Usmle2 Psychiatry

Front 1

What are the parts of the General Description of the Psychiatric Patient?

Back 1

Appearance: grooming, poise, clothes, body type (disheveled, neat). Behavior: quantitative and qualitative aspects of the patient?s motor behavior (restless, tics). Attitude toward the examiner: (cooperative, frank, and seductive).

Front 2

What is the Definition of Mood?

Back 2

A sustained emotion. Mood is a pervasive and sustained emotional "climate." Types of mood include: dysphoric, elevated, euthymic, expansive, irritable, depression, anger, and anxiety.

Front 3

What is Affect?

Back 3

Behavior that expression of a subjectively experienced emotion. Affect refers to fluctuating changes in emotional "weather." Types of affect include: euthymic, irritable, constricted; blunted; flat; inappropriate, and labile.

Front 4

What is Appropriateness of Behavior?

Back 4

Suitability or compatibility of behavior in reference to the context of the situation (appropriate or inappropriate).

Front 5

What are the Aspects of Speech?

Back 5

The physical characteristics of speech (relevant, coherent, fluent, excitable).

Front 6

What are the three types of Perceptual Disturbances?

Back 6

The three broad types of perceptual disturbances are hallucinations, pseudohallucinations and illusions.

Front 7

What are the Elements of Thought?

Back 7

Form of thought, which includes the way in which a person thinks (flight of ideas, loose associations, tangentiality, circumstantiality).

Front 8

What is Content of Thought?

Back 8

Topic of thought that the person is actually thinking about, such as delusions, paranoia, or suicidal ideas.

Front 9

What are the Elements of Sensorium and Cognition?

Back 9

Alertness, orientation, memory, concentration and attention, capacity to read and write, visuospatial ability, abstract thinking, fund of information.

Front 10

What tests are used to evaluate Concentration and Attention?

Back 10

Serial sevens and ability to spell backwards.

Front 11

How is Visuospatial Ability tested?

Back 11

The capacity to visually perceive the spatial relationship between objects, such as the ability to draw two overlapping pentagons.

Front 12

How is Abstract Thinking tested?

Back 12

The ability to reduce the information to a concept, such as interpretation of proverbs (eg, known truths, social norms, or moral values).

Front 13

How is Fund of Information and Knowledge tested?

Back 13

Calculating ability, naming of past presidents.

Front 14

How is Judgment and Insight assessed?

Back 14

By the ability to act appropriately and self-reflect, such as making sound, appropriate, and reasonable decisions.

Front 15

What is the Id?

Back 15

The id consists of the drives (instincts) that are present at birth. There are two drives: sex and aggression.

Front 16

What is the Ego?

Back 16

Defense mechanisms, judgment, relation to reality, object relationships. The ego is developed shortly after birth.

Front 17

What is the Superego?

Back 17

Superego is the conscience, formed during latency period. Superego is the part of the unconscious that is formed through internalization of the moral standards of parents and society. Superego censors and restrains ego.

Front 18

What are defense mechanisms?

Back 18

The methods that the ego uses to ward off anxiety and control instinctive urges and unpleas-ant affects (emotions). Defense mechanisms are: unconscious (except suppression), discrete, dynamic and irreversible, and adaptive and maladaptive.

Front 19

What are some types of defense mechanisms?

Back 19

Denial, repression, and suppression, projection, splitting, blocking, regression.

Front 20

What is projection?

Back 20

Attributing one?s own wishes, thoughts, or feelings to someone else, such as attributing one?s own feeling to the weather, the government, or other people.

Front 21

What is denial?

Back 21

The avoidance of becoming aware of some painful aspect of reality, which is unpleasant.

Front 22

What is splitting?

Back 22

External objects are divided into all good or all bad, such as idealizing people and devaluing them in relationships. The patient doesn?t realize that there is both good and bad in each person.

Front 23

What is blocking?

Back 23

Blocking is the cessation of thought to avoid confronting an unpleasant idea, such as a married woman who forgets the name of her new boss because she has an uncomfortable attraction.

Front 24

What is regression?

Back 24

Return to an earlier stage of development, usually an immature stage.

Front 25

What is romatization?

Back 25

Psychic derivatives are converted into bodily symptoms, such as chronic pain, problems with the digestive or nervous systems, and irritable bowel syndrome.

Front 26

What is introjection?

Back 26

Features of the external world are taken and made part of the self, such as when a child envelops representational images of his absent parents into himself, simultaneously fusing them with his own personality.

Front 27

What is displacement?

Back 27

An emotion or drive is shifted to another that resembles the original in some aspect, such as a person punching cushions when angry or getting angry at a friend when he is actually upset about an exam grade.

Front 28

What is repression?

Back 28

An idea or feeling is withheld from consciousness, such as unconscious forgetting.

Front 29

What is intellectualization?

Back 29

Excessive use of intellectual processes to avoid affective expression or experience.

Front 30

What is isolation?

Back 30

Separation of an idea from the affect that accompanies it.

Front 31

What is rationalization?

Back 31

Rational explanations are used to justify unacceptable attitudes, beliefs, or behaviors.

Front 32

What is reaction formation?

Back 32

An unacceptable impulse is transformed into an emotion that is opposite. It is a defensive process in which anxiety-producing or unacceptable emotions and impulses are mastered by exaggeration of the directly opposing tendency.

Front 33

What is undoing?

Back 33

Acting out the reverse of an unacceptable behavior, such as ?I need to wash my hands whenever I have these thoughts.?

Front 34

What is sublimation?

Back 34

Impulse gratification is achieved by changing the aim or object from unacceptable to an acceptable form; allows instincts to be channeled. Examples are altruism, anticipation, humor, identification, and introjection.

Front 35

What is suppression?

Back 35

Conscious forgetting, such ways as refusing to talk about a traumatic event until some time afterwards; only conscious defense mechanism.

Front 36

What is dissociation?

Back 36

Splitting off of the brain from conscious awareness, such as trauma or drugs, which allows the mind to distance itself from experiences that are too much for the psyche to process at that time.

Front 37

What is the intelligence quotient (IQ)?

Back 37

Measures academic performance, which is derived from one of several different standardized tests designed to assess intelligence.

Front 38

What is the Minnesota Multiphasic Personality Inventory (MMPI)?

Back 38

A personality test that uses an empirical keying approach, which means that the clinical scales were derived by selecting items endorsed by patients known to have been diagnosed with certain pathologies.

Front 39

What are projective tests?

Back 39

Used for ambiguous stimuli, revealing hidden emotions and internal conflicts. Testing includes: Rorschach test (inkblot), Thematic Apperception Test (TAT), sentence completion, drawings.

Front 40

What is the objective of neuropsychologic tests?

Back 40

Used to distinguish organic neurologic disorders from psychiatric disorders: Bender-Gestalt, Luria-Nebraska, Halted-Reitan.

Front 41

What are the theories on human development by Erik Erikson?

Back 41

Erikson believed that human personality was determined by childhood and adult experiences. His theory of human development covers infancy to old age. Stages are determined by cri-ses, which are the turning points of the stages.

Front 42

What is Stage 1 of Erikson?s Theory of Human Development?

Back 42

Basic Trust versus Mistrust (birth to 1 year). Infants develop a feeling of trust that their wants will be satisfied; if the parent is not atten-tive, the infant will learn to mistrust.

Front 43

What is Stage 2 of Erikson?s Theory of Human Development?

Back 43

Autonomy versus Shame and Doubt (1 to 3 years). Children have a sense of mastery over themselves and their drives. They can be coop-erative or stubborn. Children gain a sense of their separateness from others.

Front 44

What is Stage 3 of Erikson?s Theory of Human Development?

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Initiative versus Guilt (3 to 5 years). Initiative stimulants motor and intellectual activity. Sexual curiosity is present; sibling rivalry.

Front 45

What is Stage 4 of Erikson?s Theory of Human Development?

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Industry versus Inferiority (6 to 11 years). The child enters a program of learning and becomes able to work and acquire adult skills. Children learn that they are able to master and complete a task.

Front 46

What is Stage 5 of Erikson?s Theory of Human Development?

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Identity versus Role Diffusion (11 years through end of adolescence). Group identity develops and there is a preoccupation with appearances. Adolescent learns to deal with morality and ethics.

Front 47

What is Stage 6 of Erikson?s Theory Of Human Development?

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Intimacy versus Isolation (21 to 40 years). There is development of intimacy of sexual relations, friendships. The person learns to care and share with others without fear of losing self.

Front 48

What is Stage 7 of Erikson?s Theory Of Human Development?

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Generativity versus Stagnation (40 to 65 years). The individual deals with raising children as well as other interests outside the home. If childless, there is the development of altruism and creativity.

Front 49

What Is Stage 8 of Erikson?s Theory Of Human Development?

Back 49

Integrity versus Despair (over 65 years). The individual attains a sense of satisfaction with one?s life. Allows for an acceptance of one?s place in the life cycle.

Front 50

What was the primary belief of Jean Piaget?

Back 50

Piaget believed that intelligence was an extension of biologic adaptation and had a logical struc-ture. His theory consisted on how children and adolescents think and acquire knowledge.

Front 51

What is Stage 1 of Piaget?s theory of when children (birth to 2 years) acquire knowledge?

Back 51

Sensorimotor Stage. Infants begin to learn through sensory observation and gain control of their motor functions through activity, exploration, and manipulation of the environment. Object permanence is achieved.

Front 52

What is stage 2 of Piaget?s theory of when children (2-7 years) acquire knowledge?

Back 52

The child uses symbols and language more extensively. Children are egocentric, use ani-mistic thinking, and have a sense of immanent justice. Death is reversible. There is a lack the law of conservation.

Front 53

What is Stage 3 of Piaget?s theory of when children (7-11 years) acquire knowledge

Back 53

Egocentricity is replaced by operational thought; therefore, they can see things in other?s perspective. The law of conservation is understood, and death is understood to be irreversible at age 10.

Front 54

What is Stage 4 of Piaget?s theory of when children (age 11 to the end of adolescents) acquire knowledge?

Back 54

Ability to think abstractly, reason deductively, and define concepts. Characterized by hypothetical thinking and deductive reasoning.

Front 55

What did Sigmund Freud believe regarding children?s sex drives?

Back 55

Freud believed that children were influenced by sexual drives. He noted that infants were capable of sexual activity from birth, the initial stages being nongenital.

Front 56

What is the oral stage of Freud?s theory of children?s sex drive?

Back 56

Birth to 18 months. The mouth is the main site of gratification and is manifested by chewing, biting, and sucking.

Front 57

What is the anal stage of Freud?s theory of children?s sex drive?

Back 57

1 to 3 years. The anus is the main site of gratification. If harsh toilet training, may become anally fixated, resulting in obsessive-compulsive personality disorder.

Front 58

What is the phallic stage 3 of Freud?s theory of children?s sex drive?

Back 58

3 to 5 years. The genital area is the main site of gratification. Penis envy and fear of castration occur during this stage. Increase in genital masturbation with fantasies involving the opposite-sex parent, resulting in the oedipal complex.

