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Memorize Last-Minute For Exam Flashcards

0
Q

Epidemiology of panic disorder

A
  • prevalence: 1.5-5% (one of the top five most common reasons to see a family doctor); M:F = 1:2-3
  • onset: average late 20’s, familial pattern
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1
Q

Medical Workup of Anxiety

A
  • routine screening: physical examination, CBC, thyroid function test, electrolytes, urinalysis, urine drug screening
  • additional screening: neurological consultation, chest x-ray, ECG, CT
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2
Q

Px of panic disorder

A
  • 6-10 yr post-treatment: 30% well, 40-50% improved, 20-30% no change or worse
  • clinical course: chronic, but episodic with psychosocial stressors
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3
Q

Definition of agoraphobia

A

ƒ anxiety about being in places or situations from which escape might be difficult (or embarrassing) or where help may not be available in the event of having an unexpected panic attack
ƒ fears commonly involve situations such as being out alone, being in a crowd, standing in a line, or travelling on a bus
• situations are avoided, endured with anxiety or panic, or require companion
• treatment: as per panic disorder

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4
Q

Time frame for GAD

A

occurring more days than not for at least 6 mo

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5
Q

In GAD, the anxiety and worry are associated with ≥3 of the following 6 symptoms (with at least some symptoms present for more days than not for the past 6 mo)
Note: Only one item is required in children

A

restlessness or feeling keyed up or on edge
ƒ being easily fatigued
ƒ difficulty concentrating or mind going blank
ƒ irritability
ƒ muscle tension
ƒ sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

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6
Q

GAD epidemiology and Px

A

• 1-yr prevalence: 3-8%; M:F = 1:2
ƒ if considering only those receiving inpatient treatment, ratio is 1:1
• most commonly presents in early adulthood

Px:
• chronically anxious adults become less so with age
• depends on pre-morbid personality functioning, stability of relationships, work, and severity of environmental stress
• difficult to treat

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7
Q

Specific phobia lifetime prevalence

A

lifetime prevalence 12-16%; M:F ratio variable

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8
Q

Social phobia lifetime prevalence

A

• lifetime prevalence may be as high as 13-16%; F>M

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9
Q

OCD lifetime prevalence

A

lifetime prevalence rates 2-3%; M=F

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10
Q

Acute stress d/o

A

Acute Stress Disorder
May be a precursor to PTSD
Criteria:
• Exposure to traumatic event
• Dissociative symptoms
• Event is persistently re-experienced
• Avoidance of stimuli
• Symptoms of anxiety or increased arousal
• Causes clinically significant distress or impairment in social, occupational or other important areas of functioning
• Symptoms last 2 d to 4 wk and occur within 4 wk of event

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11
Q

Criteria for Post-Traumatic Stress Disorder

A 
TRAUMA
Traumatic event 
Re-experience the event
Avoidance of stimuli associated with 
the trauma
Unable to function
More than a Month
Arousal increased
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12
Q

PTSD epidemiology

A

• prevalence in general population: 7%
• men’s trauma is most commonly combat experience/physical assault; women’s trauma is usually
physical or sexual assault

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13
Q

Medical Workup of Mood Disorder

A

• routine screening: physical examination, CBC, thyroid function test, electrolytes, extended
electrolytes, urinalysis, drug screen
• additional screening: neurological consultation, chest x-ray, ECG, CT

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14
Q

Time frame for MDE

A

≥5 of the following symptoms have been present during the same 2-wk period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure (anhedonia)

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15
Q

Criteria for Mania

A

. a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting ≥1 wk (or any duration if hospitalization is necessary)

GST PAID - (≥3) (4 if the mood is only irritable)
Grandiosity
Sleep (decreased need)
Talkative
Pleasurable activities, Painful consequences
Activity
Ideas (flight of)
Distractible
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16
Q

Mixed Episode

A
  • criterion met for both manic episode and MDE nearly every day for 1 wk
  • criteria D and E of manic episodes are met
  • Note: in DSM-5, mixed episode is no longer a separate mood diagnosis; instead, depressed episodes and manic episodes can have a “with mixed features” specifier
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17
Q

Hypomanic episode

A
  • criterion A of a manic episode is met, but duration is ≥4 d
  • criteria B and E of manic episodes are met
  • episode associated with an uncharacteristic decline in functioning that is observable by others
  • change in function is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
  • absence of psychotic features
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18
Q

MDD risk factors

A
  • sex: female > male
  • age: onset between 25-50 yr of age
  • family history: depression, alcohol abuse, sociopathy
  • childhood experiences: loss of parent before age 11, negative home environment (abuse, neglect)
  • personality: insecure, dependent, obsessional
  • recent stressors: illness, financial, legal
  • postpartum <6 mo
  • lack of intimate, confiding relationships or social isolation
19
Q

MDD epidemiology

A

Epidemiology
• prevalence: 12.2%
ƒ lifetime prevalence: male 2.9%, female 5%
ƒ annual prevalence: peak prevalence age 15-25 yr (M:F = 1:2)

