psychiatric disorders

Question 1

Ego defenses: definition and examples

• Displacement vs Projection
• Reaction formation vs Sublimation
• Repression vs Suppression
• Altruism
• Intellectualization vs Rationalization

Answer 1

• Displacement
  
  • unacceptable feelings directed to neutral object or person
  • yell at the dog because you got yelled at
• Projection
  
  • unacceptable feelings attributed to other person
  • accuse partner of cheating when you (want to) cheat
• Reaction formation
  
  • Unacceptable feelings replaced (unconsciously) by emphasis on opposite
  • Gay social conservatives cruising bathrooms
• Sublimation
  
  • Unacceptable feelings replaced by similar but acceptable course of action
  • Play football b/c of aggression towards father
• Repression
  
  • Unacceptable feelings unconsciously avoided
  • Repressed memory
• Suppression
  
  • Unacceptable feelings consciously avoided
  • choosing not to think about exam
• Altruism
  
  • Guilty feelings alleviated by unsolicited generosity
• Intellectualization
  
  • Excessive thinking in order to avoid painful emotions or fears. Immature mechanism.
• Rationalization
  
  • Cover up unacceptable acts or ideas using convincing reasoning. Justify feelings that would otherwise appear illogical or irrational.

Question 2

Conduct disorder vs oppositional defiant disorder

Answer 2

Conduct disorder: repeated violation of rights of others

Oppositional defiant disorder: enduring pattern of hostile, defiant behavior toward authority figures.

Question 3

Tourettes criteria

Answer 3

Sudden, rapid, recurrent motor and vocal tics persist for > 1 year.

Onset < 18y.

Question 4

Autism vs Aspergers

Answer 4

Autism: greater focus on objects vs people, repetitive behavior

Asperger’s: milder, normal intelligence

Question 5

Delirium vs Dementia

Answer 5

Delirium: rapid onset, fluctuating changes in consciousness. Often reversible. EEG changes.

Dementia: slow decline, memory loss. Often irreversible. Normal EEG.

Question 6

Schizophrenia: criteria for diagnosis

What if you don’t meet the time criterion?

Answer 6

• Symptoms: require 2 of
  
  • Positive symptoms - treated by antipsychotics: Delusions, Hallucinations, Disorganized speech, Disorganized behavior or catatonia
  • Negative symptoms - flat affect, lack of speech or thought, etc
• Requires > 6 months duration
• < 1 month: brief psychotic disorder
• 1-6 months: schizophreniform disorder
• Schizoaffective disorder: 2 weeks plus depressive or bipolar

Question 7

Bipolar vs cyclothymic disorders

Answer 7

Bipolar needs manic (DIG FAST x3) or hypomanic sx. Duration at least 1 week.

Cyclothymic has dysthymia and hypomania for 2 years.

Question 8

Major depressive disorder vs dysthymia. How many sx, time course.

What is atypical depression

Answer 8

Need 5 SIG E CAPS for 2 or more weeks. Self-limited lasting 6-12 months.

Dysthymia: milder, lasts >= 2 years.

Atypical depression

• Mood reactivity (can experience happy reactions to events)
• Hypersomnia and weight gain
• leaden paralysis
• interpersonal rejection sensitivity
• TX MAOI, SSRI

Question 9

Malingering vs Factitious disorder vs Muchhausens

Answer 9

Malingering: fake sick for secondary gain (eg time off work)

Factitious disorder: fake sick for primary gain (sick role)

Munchhausens: chronic factitious disorder

Question 10

Somatoform disorders

Somatization vs Conversion vs Hyopochondriasis vs Pain

Answer 10

• Somatization: Complaints in multiple organ system, age < 30 yrs
• Conversion: Sudden loss of sensory or motor function; sometimes indifferent attitude toward sx (la belle indifference)
• Hypochondriasis preoccupation with illness
• Pain: prolonged pain with no physical findings

Question 11

Cluster A personality disorders

Paranoid, Schizoid, Schizotypal

Answer 11

• “Weird”
• Paranoid: pervasive distrust and suspiciousness; uses projection
• Schizoid = distant, content with isolation (vs avoidant)
• Schizotypal = magical thinking, odd beliefs, awkwardness

Question 12

Cluster B

Antisocial, Borderline, Histrionic, Narcissistic

Answer 12

• “Wild”
• Antisocial: disregard for rights of others (conduct disorder if < 18 yrs)
• Borderline: unstable mood and relationships; uses splitting
• Histrionic: excessive excitability, concerned with appearance, sexually provocative
• Narcissistic: grandiosity, sense of entitlement, reacts to criticism with rage

Question 13

Cluster C

Avoidant, Obsessive-Compulsive, Dependent

Answer 13

• “Worried”
• Avoidant - hypersensitivity to rejection, feelings of inadequacy, desires relationships with others
• Obsessive-compulsive - preoccupation with order, perfectionism, control
• Dependent - submissive and clinging (Amelia)

Question 14

Acute stress disorder vs PTSD

Answer 14

Acute stress disorder has duration < 4 weeks

Question 15

Generalized anxiety disorder vs Adjustment disorder

Answer 15

GAD requires > 6 mo duration. Unrelated to specific thing. Tx SSRI, SNRI.

Adjustment disorder < 6 months.

Question 16

Criteria for panic disorder?

Answer 16

Intense fear peaks in 10 minutes with:

PANICS - need 4

Palpitations, Paresthesias, Abdominal distress, Nausea, Intense fear, light-headedness, Chest pain, Chills, Choking, Disconnectedness, Sweating, Shaking, SOB

Question 17

Risk factors for suicide?

Answer 17

SAD PERSONA

• Sex (women try more often, men succeed more often)
• Age (teen or elderly)
• Depression
• Previous attempt
• EtOH or other drug use
• loss of Rational thinking
• Sickness
• Organized plan
• No spouse / social support lacking
• Access to gun

Question 18

Criteria for manic episode/bipolar

Answer 18

DIG FAST. Need 3 for 1 week:

• Distractibility
• Irresponsibility
• Grandiosity
• F