Front 59

What is the latency stage 4 of Freud?s theory of children?s sex drive?

Back 59

5-11 years. Formation of the superego, resolution of the Oedipal complex. Sexual interests dur-ing this period are quiescent. There is sublimation of sexual energy into ener-getic learning and play activities.

Front 60

What is Freud?s theory of children?s sex drive?

Back 60

Genital stage (11 years to adulthood). Capacity for true intimacy.

Front 61

What is mental retardation?

Back 61

Significantly subaverage intellectual function (IQ less than 70), as mea-sured by a variety of IQ tests, accompanied by concurrent impairment in adapting to demands in various environments. The onset is before 18 years of age.

Front 62

What are risk factors for mental retardation?

Back 62

Inborn errors of metabolism, chro-mosomal abnormalities. Rubella, CMV, other viruses. Exposure to toxins, alcohol, hypoxia, malnutrition. Postnatal toxins/infection, poor prenatal care, heavy metals, trauma, social deprivation.

Front 63

What is the prevalence of mental retardation?

Back 63

1% of the population. Occurs at a 1.5:1 male-to-female ratio.

Front 64

What is mild retardation?

Back 64

IQ of 50-70. Academic skills can be attained to sixth-grade level. Often live independently or with minimal supervision. May have problems with impulse control, self-esteem and may have con-duct disorders, substance-related disorders, ADHD.

Front 65

What is moderate retardation?

Back 65

IQ 35-50. Academic skills can be attained to a second-grade level; may be able to manage activities of daily living; live in residential community settings; problems conforming to social norms.

Front 66

What is severe retardation?

Back 66

Severe (IQ 20-35) and profound retardation (IQ less than 20): Little or no speech. Very limited abilities to manage self-care; requires highly supervised care settings.

Front 67

What are the diagnostic test abnormalities in Mental Retardation?

Back 67

Amniocentesis: May reveal chromosomal abnormalities associated with mental retardation in high-risk pregnancies (mother >35 years of age).

Front 68

What is the treatment of mental retardation?

Back 68

Special education techniques may improve ultimate level of function. Behavioral guidance and attention to promoting self-esteem may improve long-term emotional adjustment.

Front 69

What is the differential diagnosis of mental retardation?

Back 69

Includes learning and communication disorders, sensory impairment, autistic disorder, borderline intellectual functioning (IQ 70-100), and environmental deprivation.

Front 70

What are learning disorders?

Back 70

Learning achievement substantially below expectations, given the patient?s age, intelligence, sensory abilities, and educational experience. Types are reading disorder (most common), mathematics disorder, and disorder of written expression.

Front 71

What are the causes of learning disorders?

Back 71

Caused by general medical conditions, such as cerebral palsy, lead poisoning, and fetal alcohol syndrome. Many cases have no obvious etiology.

Front 72

What is the prevalence of mental retardation?

Back 72

5% of school-age children.

Front 73

What is the usual age of diagnosis of mental retardation?

Back 73

Diagnosed during elementary school. Motor problems may be present. Conduct disorder, oppositional defiant disorder, ADHD may be present. School failure and behavioral disturbances may occur.

Front 74

What diagnostic tests are used for mental retardation?

Back 74

IQ testing and academic achievement tests are the major diagnostic tools.

Front 75

What is the differential diagnosis of learning disorders?

Back 75

Environmental deprivation, hearing or vision impairment, and mental retardation.

Front 76

What is Autistic Disorder?

Back 76

Qualitative impairments in social interaction, communication, imaginative activities, and interests.

Front 77

What are the causes of Autistic Disorder?

Back 77

CNS damage caused by known or unknown factors. Medical con-ditions associated with autistic disorder include encephalitis, maternal rubella, PKU, tuberous sclerosis, fragile X syndrome, perinatal anoxia. Etiology unknown.

Front 78

What is the prevalence of Autistic Disorder?

Back 78

0.04% of the general population. Occurs at a 5:1 male-to-female ratio. Onset of autistic disorders. Before 3 years of age.

Front 79

What are social symptoms of Autistic Disorder?

Back 79

Lack of peer relationships and a failure to use nonverbal social cues.

Front 80

What are communicative symptoms of Autistic Disorder?

Back 80

Absent or bizarre use of speech.

Front 81

What are behavioral symptoms of autistic disorders?

Back 81

Odd preoccupation with repetitive activities, bizarre manner-isms, and rigid adherence to purposeless ritual. Mental retardation is present in 75% of patients with autistic disorder.

Front 82

What are the physical findings of Autistic Disorder?

Back 82

Higher incidence of abnormal electroencephalograms, sei-zures, and abnormal brain morphology. Self-injuries caused by head banging or biting are sometimes present.

Front 83

What is the disease course of Autistic Disorder?

Back 83

30% of individuals with autistic disorder become semi-inde-pendent in adulthood, but almost all have severe disabilities. Predictors of a poor outcome are mental retardation and failure to develop speech. Seizures in 25%.

Front 84

What is the treatment of Autistic Disorder?

Back 84

Family counseling, special education, and newer antipsy-chotic medications to control episodes of severe agitation or self-destructive behavior.

Front 85

What is the differential diagnosis of Autistic Disorder?

Back 85

Major rule-outs are mental retardation, hearing impairment, environ-mental deprivation, selective mutism, Rett syndrome, and Asperger syndrome.

Front 86

What is Attention-Deficit-Hyperactivity Disorder?

Back 86

Inattention, hyperactivity, and impulsivity that interfere with social or academic function. Symptoms last for at least 6 months, and onset before 7 y. Symptoms in multiple settings.

Front 87

What are the risk factors for Attention-Deficit-Hyperactivity Disorder?

Back 87

No specific etiology has been identified. Other CNS pathology and disadvantaged family and school situations are sometimes present.

Front 88

What is the prevalence of Attention-Deficit-Hyperactivity Disorder?

Back 88

5% of school-age children. 9:1 male-to-female ratio. Family history of mood and anxiety disorders, substance-related disorders, and antiso-cial-personality disorder.

Front 89

What is the onset of Attention-Deficit-Hyperactivity Disorder?

Back 89

Usually first recognized when the child enters school, and symptoms usually persist throughout childhood. ADHD persists into adulthood in 30% of affected indi-viduals.

Front 90

What are the symptoms of Attention-Deficit-Hyperactivity Disorder?

Back 90

Short attention span, fidgeting, inability to sit still, inability to wait in lines, failure to stay quiet or sit still in class, disobedience, shunning by peers, fighting, poor academic performance, carelessness, poor relationships with siblings.

Front 91

What coexisting conditions are associated with Attention-Deficit-Hyperactivity Disorder?

Back 91

Low self-esteem, mood lability, conduct disorder, learning disorders, motor skills disorder, communication disorders, drug abuse, school failure, and physical trauma as a result of impulsivity.

Front 92

What are the diagnostic tests of Attention-Deficit-Hyperactivity Disorder?

Back 92

IQ tests and various structured symptom-rating scales are often used by teachers and parents.

Front 93

What is the differential diagnosis of Attention-Deficit-Hyperactivity Disorder?

Back 93

Major rule-outs are age-appropriate behavior, response to environ-mental problems, mental retardation, autistic disorder, and mood disorders.

Front 94

What is the treatment of Attention-Deficit-Hyperactivity Disorder?

Back 94

Multiple-sensory modalities for teaching, instructions that are short and frequently repeated, immediate reinforcement for learning, and minimization of distractions. Methylphenidate (Ritalin), other amphetamines, antidepressants, and clonidine.

Front 95

What is Conduct Disorder?

Back 95

Persistent violations in four areas: aggression, property destruction, deceitfulness or theft, and rules.

Front 96

What are the risk factors for Conduct Disorder?

Back 96

Genetic influences play a role by affecting temperament. Stressful family and school environments have been implicated. Prevalence is 10% of school-age children. Occurs at a 9:1 male-to-female ratio.

Front 97

What is the onset of Conduct Disorder?

Back 97

Most often during late childhood or early adolescence.

Front 98

What is the course Conduct Disorder?

Back 98

In most individuals, the symptoms gradually remit.

Front 99

What are the symptoms of conduct disorder?

Back 99

Bullying, fighting, cruelty to people or animals, rape, vandalism, fire-setting, theft, robbery, running away, and/or school truancy.

Front 100

What are the complications of Conduct Disorder?

Back 100

Substance-related disorders and school failures.

Front 101

What are the outcomes of Conduct Disorder?

Back 101

Often, antisocial personality disorder, somatoform disorders, depressive disorders, and substance-related disorders.

Front 102

What is the differential diagnosis of Conduct Disorder?

Back 102

Major rule-outs are environmental problems, ADHD, and oppositional defiant disorder.

Front 103

What is the treatment of Conduct Disorder?

Back 103

Healthy group identity and role models are provided by structured sports pro-grams and other programs. Structured-living settings that place value on group identification and cooperation are useful.

Front 104

What is Oppositional Defiant Disorder?

Back 104

Persistent pattern of negativistic, hostile, and defiant behaviors toward adults, including arguments, temper outbursts, vindictiveness, and deliberate annoyance.

Front 105

What are the causes of Oppositional Defiant Disorder?

Back 105

High reactivity and increased motor behavior are may predispose to this disorder. Inconsistent or poor parenting may also contribute. 10% of school-age children. Occurs at a 1:1 male-to-female ratio.

Front 106

What is the onset of Oppositional Defiant Disorder?

Back 106

Usually in latency (6 years to puberty) or early adolescence and may start gradually. Onset later in girls.

Front 107

What problems are associated with Oppositional Defiant Disorder?

Back 107

Family conflict and school failure, low self-esteem and mood lability, early onset of substance abuse, ADHD and learning disorders. Family conflict often escalates after the onset of symptoms.

Front 108

What is Child Enuresis?

Back 108

Disorder characterized by repeated voiding of urine into clothes or bed in a child at least 5 years of age. Diagnosed only if the behavior is not caused by a medi-cal condition.

Front 109

What are the causes of Child Enuresis?

Back 109

Current psychologic stress, family history of enuresis, and urinary tract infections.

Front 110

What is the prevalence of Child Enuresis?

Back 110

3% of children aged 10. Slightly more common in boys. May occur only at night, only during daytime, or both.

Front 111

What is the treatment of Child Enuresis?

Back 111

Appropriate toilet training and avoiding large amounts of fluids before bed, decrease emotional stressors, and rewarding the child with praise for a dry bed. A bell-pad apparatus is sometimes used. Imipramine and desmopressin (DDAVP).

Front 112

What is Stranger Anxiety?

Back 112

Stranger anxiety: Fear of strangers in unfamiliar contexts that is present from 8 months to 2 years of age.

Front 113

What is Separation Anxiety?

Back 113

Fear of separation from the caregiver that is present from approximately 1 to 3 years of age.

Front 114

What factors predispose to Normal Childhood Anxiety?

Back 114

Excessively close-knit families, excessive expectations of children, and innate temperamental anxiety all predispose.

Front 115

What is the prevalence of Normal Childhood Anxiety?

Back 115

Five percent of school-age children.

Front 116

What are the symptoms of Normal Childhood Anxiety?

