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213 Cards in this Set
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- Back
Examples of associated features provided in the DSM 5? |
prevalence, development & course, risk & prognostic factors, gender & culture Dx issues, DDx, comorbidity |
|
Reasons to classify disorders? |
provides nomenclature, facilitates research, provides reliability & validity, req. for insurance reimbursement |
|
disadvantages of classifying disorders? |
stigma, stereotyping, labeling |
|
structure of DSM 5 |
22 sections; contains ICD-9 & ICS-10 codes; consistent w/ arrangement of ICD-11; is a categorical classification system |
|
describe "cultural syndrome" |
cluster of co-occuring Sx in a specific cultural group/community/context (e.g. ataque de nervios) |
|
3 concepts for culture-bound syndromes in DSM 5 |
cultural syndrome, cultural idiom of distress, cultural explanation or perceived cause
(discussed w/ examples in Section 3) |
|
WHODAS |
36 item questionnaire; quantifies level of functioning
(in Section 3) |
|
Section: Neurodevelopmental Disorders |
manifest early in development; characterized by develop. deficits that impair personal, social, academic functioning
(e.g. intellectual, communication, autism, ADHD, learning, motor) |
|
Section: Schizophrenia Spectrum et al. |
abnormalities in 1 or more: delusions, hallucinations, disorganized thinking, disorganized/abnl motor, neg. symptoms
(e.g. schizotypal, delusion, psychotic, catatonia) |
|
Section: Bipolar & related disorders |
recognized as bridge between: - schizophrenia/psychotic - depressive disorders regarding Sx, FHx, genetics
(e.g. bipolar, cyclothymia) |
|
Section: Depressive disorders |
sad, empty, irritable mood w/ somatic & cognitive changes
differ in duration, timing, presumed etiology
(e.g. disruptive mood regulation, depressive, premenstrual dysphoric) |
|
Section: Anxiety disorders |
excessive fear, anxiety, related behavioral disturbances
(e.g. separation/social anxiety, mutism, phobias, panic disorder, GAD) |
|
Section: Obsessive-Compulsive & related |
related in Sx & etiology; also related to anxiety
(e.g. OCD, body dysmorphic, hoarding, trichotillomania, excoriation) |
|
Section: Trauma- & Stressor-Related |
explicit trauma or stressful event; leads to anxiety-based anhedonia, dysphoria, externalizing or dissociative Sx
(e.g. reactive attachment, disinhibited social engagement, PTSD, acute stress, adjustment) |
|
Section: Dissociative disorders |
disrupted integration of consciousness, memory, identity, emotion, perception, body representation, motor control, etc.
(e.g. dissociative, depersonalization, derealization) |
|
Section: Somatic Sx & related |
prominent somatic Sx assoc w/ distress/impairment; commonly present in medical setting
(e.g. somatic, conversion, factitious) |
|
Section: Feeding & Eating disorders |
disturbance in eating-related behaviors
(e.g. pica, rumination, avoidant/restrictive food intake, anorexia, bulimia, binging) |
|
Section: Elimination disorders |
inapprop. elimination of urine/feces; usually diagnosed in childhood/adolescence; based on develop. age, may be voluntary/invol.
