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Estelle Royal College > PsypurNuls_EO > Flashcards

PsypurNuls_EO Flashcards

1
Q

Expliquez le rôle des variantes des allèles du transporteur 5HT dans les troubles de l’humeur

A

Par rapport aux homozygotes pour l’allèle long (L/L), les individus porteurs de l’allèle court ((c/L ou c/c) le pires c’est 2 copies) font plus de MDD et de tentatives de suicide lorsque confrontés à des évènements stressants

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2
Q

What age is early onset PDD?

A

21

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3
Q

3 signes de Suspicion de MAB lors d’un épisode dépressif majeur

A

Dépression psychotique avant 25 ans
Apparition et disparition rapide des sx (moins de 3 mois)
Retard psychomoteur marqué

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4
Q

Cause de mortalité numéro 1 chez les troubles de l’humeur

A

Maladie cardio-vasculaire

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5
Q

Expliquer l’effet kindling

A

Plus de stresseur dans les premiers episodes de depression majeur que dans les plus tardifs (ca en prend moins pour tomber en dépression)

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6
Q

Seuil de remission avec les echelles de HAM-D er Montgomery-asberg

A

7 = hamd

10-12=madrs

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7
Q

Black box sur antidepresseurs

A

Augmentation de la suicidalité chez les 14-18: RR de 1,5-2, NNH 143
Augmentation de la suicidalité non-significative chez les 18-24 meme si black-box aussi étandu a cette tranche d’age
Risque serait supérieur avec paxil et effexor mais black box sur tous

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8
Q

MMD comorbid avec alcohol use do

A

1ere ligne: remeron, naltrexone, naltrexone+zoloft

2iem ligne: antabuse en ajout

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9
Q

MDD comorbid avec TDAH

A

1ere ligne: buproprion, ATD+long acting stimulant, ATD+TCC

2iem ligne: desipramine, nortryptiline, venlafaxine

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10
Q

SSRI et SNRI les plus noradrénergiques

A

Paxil et duloxetine

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11
Q

Site a cibler pour deep brain stimulation en MDD

A

Cingulum sous-calleux

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12
Q

Pharmacokinétique des RIMA/IMAO

A

Rapidement absorbés et courte demi-vie (2-3h pour IMAO, 0.5-3.5 pour RIMA)

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13
Q

Patient avec saignement, quel est les meilleur atd

A

Bupropion est meilleur que ISRS et IRSN

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14
Q

Traitement de premiere ligne pour MDD seasonal?

A

Luminothx (10 000 lux, 30 min DIE, le plus tot possible au lever, ad 6 semaines, reponse habitielle en 1-3 sem, essayer au minimum 2-4 semaine, mais poursuivre jusqu’au moment de rémission habituel de 6 semaines selon canmat)…

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15
Q

Dans quels cas est recommendendé ECT en première ligne?

A

Idées suicidaires, MDD psychotique et dépression résistante aux tx

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16
Q

Contre-indication ECT

A

Il n’y a plus de contre indic absolues: HTIC est relative, tout comme space-occupying lesion, recent cva, IM recent, prob dentaire (dent lousse qui risque d’être apsirée)

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17
Q

Effets secondaires des ECT

A

Amnésie antérograde et rétrograde (antérograde transitoire, aucun deficit à 6 mois sauf trous de mémoire ponctuels persistants p/r au moment de l’ECT ; rétrograde pour des événements s’étant produits avant l’ECT, habituellement seulement qql mois avant, peut être permanente, généralement la mémoire autobiographique)
Delirium (FdeR: sevrage rapide BZD, anticonvulsivants, hx de SUD, lithium clozapine, prédit effet secondaire sur la mémoire)
Augmentation de la prolactine, céphalié, nausée, dlr musculaire, lesions dentaire, virage maniaque (10-30% chez BAD)

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18
Q

Suicide chez enfants et ado

A

Cause numéro 1: pendaison, pas intox
Précipitant: conflit avec famille ou ami
Rare chez moins de 12 ans car immaturité joue un role protecteur

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19
Q

Différence entre deuil normal et MDD

A

Plus de culpabilité, idée de mort ne correspondant pas au souhait d’être avec le défunt, sentiment de dévalorisation (pas juste concernant le défunt) hallucination autres que celles d’entendre la voix ou voir l’image du défunt, ralentissement psychomoteur marqué, durée plus que 2 mois (durée typique du deuil normal)

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20
Q

Trouble anxieux le plus prévalent

A

Phobie specifique

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21
Q

Phobie spécifique la plus fréquente

A

Animaux

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22
Q

Trouble anxieux qui augment le plus le risque de suicide

A

Trouble panique (20x p/r pop générale)

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23
Q

Début du TAG?

A

Fin ado/debut age adulte, distribution bi-modale averc age median 31 ans

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24
Q

Trouble anxieux les plus fréquents chez personnes agees

A

Phobie specifique et TAG

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25
Q

Le trouble le plus fréquemment comorbid a la MAB?

A

Trouble anxieux 75%

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26
Q

Qu’est-ce qu’on voit en imagerie chez BAD

A

Augmentation du volume des ventricules, hyperintensité de la matière blanche, déficit dans la matière grise du gyrus cingulaire

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27
Q

Caractéristiques mixtes plus frequente en MAB 1 ou 2

A

2

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28
Q

BAD 1 debute par manie ou depression généralement

A

Depression

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29
Q

Chromosome possiblement impliqués dans BAD

A

18, 21q, 22q (5, 11, 16 et x possiblement)

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30
Q

Risque qu’enfant aille trouble de l’humeur si parents on MAB

A

1 parent: 25%
2 parents: 50-75%
5-10% d’avoir MAB si 1 parent l’a
50% MAB 1 ont au moins un parent avec MAB

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31
Q

Maladie associé le plus à psychose peripartum

A

MAB (excellent probostic, resolution complère et rapide avec tx) (etio: chute abrupte des oestrogene et proges)

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32
Q

Stab de l’humeur le moins tératogène

A

Lithium (vs valproate>carbamaz)… sinon seroquel #1

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33
Q 
Risques associés aux Rx lors de la grossesse:
Li
Epival
Lamictal
Carba
Bzd
A

Li: epstein (2xplus), floppy baby syndrome
Epival: tube neural 5%, bas IQ, autisme
Lamictal: faible risque de fente palatine
Carba: formations cranio-faciales 11%, 2,9% defauts cardiaque, spina bifida, retard de dev 20%
Bzd: fente palatine, petit poids de naissance, prématurité, floppy babt, faible apgar

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34
Q

Comorbidité la plus fréquente chez TOC?