Back 116

Physical complaints: stomachaches and malaise, fears. nightmares, various phobias such as school phobia and fear of animals or the dark, difficulty sleeping, and self-mutilation such as scratching, nail-biting, and hair-pulling.

Front 117

What is the treatment of Normal Childhood Anxiety?

Back 117

Cognitive behavioral therapy is useful to decrease anxiety in older children. SSRIs and benzodiazepines are useful.

Front 118

What are complications of Normal Childhood Anxiety?

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Social avoidance, low self-esteem, and inhibited social development may occur.

Front 119

What is Tourette Syndrome?

Back 119

Tourette Syndrome is a neurological disorder characterized by tics: involuntary, rapid, sudden movements or vocalization, which occur repeatedly.

Front 120

What is the cause of Tourette Syndrome?

Back 120

Autosomal dominant transmission may occur in some cases. Associations between ADHD and obsessive-compulsive disorder. Abnormalities in the dopaminergic and adrenergic system.

Front 121

What is the prevalence of Tourette Syndrome?

Back 121

Five per 10,000. Twice as frequent in males.

Front 122

What is the onset of Tourette Syndrome?

Back 122

Onset before the age of 18. Vocal and motor tics wax and wane over time.

Front 123

What are motor tics?

Back 123

Quick eye blinks or eye jerks. Lip licking. Head twitches or head jerks. Shoulder shrugs. Muscle tensing.

Front 124

What are vocal tics?

Back 124

Grunting, barking, and hissing. Sniffing, snorting, or throat-clearing.

Front 125

What comorbid problems are associated with Tourette Syndrome?

Back 125

ADHD and obsessive-compulsive disorder are present in one-third of cases. Lifelong course with remissions and exacerbations.

Front 126

What is the treatment of Tourette Syndrome?

Back 126

High-potency antipsychotic drugs, including pimozide, haloperidol, and risperi-done. Clonidine and clonazepam are sometimes useful.

Front 127

What is Major Depressive Disorder?

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Mood disorder with depressed mood or anhe-donia. that presents with at least a 2-week course of symptoms that is a change from the patient?s previous level of functioning.

Front 128

What are the risk factors for Major Depressive Disorder?

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Major depression is seen more frequently in women. There is also a higher incidence in those who have no close interper-sonal relationships. Other risk factors include family history, exposure to stressors, and behavioral reasons.

Front 129

What is the presentation of Major Depressive Disorder?

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Depressed mood, anhedonia; weight loss or gain; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; worthlessness or guilt; diminished ability to concentrate; recurrent thoughts of death.

Front 130

What are the physical examination findings associated with Major Depressive Disorder?

Back 130

Psycho-motor retardation, stooped posture, slowing of movements, slowed speech. Cognitive impairment. Abnormal dexamethasone suppression or thyrotropin-releasing hormone test.

Front 131

What is the treatment of Major Depressive Disorder?

Back 131

Pharmacotherapy includes antidepressant medications such as SSRIs. Tricyclic antidepressants, or monoamine oxidase inhibitors. Electroconvulsive therapy may be indicated if the patient is suicidal or worried about side effects from medications.

Front 132

What is the differential diagnosis of Major Depressive Disorder?

Back 132

Medical disorders: Hypothyroidism, Parkinson?s disease, dementia, medications, pseudodementia, tumors, cerebrovascular accidents. Other mood disorders, substance disorders, and grief.

Front 133

What is Bipolar I Disorder?

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A mood disturbance in which the patient typically experiences manic symptoms for at least 1 week that cause significant distress or impairment in level of functioning.

Front 134

What are the risk factors for Bipolar I Disorder?

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Affects men and women equally; mean age of onset of 30 years. More prevalent in high-socioeconomic status. Genetic linkage. Coexisting disorders may include anxiety, alcohol dependence, and substance-related disorders.

Front 135

What is the presentation of Bipolar I Disorder?

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Persistently elevated mood lasting 1 week; increased self-esteem or grandiosity; distractibility; excessive involvement in activities; talkative; psychomotor agitation; flight of ideas; increased sexual activity; increased goal-directed activity.

Front 136

What are the physical examination findings associated with Bipolar I Disorder?

Back 136

Psycho-motor agitation and pressured speech.

Front 137

What is the treatment of Mood Disorder?

Back 137

Pharmacotherapy includes mood stabilizers, benzodiazepines, and antipsychotics. Individual psychotherapy is also indicated.

Front 138

What is the differential diagnosis of Mood Disorder?

Back 138

Mental disorders: Schizophrenia, personality disorders. Medical disorders: CNS infections, tumors, hyperthyroidism, and medications

Front 139

What is Dysthymic Disorder?

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A chronic disorder characterized by a depressed mood that lasts most of the time during the day and is present on most days for at least 2 years.

Front 140

What are the risk factors for Dysthymic Disorder?

Back 140

More common in women who are younger than 64 years of age, unmarried, and young individuals from low-income families. Patients typically have anxiety, substance abuse, and/or borderline personality disorder.

Front 141

What is the treatment of Dysthymic Disorder?

Back 141

Long--term individual insight-oriented psychotherapy to help them overcome their long-term sense of despair and resolve conflicts from childhood. Medications include SSRIs, TCAs, or MAOIs.

Front 142

What is the differential diagnosis of Dysthymic Disorder?

Back 142

Hypothyroidism, Parkinson?s, dementia, medications, pseudodementia, tumors, CVA. Other mood disorders, substance disorders, and grief; minor depressive disorder and recurrent brief depressive disorder.

Front 143

What is Cyclothymic Disorder?

Back 143

A chronic disorder characterized by many periods of depressed mood and many periods of hypomanic mood for at least 2 years. A milder form of Bipolar II Disorder.

Front 144

What are the risk factors for Cyclothymic Disorder?

Back 144

Many patients have interpersonal and marital difficulties. Frequently coexists with borderline personality disorder and is seen more frequently in women. Family history of bipolar disorder. Alcohol, substance abuse.

Front 145

What is the treatment of Cyclothymic Disorder?

Back 145

Antimanic drugs such as lithium, carbamazepine, and valproic acid are the drugs of choice. Psychotherapy focuses on helping the patients gain insight into their ill-ness and cope with it.

Front 146

What is the differential diagnosis of cyclothymic disorder?

Back 146

Medical: Seizures, substances, and medications. Mental: Other mood disorders, personality disorders.

Front 147

What is Seasonal Affective Disorder?

Back 147

Disorder characterized by depressive symptoms found during winter months and absent during summer months. Caused by abnormal melatonin metabolism (decreased MSH).

Front 148

What is the treatment of Seasonal Affective Disorder?

Back 148

Phototherapy or sleep deprivation.

Front 149

What are the 5 Stages of Death and Dying?

Back 149

Stage 1: Shock and denial. Stage 2: Anger. Stage 3:Bargaining. Stage 4: Depression. Stage 5: Acceptance.

Front 150

What is Schizophrenia?

Back 150

Schizophrenia is a thought disorder that impairs judgment, behavior, and ability to interpret reality. Symptoms must be present for a period of at least 6 months to make the diagnosis.

Front 151

What are the causes of Schizophrenia?

Back 151

Schizophrenia has been associated with high levels of dopamine and abnormalities in serotonin. It is associated with families that are critical, intrusive, and hostile. Schizophrenia is more prevalent in low-socioeconomic status.

Front 152

What is the presentation of Schizophrenia?

Back 152

Hallucinations (mostly auditory); delusions (mostly bizarre); disorganized speech or behavior; catatonic behavior; negative symptoms; usually experience social and or occupational dysfunction; saccadic eye movements, hypervigilance.

Front 153

What are psychologic tests for Schizophrenia?

Back 153

Score lower on all IQ tests. Neuropsychologic tests usually are consistent with bilateral frontal and temporal lobe dysfunction. Personality tests may show bizarre ideations.

Front 154

What is the treatment of Schizophrenia?

Back 154

Hospitalization is usually recommended for stabilization or safety of the patient. Antipsychotic medications are indicated to help control both positive and negative symptoms. Clozapine.

Front 155

What are the symptoms of Schizophrenia?

Back 155

Positive symptoms (hallucinations, delusions, racing thoughts), negative symptoms (apathy, lack of emotion, poor or nonexistant social functioning), and cognitive symptoms (disorganized thoughts, difficulty completing tasks, memory problems).

Front 156

What is the presentation of Paranoid-Type Schizophrenia?

Back 156

These patients typically have preoccupation with one or more delu-sions and/or hallucinations, involving grandeur or persecution.

Front 157

What are the risk factors for Paranoid-Type Schizophrenia?

Back 157

These patients tend to be older; typical age of onset is in late twenties or thirties.

Front 158

What is the presentation of Disorganized-Type Schizophrenia?

Back 158

Disorganized speech and behavior; flat or inappropriate affect; marked regression to primitive, disinhibited behavior; severe thought disorder; poor contact with reality. These patients tend to be younger than 25.

Front 159

What is the presentation of Catatonic-Type Schizophrenia?

Back 159

Psychomotor disturbances, ranging from severe retardation to excitation; extreme negativism; peculiarities of voluntary movements; mutism is very common.

Front 160

What are complications Catatonic-Type Schizophrenia?

Back 160

Exhaustion, malnutrition, self-inflicted injury, or hyperpyrexia.

Front 161

What is Undifferentiated-Type Schizophrenia?

Back 161

Schizophrenia with features of more than one of the different types of schizophrenia without a clear predominance of a particular set of diagnostic characteristics.

Front 162

What is the presentation of Undifferentiated-Type Schizophrenia?

Back 162

Meet criteria for schizophrenia; but does not meet criteria for paranoid type, catatonic type, or disorganized type.

Front 163

What is the presentation of Residual-Type Schizophrenia?

Back 163

Absence of delusions, hallucinations, disorganized speech/behavior, or catatonia. Have negative symptoms, such as affective flattening, alogia (decline in speech), avolition (lack or decline in motivation)

Front 164

What is the presentation of Brief Psychotic Disorder?

Back 164

Hallucinations; delusions; disorganized speech; grossly disorganized or catatonic behavior; symptoms more than one day but less than 30 days.

Front 165

What are the risk factors for Brief Psychotic Disorder?

Back 165

Seen most frequently in the low socioeconomic status and with preexisting personality disorders or psychological stressors.

Front 166

What is the treatment of Brief Psychotic Disorder?

Back 166

Hospitalization is warranted if the patient is acutely psychotic. Pharmacotherapy includes both antipsychotics and benzodiaz-epines. Benzodiazepines may be used for short-term treatment of psychotic symptoms.

Front 167

What is the presentation of Schizophreniform Disorder?

Back 167

Hallucinations; delusions; disorganized speech; grossly disorganized or catatonic behavior; negative symptoms (apathy, poor social function, lack of emotion); social dysfunction; symptoms are present >1 month, but <6 months.

Front 168

What are the risk factors for Schizophreniform Disorder?

Back 168

Symptoms like schizophren-ics, except the level of functional impairment and the duration of symptoms is less. No impairment in social, occupational, or academic functioning.

