Psych Diagnoses (Ddx)

Question 1

Delusional Disorder:

Answer 1

Def: Persistent delusions (1+ delusion for 1+ month or more) in absence of other psychotic sx; able to function apart from delusion.

Ddx: Schizophrenia (other psychotic sx present), Personality disorders (no clear delusions)

Delusion subtypes:

• Delusions of persecution (most frequent)
• Erotomanic delusions (false belief that someone of higher status is in love with pt)
• Grandoise delusions (great, talent, insights, or achievements)
• Jealous delusions (unfaithful partners)
• Somatic delusions (bodily functions/sensations)

Question 2

Anorexia

Answer 2

• Significantly low body weight (BMI <18.5 or <17)
• Intense fear of wt gain
• Distorted views of body wt/shape
• Subtypes: Binge/purge vs. Restricting
• PE: Emaciation, bradycardia, hypotension, hypothermia, hair loss, dry skin, lanugo (fine, downy body bair), amenorrhea often. If vomiting: Puffy cheeks/parotic gland hypertrophy, dental cavities, halitosis, scars/calluses on hand from contact with teeth (Russell sign), electrolyte abnormalities

Question 3

Bulemia

Answer 3

• Recurrent episodes of binge eating
• Compensatory behavior (vomiting, exercise) to prevent wt gain
• Excessive worry about body shape/wt
• Maintains normal body weight
• PE: Puffy cheeks/parotic gland hypertrophy, dental cavities, halitosis, scars/calluses on hand from contact with teeth (Russell sign), electrolyte abnormalities

Question 4

Binge Eating Disorder

Answer 4

• Recurrent binge eating w/lack of control

- No compensatory behaviors

Question 5

Anorexia vs. Bulemia key difference:

Answer 5

-Anorexia has low body wt vs. Bulemia has nl body wt.

Question 6

Adjustment Disorder vs. GAD

Answer 6

Adjustment Disorder is mood disturbance within 3 months of an identifiable stressor vs. Generalized Anxiety Disorder is >6 months of persistent worry about multiple issues.

Question 7

Social Anxiety Disorder (Social Phobia)

Answer 7

• Marked anxiety about >1 social situations for >6 months
• Fear of scrutiny by others, humiliation, embarrassment
• Social situations avoided or endured w/intense distress
• Marked impairment (social, academic, occupational)
• Subtype specifier - Performance only

Question 8

Social Anxiety Disorder/Social Phobia Tx:

Answer 8

• SSRI/SNRI
• CBT
• Beta-blocker or Benzos - for performance-only subtype

Question 9

Performance Anxiety Tx:

Answer 9

-Beta-blocker or Benzos

Question 10

Cluster A Personality Disorders:

Answer 10

“Wierd” (odd/eccentric)

1) Paranoid PD
2) Schizoid PD
3) Schizotypal PD

Question 11

Cluster B Personality Disorders:

Answer 11

“Wacky” (dramatic/erratic)

1) Borderline PD
2) Antisocial PD
3) Narcissistic PD
4) Histrionic PD

Question 12

Cluster C Personality Disorders:

Answer 12

“Worried” (anxious/inhibited)

1) Dependent PD
2) Avoidant PD
3) Obsessive-Compulsive PD

Question 13

Narcolepsy

Answer 13

DSM-5 Criteria:

1. Recurrent lapses into sleep/naps (at least 3x/wk for 3 months)
2. At least 1 of these:
   - Cataplexy: Brief loss of muscle tone precipitated by strong emotion (ie. laughter, excitement)
   - Low CSF level of hypocretin-1/orexin-A
   - Shortened REM sleep latency
3. Other features:
   - Hypnagogic or hypnopompic hallucinations (upon falling asleep or awakening)
   - Sleep paralysis (can’t move upon waking up)
   - Excessive daytime sleepiness

-Onset = usually teens-early 20s

Question 14

Brief Psychotic Disorder

Answer 14

-1 or more positive psychotic sx that last 1 day to 1 month and aren’t due to another medical disorder or substance use.