A

Depressive disorder

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35
Q

Pattern TOC les plus fréquents (obsess-compuls)?

A 
Contamination-lavage
Doute-vérification
Pulsion agressive/sexuelle
Symetrie/ordre-classer/ranger/compter
Autres compulsion fréquente: demande de rassurer
Autre obsession fréquente: religieuse
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36
Q

Fréquence des obsessions et compulsion (pas un disorder) dans la population générale?

A

Obss:80%
Compulsi:55%

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37
Q

Mécanismes de défense psychodyn liés au TOC?

A

Isolation, formation réactionelle, undoing
Régression de la phase oedipal à la phase anale
Coexistance d’amour et de haine à l’égard d’un objet résulte en doute et inhibition de l’action

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38
Q

Quels sont le seuils de réponse et de rémission dans le y-bocs?

A

<8 pour rémission

Diminution de 25% pour réponse au tx

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39
Q

Nommer le type de TCC pour le TOC et expliquez ses composantes

A

Exposition and relapse prevention

  • psychoed des effets négatifs l’évitement de l’anxieté
  • psychoed famille sur réduire les accomodations incluant la réassurance
  • exposition cognitives aux obsessions, puis in vivo (avec thérapeute puis seul)
  • prévention de la réponse: réducion des compulsions, des comportement sécurisant, de la recherce de réassurance. Permet habituation et nouveax apprentissanges
  • restructuration cognitive: réduire sentiment de responsabilité excessif, diminuer conviction qu’un pensée rend un évènement plus probable (fusion pensée-action), réévaluer qu’une émotion associée à une pensée confirme un sentiment de danger, gestion de l’intolérance à l’incertitude et du perfectionnisme
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40
Q

Types de chirurgie pour TOC réfractaire

A

Cingulotomie antérieure (aire de brodman 24 et 32) et capsulotomie antérieure

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41
Q

Changements neurobio dans le TOC

A

Diminution de volume mai hyperactivité des ganglions de la base, noyaux caudés, cortex orbitofrontal, cingulum
Augmentation de volume cingulé antérieur, thalamus

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42
Q

Évolution d’un PANDAS?

A

-Dx contreversé: minorité des jeunes avec TOC
-relation entre grosseur des ganglions de la base et sévérité des sx de TOC
-Apparition soudaine de TOC/tics suite à infection à streptocoque (ou s’aggravent soudainement suite à strep-b-hemolytique du groupe A). Survient entre 3 ans et puberté. Prophylaxie avec atb ne donne rien car ce sont des anticorps produits contre le strep (ie c’est autoimmun)
Donc on traite l’infection et pour le TOC, on fait ISRS et TCC

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43
Q

Nom de l’étude qui a permis de déterminer qu’un combinaison sertraline+TCC est supérieur que either modality alone chez la population pédiatrique?

A

POTS - pediatric obsessive compulsive disorder treatment study

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44
Q

Body dysmorphic disorder tx?

A

SSRI même si d’intensité délirante

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45
Q

Critères dx du body dysmorphic d/o

A

1-préoccupation concernant un ou plusieurs défauts perçus de l’apparence physique qui ne sont pas observables ou mineurs aux yeux des autres
2-mène à des comportements répétitifs ou actes mentaux (souvent devant miroir, demande de réassurance, évitement social)
3-souffrances significative ou altération du fonctionnement

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46
Q

Sites de trichotillomanie et actions subséquente à arrachage chez 30-40%

A

Cheveux, cils, sourcils.

Ils mangent les cheveux/poils - 1/3 développent un bézoard

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47
Q

Quelle est la neurobiologie du PTSD?

A

Diminution du volume de l’hippocampe, hypermétabolisme de l’amygdale (activation lors des flashbacks); hypocortisolémie lorsque PTSD comorbid avec MDD

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48
Q

Combien de gens en acute stress disorder convertissent en PTSD?

A

25-30%

La moitié des PTSD avait un Acute Stress D avant

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49
Q

Types de traumas les plus fréquents pour PTSD

A 
Mort d’un proche de façon inattendue
Abus sexuels
Proche avec maladie, blessure sérieuse
Enfant avec maladie sérieuse
Être victime de violence de la part du conjoint
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50
Q

Quels types de thérapies psychologique pour PTSD?

A

Trauma focused CBT = EMDR, mais réponse plus rapide avec EMDR

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51
Q

Étapes de la psychothérapie pour PTSD?

A

1) stabilisation (gestion des sx, abstinence de consomation)
2) intégration du trauma (narrative story telling, exposition prolongée, EMDR)
3) reconnection (avec réseau personnel et professionel)

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52
Q

Prevalence and incidence of schizophrenia?

A

Prevalence M=F=1%

Incidence M>F

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53
Q

Risk factors of suicide in schizophrenia?

A

Depression (most important risk factor)
high IQ, high pre-morbid fonctionning, insight, young age of onset, recent discharge, 6 years following first admission, command hallucination, akathisia, tx non-adherence

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54
Q

Risk factor of violence in schizophrenia?

A

Persecutory delusion, command hallucination, atcd of violence, young male, tx non-adherence, substance use, neurological deficits

Homicide risk in scz = gen pop

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55
Q

Evolution of patients in schizophrenia (remission, refractory…)?