Front 169

What is the treatment of Schizophreniform Disorder?

Back 169

For a 3- to 6-month course. Individual psychotherapy may be indicated to help the patient assimilate the psychotic experience into his life.

Front 170

What is the presentation of Schizoaffective Disorder?

Back 170

Delusions, hallucinations, disorganized speech, grossly disorganized behavior, catatonic behavior, negative symptom, affective flattening, alogia, avolition, anhedonia, social withdrawal. Depressive or manic episode.

Front 171

What are symptoms for Schizophrenia?

Back 171

Delusions or hallucinations for at least 2 weeks in the absence of mood symptoms.

Front 172

What is the treatment of Schizoaffective Disorder?

Back 172

Antidepressant medications and/or anticonvulsants to control the mood symptoms. Antipsychotic medications to help control the ongoing symptoms.

Front 173

What is the presentation of Delusional Disorder?

Back 173

Nonbizarre delusions for at least one month; no impairment in level of functioning; patients are usually reliable unless their delusions cause them to fear treatment; types of delusions include erotomanic, jealous, grandiose, somatic, mixed, unspecified.

Front 174

What are the risk factors for Delusional Disorder?

Back 174

Mean age of onset is about 40 years. Seen more commonly in women, and most are married and employed. Delusional disorder has been associated with low socioeconomic status. Limbic or basal ganglia abnormalities.

Front 175

What is the treatment of Delusional Disorder?

Back 175

Pharmacotherapy consists of antipsychotic medications; however, most studies indicate that many patients do not respond to treatment. Individual psychotherapy.

Front 176

What is Anxiety?

Back 176

Anxiety is a syndrome with worry that is difficult to control, hypervigilance and restlessness, difficulty concentrating, and sleep disturbance. Autonomic hyperactiv-ity and motor tension.

Front 177

What is the cause of Anxiety?

Back 177

Anxiety is a conditioned response to environmental stimuli paired with a feared situation. Biologic theories implicate various neurotransmitters (norepinephrine, and serotonin), and CNS.

Front 178

What is Panic Disorder?

Back 178

Recurrent, unexpected panic attacks characterized by intense anxiety that often includes marked tachycardia, hyperventilation, dizziness, and sweating.

Front 179

What are the causes of Panic Disorder?

Back 179

Associated with separations during childhood and interpersonal loss. Panic symptoms may be caused by panicogens (lactate CO2, yohimbine, caffeine). 2% of the population. 1:2 male-to-female.

Front 180

What is the disease course of Panic Disorder?

Back 180

Severity of symptoms may wax and wane, and may be associated with intercurrent stressors.

Front 181

What is the treatment of Panic Disorder?

Back 181

SSRIs (fluoxetine), alprazolam, diazepam, imipramine, and MAOIs. Psychotherapeutic interventions include relaxation training and systematic desensitization for agoraphobic symptoms.

Front 182

What is the presentation of Agoraphobia?

Back 182

Fear of places from which escape would be difficult if panic symptoms (public places, being outside, public transportation, crowds). More common in women. Often leads to severe restrictions on travel and daily routine.

Front 183

What is the presentation of Specific Phobia?

Back 183

Fear or avoidance of objects or situations other than agoraphobia or social phobia. Commonly involves fear of animals, natural environments, injury, and situations.

Front 184

What is the presentation of Social Phobia?

Back 184

Fear of humiliation or embarrassment in either general or specific social situations (eg, public speaking, stage fright, urinating in public restrooms).

Front 185

What is the treatment for Phobic Disorders?

Back 185

Cognitive-behavioral therapies for phobias include systematic desensitization and assertiveness training. Pharmacotherapy includes SSRIs, buspirone, and beta-blockers.

Front 186

What is Obsessive-Compulsive Disorder?

Back 186

Obsessions are anxiety-provoking, thoughts of contamination, doubt, guilt, aggression, sex. Compulsions are behaviors to reduce anxiety (hand-washing, organizing, checking, counting, praying).

Front 187

What is the cause of Obsessive-Compulsive Disorder?

Back 187

Abnormalities of serotonin metabolism.

Front 188

What is the prevalence of obsessive-compulsive disorder?

Back 188

Prevalence: 2% of population. Occurs at a 1:1 male-to-female ratio. Some evidence of heritability. Insidious onset during childhood, adolescence, or early adulthood.

Front 189

What is the disease course of Obsessive-Compulsive Disorder?

Back 189

Symptoms usually wax and wane. Depression, other anxieties, and sub-stance abuse are common comorbidities.

Front 190

What are the physical examination findings associated with Obsessive-Compulsive Disorder?

Back 190

Chapped hands from excessive hand-washing compulsion maybe present.

Front 191

What is the treatment of Obsessive-Compulsive Disorder?

Back 191

Behavioral psychotherapies are relaxation training, guided imagery, exposure, response prevention, thought-stopping techniques, and modeling. Selective serotonin reuptake inhibitors.

Front 192

What is Acute Stress Disorder (ASD)?

Back 192

Anxiety symptoms following a threat-ening event that caused fear, helplessness, or horror. When this anxiety lasts less than 1 month (but greater than 2 days) and symptoms occur within 1 month of stressor, it is diagnosed as ASD.

Front 193

What is Post-Traumatic Stress Disorder (PTSD)?

Back 193

PTSD is characterized as when the anxiety lasts longer than 1 month, it is diagnosed as PTSD. PTSD is severe anxiety.

Front 194

What are causes of Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD)?

Back 194

Physical or psychological trauma, or more frequently a combination of both, precipitate ASD and PTSD. Sources of trauma include experiencing or witnessing childhood or adult physical, emotional or sexual abuse.

Front 195

What is the age of onset of Acute Stress Disorder and Post-Traumatic Stress Disorder (PTSD)?

Back 195

Onset at any age. About 50% of cases resolve within 3 months. Symptoms usually begin immediately after trauma, but may occur after months or years.

Front 196

What are symptoms of Acute Stress Disorder and Post-Traumatic Stress Disorder?

Back 196

Re-experiencing event: Dreams, flashbacks, intrusive recollec-tions. Avoidance of stimuli associated with trauma, or numbing of general respon-siveness. Anxiety, sleep disturbances, hypervigilance, depression, emotional lability, guilt.

Front 197

What is the treatment of Acute Stress Disorder and Post-Traumatic Stress Disorder?

Back 197

Counseling after a stressful event may prevent PTSD. Group psychotherapy with other survivors is. Pharmacotherapy includes SSRIs, other antidepres-sants, and benzodiazepines.

Front 198

What is Generalized Anxiety Disorder?

Back 198

Excessive anxiety >6 months. Psychologic and physiologic symptoms of anxiety. Genetic predisposition. Prevalence 5%. Occurs at a 2:3 male-to-female ratio. Onset during childhood but can occur later.

Front 199

What is the disease course of Generalized Anxiety Disorder?

Back 199

Usually chronic, but symptoms worsen with stress. Depression, somatic symptoms, and substance abuse are comorbid conditions.

Front 200

What is the treatment of Generalized Anxiety Disorder?

Back 200

Behavioral psychotherapy includes relaxation training and biofeedback. Pharma-cotherapy includes SSRIs, venlafaxine, buspirone, and benzodiazepines.

Front 201

What are the Somatoform Disorders?

Back 201

A group of disorders characterized by physical symptoms with no medical explanation. The symptoms interfere with the patient?s ability to function in social or occupational activities.

Front 202

What is Somatization Disorder?

Back 202

Multiple symptoms affecting multiple organs. Persistent, varied physical symptoms that have no identifiable physical origin. Internal psychological conflicts are unconsciously expressed as physical signs.

Front 203

What are the risk factors for Somatization Disorder?

Back 203

Affects women more than men; inversely related to socioeconomic status. Begins by age 30. Genetic linkage to the disorder. Male relatives tend to have antisocial personal-ity disorder, whereas female relatives tend to have histrionic personality disorder.

Front 204

What is the presentation of Somatization Disorder?

Back 204

Physical symptoms affecting many organ systems; no medical explanation; diagnosis requires at least four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurologic symptom.

Front 205

What is the treatment of Somatization Disorder?

Back 205

Regular brief monthly visits. Increase patient?s awareness that the symptoms are psychological. Individual psychotherapy is needed to help patients cope with their symptoms and develop other ways of expressing feelings.

Front 206

What is the differential diagnosis of Somatization Disorder?

Back 206

Medical: multiple sclerosis, myasthenia gravis, SLE, AIDS, thyroid disorders, and chronic systemic infections. Psychiatric: depression, generalized anxiety disorder, schizophrenia.

Front 207

What is Conversion Disorder?

Back 207

Neurologic symptoms (mutism, blindness) that cannot be explained by any medical disorder. Young women, lower socioeconomic status, low IQ, military. Associated with passive-aggressive, dependent, antisocial, histrionic personality.

Front 208

What is the presentation of for Conversion Disorder?

Back 208

Neurologic symptoms affecting voluntary or sensory function. Must have psychologic factors associated with the onset or exacerbation of the symp-toms. Mutism, blindness, and paralysis are the most common symptoms.

Front 209

What are the possible finding of Conversion Disorder?

Back 209

Anesthesia and paresthesia, abnormal movements, gait disturbance, weakness, paralysis, tics, jerks, pseudoseizures. La belle indifference: Patient seems unconcerned about impairment.

Front 210

What is the treatment of Conversion Disorder?

Back 210

Psychotherapy focus on stress and coping skills. Amobarbital interview may be helpful in obtaining more information.

Front 211

What is the differential diagnosis of Conversion Disorder?

Back 211

Neurologic: Dementia, tumors, basal ganglia disease, and optic neuritis. Psychiatric: Schizophrenia, depressive disorders, anxiety disorders, factitious. Malingering.

Front 212

What is Hypochondriasis?

Back 212

Disorder characterized by the patient?s belief that she has some specific disease. Despite reassurance, the patient?s belief remains the unchanged.

Front 213

What are the risk factors for Hypochondriasis?

Back 213

Men and women are affected equally; however, hypochondriasis may be more common in men. Most common onset is between the ages of 20 and 30.

Front 214

What is the treatment of Hypochondriasis?

Back 214

Psychotherapy to help relieve stress and help cope with illness. Regularly scheduled visits to doctor.

Front 215

What is Body Dysmorphic Disorder?

Back 215

A disorder characterized by the belief that some body part is abnormal, defective, or misshapen.

Front 216

What are the risk factors for Body Dysmorphic Disorder?

Back 216

Women more than men, between 15 and 20 yrs. Comorbid disorders include depressive disorders, anxiety disorders, and psychotic disorders. Family history of depression, obsessive-compulsive disorder. Involves serotonergic system.

Front 217

What is the presentation of Body Dysmorphic Disorder?

Back 217

Most common concerns involve facial flaws; there is constant mirror-checking; attempting to hide the alleged deformity; housebound; avoids social situations; causes impairment in level of functioning.

Front 218

What is the treatment of Body Dysmorphic Disorder?

Back 218

Individual psychotherapy to help cope with stress of alleged imperfections. Pharmacotherapy may include the use of SSRIs, TCAs, or MAOIs.

