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Flashcards in Disorders Deck (66):
1

Schizophrenia

Onset: late teens to early 30s.
Cause: DA hyperactivity
Symptoms: positive (delusions, hallucinations, disorganized speech or behavior, catatonia), negative (flat affect, apathy, anhedonia, inattentiveness).
Diagnosis: pos and neg symptoms with social and occupational deterioration for >or= 6mo
Types: paranoid, catatonic, disorganized, undifferentiated, residual.
NT abnormalities: increased (5HT, NE, DA), decreased GABA
Tx: 1. antipsychotic med: haloperidol or chlorpromazine.
2. risperidone (for neg symptoms)
3. clozapine
Side effects: antipsych meds (akathisia, tremors, rigidity, TD, acute dystonia, NMS)
clozapine (agranulocytosis)

2

ADHD

Onset: before 7yr, usually males.
Cause: unknown, maybe DA depletion or prenatal substance abuse.
Symptoms: inattention, impulsiveness, hyperactive behavior.
Prognosis: usually improves with age, may develop personality disorder.
Diagnosis: age >7yr, symptoms in two separate locations.
Tx: 1. behavior management
2. psychostimulants (methylphenidate)
Side effects: insomnia, depressed mood, irritability, tics, decreased growth rate.

3

GAD

Symptoms: uncontrollable and excessive anxiety about daily events, secondary symptoms (difficulty concentrating, restlessness, easily fatigued, sleep disturbance, muscle tension).
Lab tests needed: thyroid function, CBC, glucose, electrolytes, calcium, ECG
Diagnosis: anxiety occurs most days for >or= 6mo with 3+ secondary symptoms.
Tx: 1. psychotherapy, relaxation techniques
2. anxiolytics (benzo, buspirone)
Acute anxiety tx: benzo
Chronic tx: buspirone

4

OCD

Obsession: persistent intrusive thoughts/impulses/ideas/images that cause anxiety and can't be controlled.
Compulsion: repeated mental/motor behavior to lessen anxiety, follows obsession.
Comorbidity: Tourette syndrome.
Diagnosis: recurrent obsessions and compulsions that cause significant distress, patient knows it doesn't make sense.
Tx: 1. SSRI
2. TCAs
3. behavior modification techniques

5

Panic Disorder

Onset: 20-30yrs old, females.
Medical conditions: mitral valve prolapse, thyroid disorders.
Presentation: recurrent, unexpected, discrete periods of intense fear or discomfort, >4 panic symptoms, worry about another attack.
Symptoms: palpitations, tachycardia, sweating, shaking, SOB, choking feeling, chest discomfort, nausea, dizziness, fear of losing control or dying.
Diagnosis: recurrent attacks, >4 panic symptoms, >or= 1 mo associated anxiety.
Comorbidity: agoraphobia
Tx: 1. TCAs, MAOIs, SSRIs, benzos.
2. CBT
Agoraphobia Tx: exposure therapy

6

PTSD

Risk: traumatic events
Presentation: re-experience (hallucinations, flashbacks), increased arousal (anxiety, sleep disturbance, hypervigilance), avoidance of traumatic stimuli
Diagnosis: symptoms last >1 mo with severe fear/hopelessness/horror.
Tx: psychotherapy and medication (TCAs, SSRIs, carbamazapine, valproate)
Alternative to imipramine: phenelzine (MAOI)

7

Social Phobia

Presentation: excessive, persistent fear of social or performance situations.
Diagnosis: history
Tx: 1. behavioral therapy
2. SSRI or MAOI
Take propranolol 30 min before performance situations.

