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100 Cards in this Set

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Definition of insomnia?
condition in which sleep is unrefreshing or nonrestorative; also describes an inability to fall asleep or maintain sleep.
Diagnostic criteria for narcolepsy
*irresistible attacks of refreshing sleep that occur daily over at least 3 months
*presence of one or both of the following:
1. cataplexy: sudden loss of postural tone without loss of consciusness; typically triggered by emotional stimulus
2. recurrent intrusions of REM sleep into the transition between sleep and wakefulness as manifested by one of the following:
 Sleep paralysis at the beginning or end of sleep
 Hypnagogic hallucination: hallucination while going to sleep
 Hypnopompic hallucination: while awakening
Treatment of narcolepsy
structured nighttime sleep and daytime naps; alerting agents (modafinil, or Provigil) or stimulants
what should you NOT use for long-term for treatment of sleep disorders.

Why not?
BZ;
they can result in dependence or tolerance.
Substances that can cause insomnia:
1. xanthines (caffeine, theophylline)
2. alcohol (can also cause hypersomnolence) – “Know alcohol impacts sleep architecture.”
3. nicotine
sleep terrors--
def?
waking the child during?
age?
gender?
family Hx?
significance?
Sleep terror D/O (Pavor nocturnus): child looks terrified, screams, and appears to be staring with dilated pupils; sweating, rapid pulse and hyperventilation; child is confused and cannot be comforted; child rapidly returns to sleep when the episode is over and in the morning has no memory of the event.
-Waking the child during the event may exacerbate or prolong the episode.
-3-6 y/o (isolated episodes are common throughout childhood)
-boys > girls
-considered to be developmental and not caused by anxiety or distress during the day
-family history is common;
-spontaneous resolution by adolescence
-no psychiatric conditions are typically associated with this D/O.
-Treatment is education of parents, reassure them that does not indicate serious neuro/psych problem (medications used only if episodes are frequent or physical danger for child; low dose diazepam).
systemic effects of obstructive sleep apnea
“Has huge systemic effects—Know them!”:
-Pulm HTN
-systemic HTN
-obesity/hypothyroidism
-decreased libido/erectile dysfxn
-irritability/personality change
-depression
-cognitive changes/dementia

Associated psychiatric D/Os:
1. MDD
2. Dysthymic D/O
3. Panic D/O
4. Dementia
somnambulism:
-describe
-age?
-prognosis?
-et?
-Tx?
Somnambulism (sleepwalking): episodes last a few minutes to 30 min; occurs 1-3 hours after onset of sleep, during stage 3 or 4 (non-REM) sleep
Etiology:
-overtired, stressed
-familial
-internal stimuli (urinary urgency, restless leg syndrome)
-external stimuli (noise)
Age of onset: 4-8 yrs/ peak prevalence= 12 yrs
Prognosis: most remit spontaneously by age 15
Treatment: safety precautions, low dose diazepam; maintain regular sleep schedule
Effects of MDD on sleep:
Non-REM changes:
-prolonged sleep latency (latency=time delay)
-shortened REM latency (thus REM starts sooner)
-increased wakefulness
-decreased arousal threshold
-early morning awakening
-reduced stages 3 and 4
REM changes: shorter REM latency and redistribution of REM to first half of night
who should treat Adjustment D/O?
A primary care physician should be able to provide therapy for uncomplicated adjustment D/O; meds and psych eval are not always necessary
Adjustment D/O criteria
Development of emotional or behavioral symptoms in response to an identifiable stressor; occurs within 3 months of the onset of the stressor; once the stressor has terminated, the symptoms do not persist for more than an additional 6 months
Adjustment D/O With Depressed Mood:
Acute: the disturbance lasts less than 6 mo
Chronic: disturbance lasts for at least 6 mo
Adjustment D/O With Depressed Mood falls short of criteria for major depressive D/O. If meet full criteria for MDD (p. 3 of this review), the Dx is MDD.
Impulse D/O:
-how common?
-egosystonic? egodystonic?
-do ppl have conscious resistance to impulse?
-premeditated?
-what if intoxicated with substance?
-Impulse D/Os are not rare. They are much more common than believed.
Behavior can be egosystonic (congruent with immediate conscious wish of the individual) or egodystonic or both.
Features common to D/Os of impulse control: failure to resist an impulse, drive, or temptation to perform an act harmful to oneself or to others.
EXAM- Ppl do not always have conscious resistance to impulse.
-Some maladaptive acts can be premeditated, eg pyromania
-The maladaptive behavior cannot be due to intoxication with a substance.
Bipolar I
BPI=presence currently or in the past of at least one full-blown manic or mixed episode (last >7 days) (and one or more major depressive episodes);
*must have mania + major depressive episode in the same day to = Bipolar I AKA Mixed Episode
Bipolar II
BPII= at least one hypomanic episode (last >4 days) and one or more major depressive episodes; “BP lite”
-Hypomanic (“Mel”)
1. Functionality never greatly impaired. (Mel even got a promotion.)
2. No psychotic D/O
3. No hospitalization
similarity b/w Bipolar I and II
1 Criteria in common: Major depressive episode; (also “irritability”—Pam Deaver, per Dr Talley)
what psychiatric Dz has strongest genetic basis?
EXAM—Bipolar is extremely genetic. Of all psychiatric D/O, bipolar has strongest genetic basis and strong penetrance!
lifetime prevalence of Bipolar I
1%
lifetime prevalence of MDD
16.6%
lifetime prevalence of Anxiety Depressive D/O
15-18%
criteria for MDD
"D SIG E CAPS":

