Flashcards in Cognitive, Personality, Dissociative, and Eating Disorders Deck (63):
Memory problems in the elderly: A comparison of AD, pseudodementia, and normal aging - Alzheimer disease - Clinical example:
A 65-yr old former banker cannot remember to turn off the gas jets on the stove nor can he name the object in his hand (a comb).
Memory problems in the elderly: A comparison of AD, pseudodementia, and normal aging - Alzheimer disease - Major manifestations:
1. Severe memory loss.
2. Other cognitive problems.
3. Decr. in IQ.
4. Disruption in normal life.
Memory problems in the elderly: A comparison of AD, pseudodementia, and normal aging - Alzheimer disease - Medical interventions:
1. Structured environment.
2. AChE inhibitors.
3. Ultimately, nursing home placement.
Pseudodementia (dementia that mimics dementia) - Etiology:
Depression of mood.
Pseudodementia - Clinical example:
A 65-yr old dentist cannot remember to pay her bills. She also appears to be physically "slowed down" (psychomotor retardation) and very sad.
Pseudodementia - Major manifestations:
1. Moderate memory loss.
2. Other cognitive problems.
3. No decr. in IQ.
4. Disruption of normal life.
Pseudodementia - Medical interventions:
2. Electroconvulsive therapy (ECT).
Normal aging - Etiology:
Minor changes in the normal aging brain.
Normal aging - Clinical example:
A 65-yr old woman forgets new phone numbers and names but functions well living on her own.
Normal aging - Major manifestations:
1. Minor forgetfulness.
2. Reduction in the ability to learn new things quickly.
3. No decr. in IQ.
4. No disruption of normal life.
Personality disorders - Characteristics:
Show a chronic, lifelong, rigid, unsuitable pattenrs of relating to others that cause social and occupational difficulties (Eg few friends, job loss).
Persons with PDs generally are NOT ...?
AWARE that they are the cause of their own problems (do not have "insight"), do not have frank psychotic symptoms, and do NOT seek psychiatric help.
Personality disorders are categorized by the DSM-IV-TR into:
1. Cluster A = Paranoid, schizoid, schizotypal.
2. Cluster B = Histrionic, narcissistic, borderline, and antisocial.
3. Cluster C = Avoidant, OCD, dependent.
4. NOS = not otherwise specified (Passive-aggressive).
For the DSM-IV-TR diagnosis, a PD must be present by ...?
Antisocial PD cannot be diagnosed until the ...?
Age of 18.
--> Prior to this age, the diagnosis is CONDUCT DISORDER.
DSM-IV-TR Classification and characteristics of PDs - Cluster A:
Hallmark - Avoids social relationships, is "peculiar" but not psychotic.
DSM-IV-TR Classification and characteristics of PDs - Cluster A - Genetic or familial association - Characteristics:
DSM-IV-TR Classification and characteristics of PDs - Cluster A - Paranoid:
1. Distrustful, suspicious, litigious.
2. Attributes responsibility for own problems to others.
3. Interprets motives of others as malevolent.
4. Collect gums.
DSM-IV-TR Classification and characteristics of PDs - Cluster A - Schizoid:
1. Long-standing pattern of voluntary social withdrawal.
2. Detached, restricted emotions, lacks empathy, has no thought disorder.
DSM-IV-TR Classification and characteristics of PDs - Cluster A - Schizotypal:
1. Peculiar appearance.
2. Magical thinking (ie believing that one's thoughts can affect the course of events).
3. Odd thought patterns and behavior without frank psychosis.
DSM-IV-TR Classification and characteristics of PDs - Cluster A:
DSM-IV-TR Classification and characteristics of PDs - Cluster B - Hallmark:
Dramatic, emotional, inconsistent.