8

Bipolar Disorder

Mania (or hypomania) and major depression
Manic features: highly elevated or grandiose self esteem, decreased need of sleep, pressured speech, racing thoughts, flight of ideas, easily distracted, increased goal directed activity or psychomotor activation, excessive involvement in pleasurable activities.
Manic diagnosis: 3-4 features that last 1 week or need hospitalization.
Type 1: 1+ episode of mania w/ or w/o MDD.
Type 2: 1+ hypomanic episode and MDD.
Tx: rapid = benzo or antipsychotic.
long term = 1. psychotherapy, cognitive therapy, lithium
2. carbamazepine or valproic acid.
Side effects of lithium: GI distress, weight gain, fatigue, tremor, hypothyroidism
Toxic effects of lithium: vomiting, diarrhea, ataxia, confusion, seizure, coma.

9

Adjustment Disorder

Stressors: marital problems, divorce, moving, financial hardship, criminal victim.
Presentation: depressed or anxious mood within 3 mo of stressor, lasts <6 mo.
Diagnosis: history and presentation
Tx: 1. psychotherapy
For severe anxiety: short term use of benzos.
For depressed mood: antidepressants.

10

Complicated Bereavement

Risk factors: sudden or traumatic death, death of child, concurrent stress, insecure personality
Presentation: sudden or delayed onset (up to 1 yr) of depressive symptoms after death, last >2mo.
At risk for: major depression, suicide
Tx: 1. bereavement therapy
2. has disturbed sleep or anxiety: use benzo short term
3. antidepressant if have impaired social/occupational functioning or symptoms >2mo.
4. has psychotic symptoms: antipsychotics

11

Cyclothymic Disorder

Presentation: hypomanic symptoms and depressive symptoms >or= 2yr, symptom free <2mo at a time.
Diagnosis: history and presentation
Tx: 1. group and individual psychotherapy
2. Mood stabilizers and antidepressants

12

Dysthymic Disorder

chronic, mild depression
Presentation: continuous depressed mood, symptoms most of time for >or= 2 yr.
Symptoms: appetite change, sleep disturbances, fatigue, low self-esteem, decreased concentration, hopelessness.
Diagnosis: history and presentation
Tx: psychotherapy, antidepressants.

13

MDD

Onset: 20-50yr
NT affected: NE, 5HT
Criteria: depressed mood most of day/every day, decreased interest and pleasure in activities, feel worthless or have guilt, fatigue or low energy, decreased concentration, increased indecisiveness, weight gain or loss, psychomotor agitation or retardation, recurrent thoughts of death, SI, suicide plan or attempt.
Diagnosis: five + criteria for >or=2wks includes depressed mood or loss of interest/pleasure.
Lab tests: CBC, electrolytes, liver function, UA, thyroid function, drug screen, CT or MRI.
Tx: mild = psychotherapy.
1. SSRI, TCA, MAOI for at least 4 wks at max dosage
2. ECT
Use SSRI in pts with cardiac disease and suicide risk.
SSRI side effects: GI effects, sexual dysfunction, appetite suppression.
TCA side effects: dry mouth, constipation, sexual dysfunction, fatal in OD.
Use MAOIs in those with anxiety or atypical depression (increased sleep and appetite).
MAOI side effects: hypotension, tyramine hypertensive crisis.

14

Postpartum Depression

Risk factors: mood disorder, social stresses, infant health problems or irritability
Causes: genetics, decreased estrogen/progesterone/cortisol
Diagnosis: major depressive episode within 4 wks of birth.
Up to 15% women.
Tx: psychotherapy and medication, ECT if severe.
1. SSRI
2. TCAs

15

Postpartum Blues

mild depressive symptoms in 1st week after birth, resolve in 2nd week.
85% women.

16

Puerperal Psychosis

Mood disorder with psychosis within 6wks of childbirth.
Medical Emergency

17

Body Dysmorphic Disorder

Presentation: gradual onset of excessive preoccupation with imagined defect in appearance, causes significant distress and psychosocial impairment.
Diagnosis: history and presentation
Tx: psychotherapy, medication
1. fluoxetine
2. clomipramine
3. pimozide (antipsychotic) if refractory

18

Conversion Disorder

Cause: redirection of unconscious psych conflict into physical symptoms.
Presentation: loss of physical functioning (neuro), acute stressor precedes symptoms.
Diagnosis: symptoms cause significant impairment without medical explanation, psychological stress
Tx: psychotherapy and reassurance.

