Psych + Patient Care

Question 1

Differential for MDD with a trigger and adjustment disorder with depressed mood

Answer 1

if pt has at least 5 of the MDD criteria for at least 2 weeks, EVEN IF A SIGNIFICANT STRESSOR TRIGGERED it, they are MDD (not adjustment disorder)

adjustment disorder with depressed mood can be dx’d if sadness, distress + functional impairment develop WITHIN 3 MONTHS of a stressor

Question 2

Non-measured criteria for narcolepsy

2 other criteria are actual lab values / time measurements… so… these are NOT those

Answer 2

Recurrent lapses into sleep/napping multiple times/day
at least 3 times weekly for 3 months

Cataplexy: 2 definitions

• Conscious brief episodes of sudden bilateral muscle tone loss via emotions such as laughing/joking
• Abnormal facial movements without emotional trigger

Question 3

2 measured criteria for narcolepsy

Answer 3

low HYPOCRETIN-1 in CSF (from lateral hypothalamus)

(hypocretin-2 can also be low; aka orexin A + B)

REM SLEEP LATENCY less than/equal to 15 minutes

Question 4

Diff dx

Schizoaffective disorder vs. schizophrenia

Answer 4

Schizoaffective - MOOD SX PROMINENT + RECURRENT, but also has lifetime history of PSYCHOTIC SX IN ABSENCE MOOD EPISODE (depressive or manic)

Schizophrenia - mood sx MAY be present for BRIEF periods

Question 5

Diff dx

Schizophrenia vs. schizophreniform disorder

Answer 5

Schizophreniform is same sx as schizophrenia but for BETWEEN 1 AND 6 MONTHS ONLY

Question 6

Cyclothymic disorder

what is it?

Answer 6

at least 2 years of fluctuating mild hypomanic + depressive symptoms that do not meet criteria for hypomanic or major depressive episodes

Question 7

criteria for manic episode

duration and mnemonic

Answer 7

at least 1 week of… “DIG FAST”

• Distractibility
• Irritability
• Grandiosity
• Flight of ideas
• Activity increase / Agitation
• Sleep need decreases
• Talkative

must impair psychosocial function (or is hypomania)
can include psychotic features (delusions + hallucinations)

Question 8

What is SCHIZOPHRENIFORM DISORDER

Answer 8

at least 1 but less than 6 months of schizophrenic sx

Question 9

What is BRIEF PSYCHOTIC DISORDER

Answer 9

acute onset of AT LEAST 1 psychotic sx, for…

AT LEAST 1 DAY but LESS THAN 1 MONTH

eventual complete resolution

Question 10

what is “disruptive mood dysregulation disorder”?

Answer 10

new dx in DSM-V…

PERSISTENT irritability and frequent, DEVELOPMENTALLY-INAPPROPRIATE temper outbursts

(key is developmentally inappropriate and persistent…. so occasional outbursts from a teenager are “developmentally appropriate”)

Question 11

What is TRANSFERENCE vs. COUNTERTRANSFERENCE?

Answer 11

Transference - pt with bad feelings towards someone else takes them out on the doctor

Countertransference - doctor with bad feelings towards someone else takes them out on pt

Question 12

What is PROJECTION?

Answer 12

misattributing one’s own unacceptable feelings to another person

(pt is angry with doc but thinks doc is angry with them)

Question 13

what is REACTION FORMATION?

Answer 13

uncomfortable feelings are unconsciously transformed to their polar opposite

(doc extremely gracious to patient they are angry with)

Question 14

Differentiate SOMATIC SYMPTOM DISORDER and ILLNESS ANXIETY DISORDER

Answer 14

SSD - excess anxiety + preoccupation with at 1+ unexplained symptoms

IAD - fear of having a serious illness despite FEW/NO SYMPTOMS and negative evaluations

Question 15

What is conversion disorder? other name?

Answer 15

Functional Neurologic Symptom Disorder

a NEUROLOGIC sx (weakness/numbness, etc.) incompatible with any known neuro disease, usually ACUTE ONSET associated with STRESS

Question 16

Differentiate FACTITIOUS DISORDER and MALINGERING

Answer 16

FD - intentional falsification or induction of s/s or disease to ASSUME SICK ROLE

Malingering - false/exaggerated sx to obtain EXTERNAL INCENTIVES

Question 17

4 “atypical” features of MAJOR DEPRESSION DISORDER WITH ATYPICAL FEATURES

Answer 17

1. MOOD REACTIVITY - mood improves in response to positive events
2. REJECTION SENSITIVITY - overly sensitive to slight criticism
3. LEADEN PARALYSIS - limbs feel heavy
4. VEGETATIVE REVERSAL - increased rather than decreased sleep + appetite

Question 18

A kid on dialysis awaiting kidney transplant is angry and misses dialysis appointments

what can a physician do to improve their cooperation?

Answer 18

spend more time directly speaking with the patient

Question 19

As a resident…

if an attending does something wrong, what should you do FIRST?

then NEXT?

Answer 19

first discuss it with them directly

if they refuse to correct the incorrect behavior / are dismissive of your concerns THEN go to the ethics board

Question 20

Postpartum “blues” vs. postpartum depression

onset + resolution?

tx?

Answer 20

Blues - within 2-3 days postpartum and lasts MAX 14 DAYS; tx with reassurance + monitoring

Depression - within 4-6 wks postpartum, can be UP TO ONE YEAR (resolution depends on tx); tx with meds + therapy

(generally blues sx are just milder, without suicidal ideation or major functional impairment, but if it lasts LONGER THAN 2 WEEKS start to think depression)

Question 21

Postpartum psychosis

onset?
sx? (4)
tx? (meds + management)

Answer 21

onset - variable, days to weeks

sx - delusions, hallucinations, disorganized thought + bizarre behavior

tx - antidep/antipsych/mood stabilizer; HOSPITALIZATION and DON’T LEAVE ALONE WITH BABY (infanticide risk)

Question 22

Differentiate:

Antisocial Personality Disorder
Conduct Disorder
Disruptive Mood Dysregulation Disorder

Answer 22

Conduct disorder is the same as ASPD but in patients less than 18

Disruptive mood dysregulation disorder - can also have verbal/physical outbursts, but must be LESS THAN 10 Y/O and have PERSISTENT IRRITABILITY/ANGER BTWN EPISODES