• genetic: 65-75% MZ twins; 14-19% DZ twins

20
Q

Neurotransmitters in MDD

A

neurotransmitter dysfunction: decreased activity of 5HT, NE and DA at the level of the synapse; changes in GABA and glutamate

21
Q

MDD Px

A

Prognosis
• one year after diagnosis of a MDE without treatment: 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full MDE, 20% continue to have some symptoms
that no longer meet criteria for a MDE, 40% have no mood disorder

22
Q

Dysthymia (PDD) time lines

A

ƒDepressed mood for most of the day, for more days than not, for ≥2 yr
Note: In children and adolescents, mood can be irritable and duration must be at least 1 yr

During the 2-yr period (1 yr for children or adolescents) of the disturbance, the person has never been without the symptoms in criteria A and B for more than 2 mo at a time

23
Q

Dysthymia Epidemiology & Tx

A

Epidemiology
• point prevalence: 3%; life prevalence: 6%; M:F = 1:2-3

Treatment
• psychological 
 ƒ principal treatment for dysthymia 
 ƒ individual, group, and family therapy
• biological 
 ƒ antidepressant therapy (SSRIs/SNRIs) as an outpatient
24
Q

Postpartum Depression (PPD)

A

• diagnosis: MDE, onset within 4 wk postpartum
• most lasts 2 to 6 mo; residual symptoms can last up to 1 yr
ƒ may present with psychosis – rare (0.2%) and/or mania
ƒ
• epidemiology: occurs in 10% of mothers, risk of recurrence 50%
• risk factors:
ƒ previous history of a mood disorder (postpartum or otherwise)
ƒ psychosocial factors: stressful life events, unemployment, marital conflict, lack of social support, unwanted pregnancy, colicky or sick infant

• treatment:
ƒ psychotherapy (CBT or IPT)
ƒ short-term safety of maternal SSRIs for breastfeeding infants established; long-term effects unknown
ƒ if depression severe, consider ECT

• prognosis:
ƒ impact on child development: increased risk of cognitive delay, insecure attachment, behavioural disorders
ƒ treatment of mother improves outcome for child at 8 mo through increased mother-child interaction

25
Q

Bipolar I and II criteria

A

• Bipolar I Disorder
ƒ disorder in which at least one manic or mixed episode has occurred

• Bipolar II Disorder
ƒ disorder in which there is at least 1 MDE and at least 1 hypomanic episode; no past manic or mixed episodes

26
Q

Bipolar epidemiology and risk factors

A 
Epidemiology
• prevalence: 0.6-0.9%; M:F = 1:1 
• age of onset: teens to 20’s
Risk Factors
• high SES 
• genetic: 60-65% of bipolar patients have family history of major mood disorders
27
Q

Bipolar: rapid cycling criteria

A

rapid cycling (at least 4 episodes of a mood disturbance in the previous 12 mo that meet criteria for a major depressive, manic, mixed, or hypomanic episode)

28
Q

Bipolar Tx

A

Treatment
• biological: lithium, anticonvulsants, antipsychotics, antidepressants, ECT
• psychological: supportive or psychodynamic psychotherapy, CBT, ITP or interpersonal social
rhythm therapy
• social: vocational rehabilitation, consider leave of absence from school/work, consider substitute
decision maker for finances, drug and EtOH cessation, sleep hygiene, social skills training,
education for family members

29
Q

Bipolar Px

A

Course and Prognosis
• high suicide rate (15% mortality from suicide)
• relapsing and remitting course with alternating manic and depressive episodes; depressive
symptoms tend to occur more frequently and last longer than manic episodes
• patients spend almost half of their lives symptomatic
• may switch rapidly between depression and mania without any period of euthymia in between
• high recurrence rate for mania – 90% will have a subsequent episode in the next 5 yr

30
Q

Cyclothymia: Dx & Px

A

Diagnosis
• presence of numerous periods of hypomanic and depressive symptoms (not meeting
criteria for MDE) for ≥2 yr; never without symptoms for >2 mo
• no MDE, manic or mixed episodes, no evidence of psychosis
• symptoms are not due to the direct physiological effects of a substance or GMC
• symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning
Treatment
• similar to Bipolar I: anticonvulsants ± psychotherapy

31
Q

DDx of psychosis

A 
GASPP
General medical condition
Affective disorders
Substance induced
Psychotic disorders
Personality disorders
  • primary psychotic disorders: schizophrenia, schizophreniform, brief psychotic, schizoaffective, shared psychotic, delusional disorder
  • mood disorders: depression with psychotic features, bipolar disorder (mania or depression with psychotic features)
  • personality disorders: schizotypal, schizoid, borderline, paranoid, obsessive-compulsive
  • general medical conditions: tumour, head trauma, dementia, delirium, metabolic, infection, stroke, temporal lobe epilepsy
  • substance-induced psychosis: intoxication or withdrawal, prescribed medications, toxins
32
Q