Front 219

What is the differential diagnosis of Body Dysmorphic Disorder?

Back 219

Medical: Brain damage, causing neglect syndrome. Psychiatric: Anorexia, narcissistic personality disorder, obsessive-compulsive disorder, schizophrenia, delusional disorder.

Front 220

What is Pain Disorder?

Back 220

Pain in one or more anatomic sites, causing clinically significant distress or impairment of social, occupational functioning. Psychiatric factors have a role in the onset, severity, exacerbation, or maintenance of symptoms.

Front 221

How is Pain Disorder diagnosed?

Back 221

Diagnosis is based on history after excluding a physical disorder that would explain the pain and its onset, severity, duration, and maintenance and the degree of disability. Mental or social stressors may explain the disorder.

Front 222

What are the risk factors for Pain Disorder?

Back 222

Diagnosed more frequently in women than in men. The peak ages of onset are in the fourth and fifth decades.

Front 223

What is the presentation of Pain Disorder?

Back 223

Pain in anatomic sites; pain causes distress; psychologic factors; symptoms are not faked; long medical histories; preoccupied with pain; half have depression, most patients have dysthymia.

Front 224

What is the treatment of Pain Disorder?

Back 224

Discuss the probable psychologic origin of the pain with the patient. Antidepressants, such as SSRIs. Biofeedback, hypnosis, and nerve- blocking is helpful. Individual psychotherapy to explore the emotional aspects of the pain.

Front 225

What is the differential diagnosis of factitious disorder?

Back 225

Must be distinguished from a true general medical conditions or mental disorders, including disorders that are caused by noncompliance with treatment, iatrogenic, or the result of attempted suicide, or self-mutilation.

Front 226

What is Factitious Disorder?

Back 226

Conscious production of symptoms of medical or mental disorders to assume sick role. Creates physical or psychological symptoms. Called factitious disorder by proxy if the signs and symptoms are fabricated for another person, such as a mother.

Front 227

What are the risk factors for Factitious Disorder?

Back 227

Seen more commonly in men and in hospital and health care workers. Many of the patients suffered abuse that resulted in frequent hospitalizations as children, resulting in a need to assume the sick role.

Front 228

What is the presentation of Factitious Disorder?

Back 228

May have abdominal scars from prior surgeries. These patients typically demand treatment when in the hospital; if tests are negative, they may accuse doctors and threaten litigation and become angry when confronted.

Front 229

What is the differential diagnosis of Factitious Disorder?

Back 229

Psychiatric: Other somatoform disorders, antisocial personality disorder, histrionic personality disorder, schizophrenia, substance abuse, malingering, and Ganser?s syndrome

Front 230

What is Malingering?

Back 230

The conscious production of signs and symptoms for an obvious gain (money, avoidance of work, free housing). Malingering is not a mental disorder.

Front 231

What are the risk factors for Malingering?

Back 231

Seen more frequently in men, especially in prisons, factories, and the mili-tary. Malingering often occurs in the work environment. It also occurs when there are legal disputes that involve money and medical issues.

Front 232

What is the presentation of Malingering?

Back 232

Most patients express subjective symptoms; tend to complain frequently and exaggerate the effect of the symptoms on their functioning and lives; preoccupied more with rewards than with alleviation of symptoms.

Front 233

What is the treatment of Malingering?

Back 233

Do not embarrass the patient by confronting him, and do not allow the physician-patient relationship to be damaged. If confronted, patient will become angry and more guarded and suspicious.

Front 234

What is the differential diagnosis of Malingering?

Back 234

Somatoform disorders

Front 235

What are Cognitive Disorders?

Back 235

Syndromes of delirium, dementia, and amnesia, which are caused by general medical conditions, substances, or both.

Front 236

What are the risk factors for Cognitive Disorders?

Back 236

Very young or advanced age, debilitation, general medical conditions, sustained or excessive exposure to toxic substances.

Front 237

What are the symptoms of Cognitive Disorders?

Back 237

Memory impairment. Aphasia, apraxia. Agnosia: Failure to recognize or identify people or objects. Disturbances in executive function: Inability to think abstractly and plan activities.

Front 238

What is Delirium?

Back 238

Delirium is characterized by prominent disturbances in alertness, confusion, and a short and fluctuating course. It is caused by acute metabolic problems or substance intoxication.

Front 239

What are the causes of Delirium?

Back 239

Associated with general medical conditions such as systemic infections, metabolic disorders, hepatic and renal diseases, seizures, and head trauma. High or rapidly decreasing levels of many drugs, especially in elderly and severely ill individuals.

Front 240

What is the presentation of Delirium?

Back 240

Delirium occurs in 25% of elderly, hospitalized patients. Key symptoms include agitation or stupor, fear, emotional lability, hallucinations, delusions, and disturbed psychomotor activity.

Front 241

What are the physical examination findings of Delirium?

Back 241

Motor abnormalities commonly present include incoordination, trem-or, asterixis, and nystagmus. Incontinence is common. There is often an underlying general medical conditions or substance-specific syndromes.

Front 242

What are the EEG abnormalities associated with Delirium?

Back 242

EEG often shows either generalized slowing of activity, fast-wave activity, or focal abnormalities. Abnormal findings on neuroimaging and neuropsychiatric testing may be present.

Front 243

What is the treatment of Delirium?

Back 243

Correction of physiologic problems. Frequent orientation and reassurance. Protective use of physical restraints and high-potency antipsychotic medications for dangerous agitation.

Front 244

What is the differential diagnosis of Delirium?

Back 244

Dementia, substance intoxication or withdrawal, and psychotic disorders.

Front 245

What is Dementia?

Back 245

Dementia is characterized by prominent memory disturbances coupled with other cognitive disturbances. It is caused by CNS damage and has a protracted course.

Front 246

What are the causes of Dementia?

Back 246

CVS disease, intracranial processes; brain injuries, radiation, or tumors. Seizures, metabolic; demyelinating; Wilson; uremia, endocrinopathies; nutritional deficiencies; alcohol, inhalants, sedative-hypnotics, toxins.

Front 247

What is the prevalence of Dementia?

Back 247

Five percent of the population over 65 years of age and more than 20% of persons over 85 years of age; heritability; some types of neurodegenerative dementias (eg, Huntington disease).

Front 248

What are the symptoms of Dementia?

Back 248

Disorientation, anxiety, depression, emotional lability, personality disturbances, hallucinations, and delusions. Abnormal findings on neuroimaging and neuropsychiatric testing.

Front 249

What are the physical examination findings associated with Dementia?

Back 249

Evidence of CNS motor pathology is often present. There may be underlying general medical conditions or substance-specific syndromes.

Front 250

What are the diagnostic test abnormalities associated with Dementia?

Back 250

EEG abnormalities. Neuroimaging and neuropsychi-atric testing abnormalities. Mini-Mental Status Exam abnormalities.

Front 251

What is the laboratory ecaluation of Dementia?

Back 251

Basic laboratory examination for dementia includes B12 and folate levels, RPR, CBC with SMA, and thyroid function tests.

Front 252

What is the treatment of Dementia?

Back 252

Cholinesterase inhibitors (donepezil, rivastigmine, memantine, and galantamine). Alzheimer's drugs increase levels of acetylcholine.

Front 253

What is the differential diagnosis of Dementia?

Back 253

Delirium and less-severe, age-related cognitive decline must be excluded. Alzheimer-type dementia patients occupy more than 50% of nursing-home beds; Alzheimer?s is found in 50-60% of nursing-home patients.

Front 254

What are the risk factors for Dementia?

Back 254

Female, family history, head trauma, Down syndrome. Neuroanatomic findings include cortical atrophy, flattened sulci, and enlarged ventricles.

Front 255

What is the histopathology of Alzheimer?s Disease?

Back 255

Senile plaques, neurofibrillary tangles, neuronal loss, synaptic loss, granulovacuolar degeneration. Associated with chromosome #21 (amyloid). Decreased acetylcholine, norepinephrine. Gradual deterioration with death after 8 yrs.

Front 256

What is the pathophysiology of Pick Disease?

Back 256

Atrophy of frontal and temporal lobes. Pick bodies (intraneuronal inclusions) in brain; most common in men with a family history of Pick disease; symptoms are similar to Alzheimer?s disease.

Front 257

What is Creutzfeldt-Jakob Disease?

Back 257

Rare spongiform encephalopathy caused by a slow virus (prion); dementia, myoclonus, EEG abnormalities; progresses over months from malaise and personality changes to dementia, death; visual and gait disturbances, choreoathetosis, myoclonus

Front 258

What is Huntington Disease?

Back 258

Rare, progressive loss of GABA-ergic neurons of basal ganglia; choreoathetosis and dementia; caused by a defect in an autosomal dominant gene on chromosome 4, resulting in atrophy of caudate nucleus, ventricular enlargement.

Front 259

What is Parkinson disease?

Back 259

Common, progressive, neurodegenerative disease involving loss of dopaminergic neu-rons in substantia nigra; onset 50 and 65 yrs; tremor, rigidity, bradykinesia, gait disturbances. Dementia in 40%. Depressive symptoms.

Front 260

What is HIV-related dementia?

Back 260

HIV destroys brain in 30% of individuals with AIDS, beginning with personality changes; diffuse and rapid multifocal destruction of brain. Gait disturbance, hypertonia and hyperreflexia, pathologic reflexes, and oculomotor deficits.

Front 261

What is Wilson disease?

Back 261

Wilson?s disease is a rare, inherited, genetic disorder of copper metabolism. It occurs in 1 out of every 30,000 people.

Front 262

What is normal pressure hydrocephalus?

Back 262

Dementia, urinary incontinence, and gait apraxia; enlarged ventricle; normal pressure; treatment includes shunt placement

Front 263

What is Pseudodementia?

Back 263

Typically seen in an elderly patient who has a depressive disorder but appears to have symptoms of dementia, such as psychomotor retardation and decreased concentration.

Front 264

What are Amnestic Disorders?

Back 264

Prominent memory impairment in the absence of disturbances in level of alertness or the other cognitive problems that are present with Delirium or dementia. Evidence of chronic alcohol abuse is often present.

Front 265

What are the diagnostic test abnormalities associated with Amnestic Disorders?

Back 265

EEG may show generalized slowing of activity, fast-wave activity, or focal abnor-malities; abnormal findings from neuroimaging and neuropsychiatric testing may be present.

Front 266

How do Amnestic Disorders present?

Back 266

Deficits in memory, inability to recall or retain information. Cognitive defect limited to memory. If additional cognitive defects are present, a diagnosis of dementia or delirium should be considered.

Front 267

What is the treatment of Cognitive Disorder?

Back 267

Correction of the underlying pathophysiology (eg, administration of thiamine in alcohol-induced amnestic disorder) may be effective in reversing or slowing the progression of symptoms.

Front 268

What is the differential diagnosis of Cognitive Disorder?

Back 268

Delirium, dementia, and dissociative amnesia are the common rule-outs.

Front 269

What is the clinical presentation of Dissociative Disorders?

