Psych Flashcards
(30 cards)
Generalized Anxiety Disorder (GAD) definition, sx, criteria, tx
*5-9% lifetime prevalence, women > men (2:1)
*1/3 of risk for developing GAD is genetic
*sxs begin in childhood, median onset 30yo
*physical complaints (fatigue, muscle tension)
criteria
*excessive anxiety/worry (apprehensive expectation) about various events/activities lasting ≥6MO
*difficulty controlling the worry
Associated w/ 3+SXS: restlessness/feeling keyed up, fatigue, impaired concentration, irritability, muscle tension, insomnia
*only 1 symptom required in children
tx
Psychotherapy + pharmacotherapy = most effective
*CBT
*SSRIs (sertraline, citalopram), SNRIs (venlafaxine)
*+/- short-term BDZ course or augmentation w/ buspirone
Panic Disorder definition, criteria, tx
*4% lifetime prevalence, median onset 20-24yo
*MC in females, 2:1
*up to 65% have comorbid MDD
RF: first-degree relative, childhood abuse
criteria
*2+ unexpected panic attacks w/o an identifiable trigger (4+SXS of panic attack)
*1+SXS for ≥1MO following attack
*concern about future attacks/consequences (e.g., losing control, heart attack, going crazy)
*significant maladaptive change in behavior (e.g., avoidance behavior)
tx
CBT + pharmacotherapy = most effective
*SSRIs first line (sertraline, citalopram, escitalopram)
*SNRIs (venlafaxine) also efficacious
*TCAs (clomipramine, imipramine) if above not effective
*BDZs until other medications reach full efficacy
Specific Phobias definition, sx, criteria, tx
Specific Phobia: intense fear of object/situation leading to avoidance &/or anxiety endurance
*MC psychiatric d/o in women, 2nd MC psychiatric d/o in men (substance abuse is first)
*>10% lifetime prevalence, MC in women (2:1)
*mean onset 10yo
criteria
*≥6MO of persistent, excessive fear elicited by a specific situation or object which is out of proportion to any actual danger/threat
*exposure triggers IMMEDIATE response
*avoided when possible or tolerated w/ intense anxiety
Subtypes:
*animals (spiders, dogs, mice)
*situational (airplanes, elevators)
*natural environment (heights, thunder)
*blood-injection injury (needles, blood)
tx
*CBT TOC (exposure & desensitization therapy)
*short term BDZs or BBs in some pts
Agoraphobia defintion, criteria, tx
*intense fear of being in public spaces where escape or obtaining help may be difficult
*avoidance behaviors may become as extreme as complete confinement to home
*often develops w/ panic disorder
*onset usually before 35yo
Risk Factors: genetic (60% heritability), onset often follows traumatic event
criteria
*intense fear/anxiety of 2+ SITUATIONS d/t concerns of difficulty escaping, obtaining help in case of panic, or other embarrassing sxs (e.g., falling/incontinence in elderly)
*outside home alone
*open spaces (e.g., bridges)
*enclosed spaces (e.g., stores)
*public transportation (e.g., trains, buses)
*crowds/lines
*agoraphobic situations always provoke fear/anxiety that is out of proportion to actual danger posed
*agoraphobic situations are avoided, require a companion, or endured w/ fear/anxiety
*lasting ≥6MO
tx: CBT + SSRIs
Social Anxiety Disorder (Social Phobia) definition, criteria, tx
*fear of scrutiny or acting in embarrassing way
*phobic stimulus related to social scrutiny & negative evaluation
*may develop d/t trauma encounter w/ stimulus
*avoidance results in functional impairment
*median onset 13yo, M = W
criteria
*fear/anxiety about 1+ SOCIAL SITUATIONS in which individual is exposed to possible scrutiny by others, lasting ≥6MO
*fears he/she will act in a way or show anxiety sxs that will be negatively evaluated (humiliating, embarrassing, rejection, offend others)
*social situation almost always provokes fear or anxiety that is out of proportion to actual threat posed
*social situations avoided or endured w/ intense fear/anxiety
tx
*CBT TOC
*SSRIs (sertraline, fluoxetine) or SNRIs (venlafaxine) first line pharmacotherapy if needed for debilitating symptoms
*BDZs (clonazepam, lorazepam) can be used
*beta blockers (propranolol) for performance-only/public speaking anxiety
Selective Mutism definition, criteria, tx
*failure to speak in specific situations despite intact ability to comprehend/use language (rare)
*symptom-onset typically during childhood
*majority of pts suffer from anxiety (social)
*may remain silent or whisper
criteria
*consistent failure to speak in select social situations where speaking is expected (e.g., school) despite speaking in other situations lasting ≥1MO (not limited to first month of school)
*NOT attributable to language difficulty or communication disorder
*interferes w/ educational/occupational achievement or social communication
tx
*psychotherapy (CBT, family therapy)
*Medications: SSRIs (esp. w/ comorbid social anxiety disorder)
Separation Anxiety Disorder definition, criteria, tx
Stranger Anxiety: begins ~6mo, peaks ~9mo
Separation Anxiety: emerges ~1y, peaks ~18mo
*considered pathological when anxiety becomes extreme or developmentally inappropriate
*may be preceded by stressful life event
criteria
*fear/anxiety/avoidance lasting ≥4WKS (children/adolescents) or ≥6MO (adults) that causes distress or impairment in important areas of functioning (social, academic, occupational, etc.)