19

Factitious Disorder

aka Munchausen syndrome
Presentation: intentionally produced symptoms of medical or psych illness without obvious motive, causes hospitalizations.
Diagnosis: history, presentation, evidence of feigning.
Tx: avoid unnecessary procedures and hospitalizations.

20

Hypochondriasis

Presentation: fear of having serious disease, preoccupation causes significant distress or impairs functioning.
Diagnosis: lasts >6mo despite med eval and reassurance.
Tx: regular office visits and psychotherapy

21

Pain Disorder

Presentation: pain causing disability or distress, caused by psych factors.
Diagnosis: history, presentation, negative medical workup.
Tx: manage medical disorders, treat pain with minimal surgery or opiates, psychotherapy.

22

Somatization

Presentation: starts before 30yr, persists years, multiple medical complaints needing tx or impairing functioning.
Complaints: pain, GI disturbance, menstrual irregularities, sexual, pseudoneurologic.
Diagnosis: pain in 4 sites plus symptoms in 3 areas: GI (2 symptoms), sexual, neuro.
Tx: regular office visits, no lab tests or procedures without indication, psych consult.

23

Anorexia Nervosa

Risk factors: female, family history, industrialized society.
Criteria: fear of gaining weight, distorted perception of one's weight or body.
Presentation: low weight, amenorrhea.
Symptoms: constipation, abd pain, cold intolerance, lethargy or excess energy.
Physical signs: cachexia, hypotension, hypothermia, xerosis, lanugo, bradycardia, parotid gland swelling, edema, dental enamel erosion, calluses on dorsum of hand.
Lab test abnormalities: anemia, leukopenia, hypokalemia, hypochloremic metabolic alkalosis, hypercholesterolemia, hypoalbuminemia, low plasma estradiol, high plasma cortisol
Associated medical complications: cardiac arrhythmia, prolonged QT interval, decreased LV mass, gastric/intestinal dilation, osteoporosis, sick euthyroid syndrome, cognitive dysfunction.
Psych comorbidities: depression, aniety, OCD features.
Tx: psychotherapy (family and behavioral), chlorpromazine, cyproheptadine, fluoxetine.
Prognosis: up to 50% full recovery; increased mortality in 5-18%; 25% little improvement.

24

Bulimia Nervosa

Presentation: recurrent binge eating and inappropriate behaviors to prevent weight gain.
Behaviors: vomiting, laxatives, fasting excessive exercise.
Psych symptoms: influenced by feelings toward body shape or weight.
Physical signs: normal weight, eroded dental enamel, scars on hand, enlarged parotid gland.
Lab abnormalities: electrolyte disturbances, metabolic alkalosis and increased serum amylase (vomiting type), metabolic acidosis (laxative type).
Med complications: acute dilation/rupture of stomach, esophageal tears, arrhythmias, ipecac intoxication.
Psych comorbidities: depression, anxiety, subsatnce abuse/dependence, personality disorders.
Tx: psychotheraphy (cognitive behavioral), antidepressants, hospitalize.

25

Amnestic Disorder

characterized by memory loss.
Cause: damage to limbic system, stroke, head injury, tumors, herpes encephalitis, Korsakoff encephalopathy

26

Conflabulation

unintentionally untrue responses to questions by patients with acute amnestic disorder to fill gaps in memory.

27

Wernicke Encephalopathy

ataxia, ophthalmoplegia, confusion
cause: thiamine deficiency

28

Korsakoff Psychosis

chronic amnestic disorder from heavy alcohol use.
follows acute Wernicke encephalopathy.

29

Transient Global Amnesia

Onset: late middle age.
Presentation: acute disorientation with anterograde amnesia. Resolves in 24-48 hours.