Back 269

Fragmentation of aspects of consciousness, including memory, identity, and perception. Amnesia, per-sonality change, erratic behavior, odd inner experiences.

Front 270

What is the clinical presentation of Dissociative Amnesia?

Back 270

Significant episodes in which the individual is unable to recall important and often emotionally charged memories.

Front 271

What are the causes of Dissociative Amnesia?

Back 271

Psychological stress. More common in women and younger adults. Onset is usually detected retrospectively by the discovery of memory gaps of variable duration.

Front 272

What are the symptoms of Dissociative Amnesia?

Back 272

Amnesia that may be general or selective for certain events. The amnesia may suddenly or gradually remit, particularly when the traumatic circumstance resolves, or the amnesia may become chronic.

Front 273

What comorbid disorders are associated with Dissociative Amnesia?

Back 273

Mood disorders, conversion disorder, and personality disorders are commonly present.

Front 274

What is the treatment of Dissociative Amnesia?

Back 274

Hypnosis, suggestion, and relaxation techniques are helpful. The patient should be removed from stressful situations. Psychotherapy should be directed at resolving underlying emotional stress.

Front 275

What is the differential diagnosis of Dissociative Amnesia?

Back 275

Major rule-outs are amnestic disorder due to a general medical condition, substance-induced amnestic disorder, and other dissociative disorders.

Front 276

What is Dissociative Fugue?

Back 276

Sudden, unexpected travel, accompanied by the inability to remember one?s past and confusion about personal identity, or the assumption of a new identity.

Front 277

What is the cause of Dissociative Fugue?

Back 277

Dissociative Fugue is typically precipitated by a severe trauma or stressor and eventually remits without treatment.

Front 278

What is the onset of Dissociative Fugue?

Back 278

Usually sudden, often following a stressful life event. Most episodes are isolated and last from hours to months. Resolution is usually rapid, but amnesia may persist.

Front 279

What is the treatment of Dissociative Fugue?

Back 279

Psychotherapy, cognitive therapy, medication, family therapy, and clinical hypnosis.

Front 280

What is the differential diagnosis of Dissociative Fugue?

Back 280

Major rule-outs are complex partial seizures, other dissociative disorders, factitious disorder, and malingering.

Front 281

What is Dissociative Identity Disorder?

Back 281

Presence of multiple, distinct personalities that recurrently control the individual?s behavior, accompanied by failure to recall important personal information.

Front 282

What are the causes of Dissociative Identity Disorder?

Back 282

Can be caused by previous traumatic experience, and the memory of past trauma may create a mental stigma; most patients of this disorder commit suicide.

Front 283

What other comorbid conditions often occur with Dissociative Identity Disorder?

Back 283

Borderline personality disorder, PTSD and other mood disorders, substance-related disorders, sexual disorders, and eating disorders. Symptoms may fluctuate or be continuous.

Front 284

What is the treatment of Dissociative Identity Disorder?

Back 284

Psychotherapy to uncover psychologically traumatic memories and to resolve the associated emotional conflict.

Front 285

What is the differential diagnosis of Dissociative Identity Disorder?

Back 285

Major rule-outs are borderline personality disorder, bipolar disorder with rapid cycling, and factitious disorder and malingering.

Front 286

What is Depersonalization and Derealization Disorder?

Back 286

Persistent or recurrent feeling of being detached from one?s mental processes or body, accompanied by an intact sense of reality

Front 287

What are the risk factors for depersonalization and derealization disorder?

Back 287

Psychologic stress. Childhood trauma has been associated with increased risk for both panic disorder and dissociative symptoms in adulthood.

Front 288

What is the onset of Dissociative Disorders?

Back 288

Onset in adolescence or early adulthood. Stressful events may precede onset. Depersonalization: an out-of-body experience. Derealization: Environment is distorted or strange, feeling of being detached from physical surroundings.

Front 289

What are the symptoms of Dissociative Disorders?

Back 289

Amnesia, depression and anxiety. A sense of being detached from yourself (depersonalization). A perception of the people and things around you as distorted and unreal (derealization). A blurred sense of identity.

Front 290

What is the treatment of Dissociative Disorders?

Back 290

Treatment for Dissociative Disorders may include psychotherapy, hypnosis and medication.

Front 291

What is the differential diagnosis of Dissociative Disorders?

Back 291

Major rule-outs are substance-induced mental disorders with dissociative symptoms, including intoxication, withdrawal, hallucinogen-induced persisting perceptual disorder, panic disorder, and PTSD.

Front 292

What is Adjustment Disorder?

Back 292

Maladaptive reactions to an identifiable psychosocial stressor.

Front 293

What is the onset of Adjustment Disorder?

Back 293

Within 3 months of the initial presence of the stressor. Lasts 6 months or less once the stressor is resolved. Can become chronic if the stressor continues and new ways of coping with the stressor are not developed.

Front 294

What are the symptoms of adjustment disorder?

Back 294

Overwhelming anxiety, depression, or emotional turmoil associated with specific stressors. Social and occupational performance deteriorate, erratic or withdrawn behavior.

Front 295

What is the differential diagnosis of Adjustment Disorder?

Back 295

Normal reaction to stress. Disorders that occur following stress (eg, GAD, PTSD, Major Depressive Disorder).

Front 296

What is Substance Intoxication?

Back 296

Reversible, substance-specific syndrome caused by the recent ingestion of or exposure to a substance.

Front 297

What is Substance Withdrawal?

Back 297

Substance-specific, maladaptive behavioral change, with physi-ologic and cognitive concomitants, caused by the cessation of or reduction in heavy and prolonged substance use.

Front 298

What are the causes of Substance-Related Disorders?

Back 298

Intoxication and withdrawal are disturbances that are a direct physiologic result of a substance. Many recreational drugs can cause intoxication and withdrawal.

Front 299

What is Substance Dependence?

Back 299

Loss of control; monopolization of time by substance; majority of time is spent obtaining/using drugs, recovering from use, and discussing drugs; adverse medical, social, emotional consequences, including tolerance, withdrawal.

Front 300

What is Impulse Control Disorder?

Back 300

Intermittent-explosive disorder, kleptomania, pathological gambling, pyromania, trichotillomania, onychophagia and dermatillomania.These disorders are ego-syntonic. Mediated by the serotonergic system.

Front 301

What is Intermittent Explosive Disorder?

Back 301

Aggressive impulses result in serious assaultive acts or destruction of property. Degree of the aggressive act is out of proportion to the stressor.

Front 302

What are the risk factors for Intermittent Explosive Disorder?

Back 302

Affects men more than women. History of head trauma, seizures, encephalitis, hyperactivity. Low levels of 5-hydroxyindoleacetic acid, abnormalities in limbic system, testosterone. Symptoms lessen as patient ages.

Front 303

What is the presentation of Intermittent Explosive Disorder?

Back 303

Neurologic examination may reveal right-left ambivalence; psychologic tests often normal; poor work histories; marital difficulties; problems with the law.

Front 304

What is the treatment of Intermittent Explosive Disorder?

Back 304

Anticonvulsants, antipsychotics, beta-blockers, or SSRIs are somewhat helpful. Psychotherapy may be beneficial. When psychotherapy is used, it must be with pharmacotherapy and in a group setting.

Front 305

What is the differential diagnosis of Intermittent Explosive Disorder?

Back 305

Medical: Epilepsy, brain tumors, degenerative disease, and endocrine disorders. Psychiatric: Antisocial personality disorder, borderline personality disorder, schizo-phrenia, and substance intoxication.

Front 306

What is Kleptomania?

Back 306

Disorder characterized by the recurrent failure to resist impulses to steal objects that the patient does not need. There is increased anxiety prior to the act, followed by release of anxiety after the act.

Front 307

What are the risk factors for Kleptomania?

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More common in women. Symptoms may be linked to stress. Associated with mood disorders, obsessive compulsive disorders, and eating disorders, such as bulimia nervosa. Linked to brain disease and mental retardation.

Front 308

What is the treatment of kleptomania?

Back 308

Insight-oriented therapy. Behavioral therapy, including aversive conditioning and systematic desensitization, have been helpful. If pharmacotherapy is indicated, consider SSRIs or anticon-vulsants.

Front 309

What is the differential diagnosis of kleptomania?

Back 309

Antisocial personality disorder, malingering, mania, and schizophrenia.

Front 310

What is pyromania?

Back 310

Fire-setting followed by fascination and gratification. More frequently in men who are mildly retarded and alcohol abuse. Truancy and cruelty to animals.

Front 311

What is Pathological Gambling?

Back 311

Persistent and recurrent gambling, a need to gamble with more money, attempts to stop gambling and/or to win back losses, illegal acts to finance gambling, or loss of relationships due to gambling.

Front 312

What is the differential diagnosis of Pathological Gambling?

Back 312

Medical: Brain dysfunctions. Psychiatric: Antisocial personality disorder, conduct disorder, mania, and schizophrenia.

Front 313

What are the risk factors for Pathological Gambling?

Back 313

More common in men. Alcohol dependence. Predisposed by death, loss of a loved one, poor parenting, exposure to gambling, divorce. Linked to mood disorders, obsessive compulsive disorders, panic disorder, agoraphobia, ADHD.

Front 314

What is the presentation of Pathological Gambling?

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May engage in antisocial behavior to obtain money for gambling; appear overconfident; suicide attempts; multiple arrests and/or incarceration.

Front 315

What is the treatment of Pathological Gambling?

Back 315

Gamblers anonymous (GA) is the most effective treatment. It involves public confessions, peer pressure, and sponsors.

Front 316

What is the differential diagnosis of Pathological Gambling?

Back 316

Mania, antisocial personality disorder

Front 317

What is Trichotillomania?

Back 317

Disorder characterized by pulling one?s own hair, resulting in hair loss. There is anxiety before the act and a release of anxiety after the act.

Front 318

What are the risk factors for Trichotillomania?

Back 318

Affects women more than men. Associated disorders include OCD, obsessive-compulsive personality disorder, and depressive disorders

Front 319

What is the presentation of Trichotillomania?

Back 319

Hair loss is significant; most affected is scalp; may eat hair, resulting in bezoars, obstruction, malnutrition; head-banging, nail-biting; examination of the scalp reveals short, broken hairs along with long hairs.

Front 320

What is the treatment of Trichotillomania?

Back 320

Treatment usually consists of behavior-modification techniques to decrease the patient?s anxiety, SSRIs, anticonvulsants, or antipsychotics decrease the urges.

Front 321

What is the differential diagnosis of Trichotillomania?

Back 321

Medical: Alopecia areata, tinea capitis. Psychiatric: OCD, factitious disorder

Front 322

What is Anorexia Nervosa?

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Failure to maintain a normal body weight, fear and preoccupa-tion with gaining weight, unrealistic self-evaluation as overweight, and amenorrhea for three cycles or more.

Front 323

What are the subtypes of Anorexia Nervosa?

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Subtypes are restricting type (no binge-eating or purging) and binge-eating/purging type (regularly engaged in binge-eating/purging).

Front 324

What are the risk factors for Anorexia Nervosa?

