Psychopath-Phase 2

Front 1

Definition of insomnia?

Back 1

condition in which sleep is unrefreshing or nonrestorative; also describes an inability to fall asleep or maintain sleep.

Front 2

Diagnostic criteria for narcolepsy

Back 2

*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

Front 3

Treatment of narcolepsy

Back 3

structured nighttime sleep and daytime naps; alerting agents (modafinil, or Provigil) or stimulants

Front 4

what should you NOT use for long-term for treatment of sleep disorders.

Why not?

Back 4

BZ;
they can result in dependence or tolerance.

Front 5

Substances that can cause insomnia:

Back 5

1. xanthines (caffeine, theophylline)
2. alcohol (can also cause hypersomnolence) – “Know alcohol impacts sleep architecture.”
3. nicotine

Front 6

sleep terrors--
def?
waking the child during?
age?
gender?
family Hx?
significance?

Back 6

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).

Front 7

systemic effects of obstructive sleep apnea

Back 7

“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

Front 8

somnambulism:
-describe
-age?
-prognosis?
-et?
-Tx?

Back 8

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

Front 9

Effects of MDD on sleep:

Back 9

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

Front 10

who should treat Adjustment D/O?

Back 10

A primary care physician should be able to provide therapy for uncomplicated adjustment D/O; meds and psych eval are not always necessary

Front 11

Adjustment D/O criteria

Back 11

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

Front 12

Adjustment D/O With Depressed Mood:

Back 12

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.

Front 13

Impulse D/O:
-how common?
-egosystonic? egodystonic?
-do ppl have conscious resistance to impulse?
-premeditated?
-what if intoxicated with substance?

Back 13

-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.

Front 14

Bipolar I

Back 14

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

Front 15

Bipolar II

Back 15

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

Front 16

similarity b/w Bipolar I and II

Back 16

1 Criteria in common: Major depressive episode; (also “irritability”—Pam Deaver, per Dr Talley)

Front 17

what psychiatric Dz has strongest genetic basis?

Back 17

EXAM—Bipolar is extremely genetic. Of all psychiatric D/O, bipolar has strongest genetic basis and strong penetrance!

Front 18

lifetime prevalence of Bipolar I

Back 18

1%

Front 19

lifetime prevalence of MDD

Back 19

16.6%

Front 20

lifetime prevalence of Anxiety Depressive D/O

Back 20

15-18%

Front 21

criteria for MDD

Back 21

"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

Front 22

mood congruent vs. mood incongruent psychotic features

Back 22

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).

Front 23

masked depression

Back 23

complaints of somatic symptom
s rather than complaining of feeling depressed); especially in elderly

Front 24

pseudodementia

Back 24

(appear to have cognitive impairment, but actually lack motivation to answer questions).

Front 25

Premenstrual Dysphoric D/O:
-Dx criteria?
-what does it look like? how distinguish?

Back 25

>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

Front 26

on what axis are Mood D/O?

Back 26

Axis I (all on Axis I except personality D/O and MR--which are on Axis II)

Front 27

on what axis are Personality D/O?

Back 27

Axis II

Front 28

on what axis is Bereavement?

Back 28

Axis I (although Bereavement is not a mood d/o!)

Front 29

bereavement

Back 29

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).

Front 30

Features not present in normal bereavement

Back 30

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.

Front 31

how distinguish b/w Acute Stress D/O and PTSD?

Back 31

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

Front 32

what is this an example of:

Person is scared of bridges and goes out of their way (elaborately) to avoid bridges

Back 32

specific phobia

Front 33

what is this an example of?
how Tx?

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

Back 33

social phobia

Tx: short term use of a beta-blocker (eg propanolol)

Front 34

-how recognize OCD?
-how Tx OCD?

Back 34

-OCD ppl like to control things!
-Treatment= SSRI (counterintuitive; NOT with BZ or other Anti-Anxiety agent)

Front 35

-how Dx Generalized Anxiety D/O?
-Tx?

Back 35

Generalized Anxiety D/O: excessive anxiety and worry about a number of events and activities persisting at least 6 mo
-Treatment= SSRIs

Front 36

descriptor for Cluster A?

Back 36

"odd, eccentric"

Front 37

descriptor for Cluster B

Back 37

"dramatic, erratic"

Front 38

descriptor for Cluster C?