FEAR/ANXIETY CONCERNING SEPARATION (3+):
*excessive distress when anticipating/experiencing separation from attachment figure
*worry about loss of/harm to attachment figure (illness, injury, disaster, death)
*worry about experiencing event causing separation (getting lost, kidnapped, accident, illness)
*reluctance/refusal to leave home, attend school or work, or go out d/t fear of separation
*fear of/reluctance about being alone
*reluctance/refusal to sleep alone/away from home
*nightmares about separation
*repeated physical complaints during separation (HA, N/V, stomachache, etc.)
tx
*psychotherapy (CBT, family therapy)
*medications: SSRIs can be effective as adjunct to therapy
Conduct Disorder (CD) definition, criteria, tx
*most serious disruptive behaviors that violate the rights of other humans/animals
*inflict cruelty/harm through physical/sexual violence, lack remorse & empathy for victims
*9% lifetime prevalence, males > females
*high incidence of comorbid ADHD & ODD
*associated w/ antisocial personality disorder
criteria
Persistent pattern of violating basic rights of others/societal norms, manifested by 3+SXS in last 12MO AND 1+SXS in last 6MO:
AGGRESSION TO PEOPLE/ANIMALS: bullies/threatens/intimidates others, initiates physical fights, used a weapon w/ potential to seriously harm others (e.g., bat knife), physical cruelty to people or animals, robbery, rape
PROPERTY DESTRUCTION: fire setting, deliberately destroys another’s property
DECEITFULNESS/THEFT: burglary, lies to obtain goods/favors (i.e., “cons” others)
SERIOUS RULE VIOLATION: stays out late at night, runs away from home, truant from school before 13yo
*if ≥18yo, criteria not met for Antisocial Personality Disorder
Specifiers:
*Childhood-onset type: begins before 10yo
*Adolescent-onset type: begins after 10yo
tx
*multimodal: behavior modification, family & community involvement
*Parent Management Training (PMT) can help w/ setting limits & enforcing consistent rules
*medications used to target comorbid symptoms & aggression (SSRIs, guanfacine, propranolol, mood stabilizers, antipsychotics)
Oppositional Defiant Disorder (ODD) definition, criteria, tx
*maladaptive pattern of irritability/anger, defiance, or vindictiveness causing dysfunction or distress in patient/those affected
*3% prevalence
*onset usually in preschool years
*seen more often in boys before adolescence
*↑ comorbidity substance use & ADHD
*often precedes CD, but most don’t develop CD
criteria
4+SXS from any of the following categories, occurring w/ 1+ non-sibling, lasting ≥6MO:
ANGRY/IRRITABLE: loses temper frequently, is touchy or easily annoyed, often angry/resentful
ARGUMENTATIVE/DEFIANT: breaks rules, blames others, argues w/ authority figures, deliberately annoys others
VINDICTIVE: has been spiteful/vindictive ≥2x in past 6mo
tx
*behavior modification, conflict management training, improving problem-solving skills
*Parent Management Training (PMT) can help w/ setting limits & enforcing consistent rules
*medications for comorbid conditions (ADHD)
Intermittent Explosive Disorder definition, sx, criteria, tx
*men > women
*onset usually in late childhood or adolescence
sx
HX: injury not adequately explained or inconsistent w/ hx given