(e.g. enuresis, encopresis) |
|
Section: Sleep-Wake disorders |
dissatisfaction w/ quality, timing, amt of sleep; may be prodrome of existing mental illness;
(e.g. insomnia, hypersomnolence, narcolepsy, parasomnia) |
|
Section: Disruptive, Impulse-Control, Conduct |
problems in self-control of emotions/behaviors; violate the rights of others/societal norms
(e.g. oppositional defiant, intermittent explosive, conduct, antisocial, pyromania, klepto) |
|
Section: Substance-Related & Addictive |
alcohol, caffeine, cannibis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, gambling |
|
Cluster A personality disorders |
(aloof; odd)
paranoid PD, schizoid PD, schizotypal PD |
|
Cluster B personality disorders |
(dramatic; erratic)
antisocial PD, borderline PD, histrionic PD, narcissistic PD |
|
Cluster C personality disorders |
(anxious; fearful)
avoidant PD, dependent PD, obsessive-compulsive PD |
|
DSM 5: Section 3 |
WHODAS, Cultural Formulation Interview (CFI), disorders for future study, new model to Dx personality disorders |
|
Brief Psychiatric Rating Scale (BPRS) |
18 item measure of severity of various psychiatric symptoms |
|
Hamilton Rating Scales for Depression & Anxiety (HAM-D & HAM-A) |
observer ratings of presence & severity of specific anxiety/depression Sx |
|
Scales for the Assessment of Positive Sx (SAPS) |
observer ratings of the pos. & neg. Sx of schizophrenia |
|
SAD PERSONS |
Sex (male), Age (15-25, 59+), Depression
Previous attempt, Ethanol, Rational thinking (loss of), Social support lacking, Organized plan No spouse, Sickness |
|
ideas of reference |
believe that others' words/actions have special reference to oneself even though they don't |
|
ideas of influence |
believe they're under the control of someone else, their thoughts are being read, their limbs move without their consent, etc. |
|
"infancy" stage of development |
birth to 15 mo |
|
"toddler" stage of development |
15 mo to 2.5 yrs |
|
"preschool" stage of development |
2.5 to 6 yrs |
|
"middle years" stage of development |
6 to 12 yrs |
|
"adolescence" stage of development |
12 to 19 yrs |
|
"adulthood" stage of development |
20 to 65 yrs |
|
Mothers w/ high levels of anxiety are more likely to have babies who... |
are hyperactive, irritable, low birth wt, have difficult feeding/sleeping |
|
Genetic disorder screening for pregnant women? |
recommended for all women >35 y/o
(of those tested, 2% have defect) |
|
Smoking cigarettes in pregnancy assoc. w/... |
premature birth, low wt, SIDS |
|
Marijuana use in pregnancy assoc. w/... |
low birth wt, premature, withdrawal Sx, hyperemesis |
|
Cocaine use in pregnancy assoc. w/... |
increased irritability, crying, decreased need for human contact |
|
Severe radiation exposure in pregnancy assoc. w/... |
(if between 2-15 wks)
severe deformities, stunted growth, abnl brain development, CA in later life |
|
define a "premature" baby |
gestation <34 wks OR birth wt <5.5 lb |
|
define a "postmature" baby |
born 2 wks beyond expected due date (42 wks gestation) |
|
reflexes present at birth |
rooting, grasp, plantar, knee, abd, startle, tonic |
|
survival systems present at birth |
breathing, sucking, swallowing, circulatory, temp. homeostasis |
|
When do babies develop vocalization? |
8 wks |
|
By the end of infancy... |
(15 mo)
reflexes become voluntary, begin to interact w/ environment, behaviors more intentional, begin to use symbolic play & language |
|
When do babies start to imitate facial expressions of adult caregivers? |
3 weeks |
|
When does a baby first smile? |
16th week
(usually elicited by mother) |
|
9 observable behavioral dimensions (temperament) |
activity level, distractibility, adaptability, attention span, intensity, threshold of responsiveness, mood quality, rhythmicity, approach/withdrawal
(~stability over 25 yrs) |
|
children w/ "secure" attachment |
fewer adjustment problems, had consistent/appropriate parenting |
|
Child looks to parents for emotional cues on how to respond to events. Age? |
Toddler (15 mo - 2.5 yrs) |
|
Child shows exploratory excitement & pleasure in developing new behaviors. Age? |
Toddler (15 mo - 2.5 yrs) |
|
Child shows organized demonstration of love (hugs & kisses) & of protest (turns away, cries, bangs, yells). Age? |
Toddler (15 mo - 2.5 yrs) |
|
When does conviction of being male or female begin? |
begins at 18 mo, fixed by 30 mo; is innate |
|
toilet training age? |
daytime urination - 2.5 years
nighttime urination - 4 years |
|
sleep habits in toddlers? |
fear the dark;
sleep 12 hrs/day w/ a 2 hour nap |
|
When does a child reach ~50% of their eventual adult height? |