A

25% refractory
33% remission
(12-15% functional remission ; 2 years without sx and social function)

(In ottawa review course, its 55% good outcome, 45% poor outcome)

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56
Q

What are the potential explications for such a high comorbidity between SUD and SCZ (50%)?

A
  • shared biological vulnerability between the 2 disorders
  • self medication of psychotic sx
  • psychosis induced by substance
  • temporary relief of D2 blockade from antipsychotics
  • common psychosocial factors
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57
Q

What are the cut-off age for :Very early onset, early onset, late onset and very late onset schizophrenia ?

A

very ealy: 13
Early: 18
Late: 40
Very late: 65

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58
Q

Most frequent sx in early onset scz?

A

Auditive hall

Visual hall more frequent compared to adults

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59
Q

Name the first rank sx of scz

A 
Auditory hallucinations 
Broadcasting of thoughts
Delusional perception
Thought insertion
Thought withdrawal
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60
Q

Name the negative sx of schizophrenia?

A

Anhedonia
Associability (diminution of interest for social interactions)
Alogia (diminution of speech)
Avolition (diminution of motivation to start activities)
Diminution de l’expression des emotions (contact visuel, prosodie, mouvements corpo)

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61
Q

How to differenciate negative sx of scz from depression?

A

No despair, no discouragment, no sadness, no guilt, no SI, no change in sleep or appetite in negative sx of scz

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62
Q

What are the specifiers for scz?

A

First episode, currently in (acute episode, partial or complete remission)
Multiple epsiode, currently in…
Continuous
Unspecified
With catatonia
Specify current severity with a quantitative assessment

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63
Q

Facteurs de risque de schizophrenie?

A

Urbanicity (only in developped countries).
Paternal age (more than 35yo)
In-utero infection (influenza)
Perinatal-birth complications
Winter babies
Migration (more risk in 2nd generation than 1st)

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64
Q

What do we know about genetics of scz?

A

No major gene locus, no single gene, heretability accounts for 80% of the illness
22q11 (DiGeorge)

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65
Q

Nommer des facteurs de bonne évolution de la schizophrenie

A 
Debut soudain
Evenement declencheur
Late onset
No family hx of scz
Insight
Women
Tx observance
Associated affective sx
Family hx de sx affectifs
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66
Q

Facteurs de mauvaise évolution de la schizophrenie

A 
Insidious ponset
No precipitating factor
Early age onset
Family hx of scz
Negative sx
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67
Q

Phase prémorbide de scz

A 
Anomalie comportementale
Poor social relationships
School difficulties
Manque d’intéret
Social anxiety
Adhd
Restricted affect
Develop delays
Hypersensibilité a la critique
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68
Q

Prodromal schizophrenia: epidemiology?

A

10-18% will have psychosis within the year
25-35% will have psychosis within a decade
80-90% des patients avec scz had prodrome retrospectivement

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69
Q

Describe the 3 groups of ultra-high-risk to schizophrenia

A

1- sx psychotiques atténués (many times per week, more than one week, less than 5 years). Thought disorder and content disorder, perceptual anomalies. Most frequent!

2- sx psychotiques intermittents et brefs (qql min a qql heures), less than one week.

3-risque génétique et détérioration. Hx familiale positive ou pt avec tp schizotypique.

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70
Q

Indication de scan en psychose?

A

Pas d’emblée si première psychose, only if suggestible of intra-cranial pathology (cephalée, No, Vo, seizure, rapid progression (less than 3 mo), memory deficits, focal neurological sx de novo)

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71
Q

Genetic syndrome associated with psychosis?

A

Digeorge, 22q1.2
Voix hypernasale, long visage étroit, petites oreille, nez proeminent, petite bouche, menton reculé, fissure palpébrale étroide, difficulté d’apprentissage, malformation cardiaque, deficit immunitaire, arche plantaire accentuée

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72
Q

Monitoring schedule for antipsychotic medication?

A

Smoking: baseline, 3 mo, annually
BMI, weight circumference: baseline, at 1mo, at 3mo, annually
Blood pressure: baseline, 3 mo, annually
HbA1c-fasting glucose: baseline, 3 mo, annually
Prolactin as clinically indicated
EPS: baseline, at 1mo, at 3mo, annually

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73
Q

Cognitive deficits in schizophrenia?

A
  • 70-80% of scz patients have cognitive deficits compared to gen pop.
  • Strong predictor of poor social and vocational functionning
  • First episode presentation of cognitive deficicits are correlated to negative sx once ilness is stabilized
  • Deficit present before first episode, then drop after first episode compared to their baseline, then stabilizes during early illness
  • Progressive loss of grey and white matter
  • atteinte: memore verbale et épisodique, IQ, verbal fluency, attention and executive functions
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74
Q

Imagerie de la schizophrenie?

A
  • elargissement des ventricules (80%)
  • anomalie des ganglions de la base
  • diminution de la symétrie
  • diminution du volume de l’hippocampe, amygdale, lobes temporaux, frontaux, occipitaux, cervelet
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75
Q

Psychosocial interventions in schizophrenia?

A
  • Family interventions (especially in highy expressive family because of increase risk of relapse) ; evidence for sx reduction and reduded risk of re-admission ; 10 sessions over 3 months
  • vocational therapy : coordination des services en santé mentale avec le milieu de travail ; place-then-train ; job in reel conditions
  • little research on life skills
  • cognitive remediation to be considered for patients with persistent cognitive deficits
  • social skills: no impact of positive sx, re-admission
  • CBT: for patient who remain symptomatic with AP, including with mood sx and anxiety : efficient to reduce severity of sx, re-admission, relapse
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76
Q

Tx recommendation for schizophrenia?

A

Adequate trial duration of an AP: 4-6 weeks
Tx duration after FEP: 18 months
Tx duration if more than 1 episode: 2-5 years
Relapse prevention dose of tx: 4-6mg risperidone equivalent (or 300-400mg chlorpromazine
Acute tx: if no response after 4 weeks, change. If partial response and no side effects, wait 8 weeks before re-evaluating
-relapse 82% at 5 years, 5-6x greater if rx non-observance

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77
Q

Definition of treatment resistant schizophrenia?