5 or more of the following symptoms present in the same 2 week period: (must have either depressed mood or loss of interest/pleasure in activities as one of five symptoms): “D SIG E CAPS”
• Depressed mood
• Sleep disturbance
• Interest (lack of)
• Guilt
• Energy (pervasive loss of)
• Concentration (difficulty with)
• Appetite (lack of)
• Psychomotor activity (reduced)
• Suicide intent
mood congruent vs. mood incongruent psychotic features
mood congruent psychotic features= delusions or hallucinations whose content has typical depressive themes of personal inadequacy, guilt, disease, nihilism, poverty, or deserved punishment (i.e. voices say they’re worthless and encourage suicide; that they’re responsible for plight of 3rd world country)
mood incongruent psychotic features= content doesn’t involve typical depressive themes. Included are: persecutory delusions (not directly related to depressive themes), thought insertion, thought broadcasting, and delusions of control (i.e. the army is out to get them)
Other features may present as masked depression (complaints of somatic symptom
s rather than complaining of feeling depressed); especially in elderly. May have pseudodementia (appear to have cognitive impairment, but actually lack motivation to answer questions).
masked depression
complaints of somatic symptom
s rather than complaining of feeling depressed); especially in elderly
pseudodementia
(appear to have cognitive impairment, but actually lack motivation to answer questions).
Premenstrual Dysphoric D/O:
-Dx criteria?
-what does it look like? how distinguish?
>5 of following Sx present during last wk of luteal phase and absent postmenses, with >1 Sx being either 1, 2, 3, or 4:

1. markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
2. marked anxiety, tension, or feelings of being “keyed up” or “on edge”
3. marked affective lability (moodiness)
4. persistent or marked anger or irritability/ increased interpersonal conflicts
5. physical symptoms including headaches, swelling
6. may worsen with age; may exacerbate some GMCs
7. etc
on what axis are Mood D/O?
Axis I (all on Axis I except personality D/O and MR--which are on Axis II)
on what axis are Personality D/O?
Axis II
on what axis is Bereavement?
Axis I (although Bereavement is not a mood d/o!)
bereavement
Not a mood D/O
Axis I
May present with symptoms characteristic of a major depressive episode (sadness, insomnia, weight loss), however, the bereaved person tends to view the depressed mood as “normal” and comes to see a physician for somatic symptoms (ex: insomnia, H/A).
Features not present in normal bereavement
1. Guilt about things other than actions taken or not taken by survivor
2. Suicidal ideation (thoughts of death other than feelings that he/should would be better off dead or should have died with the decreased person)
3. morbid preoccupation with worthlessness
4. marked psychomotor retardation
5. prolonged and marked functional impairment
6. seeing image of deceased; MAY transiently have auditory hallucinations of hearing deceased person’s voice—this is normal.
how distinguish b/w Acute Stress D/O and PTSD?
Distinguish by time difference

ASD: Symptoms appear within 1 month (minimum of 2 days and a maximum of 4 weeks), immediately in aftermath of traumatic event

PTSD: symptoms last longer than 1 month
what is this an example of:

Person is scared of bridges and goes out of their way (elaborately) to avoid bridges
specific phobia
what is this an example of?
how Tx?