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Higher concordance for illness in monozygotic twins. Psychologic risk factors include emotional conflicts concerning family control and sexuality.

Front 325

What is the prevalence of Anorexia Nervosa?

Back 325

0.5%. Occurs at a 1:10 male-to-female ratio.

Front 326

What is the onset of Anorexia Nervosa?

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Average age is 17 years. Very late-onset anorexia nervosa has a poorer prognosis. Onset is often associated with emotional stressors, particularly conflicts with parents about indepen-dence, and sexual conflicts.

Front 327

What are the symptoms of Anorexia Nervosa?

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Restricted intake and low-calorie diets. Purging; excessive concern with appearance. Denial of emaciated conditions; binge-eating/purging: Self-induced vomiting; laxative and diuretic abuse.

Front 328

What are the symptoms of Anorexia Nervosa?

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Excessive interest in food-related activities, obsessive-compulsive symptoms, depression. Waxing-and- waning course. Long-term mortality rate of 10%; death from starvation, purging, suicide.

Front 329

What are the physical examination findings associated with Anorexia Nervosa?

Back 329

Signs of malnutrition include emaciation, hypotension, bradycardia, lanugo, and peripheral edema. Eroded teeth caused by emesis and scarred hands from self-induce emesis.

Front 330

What are diagnostic tests for Anorexia Nervosa?

Back 330

Normochromic, normocytic anemia, elevated LFTs, abnormal electrolytes, low estrogen/testosterone, bradycardia, abnormal EEG. Metabolic alkalosis, hypochloremia, hypokalemia; metabolic acidosis caused by laxatives.

Front 331

What is the treatment of Anorexia Nervosa?

Back 331

Initial correction of consequences of starvation. Behavioral therapy, with rewards or punishments based on weight, not on eating behaviors. Family therapy to reduce conflicts over control by parents. Antidepressants for depression.

Front 332

What is the differential diagnosis of Anorexia Nervosa?

Back 332

Major rule-outs are bulimia nervosa, general medical conditions that cause weight loss, Major Depressive Disorder, schizophrenia, OCD, and body dysmorphic disorder.

Front 333

What is Bulimia Nervosa?

Back 333

Characterized by frequent binge-eating and purging and a self-image that is unduly influenced by weight.

Front 334

What are types of Bulimia Nervosa?

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Purging type: Self-induced vomiting or the use of laxatives, diuretics, or enemas. Nonpurging type: Fasting or exercise, but no purging during bulimic episodes.

Front 335

What are the risk factors for Bulimia Nervosa?

Back 335

Psychologic conflict regarding guilt, helplessness, self-control, and body image predispose. Frequent association with mood disorders.

Front 336

What is the prevalence of Bulimia Nervosa?

Back 336

Two percent in young adult females. Occurs at a 1:9 male-to-female ratio. During late adolescence or early adulthood and often follows a period of dieting Course. May be chronic or intermittent

Front 337

What is the outcome of Bulimia Nervosa?

Back 337

Seventy percent of cases remit after 10 years. Comorbid-substance abuse is associ-ated with a poorer prognosis.

Front 338

What are symptoms of Bulimia Nervosa?

Back 338

Binge-eating. Dieting, followed by binge-eating. Associated with emotional stress and followed by guilt, self-recrimination; recurrent, inappropriate compensatory behavior; self-evaluation unduly influenced by weight.

Front 339

What comorbid problems are associated with Bulimia Nervosa?

Back 339

Depressive symptoms, substance abuse, and impulsivity (eg, kleptomania). Borderline personality disorder present in about 50%.

Front 340

What are the physical examination findings associated with Bulimia Nervosa?

Back 340

Scarring on the knuckles or back of the hand. Swollen glands, such as lymph nodes, salivary glands and parotid glands. This is caused by frequent binging and purging, which aggravates areas of the face and neck.

Front 341

What are the diagnostic test abnormalities associated with Bulimia Nervosa?

Back 341

Evidence of laxative or diuretic abuse, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.

Front 342

What is the treatment of Bulimia Nervosa?

Back 342

Cognitive and behavioral therapy; psychodynamic psycho-therapies are useful for borderline personality traits. Antidepressant medica-tions, particularly SSRIs.

Front 343

What is the differential diagnosis of Bulimia Nervosa?

Back 343

Major rule-outs are anorexia nervosa, binge-eating/purging, Major Depressive Disorder? with atypical features, and borderline personality disorder.

Front 344

What is a personality disorder?

Back 344

Personality patterns that are pervasive, inflexible, and maladaptive.

Front 345

What are the three personality disorder clusters:

Back 345

Cluster A: Peculiar thought processes, inappropriate affect. Cluster B: Mood lability, dissociative symptoms, preoccupation with rejection. Cluster C: Anxiety, preoccupation with criticism or rigidity

Front 346

What are the risk factors for personality disorder?

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Risk factors include innate temperamental difficulties, such as irritability; adverse environmental events, such as child neglect or abuse; and personality disorders in parents.

Front 347

What is the prevalence of personality disorder?

Back 347

All are relatively common. More males have antisocial and narcissistic personality disorders, more females have borderline and histrionic personality disorders.

Front 348

What is the onset of personality disorder?

Back 348

Diagnosed in late adolescence or early adulthood. Chronic over decades without treatment. Symptoms of paranoid, schizoid, and narcissistic personality disorder often worsen with age.

Front 349

What are the symptoms of personality disorder?

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Long pattern of difficult interpersonal relationships, problems adapting to stress, failure to achieve goals, chronic unhappiness, low self-esteem. Mood disorders.

Front 350

What is the treatment of personality disorder?

Back 350

Intensive and long-term psychodynamic and cognitive therapy are the treatments of choice for most personality disorders. Mood stabilizers and antidepressants is sometimes useful for Cluster B personality disorders.

Front 351

What is the differential diagnosis of Personality Disorder?

Back 351

Major rule-outs are mood disorders, personality change due to a gen-eral medical condition, and adjustment disorders.

Front 352

What is Paranoid Personality Disorder?

Back 352

Distrust and suspiciousness. Individuals are mistrustful and suspicious of the motivations and actions of others and are often secretive and isolated. Patients with paranoid personality disorder are emotionally cold and odd.

Front 353

What is Schizoid Personality Disorder?

Back 353

Detachment and restricted emotionality. Individuals are emotionally distant. They are disinterested in others and indifferent to praise or criticism. Social drifting and dysphoria.

Front 354

What is Schizotypal Personality Disorder?

Back 354

Discomfort with social relationships; thought distortion; eccentricity. Socially isolated and uncomfortable with others. Ideas of reference and persecution, odd preoccupa-tions, odd speech.

Front 355

What is Histrionic Personality Disorder?

Back 355

Colorful, exaggerated behavior and excitable, shallow expression of emotions; uses physical appearance to draw attention to self; sexually seductive; and uncomfortable in situations where he is not the center of attention.

Front 356

What is Borderline Personality Disorder?

Back 356

Unstable affect, mood swings, marked impulsivity, unstable relationships, recurrent suicidal behaviors, chronic feelings of emptiness or boredom, identity disturbance, inappropriate anger. Defense mechanism is splitting.

Front 357

What is Antisocial Personality Disorder?

Back 357

Continuous antisocial or criminal acts, inability to conform to social rules, impulsivity; disregard for rights of others, aggressiveness, lack of remorse, deceitfulness. Symptoms since age 15, and at least 18 years.

Front 358

What is Narcissistic Personality Disorder?

Back 358

Sense of self-importance, grandiosity, and preoc-cupation with fantasies of success. Believes she is special, requires excessive admiration, reacts with rage when criticized, lacks empathy, is envious of others, exploitative.

Front 359

What is Avoidant Personality Disorder?

Back 359

Social inhibition, inadequacy, hypersensitivity to criticism. These persons shy away from work or social relationships because of fears of rejection based on feelings of inadequacy. Lonely and inadequate; preoccupied with rejection.

Front 360

What is Dependent Personality Disorder?

Back 360

Submissive and clinging; need to be taken care of. Worry about abandonment. They feel inadequate and helpless and avoid disagreements with others. They focus dependency on a family member or spouse.

Front 361

What is Obsessive Personality Disorder?

Back 361

Preoccupation with orderliness, perfectionism, control. Strict and perfectionistic, overconscientious, and inflexible. Obsession with work and productivity and are hesitant to delegate. Unable to give up possessions.

Front 362

What are the normal stages of sleep?

Back 362

Sleep is divided into two stages, nonrapid eye movement (NREM) and rapid eye movement (REM).

Front 363

What is REM latency?

Back 363

The period lasting from the moment sleep occurs to the first REM period.

Front 364

What is sleep latency?

Back 364

The time needed before actually falling asleep. Typically less than 15 minutes in most individuals; however, may be abnormal in many disorders, such as insomnia.

Front 365

What changes occur in the sleep cycle?

Back 365

Newborn: up to 18 hours. 1-12 months: 14-18 hours. 3-5 years: 11?13 hours. 5-12 years: 9-11 hours. Adolescents: 9-10 hours. Adults, including elderly: 7?8 hours. Sleep time decreases with age. REM decreases.

Front 366

What are the neurotransmitters of sleep?

Back 366

Serotonin: Increased during sleep; initiates sleep. Acetylcholine: Increased during sleep; linked to REM sleep. Norepinephrine: Decreased during sleep; linked to REM sleep. Dopamine: Increased during sleep; linked to arousal and wakefulness

Front 367

What are the effects of tryptophan on sleep?

Back 367

Tryptophan increases total sleep time.

Front 368

What are the effects of dopamine on Sleep?

Back 368

Dopamine agonists produce arousal. Dopamine antagonists: Decrease arousal, thus produce sleep. Benzodiazepines: Suppress Stage 4 and, when used chronically, increase sleep latency.

Front 369

What is Narcolepsy?

Back 369

Excessive daytime sleepiness and abnormalities of REM sleep for a period greater than 3 months. REM sleep occurs in less than 10 minutes. Feel refreshed upon awakening.

Front 370

What is the presentation of Narcolepsy?

Back 370

Sleep attacks; cataplexy; sudden loss of muscle tone which may have been precipitated by a loud noise or intense emotion; hypnagogic and hypnopompic hallucinations; sleep paralysis.

Front 371

What is the treatment of Narcolepsy?

Back 371

Forced naps at a regular time of day is usually the treatment of choice. When medi-cations are given, psychostimulants are preferred. If cataplexy is present, antidepressants such as TCAs are preferred.

Front 372

What is Sleep Apnea?

Back 372

Cessation of airflow at nose or mouth. Apneic episodes >10 seconds. Loud snore followed by a heavy pause. Pathologic apnea is defined as more than 5 episodes an hour or more than 30 episodes during the night.

Front 373

What is the presentation of Sleep Apnea?

Back 373

Obese, middle-aged males; daytime sleepiness, depression, mood changes; spouses complain of snoring and restlessness; dry mouth in morning; headaches; arrhythmias, hypoxemia, pulmonary hypertension, sudden death.

Front 374

What are the types of sleep apnea?