about 2.5 years |
|
When do kids begin to think symbolically? |
Preschooler (2.5 - 6 yrs) |
|
Child has egocentric thinking/no empathy skills. Age? |
Preschooler (2.5 - 6 yrs) |
|
When do kids begin being able to express complex emotions, preverbally & verbally? |
Preschooler (2.5 - 6 yrs) |
|
When do kids begin to move toward more stable/balanced emotions? (e.g. curiosity vs. fear) |
Preschooler (2.5 - 6 yrs) |
|
At what stage do people begin to develop a sense of moral awareness, right vs. wrong? |
Preschooler (2.5 - 6 yrs)
(but rules are absolute) |
|
At what stage do people begin to distinguish reality from fantasy? |
Preschooler (2.5 - 6 yrs)
(pretend/dramatic play is common) |
|
imaginary friends |
up to 50% of kids age 3-10; most gone by 12 years
kids w/ above avg intelligence; relieves loneliness/anxiety |
|
At what stage does logical exploration start to bypass fantasy play? |
Middle years (6 - 12 yrs) |
|
At what stage does thinking become organized & logical? |
Middle years (6 - 12 yrs) |
|
At what stage do people develop empathy & concern for others? |
Middle years (6 - 12 yrs) |
|
At what stage do people begin to identify with culturally accepted masculine/feminine ways of behaving? |
Middle years (6 - 12 yrs) |
|
changes in dream awareness throughout toddler-hood? |
Age 3: dreams are real/shared; rarely aggressive
Age 4: dreams are real/unique; pleasure vs. fear
Age 5: dreams aren't real
Age 7: dreams are created by self |
|
Ages w/ the most disturbing dreams? |
ages 3, 6, 10 |
|
kids' initial reactions to divorce? |
infants: changes in sleep, anxiety, fearful bowel
3-6: don't understand; feel responsible
7-12: bad grades; blame selves; hurt, angry, critical |
|
kids' recovery after a divorce? |
usually takes 3-5 years; 1/3 have lasting trauma |
|
"neo-traditional" type of step family |
resemble traditional families; absent bio parent is included; discipline & boundaries |
|
"romantic" type of step family |
expect to be traditional; absent parent is criticized; high stress |
|
"matriarchal" type of step family |
house run by strong mom; new step-parent is a "buddy" to kids |
|
parenting style: "Authoritarian" |
strict, inflexible rules
= low SE, unhappy, social withdrawal |
|
parenting style: "Indulgent-permissive" |
poor limits, unpredictable parenting
= low self-reliance, poor impulse control, aggression |
|
parenting style: "Indulgent-neglectful" |
non-involvement
= low SE, impaired self-control, aggression |
|
parenting style: "Authoritative-reciprocal" |
firm rules, shared decision-making, loving environment
= SE, reliance, social respons. |
|
Increased need for independence, complicated romantic relationships/sexuality, groups are more influential. Age? |
middle adolescence (14 - 16 years) |
|
About when do people begin to become aware of style, appearance, sexuality, modesty? |
Early adolescence (12-14 years) |
|
primary marker for physical development in girls? |
ovulation |
|
primary marker for physical development in boys? |
development of sperm |
|
Experiences increased definition of self, belonging through exploration. Age? |
Late adolescence (17 - 19 years) |
|
Kohlberg levels of morality |
Preconventional: parental punishment
Conventional: conformity, need for approval
Self-accepted moral principles: compliance based on ethics w/ exceptions |
|
developmental tasks in young adulthood? |
(20-40 years)
establish a self separate from parents; develop adult friendships; sexuality & marriage (intimacy); parenthood |
|
climacterium |
period w/ decreased biophysio functioning
women = menopause men = ~50 y/o; no clear demarcation
can lead to sudden changes in relationships, depression, EtOH/drug use, alt. lifestyle; midlife transition & crisis |
|
Best indicator of one's longevity? |
family history |
|
leading causes of death? |
heart disease, CA, stroke |
|
For pts over 65 y/o, how much does Medicare pay? |
40%
(remainder paid for by private/state insurance or personal funds; some not covered - outpt psych services, skilled nursing, etc.) |
|
depression among the elderly? |
lower rates, maybe d/t rarity of late onset depression; but higher mortality/suicidality, can be misdiagnosed as dementia |
|
When does a person develop their gender identity? |
occurs by 2-3 yrs for most
ongoing development from cues/experiences, parents, culture, ext. genitalia, genetics, etc. |
|
Major factor in developing one's "gender role" |
learning |
|
brain structures involved in sexual behavior? |
cortex, limbic system, brainstem, neurotransmitters, spinal cord |
|
neurotransmitters in relation to desire? |
desire is..