A

More or equal to 2 positive sx at moderate intensity ; or 1 positive sx at severa intensity ; after 2 adequate trials of different AP (documented observant, 6 weeks of adequate dose which is more than half of recommended therapeutic dose ; if LAI : trial of 6 weeks on steady state)

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78
Q

What is an adequate trial of clozapine?

A

More than 400mg or more than 1100nML, 8-12 week-trial

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79
Q

Provide a definition on metabolic syndrome

A

Obesité abdo + 2 parmi:

  • Obesité abdo (TT femme more than 80cm; TT homme 94cm), -TG: 1,7mmol-l
  • HTA: +=130mmg Hg sur 85mm Hg
  • cholesterol HDL: 1,03 homme, 1,3 femme
  • glycemie a jeun: 5,6 mmol-l
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80
Q

Échelle d’éval des EPS?

A

AIMS: abnormal involuntary movement scale - sur 4 ; section facial and oral movements ; section extremity ; section trunk ; score highest amplitude or frequency ; positive aims examination is a score of 2 in two or more movements or a score of 3-4 in a single movement
ESRS: extraperamidal side effect rating scale, sur 6
BARNS

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81
Q

Trouble psychotiques secondaires a maladie?

A 
Neoplasie
Maladie cerebrovasculaires
Huntington
SEP
Epilepsie
Surdité
Migraine
Infection SNC
Hyper ou hypo thyroidie, parathyroidie
Lupus
Porphyrie aigue intermittente (triade de dlr abdo, polyneuropathie et psychose)
Hypocie, hypercardbie
Hypoglycemie
Debalancement electrolytique
Maladie renale ou hepatique
82
Q

Classification des handicaps intellectuels selon le niveau de QI?

A

70-80 = limite selon DSM
Leger: 50-70 (équivalent a 3iem année primaire en moyenne, majorité des handicaps intellectuels)
Moyen: 35-50 (rarement supérieur a 2iem année ; capable d’un travail adapté sous supervision, capable de vivre seul de facon minimale)
Grave:20-35 (capable de s’exprimer, requiert soutien et supervision)
Profond: inf 20 (pas de langage expressif)

83
Q

Tx pour agressivité-self-harm dans les handicaps intellectuels

A

Risperidone (and abilify) have approval in the US

84
Q

Heritabilite du TDAH?

A

75%

40-60% des parents avec TDAH ont un enfant avec le trouble

85
Q

Comorbidités du TDAH?

A

2x plus de risque de développer un SUD (50% des ados et 25% des adultes)
TDAH seul chez enfants 31% (14% chez adultes)
Chez enfants: 0DD (50%), troubles anxieux (33%)
Chez adultes : trouble anxieux (50%), ROH (34%), drogue (30%)
Psychostimulants, SNRI et burpropion exacerbent les tics 1/3 du temps
Tx pharmaco lorsque alteration severe du fonctionnemnt: first line intuniv et clonidine, 2line risperidone et abilify. Non-pharmaco: habit reversal

86
Q

Neurobio du TDAH?

A

2 cathécolamines impliqués (DA, NE)
Augmentation de l’activité theta en frontal à l’EEG
Dysfct fronto-striatal (dysfct executives)

87
Q

Expliquer les différents mécanismes d’action des psychostimulants pour le TDAH?

A

Methylphenidate (ritalin, concerta et biphentin): bloque la recapture de DA, NE
Amphétamine (dexedrin, adderal): relachement de DA, NE et 5-HT dans la synapse et bloque la recapture DA
Tous les psychostimulants ont la meme efficacité

88
Q

What’s to know about Guanfacine?

A

Agoniste selectif des recepteurs alpha2 adrénergiques
Adjuvant aux stimulants pour tics-anxiete-ODD-agressivite
Effet max prend plusieurs semaines
Attention a HTA et augmentation FC rebond a l’arret brusque

89
Q

First line for ADHD?

A

Adderral xr, biphentin, concerta, vyvanse

90
Q

Second line for ADHD?

A

Strattera, dexedrine, ritalin (guanfacine for children)

91
Q

Traitement d’une MAB et d’un TDAH comorbid chez adulte?

A

1ligne:bupropion
2iem ligne: amphetamines, methylphenidate, modafinil, CBT
3rd line: atomoxetine, effexor, vyvanse, TCA

92
Q

What’s to know about Gilles de la tourette?

A 
Autosomal dominant
TDAH associé ddans plus de 50% des cas
TOC associé dans plus de 20-40%
Trouble d’apprentisage comorbid 
2-4x plus fréquent chez garcons
Rémission 1/3 à 2/3 À l’adolescence
Moins de 10% coprolalie et copropraxie
Tics apparaissent apres sx de TDAH, TOC
93
Q

Main factor that make parents see a docteur for their children in ASD?

A

Language delay

94
Q

Neurobio et genetique de l’autisme?

A

90% d’heritabilité
5-10% d’anomalie au clinical microarray
Associé à x-fragile, phénylcétonurie, sclérose tubéreuse
Facteur pre-perinataux: age avancé des parents, complications perinatales (diabete, petit poids de naissance, hyperbilirubinemie)

95
Q

Ration H:F chez autistes?

A

4H:1F

96
Q

Étio de handicaps intellectuels?

A

1 ere cause: trisomie 21
2 iem: x-fragil

30% des TSA ont un HI

97
Q

Anomalie anatomique dans l’ASD?

A

Perimètre cranien supérieur durant 2 premières années de vie
20% on un PC >97iem percentile
(Dans le Rett syndrome, il y a une décélération du PC entre 5-48iem mois)

98
Q

Échelles d’évaluation à considérer dans troubles développementaux?