30

Delirium

syndrome of cognitive deficits or perceptual disturbances with clouded consciousness.
Cause: head injury, drug intoxication or withdrawal, infections, metabolic and endocrine disorders.
Risk factors: older age, brain disease, severe physical illnesses, hypoalbuminemia
Onset: hours-days
Course: fluctuating
Decreased consciousness/attention
Symptoms: mood changes, anxiety, psychosis, psychomotor retardation, agitation, impaired judgment.
Tx: quiet environment, identify contributing factors/correct them, nutritional support, sedate with high potency antipsychotics.

31

Dementia

acquired and persisting memory impairment and other cognitive deficits in presence of preserved consciousness.
Pathology: loss of cortical or subcortical neurons.
Types: cortical, subcortical.
Causes: Alzheimer's, vascular disease, Lew body disease.
Reversible causes: pseudodementia, normal pressure hydrocephalus, adverse drug effects, syphilis, subdural hematoma, tumors, thyroid disorder, B12 and thiamine deficiency.
Diagnosis: history and physical, MMSE.

32

Alzheimer's Dementia

Pathology: neurofibrillary tangles of b-amyloid plaques.
Risk factors: older age, family history, female, head injury, lower education level.
Symptoms: depression, anxiety, hallucinations, delusions, agitation, sleep disturbances.
Tx: ACHEI (donepezil), established routines, support.

33

Paranoid PD

Cluster A.
extensive and excessive suspiciousness, distrust of others.

34

Schizoid PD

Cluster A.
socially isolated, emotionally cold.

35

Schizotypal PD

Cluster A.
odd thinking, eccentric behavior, social discomfort.

36

Antisocial PD

Cluster B.
disregard for social norms and interests of others, lacks remorse.
Psychopaths and sociopaths.

37

Borderline PD

Cluster B.
unstable mood swings, rocky relationships, anger and impulse control problems.

38

Histrionic PD

Cluster B.
excessive attention-seeking and dramatic behavior.

39

Narcissistic PD

Cluster B.
self-centered, insensitive to others.

40

Avoidant PD

Cluster C.
inhibited with low self-esteem, excessive fear of rejection.
associated with anxiety.

41

Dependent PD

Cluster C.
passive and submissive, can't make decisions, fear of being left alone.
associated with anxiety.

42

OCPD

Cluster C.
perfectionist, preoccupied with order and control.

43

Alcohol Intoxication

decreased motor control, impaired judgment/coodrination, ataxic gait, poor balance, lethargy, coma, respiratory depression
tx: ABC, monitor electrolytes and acid-base.
Thiamine, naloxone, folate
long term tx: AA, disulfiram, psychotherapy, naltrexone

44

Alcohol Withdrawal

mild: irritability, tremor, insomnia
mod: diaphoresis, fever, disorientation
severe: seizures, DTs.
DT: visual or tactile hallucinations, gross tremor, autonomic instability, fluctuating levels of psychomotor activity
tx: benzo (chlordiazepoxide, lorazepam)
thiamine, folate, multivitamin
magnesium sulfate

45

Cocaine Intoxication

euphoria, increased or decreased BP, tachycardia/bradycardia, nausea, dilated pupils, weight loss, psychomotor agitation or depression, chills, sweating, respiratory depression, seizures, arrhythmia, hallucination.
may cause MI or CVA
tx: mild to mod = benzo; severe or psychotic = haloperidol.
dependence: psychotherapy, TCA, amantadine or bromocriptine

46

Cocaine Withdrawal

malaise, fatigue, depression, hunger, constricted pupils, vivid dreams, psychomotor agitation or retardation.
tx: supportive.

47

Amphetamine Intoxication

euphoria, increased or decreased BP, tachycardia/bradycardia, nausea, dilated pupils, weight loss, psychomotor agitation or depression, chills, sweating, respiratory depression, seizures, arrhythmia, hallucination.
tx: mild to mod = benzo; severe or psychotic = haloperidol.
dependence: psychotherapy, TCA, amantadine or bromocriptine

48

Amphetamine Withdrawal

malaise, fatigue, depression, hunger, constricted pupils, vivid dreams, psychomotor agitation or retardation.
tx: supportive.

