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Disorders Flashcards

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0
Q

Difference between somatic symptom disorder & illness anxiety disorder

A

Somatic symptom disorder = anxiety about an illness with 1+ Sx

Illness anxiety disorder = Hypochondriasis; no symptoms

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1
Q

Criteria for adjustment disorder

A

Excessive distress within 3 months of identifiable stressor. Symptoms last less than 6 months.

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2
Q

Autism-Spectrum DSM-5 Criteria

A 
Social Deficits:
	-Social-Emotional reciprocity
	-Nonverbal communication
	-Developing & maintaining relationships
Restricted, repetitive behavior patterns:
	-Repetitive motor movements
	-Insistence on sameness or routine
	-Fixated interests
	-Adverse responses to sensory input

Occurs early in development & not better accounted for by intellectual impairment or other condition.

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3
Q

Prevalence of MDD: Women vs men

A

Women:Men = 2:1

Goes to 1:1 postmenopausal

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4
Q

Prevalence of MDD

A

15% lifetime

7% 12mo

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5
Q

Chances of having another MDE

A

1st episode - 50%
2nd episode - 75%
3rd episode - 95%

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6
Q

Average duration of MDE

A

8-18 months

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7
Q

What is the kindling theory?

A

With each episode of depression, more “kindling for the fire” - each subsequent episode can happen with weaker stressors.

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8
Q

What are the possible outcomes (graph) of depression?

A

Response (Acute phase)
Remission (Continuation phase)
Recovery (Maintenance phase)

Relapse if during continuation
Recurrence if during recovery

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9
Q

What is the typical initial treatment for MDD based on severity?

A

Mild/Moderate - respond equally well to medication & therapy

Severe - needs both medication & therapy +/- hospitalization

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10
Q

Substance-induced mood disorder criteria

A

1) Prominent mood disturbance
2) Evidence that it began soon after beginning substance/medication use & the substance is known to cause mood disturbance.
3) Not better explained by another depressive disorder
4) Does not occur exclusively during Delirium

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11
Q

What specifiers can be added to the MDD diagnosis?

A 
With anxious distress
With mixed features(some hypomanic symptoms)
With psychotic features
With melancholic features
With catatonia
With peripartum onset
With seasonal mood pattern
With atypical features
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12
Q

Criteria for melancholic depression

A

1) Prominent anhedonia
2) 3 or more of the following:
– Distinct quality of depressed mood
– Depression worse in the am
– Early am awakening ( 2hours before normal)
– Marked psychomotor agitation or retardation
– Significant weight loss
– Excessive or inappropriate guilt

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13
Q

How does depression present in elderly?

A

Irritability
Somatic complaints
Pseudodementia

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14
Q

How does MDD present in adolescents?

A

Behavioral changes
Changes in grades
Drug use
Change in friends

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15
Q

What are the monoamines?

A

5-HT
NE
Dopamine

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16
Q

What brain structures atrophy in depression?

A

Prefrontal cortex
Amygdala
Hippocampus

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17
Q

Medical conditions that mimic depression

A 
Pancreatic cancer
Hypo/Hyperthyroidism
Hypo/Hyperparathyroidism
Cushing's & Addison's
Anemia
Uremia
Pellegra
Dementias
Huntington's
Medications (Steroids, OCP's, Antipsychotics)
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18
Q

Criteria for MDD

A

5/9 of SIGECAPS
One of the 5 must be either depressed mood or anhedonia
Must be present for >2wks
Not better explained by another medical or psych illness

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19
Q

Criteria for Persistent Depressive Disorder

A

aka Dysthymia

A. Symptoms present for 2+ years (or 1+ years if child/adol.)
B. 2+ of the following symptoms present:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. Not better explained by another ilness

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20
Q

Features of PMDD (not criteria)

A

Mood la­bility
Irritability
Dysphoria
Anxiety symptoms

Occur repeatedly during the pre­-menstrual phase of the cycle and remit around the onset of menses or shortly thereafter.

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21
Q

Substance-Induce Mood Disorder criteria

A

Significant mood disturbance in which:
1 . The symptoms developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing SIMD.
3. Does not occur exclusively during delirium.

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22
Q

Depressive Disorder due to Another Medical Condition criteria

A

A. A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture.

B. There is evidence from the H&P or labs that the disturbance is the direct pathophysiological consequence of another medical condi­tion.

Does not include depression 2/2 stress from having a medical condition. Depression must be a DIRECT consequence of the medical condition.