Question 15

Oppositional Defiant Disorder

Answer 15

• Pattern of angry/irritable mood and defiant behavior towards authority figures
• ONLY IN KIDS

Question 16

Conduct DisorderAn

Answer 16

• Persistent and pervasive pattern of violating major societal rules or rights of others, including aggression, deceitfulness, theft.
• ONLY IN KIDS

Question 17

Antisocial Personality Disorder

Answer 17

• Pattern of violating basic societal rules and rights of others
• Requires hx w/sx of conduct disorder b/f age 15
• ONLY IN 18+ (ADULTS)

Question 18

Obsessive-Compulsive Disorder

Answer 18

-Numerous compulsive acts that occur in response to obsessive thoughts

Question 19

Specific Phobia

Answer 19

• Marked anxiety about a specific object or situation for >6 months (esp. Flying, heights, animals, injections, blood)
• Avoidance behavior (avoiding bridges, elevators, airplanes)
• Common (10% of population)
• Usually develops in childhood or after a traumatic event

Tx: 1) CBT, involving exposure to specific stimulus, 2) Short-acting Benzo (only acutely)

Question 20

PTSD

Answer 20

Tx: 1) SSRI (Fluoxetine), 2) Eye Movement Desensitization

Question 21

Acute Mania:

Answer 21

Sx:

• Elevated, irritable, labile mood
• Increased energy/activity, decreased sleep
• Pressured speech, racing thoughts, distractable
• Grandiosity, risky behavior
• Marked impairment, maybe psychotic sx

Tx:

1. Antipsychotic (Respiridone) - rapid onset of action
2. Lithium, Valproate, Lithium also tx acute mania, by take several days to be effective d/t need for gradual titration

Question 22

Adjustment Disorder:

Answer 22

-Mood disturbance occurring within 3 months in response to an identifiable stressor

Question 23

Generalized Anxiety Disorder:

Answer 23

-6 or more months of persistent worry about MULTIPLE issues (vs. adjustment disorder = shorter, 1 issue)

Question 24

Acute Stress Disorder:

Answer 24

-Involves exposure to a traumatic event, followed by development of anxiety, hyperarousal, and dissociative/intrusive symptoms >3 days to <1 month

Question 25

Panic Disorder

Answer 25

- Recurrent, unexpected panic attacks, fears of future attacks, and avoidance behavior - Attacks must have 4+ of these sx: - CP, palpitations, SOB - Trembling, sweating, nausea - Dizziness, paresthesias - Derealization, depersonalization - Fear of losing control, dying Tx: 1. Immediate = Benzos 2. Long-term = SSRIs/SNRIs and/or CBT

Question 26

Schizophrenia:

Answer 26

Tx: Antipsychotics

Question 27

Schizoaffective Disorder

Answer 27

-Psychotic sx for 2+ weeks in the absence of a mood episode Tx:

Question 28

Schizophreniform Disorder:

Answer 28

Tx:

Question 29

Major Depressive Disorder:

Answer 29

DEF: -Subtype: MDD w/psychotic features - unipolar depression with delusions/hallucinations w/depressive themes -.-> Tx: Antidepressant + Antipsychotic or ETC Tx:

Question 30

Illness Anxiety Disorder:

Answer 30

-Excessive concern about having a serious, undiagnozed general medical condition, without being delusional Tx:

Question 31

Delirium:

Answer 31

Precipitating factors: - CNS insult (stroke/seizure) - Infection (ie. PNA, UTI) - Meds (ie. Sedatives, Benzos) - Metabolic disturbances (ie. Electrolytes, uremia) Tx: - Avoid polypharmacy, physical restraints if needed - Maintain normal sleep-wake cycle - Provide frequent reorientation - Tx underlying cause (ie. Abx for infxtn)

Question 32

Obsessive-Compulsive Disorder

Answer 32

Sx include: 1. Obsessions - recurrent, intrusive, anxiety-provoking thoughts/urges/images 2. Compulsions - response to obsessions w/repeated behaviors or mental acts, behaviors not connected realistically w/preventing feared event - Takes >1 hr/day or causes significant distress/impairment Tx: SSRI and/or CBT (exposure/response prevention)

Question 33

ADHD

Answer 33

-Mostly dx in children - must have sx of inattention, impulsivity and hyperactivity in 2+ settings ADD FROM QBank 1. Inattention (careless mistakes, forgetfulness, not listening, avoidance/lack of follow-through of tasks) 2. Hyperactivity/Impulsivity (can't stray seated, talkative, difficulty waiting turn, interrupting)