Back 374

Obstructive apnea: Muscle atonia in oropharynx; nasal, tongue, or tonsil obstruction. Central apnea: Lack of respiratory effort during sleep. Mixed: Central at first, but prolonged due to airway collapse.

Front 375

What is the treatment of Sleep Apnea?

Back 375

Continuous positive nasal airway pressure is the treatment of choice. Weight loss, surgery.

Front 376

What is Insomnia?

Back 376

Disorder characterized by difficulties in initiating or maintaining sleep.

Front 377

What are the risk factors for sleep apnea?

Back 377

Patients often have underlying depression or anxiety. Psychiatric disorders are seen more frequently in women. Other conditions include PTSD, OCD, and eating disorders.

Front 378

What is the differential diagnosis of Insomnia?

Back 378

Pain, CNS lesions, endocrine diseases, aging, brain-stem lesions, alcohol, diet, medications. Anxiety, tension, depression, and environmental changes, other sleep disorders.

Front 379

What is Sexual Dysfunction?

Back 379

A group of disorders of a particular phase of the sexual response cycle. These disorders can be psychologic, biologic, or both, and include, desire, arousal, orgasm, and pain.

Front 380

What is Premature Ejaculation?

Back 380

Ejaculation before the man wants to ejaculate, before penetration, or just after penetration.

Front 381

What is Dyspareunia?

Back 381

Pain associated with sexual intercourse in either male or female.

Front 382

What is Vaginismus?

Back 382

Involuntary constriction of vagina that interferes with sexual act. Both vaginal lubrication and vaginal dilation decrease. When the vagina is dry and undilated, thrusting of the phallus is painful.

Front 383

What are Paraphilias?

Back 383

A pattern of recurring sexually arousing mental imagery or behavior that involves unusual and especially socially unacceptable sexual practices (sadism, masochism, fetishism, pedophilia).

Front 384

What is the presentation of Paraphilias?

Back 384

Sexual activity is ritualistic. Fantasy is typically fixed and shows very little variation. Intense urge to carry out the fantasy.

Front 385

What is the treatment of Paraphilias?

Back 385

Individual psychotherapy. Behavioral techniques, such as aversive conditioning, antiandrogens or SSRIs to help reduce patient?s sexual drive.

Front 386

What are the types of Paraphilias?

Back 386

Exhibitionism; fetishism; frotteurism; pedophilia; voyeurism; masochism; sadism; transvestism.

Front 387

What is Gender Identity Disorder?

Back 387

Gender dysphoria (discontent with the biological sex they were born with).

Front 388

What are the risk factors for Gender Identity Disorder?

Back 388

Seen more frequently in men than in women. Cause is unknown. Many believe it may be due to biologic reasons, such as hormones.

Front 389

What is the presentation of Gender Identity Disorder?

Back 389

Wear opposite gender?s clothes; girls refuse to urinate sitting down; believe they were born with wrong body; medications or surgery to change appearance; women bind breasts, mastectomies, take testosterone; men remove hair, take estrogens.

Front 390

What the three main groups of antipsychotic medications?

Back 390

Pure dopamine-2 antagonists, D2-5HTZ antagonists, Multireceptor antagonists.

Front 391

What are indications for antipsychotic medication?

Back 391

Psychomotor Agitation. Schizophrenia. Other Psychotic Disorders. Mood Disorders.

Front 392

What are general adverse effects of antipsychotic medication?

Back 392

Sedation. Hypotension. Anticholinergic.

Front 393

What are the side effects of antipsychotics?

Back 393

Dry mouth, blurred vision, urinary hesitancy, constipation, bradycardia, confusion, delirium. Gynecomastia, galactorrhea, amenorrhea. Photosensitivity, pigmentation, cataracts. Cardiac conduction abnormalities, agranulocytosis (clozapine).

Front 394

What are the movement syndromes associated with antipsychotics?

Back 394

Older antipsychotic medications are associated with extrapyramidal syndromes. Second generation antipsychotic medications cause minimal or no EPS. Low-potency antipsychotics cause less EPS, but have more sedative effects.

Front 395

What are extrapyramidal syndromes?

Back 395

Involuntary muscle movements or spasms, which occur in the face and neck. Occurs when release and re-uptake of the neurotransmitter dopamine is not regulated correctly. Primary cause is antipsychotic drugs.

Front 396

What is the clinical presentation of acute dystonia?

Back 396

Presentation: Spasms of various muscle groups. Can be dramatic and frightening to patient. Young men may be at higher risk.

Front 397

What is the treatment of acute dystonia?

Back 397

Anticholinergics, such as benztropine, diphenhydramine, or trihexyphenidyl.

Front 398

What is the presentation of bradykinesia?

Back 398

Slowed volitional movement, increased muscle tone, and resting tremor. Decreased facial expression, festinating gait, cogwheel rigidity, and pill-rolling.

Front 399

What is akathisia?

Back 399

Akathisia presents as fidgety movements while seated, rocking in place while standing, pacing, or the inability to sit or stand still for an extended period of time as well as the overwhelming urge to move.

Front 400

What is the treatment of akathisia?

Back 400

Benzodiazepines or beta-blockers for patients who do not have symptoms of Parkinson's disease. Anticholinergics for patients with Parkinson's symptoms.

Front 401

What is neuroleptic malignant syndrome?

Back 401

Rare and potentially life-threatening condition characterized by muscular rigidity, hyperthermia, autonomic instability, and delirium. Usually associated with high dosages of high-potency antipsychotics.

Front 402

What is the treatment of neuroleptic malignant syndrome?

Back 402

Medications include dantrolene and bromocriptine. Dantrolene can be given intravenously or orally starting with 2-3 mg per kg doses divided TID up to a total of 10 mg/kg/day. Bromocriptine can be given orally or by NG tube.

Front 403

What are the second generation antipsychotic medications?

Back 403

Clozapine, Risperidone, Olanzapine, Quetiapine, Ziprasidone, Aripiprazole.

Front 404

What is the mechanism of action of antidepressants?

Back 404

Antidepressants inhibit reuptake of serotonin, norepinephrine, or both. Some antidepressants block acetylcholine (muscarinic) and alpha-adrenergic and histamine receptors.

Front 405

What is the treatment of Major Depressive Disorder?

Back 405

SSRIs, Atypical antidepressants, tricyclic antidepressants, monoamine oxidase inhibitors. Cognitive behavior therapy. Psychotherapy. Electroconvulsive therapy

Front 406

What is the overall efficacy of the treatment of Major Depressive Disorder?

Back 406

Around 70%. Antidepressants are superior to placebo, but overall effect is low to moderate. The first-line alternative to medication is psychotherapy, which does not have superior efficacy.

Front 407

What are the selective-serotonin-reuptake inhibitors (SSRIs)?

Back 407

Fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), and fluvoxam-ine. (Luvox), citalopram (Celexa), escitalopram (Lexapro).

Front 408

What are the commonly used tricyclic antidepressants?

Back 408

Tertiary TCAs are imipramine, amitriptyline, doxepin, clomipramine, and trimipramine. Secondary amine TCAs are Desipramine, nortriptyline, and protriptyline.

Front 409

What are monoamine oxidase inhibitors (MAOIs)

Back 409

Inhibit MAO-A and/or MAO-B in the CNS and have antidepressant efficacy; hydrazines are more sedating; tranylcypromine is more activating; selegiline is used for the treatment of early-stage Parkinson's, depression, senile dementia.

Front 410

What are the indications for monoamine oxidase inhibitors?

Back 410

Prescribed for patients resistant to TCAs. Newer MAOIs such as selegiline are safer. MAOIs are second-line treatment depressive disorders with atypical features, and anxiety disorders.

Front 411

What are the causes of hypertensive crises in patients taking MAO inhibitors?

Back 411

HTN crisis may occur with tyramine foods, decongestants, beta agonists, amphetamines.

Front 412

What are the indications for electroconvulsive therapy?

Back 412

Major depressive episodes that have not responded. Major depressive episodes with imminent risk of suicide. Major depressive episodes in patients with contraindications to antidepressant medication.

Front 413

What are the adverse effects of electroconvulsive therapy?

Back 413

Transient memory disturbance. Transiently increased intracranial pressure.

Front 414

What are the indications for lithium?

Back 414

Bipolar and schizoaffective disorders: First-line medication for treatment and prophylaxis of mood episodes. May augment responsiveness to anti-depressant medications.

Front 415

What are adverse effects of lithium?

Back 415

Tremor, GI distress, headache; acne; weight gain. Benign ECG changes; 5% of patients develop thyroid problems; leukocytosis, polyuria: Diabetes insipidus; teratogenicity. Dehydration and hyponatremia predispose to toxicity.

Front 416

What are the indications for divalproex?

Back 416

Prophylactic therapy for migraines or treatment of epilepsy or mania. Treatment of choice for rapid-cycling bipolar disorder, or for bipolar disorder when lithium is ineffective, impractical, or contraindicated.

Front 417

What are the indications for carbamazepine?

Back 417

An anti-seizure medication. Second-line choice for treatment of bipolar disorder when lithium and divalproex are ineffective or contraindicated. Other mood stabilizers: lamotrigine, gabapentin topiramate.

Front 418

What are the indications for anxiolytic medications?

Back 418

Adjustment disorder with anxiety. Panic disorder: SSRIs, alprazolam, and clonazepam decrease frequency and intensity of panic attacks. Generalized Anxiety: venlafaxine, SSRIs, buspirone. OCD: SSRIs, clomipramine. Social phobia: SSRIs, buspirone.

Front 419

What precautions should be taken when prescribing benzodiazepines?

Back 419

Avoid abrupt changes in benzodiazepine dosage. Use lower dosages for the elderly. Do not mix with alcohol or other sedative-hypnotic medications. Dependency potential.

Front 420

What are the adverse effects of benzodiazepines?

Back 420

Sedation; impairment of cognitive and motor performance; disinhibition; tolerance and withdrawal; abuse; possible teratogenicity.

Front 421

What are the pharmacologic properties of buspirone?

Back 421

Effective in the treatment of generalized anxiety disorder and social phobia; lag time of 1 week before clinical response; no withdrawal syndrome; no sedation or cognitive impairment; headache.

Front 422

What are risk factors for suicidal behavior?

Back 422

History of suicide threats and attempts; perceived hopelessness (demoralization); presence of psychiatric illness/drug abuse; males; elderly; social isolation; low job satisfaction; chronic illness.

Front 423

What is the emergency management of suicide?

Back 423

Set limits; search for concealed weapons; use antipsychotic medications or benzodiazepines to control agitation; establish rapport. Remove any means for committing suicide. Notify police.

Front 424

What are the three components of informed consent?

Back 424

Information: risks, benefits, alternatives. Voluntariness: noncoerced. Competency: understanding and judgment.

Front 425

What are the situations when informed consent is not required?

Back 425

Exceptions: emergencies; waiver by patient: if patient is competent to do so. Therapeutic privilege. Information would be harmful to patient.

Front 426

What are the indications for involuntary treatment?

Back 426

Suicidal, homicidal, gravely disabled; grave disability: Inability to provide for food, clothing or shelter; medication, seclusion, physical restraint: psychiatric emergencies.