increased by: dopamine, testosterone, estrogen
decreased by: serotonin, progesterone
|
|
define "heterosexism" |
belief that heterosexual relationships is preferable to all others; implies discrimination |
|
Male Hypoactive Sexual Desire Disorder |
deficiency/absence of sexual fantasies & desire for sex for min. of ~6 mo
prevalence increases w/ age |
|
Female Sexual Interest/Arousal Disorder |
inability to feel interest/arousal; decreased erotic feelings/thoughts/fantasies, etc; decreased receptivity to partner
+/- dysfunction across entire range of sexual response/pleasure |
|
Genito-Pelvic Pain disorder |
one or more of the following: - difficulty having sex - genito-pelvic pain - fear of pain - tension of pelvic floor muscles |
|
vaginismus |
involuntary muscle constriction of the outer 1/3 of vagina d/t involuntary pelvic floor muscle tightening/spasm
interferes w/ intercourse |
|
substances that can induce sexual dysfunction? |
alcohol, amphetamine, cocaine, opioids, sedatives, hypnotics, anxiolytics, antipsychotics, antidepressants, stimulants |
|
Viagra |
nitric oxide enhancer; not effective w/o sexual stimulation |
|
diagnosing a paraphilia |
sexuality is restricted to specific stimuli/acts; inhibited from responding to NL erotic stimuli; must have acted upon fantasy/impulse |
|
exhibitionism |
recurrent urge to expose genitals to a stranger/unsuspecting person |
|
fetishism |
sexual focus is on object that are intimately assoc. w/ human body or non-genital body parts
(e.g. shoes, gloves, pantyhose, stockings) |
|
frotteurism |
rubbing penis against fully clothed female in crowded places (buses, subways); extremely passive/isolated |
|
most common paraphilia? |
pedophilia (victims 13 or younger; perpetrator at least 16 y/o & 5 yrs older than victim)
(most common: fondling, oral sex) |
|
voyeurism |
aka scopophilia;
recurrent preoccupation w/ fantasies/acts that involve observing unsuspecting persons who are naked or engaged in grooming/sexual activity |
|
telephone/computer scatologia |
making obscene phone calls for sexual pleasure;
a form of exhibitionism |
|
partialism |
sexual interest w/ an exclusive focus on a specific part of the body |
|
prognosis of treating a paraphilia? |
poor prognosis: related to early onset, freq, no guilt, alcohol, drugs
better prognosis: Hx of NL sex, self-referred, only one paraphilia, no drugs, avg IQ, no personality disorder, successful adult attachment |
|
paraphilia: 5 treatment types |
external control, reduction of sexual drives, Tx of co-morbid condition, CBT, dynamic psychotherapy |
|
difference between anxiety & fear? |
both are alerting signals, but...