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23
Q

Atypical depression criteria

A

A. Mood reactivity (mood can brighten in response)
B. Two+ of the following:
1 . Significant weight gain or increase in appetite.
2. Hypersomnia.
3. Leaden paralysis
4. A long-standing pattern of interpersonal rejection sensitivity (not limited to epi­sodes of mood disturbance)

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24
MDD with peripartum onset criteria
MDE during pregnancy or within 4 weeks postpartum
25
Indications for admitting an anorexic patient
Electrolyte disturbances Bradycardia Unstable vitals Dehydration
26
When do DT's occur?
2-4 days after last drink
27
What are the 1st & 2nd line treatment options for GAD?
``` 1st line: -CBT -SSRI's or SNRI's 2nd line: -Benzodiazepines -Buspirone ```
28
What are the mature defense mechanisms?
SASH - Sublimation - Altruism - Suppression - Humor
29
How long to continue bipolar maintenance therapy?
1st episode of mania - at least 1 year 2 or more episodes - lifetime
30
What psychiatric problems are seen in victims of sexual assault?
PTSD MDD Increased risk of suicide
31
What antidepressants are specifically indicated for treatment of OCD?
``` Sertaline Fluoxetine Paroxetine Fluvoxamine Clomipramine (TCA; 2nd line) ```
32
What is the typical course of alcohol withdrawal?
6-24h - Mild withdrawal (anxiety, tremors, insomnia, sweating, GI) 12h-2d - Seizures & alcoholic hallucinosis 2d-4d - DT's (autonomic instability, delirium)
33
Schizoaffective criteria
1) Multiple psychotic episodes with concurrent major depressive or manic symptoms 2) 2 or more weeks of psychosis without mood symptoms 3) Mood symptoms present for the majority of total illness 4) Not due to substances or other medical illness ``` #2 distinguishes from MDD or BAD with psychotic symptoms #3 distinguishes from schizophrenia ```
34
Specifiers for persistent depressive syndrome
aka Dysthymia 1) With pure dysthymic syndrome - MDE criteria never fully met 2) With intermittent MDE's 3) With persistent MDE's (MDE criteria met for the 2y)
35
What are the Cluster B personality disorders?
Borderline Antisocial Histrionic Narcissistic
36
Indications for ECT
``` Severe/refractory depression Depression in pregnancy Refractory mania NMS Catatonic schizophrenia ```
37
ECT adverse effects
``` Amnesia (anterograde & retrograde) Seizures Delirium HA Nausea ```
38
Manic episode criteria
I) Elevated or irritable mood with increased energy or goal directed activity. Must be at least 1 week or any time if hospitalized. II) 3 or more of DIG FAST: -Distractibility -Irresponsibility -Grandiosity -Flight of ideas -Activity increased (goal-directed or sexual) -Sleep decreased -Talkativeness III) Not better explained by another medical illness or substance
39
Hypomanic episode criteria
I) Elevated or irritable mood with increased energy or goal directed activity. Lasts at least 4 days. II) 3 or more of DIG FAST: -Distractibility -Irresponsibility -Grandiosity -Flight of ideas -Activity increased (goal-directed or sexual) -Sleep decreased -Talkativeness III) Not better explained by another medical illness or substance IV) Episode is NOT severe enough to cause significant impairment, does not require hospitalization, & does not have psychotic symptoms.
40
Difference between Bipolar I & Bipolar II
Bipolar I = manic episode +/- MDE Bipolar II = Hypomanic episode + MDE
41
What constitutes rapid cycling of bipolar disorder?
4 or more mood episodes in a year Poor prognosis with rapid cycling. Depakote is the drug of choice.
42
Suicide risk in bipolar
35% of patients attempt suicide in both types
43
Cyclothymic criteria
A. For at least 2y (1y for children/adolescents), multiple episodes resembling hypomania & depression, without ever meeting criteria for either. B. During the above period, the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time. C. Criteria for a major depressive, manic, or hypomanic episode have never been met. D. Can't account for symptoms due to other medical illness or substance
44
Substance/Medication Induced Bipolar Disorder criteria
A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by elevated, expansive, or irritable mood, with OR without depressed mood or anhedonia. B. There is evidence from the H&P of both (1) and (2): 1 . The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication. 2. The involved substance/medication is capable of producing the symptoms in Crite­rion A. C. Symptoms not better explained by an independent disorder D. Does not occur exclusively during delirium