Person is anxious about giving a speech in front of people at a business meeting.
social phobia

Tx: short term use of a beta-blocker (eg propanolol)
-how recognize OCD?
-how Tx OCD?
-OCD ppl like to control things!
-Treatment= SSRI (counterintuitive; NOT with BZ or other Anti-Anxiety agent)
-how Dx Generalized Anxiety D/O?
-Tx?
Generalized Anxiety D/O: excessive anxiety and worry about a number of events and activities persisting at least 6 mo
-Treatment= SSRIs
descriptor for Cluster A?
"odd, eccentric"
descriptor for Cluster B
"dramatic, erratic"
descriptor for Cluster C?
"anxious"
what cluster--"odd, eccentric"
Cluster A
what cluster--"dramatic, erratic"
cluster B
what cluster--"anxious"
Cluster C
what cluster--paranoid
Cluster A
what cluster--schizoid
A
what cluster--schizotypal
A
what cluster--antisocial
B
what cluster--histrionic
B
what cluster--narcisstic
B
what cluster--borderline
B
what cluster--avoidant
C
what cluster--dependent
C
what cluster--obsessive compulsive
C
what personality D/O--excessive emotionality and attention seeking
-"drama queen"
Histrionic
what personality D/O--
-instability of interpersonal relationships, self-image and affect
-marked impulsivity beginning by early adulthood
-abandonment frantically avoided
Borderline
defense mech of Borderine PD
1. projective identification—Know definition (below). Recognize from case vignette & know it’s associated with BPD.
2. dissociation—They do this when they are stressed.

Projective identification= unacceptable feelings in one’s self are projected onto another person as one acts in such a way to create the projected feelings in the other person; e.g. patient is angry, and the doctor becomes angry as well
Dissociation= feels like she’s outside her body;
pervasive pattern of disregard for and violation of rights of others occurring since age 15
antisocial PD
what personality D/O:
need for admiration and lack of empathy for others
narcisstic
how act with a narcisstic pt
don’t be self-effacing, don’t suggest they seek psychiatric help, do subtly acknowledge their importance (“mirroring”).
what personality D/O:
-pervasive social detachment and a limited range of emotional expression, without other striking communicative or behavioral eccentricities
-solitary, few friends
-relationships of no interest
-activities not enjoyed
schizoid PD
chronic pattern of eccentric communication and behavior with cognitive and perceptual distortion of the environment, resulting in impairment in the capacity to form social relationships, symptoms must not be part of the course for schizophrenia or another psychotic D/O
schizotypal PD
def of schizoid PD?
def of schizotypal PD?
“Know”Schizoid PD= pattern of pervasive social detachment and a limited range of emotional expression, without other striking communicative or behavioral eccentricities; symptoms must not be part of the course for schizophrenia or another psychotic D/O; SIR SAFE; S= solitary lifestyle, I= indifferent to praise or criticism, R= relationships of no interest, S= sexual experiences not of interest, A= activities not enjoyed, F= friends lacking, E= emotionally cold and detached