SCZ criteria

A

A. characteristic symptoms (active phase): ≥2 of the following, each present for a significant portion of time during a 1-mo period (or less if successfully treated)
ƒ delusions
ƒ hallucinations
ƒ disorganized speech (e.g. frequent derailment or incoherence)
ƒ grossly disorganized or catatonic behaviour
ƒ negative symptoms [e.g. affective flattening, alogia (inability to speak), or avolition (inability to initiate and persist in goal-directed activities)]
Note: only 1 “A” symptom is required if delusions are bizarre or hallucinations consist of a voice keeping a running commentary on the person’s behaviour or thoughts, or 2 or more voices conversing with each other

B. social/occupational dysfunction: ≥1 major areas of functioning (work, interpersonal relations, self-care) markedly below the level achieved prior to the onset of symptoms

C. continuous signs of disturbance for ≥6 mo, including ≥1 mo of active phase symptoms; may include prodromal or residual phases

33
Q

SCZ epidemiology

A

Epidemiology
• prevalence: 0.5%-1%; M:F = 1:1
• mean age of onset: females ~27; males ~21

genetic: 40% concordance in monozygotic (MZ) twins; 46% if both parents have schizophrenia; 10% of dizygotic (DZ) twins, siblings, children affected

34
Q

SCZ good prognostic factors

A 
Good Prognostic Factors
• Acute onset
• Later age at onset
• Shorter duration of prodrome
• Female gender
• Good cognitive functioning 
• Good premorbid functioning
• No family history
• Presence of affective symptoms 
• Absence of structural brain abnormalities
• Good response to drugs
• Good support system
35
Q

Management of SCZ

A

Management of Schizophrenia
• biological
ƒ acute treatment and maintenance with antipsychotics ± anticonvulsants ± anxiolytics
• psychosocial
ƒ psychotherapy (individual, family, group): supportive, CBT (see CBT, PS41)
ƒ assertive community treatment (ACT): mobile mental health teams that provide
individualized treatment in the community and help patients with medication adherence,
basic living skills, social support, job placements, and community resources
ƒ social skills training, employment programs, disability benefits
ƒ housing (group home, boarding home, transitional home)

36
Q

SCZ Px

A

• course is variable: some individuals have exacerbations and remissions and others remain
chronically ill; accurate prediction of the long term outcome is not possible
• early in the illness, negative symptoms may be prominent; positive symptoms appear and
typically diminish with treatment; negative symptoms may become more prominent and more
disabling
• over time: 1/3 improve, 1/3 remain the same, 1/3 worsen

37
Q

Schizophreniform

A
  • diagnosis: criteria A, D and E of schizophrenia are met; an episode of the disorder lasts from 1-6 mo. If the symptoms have extended past 6 mo the diagnosis becomes schizophrenia
  • treatment: similar to acute schizophrenia
  • prognosis: better than schizophrenia; begins and ends more abruptly; good pre- and post-morbid function
38
Q

Brief psychotic disorder - note time line

A
  • diagnosis: acute psychosis (presence of 1 or more positive symptoms in criteria A 1-4 of schizophrenia) lasting from 1 day to 1 mo, with eventual full return to premorbid level of functioning
  • can occur after a stressful event or postpartum
  • treatment: secure environment, antipsychotics, anxiolytics
  • prognosis: good, self-limiting, should return to pre-morbid function in about 1 mo
39
Q

Schizoaffective criteria

A

A. uninterrupted period of illness during which there is either a MDE, manic episode, or a mixed episode concurrent with symptoms meeting criteria A for schizophrenia
B. in the same period, delusions or hallucinations for ≥2 wk in the absence of prominent mood symptoms
C. symptoms that meet criteria for a mood episode are present for a substantial portion of total duration of active and residual periods of the illness

  • treatment: antipsychotics, mood stabilizers, antidepressants
  • prognosis: between that of schizophrenia and of mood disorder
40
Q

Delusional disorder criteria

A

A. The presence of one (or more) delusions with a duration of 1 month or longer.

B. Criterion A for schizophrenia has never been met.

Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.

D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

Specify if:
With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual’s belief that a stranger has removed his or her internal organs and replaced them with someone else’s organs without leaving any wounds or scars).

Individuals with delusional disorder may be able to factually describe that others view their beliefs as irrational but are unable to accept this themselves (i.e., there may be “factual insight” but no true insight).

41
Q

Delusional disorder Tx & Px

A
  • treatment: psychotherapy, antipsychotics, antidepressants

* prognosis: chronic, unremitting course but high level of functioning

42
Q

Atypical depression “criteria”

A

atypical: mood reactivity (brightens with real or potential positive events), increased sleep, weight gain, leaden paralysis, rejection hypersensitivity

43
Q

Melancholic depression “criteria”

A

melancholic: quality of mood is distinctly depressed, mood is worse in the morning, early morning awakening, marked weight loss, excessive guilt, psychomotor retardation or agitation

44
Q

Catatonic depression “criteria”

A

catatonic: at least two of: motor immobility, excessive motor activity, extreme negativism or mutism, peculiarities of voluntary movement, echolalia or echopraxia

CC Psych (18 decks)

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