A

Autism diagnostic observation schedule (ADOS): évaluation interactive à travers 4 modules
Autism Diagnostic interview (ADI-R): entrevue semi-structurée avec parents
Wechsler intelligence scale of children (wisc) 6-17 ans
WAIS: 17 et ples
WPPSI-R: 3-7 ans
Social communication questionnaire
Social responsiveness scale
Échelle de vineland (VABS): mesure comportement adaptatifs en communication, habilités de la vie quotidienne, socialisation, motricité

99
Q

Deficits in which area in Communication disorders?

A

Speech: expressive production of words - reduced vocabulary
Language: form, function and use of conventional system of symbols (spoken words, sign language, written words) - limited sentence structure
Communication: verbal or nonverbal behavior - impairment in discourse
Type mixte receptif/expressif (le pire pronostic)
Type expressif (2-3x plus de garcon)

100
Q

Qu’est-ce qu’une circumlocution?

A

Word substitutions to avoid problematic words in fluency disorder (stuttering)

101
Q

What are the specifiers of specific learning disorders?

A
  • with impairment in reading (word accuracy, rate or fluency, comprehension) Test: woodcok-johnson, peabodu
  • with impairment in written expression (spelling accuracy, grammar and punctuation accuracy, clarity of organization of written expression) Test: TOWL, DEWS, TEWL
  • with impairment in mathematics (number sense, memorization of arithmetic facts, accurate or fluent calculation, math reasoning) Test: keymath diagnostic arithmetic test
102
Q

What disorder has to be excluded to make the dx of ODD?

A

DMDD

103
Q

Gender ratio in ODD?

A

H>F in childhood, then H=F

104
Q

Poor prognostic factors in ODD?

A

Early onset, severity of sx and comorbid ADHD. Increased risk of CD and ASPD (40% will become ASPD; 30-50% de ceux avec début dans l’enfance, 25% de ceux avec debut dans l’adolescence)

105
Q

What is the cutoff year of child onset Conduct Do?

A

10

106
Q

What are the specifiers of conduct Do?

A

Childhood onset
Ado onset
Unspecified onset

With limited prosocial emotions (lack of remorse or guilt type, callous-lack of empathy type, unconcerned about performance type, shallow or deficient affect type)

Mild, moderate or severe

107
Q

What are the criteria for Dx of conduct disorder?

A

3/15 criteria in the past 12 months from any category (aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules). With at least one criteria present in the past 6 months

If individual is 18 yo or older, the criteria for ASPD are not met

108
Q

Comorbidities of conduct disorder?

A

Adhd (36% in communitee, 90% severe)
Learning disorder, especially reading and verbal capacity
Anxious do (22-33%)

109
Q

Risk factor for conduct do?

A

Impulsivity, low IQ, poor school performance
Sexual, physical abuse or neglect
Poor parental supervision
Punitive education

110
Q

Treatment of ODD/conduct Do?

A

Parent management training when child (more focus on child prosocial behavior; less attention on child undesired behavior)

Multisystemic therapy when adolescent (individual therapy- social skills training and CBT, parent management training, school support, pharmacothx)

Pharmaco: risperidone > epival if no ADHD
If ADHD: psychostimulants> nonstimulants (atomoxetine, guanfacine, clonidine) > risperdal>epival

Not recommended: seroquel, haldol, lithium

111
Q

What you need to know about Intermittent explosive Do?

A

Failure to control agressive impulse by either verbal/physical agression that does not result in detroying property/injury or 3 behavioral outburst involving in damage within 12 months.
Usually cause marked distress or impairment in functioning.
Pt is at least 6 yo
Not premeditated, no tangible objectives
More common in males
According to winnicott, it is a way to regain a primitive maternal relationship.

112
Q

What is to know about kleptomania ?

A

Usually starts in adolescence, tends to be chronic.

113
Q

what to know about pyromania?

A

Poor prognostic: denial, poor insight, SUD

114
Q

Describe early and prolonged remission in SUD

A

Early: Aucun critere rempli (a l’exception de cravings) depuis au moins 3 mois mais moins de 12

Prolongée: Aucun critere rempli (a l’exception de cravings) depuis au moins 12 mois

Specify if in a controlled environment

115
Q

Lifetime prevalence of SUD (excluding nicotine)

A

35-60%

116
Q

Provide definitions for intox and withrawal of substance?

A

Intox: Development of a reversible syndrome, specific to a substance, because of recent exposure to that substance

Withrawal: development of a syndrome, specific to a substance, because of recent stop or reduction of the prolongue and massive use of the substance.

117
Q

Lors de l’évaluation de l’aptitude à comparaitre et la la responsabilité criminelle, quelle est la limite de la confidentialité?

A

Lors du consentement, préciser au patient que ce qu’il dira ne pourra servir à le reconnaitre coupable mais pourra influencer sa crédibilité si des versions des évènements s’avèrent discordantes.

Statements are protected and can only be used to determine fitness or NCR, determine disposition, challenge credibility of later statements, establish purjery

118
Q

Nommer les critères de Regina vs Taylor (ou Mcgarry)

A

Pour l’aptitude à comparaitre (nom du test est «limited cognitive capacity»:

  • capacité a communiquer avec son avocat
  • capacité d’indentifier les membres de la cour
  • comprendre la nature-objet de la poursuite
  • comprendre les conséquences éventuelles des poursuites
  • capacité à distinguer les plaidoyers (coupable, nonpcoupable)
119
Q

Nommer les critÈre de McNaghtan

A

NCR (cour fédérale mais gestion provincial via TAQ):
-necessité d’avoir un probleme de sante mentale
Et
-ne pas distinguer le bien du mal
Ou
-capacité d’apprecier la nature-qualité de l’acte commis (les conséquences physiques et matérielles)

Lack of mens rea (the guilty mind, act done purposely, knowingly)

120
Q

Que signifie Winko vs colombie-britannique (1999)?

A

A défini la notion de danger significatif à la population. Si n’est plus un danger, patient peut être libéré sans condition. S’il est encore un danger, il peut avoir conditional discharge or detained in hospital.