*bruises, lacerations, soft tissue swelling, dislocations/fx, spiral fx
*burns (doughnut-shaped, stocking-glove, symmetrically round)
*bruises/injuries w/ regular patterns on face, back, buttocks, thighs
*internal hemorrhages, abdominal injuries, bite marks, injury w/ shape of instrument used
Other manifestations: anxiety, aggression/violence, PTSD, depression/suicide, substance abuse, poor self-esteem, dissociative disorders, paranoid ideation, FTT
DX: careful hx obtained & documented from all caregivers separately, complete head-to-toe PE
*Hx from child, if <14y 🡪 forensically informed manner w/o asking leading questions
*Rape kit within 72h of assault
*Labs to assess for bleeding disorders
Radiographic skeletal survey: all children w/ suspicious injuries up to 2y
CT/MRI: all children <6mo, children >1y if neuro changes
tx
FIRST: care for any immediate injuries
Providers required to report any suspicions of abuse to CPS; report to law enforcement for suspected physical/sexual abuse
Involve social worker
Safe disposition plan prior to DC
Suicide about, RF, and tx
Women attempt more
Men more successful
Evaluation: includes assessment of ideation, method, plan, & intent
- PHQ-9
- Beck Hopelessness Scale
Risk Factors: “SAD PERSONS”
S – sex (male)
A – age: <19 or >60
D – depression
P – previous attempt
E – ETOH/substance abuse
R – rational thinking loss
S – suicide in family
O – organized plan
N – no spouse
S – sickness
tx
- hospitalization
- antidepressants
- psychotherapy
Attention-Deficit- Hyperactivity Disorder (ADHD) definition, types and associations
Characterized by persistent inattention, hyperactivity, & impulsivity inconsistent w/ patient’s developmental age
3 Subcategories: predominantly inattentive type, predominantly hyperactive/impulsive type, combined type
*5% of children, 2.5% of adults
*Males > females, 2:1
*females present more often w/ inattention
Etiology is multifactorial: first-degree relative, low birth weight, smoking when pregnant, childhood abuse/neglect, neurotoxin/alcohol exposure
Stable through adolescence, many continue to have sxs as adults (inattentive > hyperactive)
*high incidence comorbid ODD, CD, & specific LD
Attention-Deficit- Hyperactivity Disorder (ADHD) criteria inattentive vs hyperactive
ONSET BEFORE AGE 12, SXS ≥6MO, IN 2+ SETTINGS
INATTENTIVE (6+):
*no attention to details or careless mistakes
*difficulty sustaining attention
*does not appear to listen when spoken to
*struggles to follow instructions & fails to finish assignments
*unorganized
*avoids/dislikes tasks requiring sustained mental effort
*misplaces/loses things often
*easily distracted
*forgetful
HYPERACTIVE/IMPULSIVE (6+):
*fidgets w/ hands/feet or squirms in chair
*difficulty remaining seated
*runs about/climbs excessively in childhood (extreme restlessness in adults)
*difficulty engaging in activities quietly
*“on the go” or “driven by a motor”
*talks excessively
*blurts out answers before questions completed
*difficulty waiting his/her turn
*interrupts/intrudes on others
Attention-Deficit- Hyperactivity Disorder (ADHD) tx
Multimodal: medications most effective for ↓ core sxs, but should be used in conjunction w/ educational & behavioral interventions
Pharmacological:
*First line: stimulants (methylphenidate, dextroamphetamine, etc.)
