fear of certain situations, activities, things, animals, or people. (Intense Fear)

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PHOBIA

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Persistent Pattern of Inattention, Hyperactivity, & Impulsivity

Symptoms must occur At Home/Work/School for DX

And must have 6 symptoms of either > 6 Months for DX

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ADD / ADHD

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Ongoing pattern of disobedient, hostile, defiant behavior towards Adults & Authority figures beyond normal childhood behavior; (B > G)

Lacks Conscience & violates the Rights of others

Hallmark is “Interpersonal Style with Irritability & Defiance”

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OPPOSITIONAL DEFIANT D/O

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Neural development D/O characterized by impaired social interaction, communication & repetitive behavior.
Symptoms begin before 3 y/o
S/S: Lack of attachment, Avoids eye Gaze, Does not Change Patterns, Intense Attachment to objects, Speech/Language Problems

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AUTISM

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AXIS I of the DSM includes?

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All mental D/O + Substance abuse & Developmental D/O

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AXIS II of the DSM includes?

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Personality D/O + Mental Retardation

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AXIS III of the DSM includes?

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General medical condition or Physical D/O

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AXIS IV of the DSM includes?

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Psychosocial,environmental situations: Homeless

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WHAT IS AXIS V?

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Level of Daily Function based on Social Occupational & Psychological assessment