On doit tenir compte des critères suivant pour déterminer la disposition:

  • the need to protect the public from danger
  • the mental condition of the accused
  • the reintegration of the accused in society
  • the other needs of the accused
121
Q

Que veulent dire les 2 projets de loi C-14?

A

1- Qu’un patient NCR peut être déclaré à haut risque (conséquence: détention stricte et que ce statut ne peut être retiré que suivant une audience devant tribunal, et que les audiances au TAQ son aux 36 mo au lieu de 12mo)

2-Loi canadienne de l’aide médicale à mourir (Carter vs Canada) dont les critères sont essentiellement les mêmes que la loi québécoise

  • assurée
  • majeur et apte à consetir
  • maladie grave et incurable
  • declin avancé et irréversible
  • souffrance phys et psy qui ne peuvent être apaisée
  • demande libre et éclairée
  • en fin de vie
122
Q

Cause la plus fréquente de violence?

A

SUD (50% des homicides sont sous l’effet de l’alcool()

123
Q

Nommer des outils d’éval du risque de violence

A

HCR-20 : historical, clinical, risk management. Pour clientèle carcérale et psychiatrique

START (dangerosité court terme1-8 sem)
DASA (dangerosité court terme - 24hr)
VRAG (dangerosité long terme-7-10 ans)
SORAG (sex offenders)
Static-99R (violence sexuelle)

PCL-R: «psychopathy check list» ne constitue pas une échelle d’éval de la dangerosité

McArthur: prédicteur de violence le plus fort: psychopathy

124
Q

Qu’est-ce que la psychopathie

A

Un mix de narcissique et d’antisociaux

Premier facteur de non traitabilité

PCL-R a 20 critères et un score >30 = psychotpahtie)
(Charme superficiel, suestime de soir, tendance à s’ennuyer, mensonges, manipulation, pas de remors, pas d’empathie, …

125
Q

C’est quoi Tarassof?

A

USA, 1976 et 1982, Duty to warn et Duty to protect

126
Q

C’est quoi Smith vs Jones ?

A

Canada, la sécurité a préséance sur la confidentialité si:
1-il existe une cible claire
2-les risque est sérieur
3-le risque est imminent

127
Q

C,est quoi la différence entre un témoin expert et un témoin de fait?

A

Le premier est payé et n’a pas besoin de rencontrer le patient avant de témoigner.
Le deuxième n’est pas payé, est obligé de témoigner (subpoena) et ne peut donner son opinion, juste des faits

128
Q

Nommer les facteurs statiques de violence

A 
1 ATCD de violence
2 ATCD de SUD
3 Dans la vingtaine
4 H>F (mais dans la pop psychiatrique H=F)
5. QI faible
6 violence dans l’enfance
7 faible niveau socio-économique
8 psychopathie
129
Q

Nommer facteur de risque dymanique de violence

A 
1 current SUD
2 agitation impulsivité
3 réseau de soutien
4 accès  à des armes
5 stresseurs
6 motivation au tx
7 introspection
8 acces aux victimes
9 trouble psychiatriques
130
Q

Nommer les Facteurs de risque de violence spécifiques À la santé mentale

A 
1 délires de contrôle
2 délires paranoides
3 hallucination mandatoires
4 inobservance au tx
5 érotomanie
Dx:
1 TP
2 SUD
3 Scz
4 mood Do
5 Anxiete
6 PTSD
131
Q

Facteurs de risques des troubles de comportement (BIO, PSYCHO, SOCIAL, FAMILIAL)

A

Bio: Hx fam, hypocortisolémie, hypertestostéronémie, tempérament diff, hyperactivité, maladie neurologique

PSYCHO: externalisation de la responsabilité, pas d,empathie, pauvre capacité de résolution de problème

SOCIAL: faible niveau socio-economique

Familial: famille punitive, manque de supervision, discipline inconstante, trouble psy ou de SUD dans la famille, abus, rejet ou négligence

132
Q

Cause #1 de poursuite en psy?

A

Suicide

133
Q

Consentement relation sexuelle chez les mineurs ?

A

16-17 peuvent consentir
14-15: peuvent consentir si la différence d’age est de 5 ans max
12-13 : peuvent consentir si la diff d’age est de max 2 ans
12 ans ne peuvent consentir

Toujours considérer la relation de pouvoir peu importe la tranche d’age

134
Q

Consentement au soins médicaux chez les mineurs

A

Si plus de 14 ans:

  • apte a consentir (qu’ils soient requis ou non), mais si effets sérieux ou permanents parents doivent donner consentement
  • si refuse soins nécessaire, demander aux parents, que les parents acceptent ou refusent, doit aller voir juge
  • si trop urgent, prodiguer soins
  • aviser parents que leur kid est a l’hopital sans dire pour quelle raison si il est là depuis plus que 12 hrs
135
Q

C’est quoi la relation de fiducie avec le patient?

A
  • agir dans son meilleur intérêt
  • relation de confience
  • contral légal entre le md et le patient
136
Q

Nommer les critéères de l’aptitude à consentir aux soins

A

-le patient coomprend la nature de la condition
-le patient comprend le but du tx
-le patient comprend les risques du traitment
-le patient comprend les risques de ne pas recevoir le tx
-la capacité à consentir est-elle affectée par sa maladie
Comprend l’information
Communique son choix
Capable de résonner
Capable d’apprécier

137
Q

Quelle est la différence entre tutelle et curatelle?

A

Tutelle: inaptitude partielle (biens vs personne) ou temporaire, assumer la simple gestion des biens, ne peut disposer des biens sans obtenir l’autorisation du conseil de tutelle
Curatelle: inaptitute totale et permanente, assure la pleine gestion des biens, incluant les faire fructifier.

Dans les deux cas, pour le role a la personne, doit assurer son bien-être moral, sa garde et son entretien, et consentir ou refuser les soins exigés par son état de santé

138
Q

Quel est le principe fondamental de l’AMC?

A

La bienfaisance (s’assurer de bien-être du pt) et non-malfaisance (ne pas nuire)

139
Q

Dans quel context on peut traiter un patient même s’il est apte à consentir?

