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Flashcards in Psych disorders Deck (141)
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1

Brief overview of general anxiety disorder as described in the DSM-V

Excessive anxiety and worry occurring on more days than not over 6 months about a NUMBER of events or activities. The worry is difficult to control and also experience physical symptoms of the anxiety

2

Brief overview of panic disorder as described in the DSM-V

Recurrent, unexpected panic attacks followed by at least one month of persistent concern about having another panic attack.

3

What is a panic attack

An abrupt surge of intense fear or discomfort in which 4+ symptoms develop within a few minutes to reach peak intensity (palpitations, sweating, SOB, autonomic symptoms)

4

Brief overview of agoraphobia as described in the DSM-V

Anxiety about being in particular places or situations from which escape may be difficult or help may not be available in the event of a panic attack or other embarrassing/incapacitating symptom (falling, incontinence, vomiting)

5

Brief overview of specific phobia as described in the DSM-V

Marked, persistent fear of clearly discernible objects or situations which invoke an immediate anxiety response when exposed to it

6

Brief overview of social phobia/ social anxiety disorder as described in the DSM-V

Marked or persistent fear of one or more social or performance situations in which person is exposed to possible scrutiny by others - fear behaving in an embarrassing way leading to total (physical absence) or partial (minimal eye contact) avoidance

7

Brief overview of obsessive compulsive disorder as described in the DSM-V

Unwanted, intrusive and recurrent obsessions which the client attempts to suppress or ignore but usually end up performing compulsions to neutralise and reduce the anxiety associated. Usually obsessions about contamination, orderliness etc.

8

Brief overview of post-traumatic stress syndrome as described in the DSM-V

Following threat that is perceived to be potentially life threatening or cause physical harm (direct experience, witnessing, learning of event occurring to close family member, repeated or extreme exposure to aversive details) - relive traumatic event with intrusive memories, avoidance of stimuli, persistent hyper-arousal symptoms (insomnia, irritability, exaggerated startle response etc.)

Acute stress disorder: 2d-1 month post trauma lasting 3d-1m

Post-traumatic stress disorder: symptoms persist more than 1m

9

DSM for generalised anxiety disorder

Excessive anxiety and worry more days than not for more than 6 months about a number of different events/activities

Difficulty controlling worry

3+ physical symptoms (restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance)

Stressful life events occurring or have had since childhood/adolescence

10

Symptoms of post traumatic stress disorder

Reliving of event: intrusive memories, flashbacks, nightmares
Avoidance of stimuli associated with trauma
Emotional numbing
Persistent hyper-arousal: insomnia, irritability, impaired concentration, hypervigilance
Negative alterations in cognition and mood: inability to recall key features, persistent -ve beliefs and expectations about self
- marked diminished interest
- feeling alienated from others
- constricted affect
Symptoms persisting for more than 1 month
Onset of symptoms within 2 days to 1 month after traumatic event

11

Clinical features of a panic attack

Abrupt surge of intense feat plus 4+ of the following:
- palpitations
- sweating
- trembling and shaking
- SOB
- feeling of choking
- chest pain/discomfort
- nausea/abdominal distress
- dizzy, unsteady, faint, light-headed
- chills or heat sensations
- paraesthesia
- de-realisation or de-personalisation
- fear of losing control or going crazy
- fear of dying

12

Differential diagnoses of panic attack

IHD
Cardiac arrhythmias
Cardiac valve pathologies
Pulmonary embolus
Asthma
Hyperthyroidism
Hypoglycaemia
Phaeochromocytoma
Hypoparathyroidism
TIA
Seizure

13

Assessment and management of panic attacks

CVS and resp exams
ECG etc. rule out IHD, arrhythmias
Immediate management:
- slow-breathing exercises
- muscle tension-relaxation exercise
- benzodiazepines
Short-long term manageemnt
- CBT
- Cognitive therapy
- interoceptive and in vivo exposure
- antidepressants (SSRIs, TCAs)

14

Brief overview of anorexia nervosa as described in the DSM-V

Self-induced starvation due to relentless drive for thinness or fear of fatness with presence of medical signs and symptoms resulting from starvation, body weight less than 85% expected
Can be restricting type or binging/purging type

15

Brief overview of bulimia nervosa as described in the DSM-V

Client has a goal to reduce weight but cannot tolerate prolonged periods of starvation, leading to binge eating - panic about amount eaten and secondary attempts to prevent weight gain (e.g. purging)