*Second line: Atomoxetine
*Alpha2-Agonists (clonidine, guanfacine) can be used instead of or as adjunct to stimulants
Nonpharmacological:
*behavior modification techniques & social skills training
*educational interventions (classroom modifications)
*parental psychoeducation
Autism Spectrum Disorder (ASD) definition and etiology
Characterized by impairments in social communication/interaction & restrictive, repetitive behaviors/interests
*encompasses spectrum of symptomatology formerly diagnosed as autism, Asperger’s, childhood disintegrative disorder, & pervasive developmental disorder
*1% of population
*4:1 male to female ratio
*typically recognized between 12-24mo, but varies based on severity
Etiology is multifactorial:
*prenatal neurological insults (infection, drugs), advanced paternal age, low birth weight
*15% associated w/ known genetic mutation, Fragile X MC known single gene cause of ASD
*Down Syndrome, Rett Syndrome, & TSC are other genetic causes
*high comorbidity w/ ID, associated w/ epilepsy
Autism Spectrum Disorder (ASD) dx criteria
SOCIAL COMMUNICATION/INTERACTION DEFICITS (ALL REQUIRED):
*social-emotional reciprocity deficits
*nonverbal communicative behavior deficits
*developing, maintaining, & understanding relationships deficits
RESTRICTED/REPETITIVE BEHAVIOR/INTERESTS (2+):
*stereotyped/repetitive motor movements, use of objects, or speech (echolalia, idiosyncratic phrases)
*insistence on sameness, inflexible adherence to routines, ritualized verbal/nonverbal behavior
*highly restricted/fixated interests of abnormal intensity
*hyper/hyporeactivity to sensory input or unusual interest in sensory aspects of environment (sounds, textures, pain)
Other signs: failure to develop social relationships, no parental preference over other adults, unusual sensitivity, unusual attachments, savantism (unusual talents)
Autism Spectrum Disorder (ASD) tx
Chronic condition, prognosis variable
2 most important predictors of adult outcome: level of intellectual functioning & language impairment
TX for sxs management & improvement of basic social, communicative, & cognitive skills:
*early intervention
*remedial education
*behavioral therapy
*psychoeducation
*low-dose atypical antipsychotic (Risperidone, Aripiprazole) may help reduce disruptive behavior, aggression, & irritability
Major Depressive Disorder (MDD) definition
*marked by episodes of depressed mood associated w/ loss of interest in daily activities
*+/- somatic sxs (fatigue, HA, abdominal pain, muscle tension, etc.)
*12% lifetime prevalence worldwide
*onset peaks in 20s, but can be any age
*1.5-2x as prevalent in reproductive ♀︎
*up to 15% of pts eventually die by suicide
RF: adverse childhood events, family hx (2-4x more likely if first-degree relative w/ MDD)
Etiology: HPA overactivity, dysfunctional neuronal connectivity, 5HT, DA, NE, GABA
Major Depressive Disorder (MDD) criteria
≥2WKS, 5+SXS *1 symptom must be 1) depressed mood or 2) loss of interest or pleasure (anhedonia)
S sleep (insomnia or hypersomnia)
I interest (loss of interest or pleasure in activities i.e., anhedonia)
G guilt (excessive or inappropriate guilt; feelings of worthlessness)
E energy (loss of energy or fatigue)
C concentration (diminished concentration or indecisiveness)
A appetite (decrease or increase in appetite; weight loss or gain)
P psychomotor agitation/retardation (i.e., restlessness or slowness)
S suicide (recurrent thoughts of death, SI/SA)
Specifiers:
*w/ melancholic features: anhedonia, early morning awakening, depression worse in morning, psychomotor agitation/retardation (i.e., restlessness or slowness), excessive guilt, anorexia
*w/ atypical features: hypersomnia, hyperphagia, mood reactivity (i.e., mood ↑ in response to actual or potential positive events), leaden paralysis (i.e., heavy feeling in limbs, weighed down), rejection sensitivity
*w/ mixed features: ≥3SXS of DIGFAST present during depressive episode
w/ catatonia: catalepsy (immobility), purposeless motor activity, extreme negativism or mutism, bizarre postures, echolalia (esp. responsive to ECT)
*w/ psychotic features: presence of delusions &/or hallucinations
*w/ anxious distress: feeling keyed up/tense, restlessness, concentration difficulty, fear of something bad happening, feelings of loss of control
*w/ peripartum onset: occurs during pregnancy or within 4wks postpartum
*w/ seasonal pattern: relationship of MDE onset w/ time of year (winter MC but can be any season)