A

Lorsque la cour l’ordonne pour l’aptitude a comparaitre (on a 60 jours, pas d’ECT ou de psySx ; si ca marche pas, il va au TAQ apres 60 jours)

140
Q

Name exceptions to confidentiality

A
  • child abuse
  • occupational hazard (flying and railway is federal)
  • elder abuse
  • professional sexual misconduct
  • communicable disease (MADO)
  • driving (only in Qc that its not mandatory)
  • gunshot wood
  • health insurance fraud
  • civil litigation(the patient makes their personal health info the subject of a lawsuit)
  • court ordered assessment
141
Q

Quels sont les critères de medical malpractice?

A
  • Duty (fiduciary duty)
  • Dereliction (provide standard care)
  • damages
  • direct cause
142
Q

Which PD does not have friends ?

A

Schizoid (can have relationship with parents)

143
Q

Which PD holds gruges?

A

Paranoid

144
Q

Which PD has few friends?

A

Schizothypal

145
Q

Which PD has ideas of reference?

A

Schizotypal

146
Q

Which PD has increased risk of schizophrenia?

A

Schizotypal, 10-20% develop scz

147
Q

What is the difference between paranoid PD and delusional disorder?

A

In PD, the delusion is not fixed

148
Q

Which cluster A does not have paranoid ideaation?

A

Schizoid

149
Q

Which PD has the highest premature mortality rate?

A

ASPD (suicide homicide accident violent mean)

RR 9 in man, 3 in women

150
Q

which PD has anomalies at EEG

A

ASPD and BPD (slow-wave activity)

151
Q

In which axis 1 disorder is avoidant PD most prevalent?

A

Scz

152
Q

What is the most prevalent PD in the elderly population?

A

NOS

153
Q

which PD does NOT improve with age?

A

OCPD and schizotypal

154
Q

Five factor model: name the ocean

A 
Openness
Conscientiousness
Extraversion
Agreeableness
Neuroticism
155
Q

Name cluster A defense mechanism

A

Projection

Denial

156
Q

Name cluster B defense mechanism

A 
Projective indetification
Dissociation
Denial
Primitive idealization
Omnipotence
Devalorization
157
Q

name cluster C defense mechanism

A 
Undoing
Reaction formation
Isolation of affect
Displacment
Annulation (OCPD)
Somatization
158
Q

Summarize what narcissistic PD is about?

A

Pathological regulation of self-esteem

Defensive mechanism used in response of fragile ego

159
Q

What is the difference between kohut and kernberg’s definition of narcissistic PD?

A

Kohut: hypervigilent - avoids criticism, easily feels humiliated, timid.ashamed of his grandiose ideations, so projects them on others.

Kernberg: grandiose - arrogant, aggressive, enjoys being center of attention, disregards others’ opinions. Uses grandiosity to defend themselves against low self-esteem.

160
Q

What are kernberg and Kohut therapeutic techniques

A

Kernberg: confrontation (interpret defenses)
Kohut: empathy (accept idealisation as a developmental need, empathy towards patient’s feelings as it is reaction to parents failure)

161
Q

What the evolution of BPD

A

Impulsivity improves, interpersonal difficulties persist

162
Q

What’s the comorbidity rate of BPD and BAD?

A

30%. It is higher than in other PD

163
Q

What are the Rx we can prescribe for impulsivity in BPD?

A

Topamax, lamictal and abilify, but low evidence

164
Q

Name all psychotherapies indicated for BPD

A 
DBT
psychodyn
Transfer focused thx (kernberg)
Schema thx (young)
MBT
Good psychiatric management (Gunderson)
165
Q

Whats chain analysis?

A

Identify prompting event, emotions and thoughts, short-term problematic behavior and long term problematic behavior with consequesnces

166
Q

What are main comorbidities of ASPD?

A

SUD (54%)
ADHD (60%)
Anxiety (53%)

167
Q

What is the female parent of ASPD?

A

Somatization disorder

168
Q

Heritabilité ASPD?

A

5

169
Q

neurobiological etiologies of ASPD?

A

Anomalies EEG
Reduction of prefrontal activity and gray matter
Hypertestoreronemia
Hypocortisolemia

170
Q

Which substance does not cause withdrawal according to DSM?

A

PCP
Hallucinogenes
Inhalents

171
Q

According to DSM, which psychiatric dx are caused by cannabis intox?

Which psych dx is caused by withdrawal?

A

1- psychotic, anxious, delirium, sleep do

2- sleep do

172
Q

Which substances cause delirium in withdrawal?

A

Opiods
Alchohol
Sedative-hypnotics

173
Q

Which substance can cause OCD (in intox and withdrawal)

A

Stimulants

174
Q

Which substances can cause persistent NCD ?

A

Alcohol
Sedative-hypnotivs
Inhalants

175
Q

What do the cloninger types mean ?

A

In alcohol use disorder
Type 1 starts later, F=M, slow progression, environmental and genetic factors involved, most prevalent

Type 2: almost exclusive to male, starts before 20yo, rapid progression, behavioral problems during intox, more genetic

176
Q

Quels sont les marqueurs biologiques de prise d’alcool?

A

CDT (carbohydrate-deficient transferrin) most sensitive and specific

GGT - helps to indentify relapse

VGM, LDL, TG

AST/ALT 2:1

177
Q

What is the Mellanby effect?

A

Les effets de l’intox sont plus grands lorsque l’alcoolémie augmente que lors qu’elle diminue

178
Q

Describe alcoholic hallucinosis

A

= psychotic disorder induced by alcohol

During of after prolonged use of etoh
Reality testing is preserved and clear sensorium
Paranoid delusions
Most often auditiv hall (in DT, they are + visual)
Presents with depressed and anxious mood
Can respond to antipsychotics

179
Q

What is wernicke triad and tx

A

1- ataxia, confusion and ophtalmoplegia (nystagmus, occular palsy, pupil anomalies)

Thiamine 100mg IM-IV DIE x3 days minimum than PO

Give thiamine before glucose repletion

80% develop korsakoff

180
Q

Describe stages of alcohol withdrawal

A

1- tremors : within 6hrs, can last up to 3 days. Accompanied by HTA, tachycardia, anxiety, diaphoresis

2-hallucinations: within the first day, can last up to 3 days.