fear = response to known, external, definite, non-conflictual threat
anxiety = more diffuse; response to unknown, internal, vague, or conflictual threat |
|
Yerkes-Dodson law |
there's an optimal level of anxiety to enhance funcitoning |
|
3 primary neurotransmitters involved w/ anxiety |
NE, serotonin, GABA
(benzos support GABA) |
|
Anxiety disorders: which has strongest evidence of genetic predisposition? |
panic disorder
(though there's evidence for others too) |
|
diagnosing panic disorder |
recurrent/unexpected panic attack; worried about having another for at least 1 mo |
|
diagnosing agoraphobia |
marked fear & anxiety about 2 or more: - public transportation - open spaces - enclosed places - standing in line/crowd - being alone outside of home
x6 months or more |
|
panic disorder: stats |
more common in females
attacks = 20-30 min duration
onset of attacks: late adolescence/early adult
|
|
origin of fear in agoraphobia? |
fear/avoid situations b/c escape may be difficult or help may not be available if panic/incapacitating/embarrassing Sx occur
(more common in females) |
|
Tx panic disorder & agoraphobia |
SSRIs, benzos (risk of addiciton), TCAs (side effects), MAOIs (diet restrictions)
can augment w/ benzo, Buspirone
+ cognitive therapy, applied relaxation, resp. training, exposure therapy, family therapy |
|
specific phobias: prevalence |
2x as common in women;
environment/blood/needle: onset in childhood
situational: onset in mid-20s |
|
blood-injection-injury phobia |
onset in childhood;
often tachycardia, then bradycardia & HOTN; runs in families |
|
diagnosing specific phobia |
marked fear/anxiety about object/situation x6 mo or more |
|
Tx specific phobia |
most effective = behavior therapy (systematic desensitization, exposure therapy)
no evidence for effectiveness of insight-oriented therapy
if severe, can adjunct w/ meds |
|
social anxiety disorder: stats |
most onset in teens (8-15 y/o);
general pop.: more females clinical pop.: more males
often comorbid w/ avoidant PD |
|
diagnosing social anxiety disorder |
marked fear/anxiety about social situations in which pt is exposed to possible scrutiny by others x6 mo or more
specify if Performance Only (fear restricted to public speaking/performing) |
|
Tx social anxiety disorder |
CBT, meds, or combo; restructures neg. automatic thoughts, may include exposure therapy
meds: SSRIs, benzo, Effexor, BuSpar if severe, MAOI |
|
generalized anxiety disorder: stats |
2x more common in females;
very highly comorbid w/ other anxiety, mood, substance-use disorders |
|
diagnosing GAD |
excessive anxiety/worry more days than not x6 mo or more |
|
Tx GAD |
CBT + meds
benzos PRN, SSRIs (best when comorbid depression), Effexor (reduces insomnia, poor concentration, restlessness, irritability, tension) BuSpar (reduces cognitive Sx, less effective at somatic Sx) |
|
obsessive compulsive disorder: stats |
females more than males overall; but males more often in childhood
avg onset = 19.5 yrs
w/o Tx, is chronic; most common obsession = contamination |
|
specifiers assoc. w/ OCD? |
with good/fair insight; with poor insight; w/ absent insight/delusional beliefs
must also specify +/- Hx of tic disorder |
|
OCD Tx |
most effective = behavior therapy (esp. Exposure & Response Prevention)
Meds: SSRIs, Clopramine (TCA) (high rates of relapse upon d/c of meds)
some use of psychosurgery, transcranial electromagnetic stimulation |
|
body dyspmorphic disorder: etiology |
unknown etiology; may involve serotonin;
higher than expected FHx mood disorder, OCD |
|
Most common areas of focus in body dysmorphic disorder? |
skin (acne, scars, lines), hair (thinning, excessive), nose (size, shape)
(time consuming preoccupation; avg 3-8 hrs/day) |
|
Bias for detail rather than holistic aspect of visual stimuli. What disorder? |
Body Dysmorphic Disorder
(visual processing abnormalities, executive dysfunction) |
|
body dyspmorphic disorder: prevalence |
more common in females; avg onset: 12-13 y/o; gradual & chronic
area of focus may remain same or change |
|
Tx body dysmorphic disorder |
serotonin specific drugs (Anafranil, Prozac)
tricyclics, MAOIs, Orap |
|
hoarding disorder: prevalence |
equal among men/women; more common if unmarried
onset: early adolescence
deficits may resemble ADHD |
|
hoarding disorder: driving force? |
items may be of use at some point; distorted beliefs about importance; emotional attachment to items |
|
hoarding disorder: comorbidities |
highest co-morbidity w/ OCD
also PDs (dep., avoidant, schizotypal, paranoid), schizophrenia, dementia, other neurocog. disorders |
|
Tx hoarding disorder |
most effective: CBT (training in decision-making, categorizing, exposure, etc)
meds: SSRIs (mixed results, even tho effective in OCD)
limited studies b/c only recently a Dx |
|
Trichotillomania onset may be related to... |
stressful situation; e.g. disturbances in mother-child relationships, fear of being left alone, recent object loss |
|
trichotillomania: most commonly affected areas |
scalp
(others: eyebrows, eyelashes, beard) |
|
trichotillomania: 2 types described |
focused pulling: intentional
automatic pulling: unaware; usually during sedentary activities |
|
Tx trichotillomania |
no consensus; SSRIs (if poor response, add pimozide (Orap), - dopamine receptor antag.)