Major Depressive Disorder (MDD) tx
sychopharmacologic: SSRIs/SNRIs first-line
*evaluate response q3-4wks
*once therapeutic effect achieved, continue ≥6mo
Therapy: CBT
*combo of meds + CBT = most success
Treatment-Resistant: TCAs, MAOIs, atypical APs, stimulants, carbamazepine, ECT
Pharm: should give drug ≥6wks at maximum dose before switching
Persistent Depressive Disorder (Dysthymia) defintion, criteria, tx
DSM V combined dysthymia & chronic major depressive disorder into PDD
*criteria for MDD may be continuously present for 2yrs
*2% 12mo prevalence
*more common in women
*onset often in childhood, adolescence, & early adulthood
criteria
*Depressed mood majority of the day on most days lasting ≥2YRS (1y in children/adolescents)
*never been without symptoms >2MO at a time
*never had manic/hypomanic episode
2+SXS:
1) poor appetite or overeating 2) insomnia or hypersomnia
3) low energy or fatigue 4) low self-esteem
5) poor concentration or indecisiveness
6) feelings of hopelessness
tx
*combo treatment w/ psychotherapy & pharmacology more efficacious than either alone
Pharmacotherapy: SSRIs, SNRIs, TCAs, MAOIs
Psychotherapy: interpersonal, cognitive, insight-oriented
Disruptive Mood Dysregulation Disorder (DMDD) definition, criteria, tx
*core feature of DMDD is chronic severe, persistent irritability occurring in childhood & adolescence
*irritability: frequent temper outbursts + persistent irritable or angry mood between outbursts
criteria
Occurs ≥3X/WK for ≥12MO + NO PERIOD ≥3MO W/O SXS, PRESENT IN 2+ SETTINGS
*Recurrent temper outbursts manifested verbally (e.g., verbal rages) &/or behaviorally (e.g., physical aggression) that are out of proportion to situation/provocation & inconsistent w/ developmental level
*Mood between outbursts is persistently irritable or angry & observable by others
*Symptoms began BEFORE AGE 10 (not diagnosed before 6yo or after 18yo)
tx
*psychotherapy (parent management training) first line
*medications for symptom control & comorbidities (stimulants, SSRIs, mood stabilizers, second-generation antipsychotics)
Premenstrual Dysphoric Disorder (PMDD) definition, criteria, tx
PMS: cluster of physical, behavioral, & mood changes w/ cyclical occurrence during the luteal phase of the menstrual cycle
Premenstrual Dysphoric Disorder (PMDD): severe PMS w/ FUNCTIONAL IMPAIRMENT
*PRESENT week BEFORE MENSES ONSET, IMPROVE after a few days of onset, MINIMAL/ABSENT week AFTER MENSES ENDS
*must be confirmed by recording of AT LEAST 2 CYCLES
criteria
1+SXS from (A) AND 1+SXS from (B) to equal 5+SXS TOTAL
(A) 1+SXS:
*affective lability (e.g., mood swings, suddenly tearful, more sensitive)
*irritability, anger, or increased interpersonal conflict
*depressed mood, feelings of hopelessness, or self-deprecating thoughts
*anxiety, tension, &/or feelings of being keyed up or on edge
(B) 1+SXS:
*decreased interest in usual activities
*subjective concentration difficulty
*lethargy, easily fatigued, or lack of energy
*change in appetite, overeating, or specific cravings
*hypersomnia or insomnia
*feeling overwhelmed or out of control
*physical sxs (breast tenderness/swelling, joint/muscle pain, bloating, weight gain)
tx
*underlying cause must be ruled out w/ TSH, hCG, CBC, FSH
Lifestyle modifications: stress reduction + exercise, limit caffeine, alcohol, cigarettes, & salt, NSAIDs, vitamin B6 & E
*SSRIs first line for emotional sxs w/ dysfunction
*Fluoxetine, Sertraline, Citalopram
*OCPs: drospirenone-containing
*Spironolactone: improves sxs of bloating & tender breasts
Anorexia Nervosa definition
LOW WEIGHT + CALORIE INTAKE RESTRICTED
Patients w/ anorexia nervosa are preoccupied w/ their weight, body image, & health; often associated w/ obsessive-compulsive personality traits
2 SUBTYPES:
1) Restricting Type: has not regularly engaged in binge-eating or purging behavior, weight loss achieved through diet, fasting, &/or excessive exercise
2) Binge-Eating/Purging Type: eating binges followed by self-induced vomiting &/or use of laxatives, enemas, or diuretics; some individuals purge after eating small amounts of food w/o binging
*10:1 female to male ratio, 0.4% 12mo prevalence in young females
*BIMODAL ONSET AGE
*13-14 (hormonal influences)
*17-18 (environmental influences)
*↑ in industrialized countries w/ abundant food & thin body ideal
*↑ in sports involving thinness, revealing attire, subjective judging, & weight classes (e.g., running, ballet, wrestling, diving, cheerleading, figure skating)