3-convulsions: within first day. generalized, tonico-clonique, with short post-ictal state,

4- Delirium: within 3 days, can last up tp 5 days. Confusion, agitation, vo, fever, dehydration

20% mortality when DT not treated. More frequent after 5-15 yo of important intake. NO HALDOL!

181
Q

What’s specific to MDMA intox ?

A

Hyperesthesia, bruxism, hyperthermia

Amphetamin-like effect
Hallucinogen-like effect

182
Q

what are the 3 relapse pathways?

A

1) stress, including anxiety and depression: increased amygdala activity resulting in increased level of CRF and norepinephrine
2) cues activate glutamatergic pathways
3) low dose or other substance use re-initiates use via D3 pathway

183
Q

what brain structure is responsible for identifying the salience of a substance?

A

nucleus accumbens (with dopamine)

184
Q

What are the main withdrawal sx of cannabis?

A

anxiety, decreased sleep and appetite

185
Q

when is an opiod dependant patient most likely to die from overdose?

A

after detox

186
Q

Sx of opiods

1) intox
2) withdrawal

A

1) pinpoint pupils, sedation, resp suppression

2) Diarrhea, lacrimation, rhinorrhea, cold turkey, myoclonus, insomnia, HTN, fever

187
Q

Sedative hypnotic

1) intox
2) withdrawal

A

1) slurred speech, ataxia, incoordination, amnesia, resp suppression (like Etoh)
2) tachycarida, HYN, insomnia, anxiety, Gi disturbance, delirum, seizures, detah (like Etoh)

188
Q

stimulant include which drugs?

1) intox
2) withdrawal

A

cocaine, crack (dopamine re-uptake inhibitor), amphetamine (release of dopamine) and MDMA (mix of hallucinogene -serotonine release promoter- and amphetamine)

1) increased energy, alertness, euphorie, decrease appetite, then agitation, irritability, paranoia, hallucination tactile, delirium, seizure, cardio or cerebro vascular events
2) depression, inattention, increased appetite, fatigue, hypersomnolence, cravings, intense dreams/nightmares

189
Q

hallucinogenes (LSD, psilocybin, mescaline)?

A

5HT2 agonist, limited addiction potential, talk down to reassure during intox, persisting flashbacks

190
Q

NMDA antagonists include which drug?

1) intox
2) withdrawal

A

ketamine and PCP

1) agressivité, hypersensitivity to stimuli, no pain
2) muscle rigidity, seizure, agitation, delirium, HTN, NYSTAGMUS, ataxia, hallucination, coma ; 50% psychosis,

191
Q

inhalants (paint thinner, glue, gas)

1)intox

A

1) amnesia, incoordination, euphorie, sedation, ataxia, nystagmius, dysarthria, hyporeflexia, tremor, diplopia, coma

192
Q

What are the criteria for Children and ado/adult gender dysphoria?

A

At least 6 for children

  • strong desire or insistance to be of the other gender
  • cross-dressing
  • cross-gender role in make-believe play
  • preference for toys and games stereotypically used by the other gender
  • preference for playmates of the other gender
  • in boys, avoidance of rough-and-tumble play; in girls, rejection of typically feminie activities
  • strong dislike of one’s sexual anatomy
  • strong desire for the sex characteristics that match one’s experienced gender

At least 2 for ado/adult

  • marked incongruence between one’s experienced gender and sex characteristics
  • strong desire to be rid of sex characteristics
  • strong desire for the sex charact of the other gender
  • strong desire to be the other gender
  • strong desire to be treated as the other gender
  • strong conviction that one has the typical feelings and reactions of the other gender

For at least 6 months

Specify if

  • with a disorder of sex development
  • posttransition
193
Q

What is the course of gender dysphoria regarding sexual orientation by gender?

A

Male with early-onset gender dysphoria persists as adult will be attracted male
Male with late-onset gender dysphoria will be attracted to female and consider themselves as lesbian

Female with early-onset gender dysphoria will be attracted to female.
Female with late-onset gender dysphoria will be attracted to male and consider themselves gay.

194
Q

What is the course of gender dysphoria regarding transition?

A

More male transition to female than female to male

4-5F:M in childhood ; H=F in adolescence

195
Q

What is the most important risk factor for gender dysphoria?

A

Death of mother or sick/depressed mother leads to boy wanting to replace her so identifies as her.

196
Q

Gender identity milestones?

A

Become aware of gender by 2-3 yo

Permanance of gender by 5yo

197
Q

What are the 8 paraphilic disorders

A 
Voyeurism
Fetishistic
-body parts
-nonliving objects
-other
Pedophilia
-limited to incest
-sexually attracted to males
-sexually attracted to female
-or both
Sexual Masochism
Sexual Sadism
Exhibitionism
-sexually aroused by exposing genitals to prepubertal children, -to mature ind - to both
Frotteuristic
Transvestic

All have in common at least 6 months of recurrent and intense sexual arousal from

The full remission specifier means the individual has not acted on the urges and that there is no distress in areas of functionning for 5 years

198
Q

How to treat paraphilias?

A

CBT (often group)

low risk case: SSRI (partial reduction)
Moderate case: medroxyprogesteron (provera) (partial reduction)
Severe case: antiandrogene (cyproterone) (partial reduction)
Very severe: lupron/leuprolide, Goserelin ; ablation de la testosterone with GnRH agonist

199
Q

what is the sexual orientation of pedophiles?

A

95% are heterosexuals

50% intoxicated with alcohol during the act

200
Q

What age first masturbation starts?

A

15-19 months

Estelle Royal College (23 decks)

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