45
What are the negative symptoms seen in schizophrenia?
``` Flat affect Avolition Anhedonia Alogia (not speaking much) Antisociality (not seeking out interaction) ```
46
Time-course for schizophrenia spectrum disorders
Brief psychotic disorder = 1 day to 1 month Schizophreniform = 1 month to 6 months -Does not require a decline in functioning Schiophrenia = 6 months or more of symptoms & 1 month or more of active phase psychosis
47
Brief psychotic disorder criteria
A. Presence of one (or more) of the following symptoms. At least one of these must be (1 ), (2), or (3): 1 . Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. B. More than 1 day but less than 1 month, with eventual full return to premorbid level of functioning. C. Not better explained by another mental/medical illness or substance
48
Schizophreniform criteria
A. Two of the following present for >1 month but < 6 months (less than 1 month if successfully treated) -Delusions. -Hallucinations. -Disorganized speech -Grossly disorganized or catatonic behavior. -Negative symptoms B. If symptoms have not yet resolved but within this time frame, diagnosed as "provisional schizophreniform" C. No manic or MDE during the period or have been present for <50% of the time. D. Not due to a substance or other medical/psych illness
49
Modifiers for schizophreniform
1) With good prognostic features: Two of the following present - Good premorbid social & occupational function - Onset of psychosis within 4 weeks of 1st noticeable change - Absence of blunted affect 2) Without good prognostic features 3) With catatonia
50
Schizophrenia criteria
A. Two of the following present for >1 month: -Delusions. -Hallucinations. -Disorganized speech -Grossly disorganized or catatonic behavior. -Negative symptoms B. Level of functioning (work, social, self-care) is markedly below prior achievement. C. Meets A criteria for at least 1 month & has shown prodromal symptoms for at least 6 months. D. No manic or MDE, or have been present for <50% of the time. E. Not due to a substance or other medical/mental illness.
51
Schizoaffective criteria
A. MDE or manic episode concurrent with Criterion A of schizophrenia B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood epi­sode (depressive or manic) C. Symptoms that meet criteria for a major mood episode are present for >50% of the total duration of the active and residual portions of the illness. D. The disturbance is not attributable to the effects of a substance or another medical condition.
52
Substance/Medication-induced psychotic disorder criteria
A. Presence of one or both of the following symptoms: 1. Delusions. 2. Hallucinations. B. There is evidence from the H&P/labs of both (1) and (2): 1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication. 2. The involved substance/medication is capable of producing the symptoms in Crite­rion A. C. Does not occur exclusively during delirium & not better accounted for by another condition
53
Criteria for Borderline PD
A. Instability of relationships, self image, & impulsivity including 5 or more of the following 9: - Impulsive - Moody - Paranoid or dissociative under stress - Unstable self image - Labile, intense relationships - Suicidal - Inappropriate anger - Vulnerable to abandonment - Emptiness Presents by early adulthood & present in multiple aspects of life.
54
Histrionic PD criteria
5 or more of the following: - Uncomfortable not being center of attention - Inappropriate sexuality - Rapid shifting, shallow emotions - Uses physical appearance to draw attention - Impressionistic speech, lacking in detail - Dramatization of emotion - Easily influenced by others - Considers relationships more intimate than they are
55
Chance of developing Bipolar: - General population - 1 parent has it - 2 parents have it - Identical twin has it
General population = 1% 1 Parent = 10% 2 Parents = 60% Identical twin = 70%
56
Treatment for conversion disorder
1) Education & self-help techniques | 2) CBT
57
What are the dopamine pathways & their effects?
Mesolimbic - Positive symptoms Mesocortical - Negative & cognitive symptoms Nigrostriatal - EPS Tuberoinfundibular - Prolactin
58
What is the ideal % of receptor blockade for antipsychotics?
65-80% ``` Less = not effective More = SE's ```
59
Longest half life of antipsychotics?
Abilify
60
What is the typical response rate to antipsychotics?