Schizotypal PD= chronic pattern of eccentric communication and behavior with cognitive and perceptual distortion of the environment, resulting in impairment in the capacity to form social relationships, symptoms must not be part of the course for schizophrenia or another psychotic D/O
-Schizotypal (vs. Schizoid) often develop schizophrenia;
UFO AIDER; U= unusual perceptions, F= friendless except for family, O= odd beliefs/ speech, A= affect inappropriate and constricted, I= ideas of reference, D= doubts others/ suspicious, E= eccentric, R=reluctant in social situations
what often becomes schizophrenia?
schizotypal Personality D/O
which psychotherapy uses learning theory?
Behavior Therapy
behavior psychotherapy
applies learning theory to symptomatic behavior
cognitive psychotherapy
theoretical basis; psychopathology occurs when cognitive processes distorts reality (thus, work on how ppl think thru things); depressive anxious symptoms result; example: cognitive traid of depression: view of self is negative
5 types of psychotherapy
1. Behavior therapy= applies learning theory to symptomatic behavior; does not concern itself with unconscious dynamics, technique is positive reinforcement and extinction, desensitization, and aversion therapy;
2. Cognitive therapy= theoretical basis; psychopathology occurs when cognitive processes distorts reality (thus, work on how ppl think thru things); depressive anxious symptoms result; example: cognitive traid of depression: view of self is negative, interpretation of experience is self-deprecating and catastrophic and view of future is hopeless; ID and alter cognitive distortions/ no focus on resolving underlying conflicts
3. Explorative psychotherapy= anxiety increased during therapy, uncovering of unconscious material occurs;
a. psychoanalysis (working through unconscious childhood conflicts and focusing on reexperiencing childhood relationships recreated with the analyst)
b. psychodynamic= focused more on current conflicts, dynamics patterns, and defense mechanisms; uses suggestion, reality testing, education and confrontation
c. brief dynamic= narrowly defined focus on current functioning; quick interaction with therapist
4. Supportive= reinforces patients coping; suppresses disturbing psychological material and reduces anxiety, strengthens intellectualization and rationalization,
5. Interpersonal= assumes connection between onset of D/O and interpersonal context; tries to improve current interpersonal skills and communications
what kind of drug is phenelzine?
MAOi
what kind of drug is Nardil?
MAOi
what kind of dryg is Parnate
MAOi
S/E of MAOi
People on MAOi’s can die from Hypertensive crisis= ingesting tyramine rich foods (cheese, chianti, fava beans, pickled herring) headache, vomiting, fever
S/E of SSRI's
(1) serotonin syndrome= excess 5HT in CNS; myoclonus, hyperreflexia, shivering, confusion and tremor; stop medicine and give propranolol or cyproheptadine
(2) serotonin discontinuation syndrome=
if stop abruptly (should taper):
-shock-like sensations
-nausea
-disequilibrium
-dysphoria
-agitation,
-occurs especially with Paxil (short half-life)
what drug class is amitriptyline
TCA
what drug class is Elavil
TCA

mneum: "ELEVate your mood with the TCA ELAVil"
what drug class is imipramine
TCA
what drug class is Tofranil
TCA
S/E of TCA
S/E=Narrow therapeutic margin of safety (150-300 mg is therapeutic dose and 1 g is toxic dose) easy to OD (this can kill them); quinidine-like effect (Type 1 antiarrhythmic);
what drug class is clozapine
atypical
what drug class is Clozaril
atypical
what drug class is risperidone
atypical
what drug class is Risperdal
atypical
what drug class is quetiapine
atypical
S/E of atypical antipsychotics
Certain (not all) atypicalsMetabolic syndrome= abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP (Atypicals can make you fat!)
atypical vs. typical antipsychotics
Atypicals treat negative symptoms of schizophrenia/ have better side effect profile (no EPS).
Rx for Bipolar
lithium salts (narrow margin of safety, lots of bad S/Es) (mood stabilizer)
anticonvulsants: valproic acid (=Depakote: USE IT!! safer than lithium, S/E are weight gain and GI upset), carbamazepine (Tegretol)
most effective Tx for MDD
Electroconvulsive Therapy
what is executive fxn
ability to plan, organize, sequence, monitor, inhibit complex goal-directed activities; ex=clock drawing or balancing check book; sign of frontal lobe pathology)
failure to balance a checkbook indicates problem with what?
executive fxn
Alz Dz
• Gradual progressive onset
• Cognitive defects not due to another disorder (metabolic, neurological)
• Early stage- pts have insight and highest risk of suicide
• Amyloid and neuritic plaques, neurofibrillary tangles
• Neurotransmitter- decreased ACh in nucleus basalis of Meynert
• Treatment- acetylcholinesterase inhibitors
time periods for schizophreniform vs schizophrenia
Schizophreniform D/O- meets criteria for schizophrenia, for >1mo, but <6mo

Schizophrenia
>6 months of continuous signs of prodromal disturbance (i.e. poor hygiene, social withdrawal), including >1 month of Active Phase—also NOT due to GMC or Substance:

>2 of the following for a significant portion of time during one-month period:
a. Delusions
b. Halluc
c. Disorganized speech
d. Grossly disorganized or catatonic behavior
e. Negative Sx
what class is thorazine
typical
what class is chloropromazine
typical
what class is haloperidol
typical
what class is clozapine
clozapine works best!
atypical
S/E=agranulocytosis
what works best ?
clozapine
what class is clorazil
clozapine works best!
atypical
S/E=agranulocytosis
whwta class is olanzapine
atypical
S/E=metabolic syndrome (abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP)
what class is zyprexa
atypical
S/E=metabolic syndrome (abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP)
what class is risperidone
S/E=metabolic syndrome (abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP)
what class is Risperdal
S/E=metabolic syndrome (abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP)
what class is quetiapine
atypical
what class is Seroquel
atypical