Back 38

"anxious"

Front 39

what cluster--"odd, eccentric"

Back 39

Cluster A

Front 40

what cluster--"dramatic, erratic"

Back 40

cluster B

Front 41

what cluster--"anxious"

Back 41

Cluster C

Front 42

what cluster--paranoid

Back 42

Cluster A

Front 43

what cluster--schizoid

Back 43

A

Front 44

what cluster--schizotypal

Back 44

A

Front 45

what cluster--antisocial

Back 45

B

Front 46

what cluster--histrionic

Back 46

B

Front 47

what cluster--narcisstic

Back 47

B

Front 48

what cluster--borderline

Back 48

B

Front 49

what cluster--avoidant

Back 49

C

Front 50

what cluster--dependent

Back 50

C

Front 51

what cluster--obsessive compulsive

Back 51

C

Front 52

what personality D/O--excessive emotionality and attention seeking
-"drama queen"

Back 52

Histrionic

Front 53

what personality D/O--
-instability of interpersonal relationships, self-image and affect
-marked impulsivity beginning by early adulthood
-abandonment frantically avoided

Back 53

Borderline

Front 54

defense mech of Borderine PD

Back 54

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;

Front 55

pervasive pattern of disregard for and violation of rights of others occurring since age 15

Back 55

antisocial PD

Front 56

what personality D/O:
need for admiration and lack of empathy for others

Back 56

narcisstic

Front 57

how act with a narcisstic pt

Back 57

don’t be self-effacing, don’t suggest they seek psychiatric help, do subtly acknowledge their importance (“mirroring”).

Front 58

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

Back 58

schizoid PD

Front 59

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

Back 59

schizotypal PD

Front 60

def of schizoid PD?
def of schizotypal PD?

Back 60

“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

Front 61

what often becomes schizophrenia?

Back 61

schizotypal Personality D/O

Front 62

which psychotherapy uses learning theory?

Back 62

Behavior Therapy

Front 63

behavior psychotherapy

Back 63

applies learning theory to symptomatic behavior

Front 64

cognitive psychotherapy

Back 64

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

Front 65

5 types of psychotherapy

Back 65

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

Front 66

what kind of drug is phenelzine?

Back 66

MAOi

Front 67

what kind of drug is Nardil?

Back 67

MAOi

Front 68

what kind of dryg is Parnate

Back 68

MAOi

Front 69

S/E of MAOi

Back 69

People on MAOi’s can die from Hypertensive crisis= ingesting tyramine rich foods (cheese, chianti, fava beans, pickled herring) headache, vomiting, fever

Front 70

S/E of SSRI's

Back 70

(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)

Front 71

what drug class is amitriptyline

Back 71

TCA

Front 72

what drug class is Elavil

Back 72

TCA

mneum: "ELEVate your mood with the TCA ELAVil"

Front 73

what drug class is imipramine

Back 73

TCA

Front 74

what drug class is Tofranil

Back 74

TCA

Front 75

S/E of TCA

Back 75

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);

Front 76

what drug class is clozapine

Back 76

atypical

Front 77

what drug class is Clozaril

Back 77

atypical

Front 78

what drug class is risperidone

Back 78

atypical

Front 79

what drug class is Risperdal

Back 79

atypical

Front 80

what drug class is quetiapine

Back 80

atypical

Front 81

S/E of atypical antipsychotics

Back 81

Certain (not all) atypicalsMetabolic syndrome= abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP (Atypicals can make you fat!)

Front 82

atypical vs. typical antipsychotics

Back 82

Atypicals treat negative symptoms of schizophrenia/ have better side effect profile (no EPS).

Front 83

Rx for Bipolar

Back 83

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)

Front 84

most effective Tx for MDD

Back 84

Electroconvulsive Therapy

Front 85

what is executive fxn

Back 85

ability to plan, organize, sequence, monitor, inhibit complex goal-directed activities; ex=clock drawing or balancing check book; sign of frontal lobe pathology)

Front 86

failure to balance a checkbook indicates problem with what?

Back 86

executive fxn

Front 87

Alz Dz

Back 87

• 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

Front 88

time periods for schizophreniform vs schizophrenia

Back 88

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

Front 89

what class is thorazine

Back 89

typical

Front 90

what class is chloropromazine

Back 90

typical

Front 91

what class is haloperidol

Back 91

typical

Front 92

what class is clozapine

Back 92

clozapine works best!
atypical
S/E=agranulocytosis

Front 93

what works best ?

Back 93

clozapine

Front 94

what class is clorazil

Back 94

clozapine works best!
atypical
S/E=agranulocytosis

Front 95

whwta class is olanzapine

Back 95

atypical
S/E=metabolic syndrome (abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP)

Front 96

what class is zyprexa

Back 96

atypical
S/E=metabolic syndrome (abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP)

Front 97

what class is risperidone

Back 97

S/E=metabolic syndrome (abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP)

Front 98

what class is Risperdal

Back 98

S/E=metabolic syndrome (abdominal obesity, glucose intolerance, ↑TG, hyperlipidemia; ↑BP)

Front 99

what class is quetiapine

Back 99

atypical

Front 100

what class is Seroquel

Back 100

atypical