16

Brief overview of binge-eating disorder as described in the DSM-V

Recurrent episodes of binge eating, sense of lack of control over eating at least once a week for 3 months

17

Subtypes of anorexia nervosa

Restrictive type:
- reduced food intake +/- increased exercise
- not engaged in binge eating or purging behaviour

Binge-eating/purging type:
- have periods of binge eating followed by panic and secondary attempts to lose weight (vomiting, misuse of laxatives, diuretics or enemas)

18

Physical complications of anorexia nervosa

Endocrine/metabolic:
- hypoglycaemia
- hypoK - arrhythmias
- hypoCl alkalosis
- hypoMg
- hypoNa
- Delayed puberty
- amenorrhoea
- anovulation
- increase GH
- reduced ADH
- hypercortisolism
- arrested growth
- osteoporosis
CVS:
- ECG changes
- cardiomyopathy
- MV prolapse
- arrhythmias (due to hypoK)
- hypotension
- bradycardia
Renal:
- Reduced GFR
- increased urea
- dependent oedema
- renal calculi
GI:
- constipation
Other:
- lanugo
- hair loss
- dry skin
- hypothermia
- anaemia
- leukopenia
- thrombocytopenia

19

What are the complications of bulimia nervosa

Mallory-Weiss tears (rare)
Dry skin
Menstrual irregularity
Infertility

Secondary to laxative abuse:
- chronic constipation
- cathartic colon

20

Risk factors associated with anorexia nervosa

Teenage
female
Developed country
Certain professions (ballet, gymnastics)
Gay orientation
Close and trouble relationships with parents
Isolation
Low levels of nurturance

21

Risk factors associated with bulimia nervosa

Early adulthood
Females
Sometimes past history of obesity
Industrialised countries
More conflictual families, parents neglectful and rejecting
Angry, outgoing, impulsive clients
Alcohol dependence

22

What is meant by the term somatic symptom and related disorders

A group of diseases where bodily signs and symptoms are a major focus, which are medically unexplained, and patients are convinced suffering comes from some undetected bodily condition

23

Types of somatic symptom and related disorders

Somatic symptom disorders:
- somatisation disorders
- hypochondriasis
- body dysmorphic disorder
- pain disorder
Conversion disorder

24

DSM-V of somatisation disorder

Many physical symptoms before age of 30y
Occurring over a period of years
Multiple medical consultations, significant impairment in functioning
Pain, GI, sexual/reproductive, pseudoneurological symptoms

25

DSM-V summary of hypochondriasis

Generalised and non-delusional (not fixed) preoccupation with fears of having a SPECIFIC illness
Based on misinterpretation of bodily symptoms
Persists despite appropriated evaluation and reassurance

26

Brief overview of Body dysmorphic disorder as described in the DSM-V

Preoccupation with an imagined defect in appearance causing significant distress or impairment due to ideas or delusions of reference
Excessive mirror checking or avoidance
If anomaly is present, person's concern is excessive and bothersome
Hair, nose, skin, head/face
Present to dermatologists, plastic surgeons, internists

27

Brief overview of pain disorder as described in the DSM-V

A psychological disorder where pain is the main focus, and of sufficient severity to warrant clinical attention. It is not intentionally produced or better accounted for by another medical conditions - may have begun in response to real condition but persists chronically

28

Brief overview of conversion disorder as described in the DSM-V

Conversion of emotional pain or energy into physical, NEUROLOGICAL symptoms:
- motor symptom deficit
- sensory symptom deficit
- seizure or convulsions
- mixed presentations
initiation or exacerbation of the symptom is preceded by conflicts or stressors

29

How would you explain the diagnosis of conversion disorder to a patient that may in your opinion have the condition?

would explain as the mind being unable to express strong emotions AS emotions, and as such, converts into a physical symptom which cannot be explained by stressors

30

Approach to managing conversion disorder

95% remit spontaneously within 2w of hospital admission
Therapeutic relationships with a caring and confident psychotherapist
insight-oriented supportive or behaviour therapy
ACKNOWLEDGE THAT PATIENTS SYMPTOMS ARE REAL
Hypnosis, anxiolytics, behavioural relaxation exercises
Psychodynamic psychotherapy