misc: Luvox, Celexa, Effexor, ReVia, lithium
insight-oriented therapy
|
|
excoriation disorder: stats |
women more than men;
most common site: face (others: legs, arms, torso, hand, cuticles, fingers, scalp)
picking relieves stress, tension, etc. |
|
Tx excoriation disorder |
SSRIs (e.g. Prozac)
ReVia (opioid antag; reduces urge, esp. if pleasurable)
misc: lamictal, brief CBT |
|
diagnosing PTSD - for how long? |
more than one month |
|
PTSD specifiers |
w/ dissociative Sx: depersonalization, derealization
w/ delayed expression: doesn't meet criteria till at least 6 mo after event
(note: separate criteria for kids 6 & younger) |
|
PTSD Tx |
SSRIs, tricyclics, MAOIs, trazodone, anticonvulsants
CBT (refer to trauma specialist) |
|
diagnosing adjustment disorder: how soon after stressor? |
Sx must begin within 3 mo of the stressor |
|
adjustment disorder: examples of stressors |
beginning school, leaving home, getting married, becoming a parent, not reaching occupational goals, empty nest, retiring |
|
adjustment disorders: 6 subtypes |
w/ depressed mood, w/ anxiety, w/ depressed mood + anxiety, w/ disturbance of conduct, w/ disturbance of emotion + conduct; unspecified |
|
Tx adjustment disorder |
Tx of choice = psychotherapy (group therapy, etc.)
maybe meds for a brief time |
|
define "epileptoid personality" |
may include auras, sound/light sensitivity
seen in Intermittent Explosive Disorder |
|
course/prognosis: Intermittent Explosive Disorder |
onset: late adolescence, early adulthood
decreased severity w/ age |
|
Tx Intermittent Explosive Disorder |
meds + therapy
Lithium, Depakote, anticonvulsants, antipsychotics, SSRIs |
|
diagnosing Intermittent Explosive Disorder? |
no damage: 2x weekly for 3 mo
damage: 3x within one year
must be at least 6 y/o |
|
comorbidities w/ kleptomania? |
mood disorders, anxiety; gambling, compulsive shopping, AoD, eating disorders |
|
DDx kleptomania |
for personal gain (personality disorder), w/ psychosis (hallucinating, depersonalization), Alzheimers/Dementia, malingering
|
|
repetitive self-mutilation? |
is always co-morbid to something
(think Borderline PD, paraphilia, etc; interpersonal or physiological gain) |
|
paranoid PD: who has it? |
males more than females; more among minorities, deaf |
|
paranoid PD vs. Delusional disorder? |
paranoid PD doesn't have fixed delusions; no hallucinations or thought disorder |
|
Paranoid PD vs. Borderline PD? |
paranoid PD: no over involvement in relationships; no Hx of antisocial behavior |
|
Tx paranoid PD |
Tx of choice = psychotherapy
meds: anti-anxiety (+ anti-psychotics if severe) |
|
Schizoid PD: who has it? |
males more than females; ppl w/ solitary jobs (night, minimal contact w/ others) |
|
clinical features of Schizoid PD? |
cold, aloof, social withdrawal, eccentric, isolated, difficulty w/ intimacy, difficulty expressing anger, +/- fantasy sex life |
|
How is schizoid PD different from paranoid PD? |
schizoid PD has less social engagement & less self-expression |
|
Tx schizoid PD |
Tx of choice = psychotherapy (distant but devoted clients)
meds: small doses of anti-psychotics, anti-depressants, benzos, stimulants |
|
Pt is detached from social relationships & has a restricted range of emotional expression. Dx? |
schizoid PD |
|
How is schizotypal PD different from schizophrenia? |
unlike schizophrenia, schizotypal PD has no psychosis
(note: but schizotypal can be co-diagnosed w/ Borderline PD!) |
|
Tx schizotypal PD |
Tx of choice = psychotherapy
meds: antipsychotics (if depressive features, SSRIs) |
|
antisocial PD: who has it? |
more in males; more in poor, urban areas, more in prison
conduct disorder before age 15 (can't Dx antisocial till 18); runs in families |
|
"mask of sanity" Dx |
Antisocial PD |
|