70%
61
How often to reassess response to anti-psychotic trial?
Every 4 weeks If partial response --> increase dose If no response --> next step in algorithm
62
How long is an adequate trial for Clozapine?
4 weeks to titrate 12 weeks at therapeutic dose Can give another 12 weeks at increased dose
63
What percent of pts respond to Clozapine?
30-50% of previously treatment-resistant pts will respond
64
Indications for Clozapine trial in schizophrenia
1) Recurrent suicidality or violence 2) Failed 2 other antipsychotics 3) Persistence of positive symptoms for >2y
65
Who is most susceptive to TD?
Older pts
66
Treatment for TD
1) Reduce antipsychotic dose or stop | 2) Clozapine (50% of pts show 50% improvement)
67
Risk of EPS across antipsychotics?
HP FGA > LP FGA > Risperidone > most SGA's > Cloz & Olanz
68
What is the advantage of Paliperidone?
Mostly renal excretion. Use in pts with liver disease
69
Criteria for Panic Disorder
A. Recurrent, unexpected panic attacks B. An attack is followed by at least 1 month of either: -Persistent concern or worry about another attack -Significant change in behavior to avoid attacks C. Not secondary to a substance or medical condition
70
Panic disorder: - Women:Men - Average age of onset
Women:Men = 2:1 Onset in late teens or 20's Higher risk of CVD & CVA
71
Treatment for panic disorder
CBT (70%+ effectiveness) SSRI's/SNRI's (1st line) Benzodiazepines TCA's, MAOI's
72
Criteria for Agoraphobia
A. Marked fear or anxiety about 2 or more of the following: -Public transportation -Open spaces -Enclosed spaces -Crowds -Being outside of home alone B. Clinically sig. fear/anxiety & avoidance of these situations C. Fear/anxiety/avoidance lasts 6mo or more
73
Criteria for GAD
``` A. Excessive anxiety/worry for 6mo or more B. 3+ of following symptoms: -Restlessness, on-edge -Easily fatigued -Difficulty concentrating -Irritability -Muscle tension -Sleep disturbance ```
74
GAD lifetime prevalence | Age of onset
Lifetime prevalence = 5% Women > Men Median age of onset = 31
75
What anxiety disorder shows most comorbidity?
GAD MDD = 62% Substance = 38% Social anciety = 35%
76
PTSD components & duration
1) Re-experiencing 2) Avoidance 3) Negative alterations in mood 4) Hyperarousal Symptoms present for at least 1mo
77
Acute stress disorder criteria
A. Symptoms last 3 days-1mo - Re-experiencing - Avoidance - Negative mood - Hyperarousal - Dissociative symptoms (not included in PTSD criteria)
78
PTSD treatment
``` CBT Exposure therapy SSRI's (1st line) Prazosin (nightmares) Clonidine/Propranolol (hyperarousal) ```
79
OCD Criteria
A. Presence of obsessions, compulsions, or both | B. Obsessions & compulsions take >1h per day or impair function
80
Treatment of OCD
``` SSRI's (1st line; higher dosages needed) Clomipramine (TCA) SNRI's CBT Exposure & relapse prevention therapy ```
81
Social anxiety disorder criteria
Fear/anxiety out of proportion in social situations or giving speeches Must last 6mo or longer
82
Specific phobia treatment
Systematic desensitization (exposure therapy)
83
Drugs that can cause Serotonin Syndrome when mixed with SSRI's
``` Tramadol Triptans Linezolid Ondansetron Metoclopramide MAOI's ```
84
Treatment for serotonin syndrome
1) Stop the meds causing it | 2) Cyproheptadine (5-HT antagonist)
85
What are the Cluster A personality disorders?
Paranoid Schizoid Schizotypal
86
What are the cluster C personality disorders?
OCPD Avoidant Dependent
87
Treatment of PD's
Psychotherapy (CBT & others) Pharmacotherapy only for comorbid axis I disorders
88
Delirium criteria
A. Disturbance of consciousness B. Change in cognition C. Develops over short period & fluctuates D. Evidence that it is caused by physiological consequences of medical condition or substance
89
Tests to get in delirium
``` CBC, CMP, TSH, B12, NH4 UA, UDS CXR LP if indicated Neuroimaging ```
90
Antipsychotics used in delirium
- Haldol - Risperidone - Quetiapine - Olanzapine
91
Types of dementia
Alzheimer's dementia Lewy body dementia Frontotemporal dementia Vascular dementia
92
Pharmacologic management of dementia
``` AChE Inhibitors -Donepezil -Galantamine AChE & BuChE Inhibitor -Rivastigmine NMDA Antagonist -Memantine ```
93
Causes of delirium
I WATCH DEATH - Infection - Withdrawal - Abuse (substances) - Trauma - CNS pathology - Hypoxia - Deficiencies - Endocrine - Acute vascular/MI - Toxins/drugs - Heavy metals

Psych Clerkship (2 decks)

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