DSM-IV-TR Classification and characteristics of PDs - Cluster B - Genetic or familial association:
1. Mood disorders.
2. Substance abuse.
3. Somatoform disorders.
DSM-IV-TR Classification and characteristics of PDs - Cluster B - Histrionic:
1. Theatrical, extroverted, emotional, sexually provocative, "life of the party".
2. Shallow, vain.
3. In men, "Don Juan" dress and behavior.
4. Cannot maintain intimate relationships.
DSM-IV-TR Classification and characteristics of PDs - Cluster B - Narcissistic:
1. Pompous, with a sense of special entitlement.
2. Lacks empathy for others.
DSM-IV-TR Classification and characteristics of PDs - Cluster B - Antisocial:
1. Refuses to conform to social norms and shows no concern for others.
2. Associated with conduct disorder in childhood and crimical behavior in adulthood ("psychopaths" or "sociopaths").
DSM-IV-TR Classification and characteristics of PDs - Cluster B - Borderline:
1. Erratic, impulsive, unstable behavior and mood.
2. Feeling bored, alone, and "empty".
3. Suicide attempts for relatively trivial reasons.
4. Self-mutilation (cutting or burning oneself).
5. Often comorbid with mood and eating disorders.
6. Mini-psychotic episodes (ie brief periods of loss of contact with reality).
DSM-IV-TR Classification and characteristics of PDs - Cluster C - Hallmark:
Fearful and anxious.
DSM-IV-TR Classification and characteristics of PDs - Cluster C - Genetic or familial association:
DSM-IV-TR Classification and characteristics of PDs - Cluster C - Avoidant:
1. Overly sensitive to critisism or rejection.
2. Feelings of inferiority, socially withdrawn.
DSM-IV-TR Classification and characteristics of PDs - Cluster C - Obsessive-compulsive disorder;
1. Perfectionistic, orderly, inflexible.
2. Stubborn and indecisive.
3. Ultimately insufficient.
DSM-IV-TR Classification and characteristics of PDs - Cluster C - Dependent:
1. Allows other people to make decisions and assume responsibility for them.
2. Poor self-confidence, fear of being deserted and alone.
3. May tolerate abuse by domestic partner.
DSM-IV-TR Classification and characteristics of PDs - Not otherwise specified:
1. Procrastinates + is inefficient.
2. Outwardly aggreeable and compliant but inwardly angry and defiant.
Dissociative disorders - Characterized by:
Abrupt but TEMPORARY loss of memory (amnesia) or identity, or by feelings of detachment owing to psychological factors.
In contrast to the cognitive disorders in which memory loss is caused by biological brain dysfunction, dissociative disorders are related to ...?
Disturbing emotional experience in the patient's recent or remote past.
DSM-IV-TR Classification and characteristics of dissociative disorders:
1. Dissociative amnesia.
2. Dissociative fugue.
3. Dissociative identity disorder (formerly multiple personality disorder).
4. Depersonalization disorder.
5. Dissociative disorder not otherwise specified.
DSM-IV-TR Classification and characteristics of dissociative disorders - Dissociative amnesia:
1. Failure to remember important information about oneself after a successful life event.
2. Amnesia usually resolves in minutes or days but may last years.
DSM-IV-TR Classification and characteristics of dissociative disorders - Dissociative fugue:
1. Amnesia combined with sudden wandering from home after a stressful life event.
2. Adoption of a different identity.
DSM-IV-TR Classification and characteristics of dissociative disorders - Dissociative identity disorder (formerly multiple personality disorder):
1. At least 2 distinct personalities ("alters") in an individual.
2. More common in women (particularly those sexually abused in childhood).
3. In a forensic (eg jail) setting, malingering and alcohol abuse must be considered and excluded.
DSM-IV-TR Classification and characteristics of dissociative disorders - Depersonalization disorder:
1. Recurrent, persistent feelings of detachment from one's own body, the social situation, or the environment (derealization) when stressed.
2. Understaning that these perceptions are only feelings, ie, normal reality testing.
DSM-IV-TR Classification and characteristics of dissociative disorders - Dissociative disorder not otherwise specified:
Dissociative symptom (Eg trance-like stae, memory loss):
1. In persons exposed to intense coercive persuasion (eg brainwashing).
2. Indigenous to particular locations or cultures (eg Amok in Indonesia).
Management of the dissociative disorders includes:
2. Drug-assisted interviews as well as long-term psychoanalytically oriented psychotherapy to recover "lost" (repressed) memories of disturbing emotional experiences.