course/prognosis: antisocial PD |
once developed, is lifelong; but symptoms decrease later in life |
|
Tx antisocial PD |
Tx of choice = psychotherapy (firm limit-setting, focus on fear of intimacy, self-destructive behaviors)
meds: stimulants, anti-epileptic (Depakote, Tegretol)
|
|
Borderline PD: who has it? |
more common in women;
1st deg. relatives may have depression, AoD |
|
How is Borderline PD different from schizophrenia? |
Borderline PD has no prolonged psychosis |
|
Tx Borderline PD |
Tx of choice = psychotherapy + meds
hospitalizations w/ Dialectical Behavior Therapy (DBT)
meds: anti-psychotics, SSRIs, MAOIs, benzos |
|
possible co-existing diagnoses w/ histrionic PD? |
brief psychotic, dissociative, & somatization disorders |
|
Tx histrionic PD |
Tx of choice = psychotherapy (bring inner feelings into awareness)
meds: SSRIs, anxiolytics, anti-psychotics |
|
Tx narcissistic PD |
Tx of choice = psychotherapy
lithium, SSRIs |
|
Infant has timid temperament. What PD might this suggest later in life? |
avoidant PD |
|
Tx avoidant PD |
Tx of choice = psychotherapy
meds: anti-depressants, anxiolytics |
|
Chronic physical illness in childhood leads to risk of developing what PD? |
dependent PD |
|
Tx dependent PD |
Tx of choice = psychotherapy (insight-oriented, family/group, etc)
anti-depressants, anxiolytics |
|
obsessive-compulsive PD: who has it? |
more common in males; more in oldest child; Hx of harsh discipline |
|
Tx obsessive-compulsive PD |
Tx of choice = psychotherapy
clonazepam (Klonopin), Prozac (anxiolytic, antidepressant) |
|
diagnosing a "major depression episode"? |
Sx appearing in the same 2 wk period |
|
manic episode: duration? |
at least one week; most of the day, nearly every day |
|
hypomanic episode: duration? |
at least 4 consecutive days; present most of the day, every day |
|
untreated episode of depression: duration?
What if treated? What about over time? |
untreated: 6-13 mo
treated = 3 mo
over time, freq & length of episodes increases (over 20 yrs, avg. 5-6 episodes) |
|
major depressive disorder: who generally experiences a more chronic course, men or women? |
men |
|
Most common mistake leading to unsuccessful trial of an antidepressant? |
too low a dosage for too short a time
(before considered unsuccessful, should be at max dose for at least 4-5 wks) |
|
MDD: How long to keep a pt on anti-depressants? |
at least 6 mo, or the length of a previous episode
(then taper gradually over 1-2 wks) |
|
Name some SSRIs |
Prozac, Paxil, Zoloft, Celexa, Lexapro |
|
Name some SNRIs |
Cymbalta, Effexor, Pristiq |
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Name an NDRI |
Wellbutrin |
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What should we know about trazodone & Remeron? |
atypical antidepressants; are sedating (take in the evening) |
|
Diagnosing dysthymia: duration? |
at least 2 years; most of the day for more days than not
never w/o Sx for more than 2 mo at a time |
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What might present diagnostically like dysthymic disorder? |
long-term substance abuse |
|
Tx dysthymia |
CBT + meds
SSRIs, SNRIs, TCAs |
|
How far apart do manic episodes need to be in order to be considered distinct? |
separated by at least 2 mo |
|
how long does an untreated manic episode last? |
about 3 mo |
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as bipolar I progresses, how do the episodes change? |
time between episodes decreases;
stabilizes after 5 episodes to about once every 6-9 mo |
|
Tx bipolar disorder |
lithium, Depakote, valproic acid, Lamictal, Tegretol, Abilify, etc.
Prozac, Paxil, Zoloft |
|
cyclothymia vs. bipolar II? |
cyclothymia is less severe w/ shorter cycles |
|
Tx cyclothymia |
psychosocial therapy, lithium, depakote |