49

PCP Intoxication

recklessness, impulsiveness, impaired judgment, assaultiveness, rotatory nystamgus, ataxia, HTN, tachycardia, muscle rigidity, high tolerance to pain.
OD: seizures and coma
tx: monitor vitals and electrolytes.
acidify urine with ammonium chloride and ascorbic acid.
benzo or DA antagonist
diazepam
haloperidol

50

Sedative-Hypnotic Intoxication

drowsiness, slurred speech, incoordination, ataxia, mood lability, impaired judgment, nystagmus, respiratory depression, coma, death.
tx: ABCs, activated charcoal.
barbituates tx: alkalinize urine with sodium bicarb
benzo tx: flumazenil in OD

51

Sedative-Hypnotic Withdrawal

life threatening
autonomic hyperactivity (tachycardia/sweating), insomnia, anxiety, tremor, N/V, delirium, hallucinations, seizures.
tx: long acting benzo (chlordiazepoxide or diazepam)
tegretol or valproic acid for seizures

52

Opiate Intoxication

drowsiness, N/V, constipation, slurred speech, constricted pupils, seizures, respiratory depression, coma, death.
tx: ABCs.
OD: naloxone or naltrexone
Dependence: oral methadone

53

Serotonin Syndrome

hyperthermia, confusion, HTN or hypotension, muscle rigidity.

54

Opiate Withdrawal

dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, N/V, fever, dilated pupils, muscle ache.
tx: mod = clonidine and/or buprenorphine
severe = detox with methadone

55

Hallucinogen Intoxication

perceptual changes, papillary dilation, tachycardia, tremors, incoordination, sweating, palpitations.
tx: reassurance, antipsychotics or benzos.

56

Marijuana Intoxication

euphoria, impaired coordination, mild tachycardia, conjunctival injection, dry mouth, increased appetite.
tx: supportive

57

Marijuana Withdrawal

mild irritability, insomnia, nausea, decreased appetite

58

Inhalant Intoxication

impaired judgment, belligerence, impulsivity, perceptual disturbances, lethargy, dizziness, nystagmus, tremor, muscle weakness, hyporeflexia, ataxia, slurred speech, euphoria, stupor, coma.
OD fatal from respiratory depression or arrhythmia.
tx: ABCs, symptomatic treatment.

59

Inhalant Withdrawal

not real.
irritability, N/V, tachycardia, hallucinations.

60

Caffeine Intoxication

>250mg: anxiety, insomnia, twitching, rambling speech, flushed face, diuresis, GI disturbance, restlessness.
>1g: tinnitus, severe agitation, cardiac arrhythmia.
>10g: death from seizure or respiratory failure.
tx: symptomatic

61

Caffeine Withdrawal

HA, N/V, drowsiness, anxiety, depression.
tx: taper coffee, analgesics

62

Nicotine Intoxication

restlessness, insomnia, anxiety, increased GI motility, improved attention/mood, decreased tension.
tx: stop

63

Nicotine Withdrawal

intense craving, dysphoria, anxiety, increased appetite, irritability, insomnia.
tx: counseling
nicotine replacement therapy
zyban
clonidine

64

Normal Pressure Hydrocephalus

gait disturbance, urinary incontinence, dementia

65

Rett Syndrome

loss of previously learned skills in girls between ages 5-30 mo.
stereotyped hand movements (hand wringing, hand washing)
problems with gait or trunk movements
impaired language and psychomotor development.
seizures
cyanotic spells
tx: supportive

66

Childhood Disintegrative Disorder

normal development until 2 yr.
loss of previous skill in at least two of: language, social skills, bowel/bladder control, play, motor skills
at least two of: impaired social interaction, impaired use of language, restricted/repetitive/stereotyped behaviors and interests.