Obesity - Give a definition:
More than 20% over ideal weight on the basis of common height and weight charts or having a BMI of 30 of higher.
At least ...% of adults are obese and an increasing number of children are overweight (at or above the 95th percentile of BMI for age) in the USA.
Is obesity an eating disorder?
What is most important in obesity?
--> Adult weight is closer to that of biologic rather than adoptive parents.
Obesity is more common in low or in high socioeconomic groups?
IN LOW SOCIOECONOMIC GROUPS.
Most weight loss achieved using commercial dieting and weight loss programs is ...?
REGAINED WITHIN A 5-YEAR PERIOD.
Bariatric surgery (Eg gastric bypass, gastric banding):
Initially effective BUT of limited value for maintaning long-term weight loss.
Pharmacologic agents for weight loss include:
1. Orlistat (Xenical, Alli) = Pancreatic LIPASE INHIBITOR that limits the breakdown of dietary fats.
2. Phentermine (lonamin), a symphathomimetic aine that decreases appetite.
In anorexia nervosa and bulimia nervosa the patient shows ...?
Abnormal behavior associated with food DESPITE NORMAL APPETITE.
The subtypes of anorexia nervosa are:
1. The restricting type (eg excessive dieting).
2. In 50%, the binge eating purging type (eg excessive dieting plus binge eating and purging).
The subtypes of bulimia nervosa are the:
1. Purging type (binge eating and purging).
2. Non-purging type (binge eating and excessive dieting or excercising but no purging).
The purging type of either anorexia nervosa or bulimia nervosa is associated with ...?
Specific electrolyte abnormalities are related to the type of purging seen:
1. Low K, low Na, and High HCO3 (metabolic alkalosis) --> VOMITING/DIURETIC USE.
2. Low K, high Cl, low HCO3 (together known as hyperchloremic metabolic acidosis) are seen with laxative abuse.
Eating disorders are more common in ...?
2. Higher socioeconomic groups.
Anorexia nervosa - Physical characteristics:
1. Extreme weight loss (15% or more of normal body weight).
2. Amenorrhea (3 or more consecutive missed menstrual periods).
3. Electrolyte disturbances.
5. Mild anemia and leukopenia.
6. Lanugo (downy body hair on the trunk).
7. Melanosis coli (blackened area of the colon if there is laxative abuse).
9. Cold intolerance.
Anorexia nervosa - Psychological characteristics:
1. Refusal to eat despite normal appetite because of an overwhelming fear of being obese.
2. Belief that one is fat when very thin.
3. High interest in food-related activities (eg cooking).
4. Simulates eating.
5. Lack of interest in sex.
6. Was a "perfect child" (eg good student).
7. Interfamily conflicts (eg patient's problem draws attention away from parental marital problem or an attempt to gain control to separate from the mother).
8. Excessive exercising ("hypergymnasia").
Anorexia nervosa - Management (in order of highest to lowest utility):
1. Hospitalization directed at reinstating nutritional condition (starvation and compensatory behavior such as purging can result in metabolic abnormalities (eg hypokalemia) leading to death).
2. Family therapy (aimed particularly at normalizing the mother - child relationship).
3. Group psychotherapy in an inpatient eating disorders program.
Bulimia nervosa - Physical characteristics:
1. Relatively normal body weight.
2. Esophageal varices caused by repeated vomiting.
3. Tooth enamel erosion due to gastric acid in the mouth.
4. Swelling or infection of the parotid glands.
5. Metacarpal-phalangeal calluses (Russell sign) from the teeth because the hand is used to induce gagging).
6. Electrolyte disturbances.
7. Menstrual irregularities.
Bulimia nervosa - Psychological characteristics:
1. Binge-eating (in secret) of high-calorie foods, followed by vomiting or other purging behavior to avoid weight gain.
Bulimia nervosa - Management (in order of highest to lowest utility):
1. Cognitive and behavioral therapies.
2. Average to high doses of antidepressants, particularly SSRIs; fluoxetine is the only FDA-approved agent.
3. Bupropion is contraindicated.
4. Group psychotherapy in an inpatient or outpatient eating disorders program.